A fatal and metabolic experimental hemorrhagic shock in immature swine.

Purpose: To use blood lactate (BL) as an end-point metabolic marker for the begin resuscitation of volume replacement in experimental hemorrhagic shock.

Methods: Group I (n=7) was not bled (Control). Animals in Group II (n=7) were bled to a MAP of 30mmHg in thirty minutes.

[Thrombolysis in massive pulmonary embolism based on the volumetric capnography].

This is the first report of a patient submitted to chemical thrombolysis due to massive pulmonary embolism (PE) during the postoperative period of neurosurgery, in whom due to the lack of adequate clinical conditions, no imaging assessment was performed. Clinical, gasometric and capnographic data allowed the decision to perform the thrombolysis with safety. The P(a-et)CO2 gradient decreased from 46.

Volumetric capnography: in the diagnostic work-up of chronic thromboembolic disease.

The morbidity and mortality of pulmonary embolism (PE) have been found to be related to early diagnosis and appropriate treatment. The examinations used to diagnose PE are expensive and not always easily accessible. These options include noninvasive examinations, such as clinical pretests, ELISA D-dimer (DD) tests, and volumetric capnography (VCap).

Alveolar dead space and capnographic variables before and after thrombolysis in patients with acute pulmonary embolism.

Pulmonary embolism (PE) is a common condition. The central aim of this study was to describe the use of volumetric capnography (VCap) before and after fibrinolytic treatment of major PE. Lung scintigraphy was used as a base of comparison for the results of this treatment.

Effects of different tidal volumes and positive end expiratory pressure on gas exchange in experimental bronchopleural fistula.

Objectives: The present study was designed to identify the effect of positive end expiratory pressure (PEEP) and the ideal pulmonary tidal volume to ventilate animals with a surgically produced bronchopleural fistula, aiming to reduce fistula output without affecting gas exchange.

Methods: Hemodynamic and respiratory assessment of gas exchange was obtained in five, healthy, young, mechanically ventilated Large White pigs under volume controlled ventilation with FiO2 of 0.4 and an inspiration:expiration ratio of 1:2, keeping respiratory rate at 22 cpm.

Volumetric capnography as a noninvasive diagnostic procedure in acute pulmonary thromboembolism.

Pulmonary thromboembolism is a common condition. Its diagnosis usually requires pulmonary scintigraphy, computed angiotomography, pulmonary arteriography and, in order to rule out other diagnoses, the measurement of D-dimer levels. Due to the fact that these diagnostic methods are not available in most Brazilian hospitals, the validation of other diagnostic techniques is of fundamental importance.

Pre and post-pulmonary thromboendarterectomies capnographic variables.

In these case report, the results of late dead space fraction (fDlate), end-tidal alveolar dead space fraction (AVDSf), arterial-alveolar gradient CO2 [P(a-et)CO2], and slope phase 3 of spirogram of two patients who underwent thromboendarterectomy for pulmonary embolism (PE) are shown. PE was diagnosed by pulmonary scintigraphy, helical tomography, and pulmonary angiography. The calculation of fDlate, AVDSf and P(a-et)CO2 was based on volumetric capnography associated with arterial blood gas analysis.

Vasopressin serum levels and disorders of sodium and water balance in patients with severe brain injury.

Background: Disorders of water and sodium balance are frequently seen in patients with severe brain injury (SBI), and may worsen their prognosis.

Purpose: To evaluate vasopressin (AVP) serum levels and sodium and water balance disorders during the first week post-injury in patients with SBI.

Method: Thirty-six adult patients with SBI (admission Glasgow Coma Scale score < or= 8) and an estimated time of injury View Article and Find Full Text PDF

Syndromes related to sodium and arginine vasopressin alterations in post-operative neurosurgery.

Background: Cerebral salt wasting syndrome (CSWS), syndrome of inappropriate antidiuretic hormone secretion (SIADH) and diabetes insipidus (DI) are frequently found in postoperative neurosurgery.

Purpose: To identify these syndromes following neurosurgery.

Method: The study included 30 patients who had been submitted to tumor resection and cerebral aneurysm clipping.

