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Consenso brasileiro de monitoriza??o e suporte hemodinamico - Parte IV: monitoriza??o da perfus?o tecidual
Réa-Neto, álvaro;Rezende, Ederlon;Mendes, Ciro Leite;David, Cid Marcos;Dias, Fernando Suparregui;Schettino, Guilherme;Lobo, Suzana Margareth Ajeje;
Revista Brasileira de Terapia Intensiva , 2006, DOI: 10.1590/S0103-507X2006000200009
Abstract: background and objectives: the main cardiovascular function is to maintain the adequate perfusion e oxygen delivery to the cells. physiologically, this is controlled by the cellular metabolic rate. the critically ill patients are in high danger of tissue hipoperfusion and this is directly related to cellular injury and organ dysfunction. therefore, the tissue perfusion monitoring makes part and is indissociated of hemodynamic evaluation of the critically ill patient and is indicated to all this patients. the objective was to define recommendations about clinical utility of different tolls to bedside perfusion monitoring. methods: modified delphi methodology was used to create and quantify the consensus between the participants. amib indicated a coordinator who invited more six experts in the area of monitoring and hemodynamic support to constitute the consensus advisory board. twenty five physician and two nurses selected from different regions of the country completed the expert panel, which reviewed the pertinent bibliography listed at the medline in the period from 1996 to 2004. results: recommendations were done about the utility of clinical monitoring of tissue perfusion, temperature gradient and transcutaneous oxygen monitoring, serum lactate, base excess, svo2 and scvo2, gastric and sublingual capnometry, co2 venous-arterial gradient and orthogonal polarization spectral (ops). conclusions: the homodynamic compensation of a critically ill patient isn?t complete unless the tissue perfusion is corrected. many different methods of monitoring is available and are useful in clinical practice, however, none has accuracy and effectiveness characteristics to be used independently of clinical context.
Consenso brasileiro de monitoriza??o e suporte hemodinamico - parte III: métodos alternativos de monitoriza??o do débito cardíaco e da volemia
Schettino, Guilherme;Ederlon, Rezende;Mendes, Ciro Leite;Réa-Neto, álvaro;David, Cid Marcos;Lobo, Suzana Margareth Ajeje;Barros, Alberto;Silva, Eliézer;Friedman, Gilberto;Amaral, José Luiz Gomes do;Park, Marcelo;Monachini, Maristela;Oliveira, Mirella Cristine de;Assun??o, Murillo Santucci César;Akamine, Nelson;Mello, Patrícia Veiga C;Pereira, Renata Andréa Pietro;Costa Filho, Rubens;Araújo, Sebasti?o;Pinto, Sérgio Félix;Ferreira, Sérgio;Mitushima, Simone Mattoso;Agareno, Sydney;Brilhante, Yuzeth Nóbrega de Assis;
Revista Brasileira de Terapia Intensiva , 2006, DOI: 10.1590/S0103-507X2006000100013
Abstract: background and objectives: cardiac output and preload as absolute data do not offer helpful information about the hemodynamic of critically ill patients. however, monitoring the response of these variables to volume challenge or inotropic drugs is a very useful tool in the critical care setting, particularly for patients with signs of tissue hypoperfusion. although pac remains the " gold standard" to measure cardiac output and preload, new and alternative technologies were developed to evaluate these hemodynamic variables. methods: modified delphi methodology was used to create and quantify the consensus between the participants. amib indicated a coordinator who invited more six experts in the area of monitoring and hemodynamic support to constitute the consensus advisory board. twenty three physician and two nurses selected from different regions of the country completed the expert panel, which reviewed the pertinent bibliography listed at the medline in the period from 1996 to 2004. results: recommendations regarding the use of arterial pulse pressure variation during mechanical ventilation, continuous arterial pulse contour and lithium dilution cardiac output measurements, esophageal doppler waveform, thoracic electrical bioimpedance, echocardiography and partial co2 rebreathing for monitoring cardiac output and preload were created. conclusions: the new and less invasive techniques for the measurement of cardiac output, preload or fluid responsiveness are accurate and may be an alternative to pac in critically ill patients.
II Consenso Brasileiro para o uso da monitoriza o ambulatorial da press o arterial
Amodeo Celso,Giorgi Dante M. A.,Mion Jr Décio,Nobre Fernando
Arquivos Brasileiros de Cardiologia , 1997,
Abstract:
Parametros de prática clínica para suporte hemodinamico a pacientes pediátricos e neonatais em choque séptico  [cached]
Carcillo Joseph A.,Fields Alan I.