Optimized hyperventilation preserves 2,3-diphosphoglycerate in severe traumatic brain injury.

Introduction: The concentration of 2,3-diphosphoglycerate (2,3-DPG/Hct) increases as a physiological occurrence to pH increase and hyperventilation. This response was tested in patients with severe traumatic brain injury (TBI).

Method: The concentration of 2,3-DPG/Hct was measured daily for six days in eleven patients with severe TBI in need of optimized hyperventilation because of intracranial hypertension.

Severe heart failure at intensive therapy unit--is there an ideal prognostic index?

Objective: To assess the applicability of three prognostic indexes--APACHE II, SAPS II and UNICAMP II--in a subgroup of critical heart failure (HF) patients.

Methods: Ninety patients were studied, being 12 females and 78 males. Mean age was 56 (18-83).

[Comparison of two methods for measurement of maximal inspiratory pressure in patients with and without alterations of the conscience's level].

Background And Objectives: There is no literature consensus about the time of airway occlusion sufficient enough to get a true PImax during weaning from mechanical ventilation (MV). So, the main objectives of the present study were to compare two methods PImax measurement and to evaluate the influence of patients' level of conscience on them.

Methods: The population was composed by 28 general ICU patients, with MV > 48h, in a weaning process, divided into two groups according to Glasgow coma scale score: with (GCS < 15) and without (GCS = 15) alterations of conscience level.

Early colloid replacement therapy in a near-fatal model of hemorrhagic shock.

Several controlled, experimental, hypotensive models of hemorrhagic shock have evaluated the effects of timing, rate, and types of fluid replacement. In a near-fatal experimental model we evaluated the hemodynamic and metabolic effects of two types of solutions for fluid resuscitation. In this study, 30 young Large-White pigs were randomly assigned to three groups: Group I (control, n= 10), not bled; Group II (hydroxyethyl starch, HES, n = 10), submitted to controlled hemorrhage to a mean arterial blood pressure (MAP) of 30 mmHg and blood lactate >10 mM/L, at which time resuscitation was initiated with 7 mL/kg of HES 130/0.

[Influence of the respiratory physiotherapy on intracranial pressure in severe head trauma patients].

Objective: To evaluate influence of the respiratory physiotherapy on intracranial pressure (ICP) in patients with severe head trauma.

Method: Thirty five patients with severe head trauma were included in the study. The patients were divided into three groups: ICP 0-10, 11-20 and 21-30 mmHg.

[Relevant factors influencing the evolution of 206 patients with severe head injury].

The search for head injury prognostic factors has been intense in the last decades. The importance of identification of these factors has been also recognised to treatment orientation and results estimatives. Based on 206 severe head injuried patients series, we analyzed the influence of factors over the outcome.

Vasopressin serum levels in patients with severe brain lesions and in brain-dead patients.

Introduction: Patients with severe brain lesions (SBL) and brain-dead patients (BD) frequently present with vasopressin (AVP) secretion disorders.

Objective: To evaluate AVP serum levels in SBL and BD patients.

Design: Prospective, open label, observational trial.

Gut mucosal damage during endotoxic shock is due to mechanisms other than gut ischemia.

Whether the gut alterations seen during sepsis are caused by microcirculatory hypoxia or disturbances in cellular metabolic pathways associated with mitochondrial respiration remains controversial. We hypothesized that hypoperfusion or hypoxia and local production of nitric oxide might play an important role in the development of gut mucosal injury during endotoxic shock and investigated their roles by using differing levels of fluid resuscitation and occlusion of the superior mesenteric artery (SMA). Anesthetized New Zealand rabbits were allocated to group I (sham, n = 8); group II [low-dose endotoxin (LPS, Escherichia coli-055:B5, 150 microg/kg)/fluid resuscitation (12 ml x kg(-1) x h(-1)); n = 8]; group III [high-dose LPS (1 mg/kg)/fluid resuscitation (12 ml x kg(-1) x h(-1)); n = 8]; group IV [high-dose LPS (1 mg/kg)/hypovolemia (4 ml x kg-1 x h(-1) fluids); n = 8]; and group V [SMA ligation/fluid resuscitation (12 ml x kg(-1) x h(-1)); n = 4].