Jornal de Pediatria , 2002,
Abstract: Introdu o: o Institute of Medicine requisitou o desenvolvimento de diretrizes e parametros de prática clínica para promo o da "melhor prática", a fim de melhorar potencialmente a evolu o de pacientes. Objetivo: Fornecer ao American College of Critical Care Medicine parametros clínicos para o suporte hemodinamico a neonatos e crian as em choque séptico. Cenário: Foram identificados, através de revis o da literatura e questionamento geral em simpósios da Society of Critical Care Medicine (1998-2001), membros individuais da Sociedade com especial interesse em choque séptico em pacientes neonatais e pediátricos. Métodos: Foi realizada uma pesquisa no banco de dados do MEDLINE com os seguintes termos, restritos por idade: sepse, septicemia, choque séptico, endotoxemia, hipertens o pulmonar persistente, óxido nítrico, oxigena o por membrana extracorpórea. Mais de 30 especialistas avaliaram a literatura e selecionaram recomenda es específicas, usando o método Delphi modificado. Outros 30 especialistas revisaram, ent o, as recomenda es compiladas. O presidente da for a-tarefa modificou o documento até que Resultados: Foram identificados apenas quatro estudos clínicos controlados com crian as em choque séptico. Nenhum desses estudos randomizados levou a modifica es na prática clínica, a qual vem sendo baseada, em grande parte, em experimentos fisiológicos, séries de casos e estudos de coorte. Apesar da existência de um número relativamente pequeno de evidências avaliadas na literatura pediátrica pelo American College of Critical Care Medicine, a evolu o desses pacientes vem apresentando melhora nos índices de mortalidade, que passaram de 97% na década de 1960 para 60% na década de 1980, atingindo 9% em 1999. O índice de sobrevivência registrado entre crian as admitidas a hospitais norte-americanos em choque séptico foi, em 1999, três vezes maior do que o índice observado entre adultos (mortalidade de 9% versus 27%). A fisiopatologia do choque e a resposta a terapias variam de acordo com a idade do paciente. Por exemplo, insuficiência cardíaca é uma das causas predominantes de morte entre pacientes neonatais e pediátricos, enquanto insuficiência vascular é causa predominante de morte entre adultos. Agentes inotrópicos, vasodilatadores (crian as), óxido nítrico inalado (neonatos) e oxigena o por membrana extracorpórea podem ser contribui es mais importantes para a sobrevivência de popula es pediátricas, enquanto vasopressores podem contribuir mais diretamente para a sobrevivência de pacientes adultos. Conclus es: As diretrizes do American College of Cri
Tratamento da doen a de Gaucher: um consenso brasileiro  [cached]
Martins Ana M.,Lobo Clarisse L.,Sobreira Elisa A. P.,Valadares Eugenia R.
Revista Brasileira de Hematologia e Hemoterapia , 2003,
Abstract: A doen a de Gaucher (DG) é um erro inato do metabolismo do grupo das doen as lisoss micas de depósito, sendo a mais freqüente do referido grupo. é de heran a autoss mica recessiva, portanto com risco de 25% a cada gesta o de casal heterozigoto. A doen a é resultante da deficiência da beta-glicosidase ácida ou beta-glicocerebrosidase, que leva ao acúmulo de glicolipídios nos macrófagos principalmente em ba o, fígado, medula óssea e pulm o. As manifesta es clínicas ou fenotípicas da DG v o depender do grau de deficiência da enzima, existindo três tipos: Tipo I, forma n o neuropática, afeta crian as e adultos com hepatoesplenomegalia, anemia, trombocitopenia, leucopenia e les es ósseas; Tipo II, forma neuropática aguda, afeta crian as com 4-5 meses com quadro neurológico grave, hepatoesplenomegalia e comprometimento pulmonar e o Tipo III, forma neuropática cr nica, afeta crian as e adolescentes com quadro neurológico menos grave que o Tipo II e ainda pode comprometer fígado, ba o e ossos. Um grupo de catorze médicos com experiência no tratamento da DG com reposi o enzimática realizaram extensa revis o da literatura, confrontaram com os dados evolutivos dos pacientes brasileiros e chegaram a um consenso quanto aos critérios para iniciar o tratamento, a dose da enzima e freqüência das infus es, do acompanhamento ambulatorial, laboratorial e radiológico. O Grupo Brasileiro de Estudos em Doen a de Gaucher e outras Doen as de Depósito Lisoss mico (GBDDL) tem o objetivo de estabelecer diretrizes para o diagnostico, tratamento e acompanhamento de pacientes com doen a de Gaucher no Brasil. Esta iniciativa pioneira visa uniformizar a conduta no país com rela o ao tratamento de DG com reposi o enzimática, tratamento de alto custo porém de grande eficácia.
Primeiro consenso brasileiro do tratamento da fase aguda do acidente vascular cerebral  [cached]
Arquivos de Neuro-Psiquiatria , 2001,
Abstract: Este texto apresenta a síntese das conclus es do Io Consenso Brasileiro do Tratamento da Fase Aguda do Acidente Vascular Cerebral (AVC). Tratou-se de reuni o patrocinada e coordenada pela Sociedade Brasileira de Doen as Cerebrovasculares, com neurologistas especializados nas doen as cerebrovasculares, que analisaram os principais itens da conduta dos AVC.
Primeiro consenso brasileiro para trombólise no acidente vascular cerebral isquêmico agudo
Arquivos de Neuro-Psiquiatria , 2002,
Abstract: Este texto apresenta a síntese das conclus es do I Consenso Brasileiro para Trombólise no Acidente Vascular Cerebral. Tratou-se de reuni o promovida e coordenada pela Sociedade Brasileira de Doen as Cerebrovasculares, com neurologistas especializados em doen as cerebrovasculares, que analisaram e discutiram os requisitos assistenciais e profissionais, bem como as diretrizes e os protocolos clínicos, para o uso de trombólise em pacientes com acidente vascular cerebral isquêmico agudo.
Pneumonias adquiridas na comunidade em pacientes idosos: aderência ao Consenso Brasileiro sobre Pneumonias
Almeida, José Roberto de;Ferreira Filho, Olavo Franco;
Jornal Brasileiro de Pneumologia , 2004, DOI: 10.1590/S1806-37132004000300008
Abstract: background: pneumonia is a common disease with a high mortality rate, being the sixth leading cause of death among elderly people in the usa and the fifth among those in brazil. initial treatment of pneumonia is usually empirical since the ethiological agent is identified in only approximately 50% of cases. therefore, several scientific societies have defined some guidelines for initial antimicrobial therapies. objectives: this study evaluated adherence to the guidelines set forth by the consenso brasileiro sobre pneumonias (brazilian consensus on pneumonia) for treatment of community-acquired pneumonia in hospitalized elderly patients. method: fifty-four patients, aged 60 or over, hospitalized at londrina university hospital with community-acquired pneumonia between 2 august 1999 and 2 august 2000 were evaluated. whether their treatment adhered or did not adhere to guidelines, the patients were compared in terms of 30-day mortality, average time for clinical stabilization, average length of hospital stay, cost of treatment and severity score. results: the average age was 74.1, and 61.1% of the patients were treated in accordance with the brazilian guidelines for treatment of community-acquired pneumonia. there were no differences in length of hospital stays, cost of treatment, time to clinical stability and severity score between the two groups (adherent and non-adherent). however, there was a difference in mortality. the rate of mortality was higher in patients with pneumonia severity index (psi) scores of iv or v who were treated according to the guidelines than in those with the same score whose treatment was non-adherent (p = 0.04). in general, psi score was related to mortality. the mortality rate among patients with scores of ii and iii was 9.5%, compared with 30.3% in patients with scores of iv and v. conclusion: adherence to the brazilian guidelines for treatment of community-acquired pneumonia in elderly patients was satisfactory, and there was no differen
Consenso brasileiro sobre cancer gástrico: diretrizes para o cancer gástrico no Brasil Brazilian consensus in gastric cancer: guidelines for gastric cancer in Brazil  [cached]
Bruno Zilberstein,Carlos Malheiros,Laercio Gomes Louren?o,Paulo Kassab
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (S?o Paulo) , 2013,
Abstract: RACIONAL: No Brasil, o cancer gástrico é o quarto tumor maligno mais frequente entre os homens e sexto entre as mulheres. A causa é multivariada e os componentes de risco conhecidos. Ele tem seu prognóstico e tratamento definidos pela localiza o e estadiamento do tumor e número de linfonodos ressecados e acometidos. OBJETIVO: O Consenso Brasileiro sobre Cancer Gástrico foi idealizado pela ABCG com o intuito de emitir diretrizes que possam orientar os profissionais médicos no atendimento aos pacientes portadores desta afec o. MéTODOS: Foram respondidas e resumidas 43 quest es refletindo consenso ou n o sobre diagnóstico e tratamento que poder o ser empregadas como orienta o para sua abordagem multiprofissional. O método envolveu três etapas. Inicialmente 56 cirurgi es do aparelho digestivo e médicos de especialidades correlatas reuniram-se para formular as perguntas que foram enviadas aos participantes para embasarem as respostas em evidências científicas e na experiência pessoal. Resumos aos temas foram apresentados, discutidos em plenário e votados em duas outras reuni es. Os temas abrangeram 53 perguntas envolvendo: diagnóstico e estadiamento (seis quest es); tratamento cirúrgico (35 quest es); quimioterapia e radioterapia (sete quest es); e anatomopatologia, imunoistoquímica e perspectivas (cinco quest es). Considerou-se consenso a concordancia de mais de 70% dos votos em cada tema. RESULTADOS: Todas as respostas foram apresentadas e votadas, e em 42 delas houve consenso. CONCLUS O: P de ser elaborado consenso na maior parte das quest es que acompanham o atendimento dos pacientes com cancer gástrico, permitindo a elas serem encaminhadas para a confec o de Diretrizes sobre o tema. BACKGROUND: In Brazil, gastric cancer is the fourth most common malignancy among men and sixth among women. The cause is multivariate and the risks are well known. It has prognosis and treatment defined by the location and staging of the tumor and number of lymph nodes resected and involved. AIM: The Brazilian Consensus on Gastric Cancer promoted by ABCG was designed with the intention to issue guidelines that can guide medical professionals to care for patients with this disease. METHODS: Were summarized and answered 43 questions reflecting consensus or not on diagnosis and treatment that may be used as guidance for its multidisciplinary approach. The method involved three steps. Initially, 56 digestive surgeons and related medical specialties met to formulate the questions that were sent to participants for answers on scientific evidence and personal experience. Summar
I Consenso Brasileiro de Ecoendoscopia
Maluf-Filho, Fauze;Dotti, Carlos Marcelo;Farias, Alberto Queiroz;Kupski, Carlos;Chaves, Dalton Marques;Artifon, Everson;Nakao, Frank;Rossini, Giulio Fabio;Paulo, Gustavo Andrade de;Ardengh, José Celso;Silva, José Edmilson Ferreira da;Rossini, Lucio;Lima, Luiz Felipe Pereira de;Averbach, Marcelo;Cury, Marcelo S.;D'Aassun??o, Marco Aurélio;Silva, Marcus Clarêncio;Ney, Marcus Vinicius;Spinosa, Sérgio;Matuguma, Sérgio E.;Guaraldi, Simone;Arantes, Vitor;Mello, Vera Helena;
Arquivos de Gastroenterologia , 2007, DOI: 10.1590/S0004-28032007000400014
Abstract: background: in the last 20 years, several papers have focused on demonstrating the impact of endoscopic ultrasonography findings on the management of different clinical scenarios in digestive disease. this fact is an indirect evidence of the difficulty of popularization of the method. on other hand, the limited availability of endoscopic ultrasonography in brazil is a direct evidence of this limitation. this was the rationale for the organization of a consensus meeting on endoscopic ultrasonography. it was aimed to identify the best evidence that support the use of endoscopic ultrasonography in gastroenterology. methods: a panel of experts on endoscopic ultrasonography was selected based on the files of the gastroenterology and endoscopy societies and on the registries of endoscope manufacturers. two members of the meeting selected the relevant topics that were transformed into questions. the topics and the questions were debated among the experts five months before the consensus meeting. the experts were asked to perform systematic reviews in order to answer the questions so it could be possible to grade the answers based on the strength of the evidence. during the two days of the meeting the answers were presented, debated and voted. consensus was reached when a minimum of 70% of the voters were in agreement. the final consensus report was submitted to the experts' evaluation and approval. results: seventy nine questions were debated by the experts at the pre-consensus meeting. as the result of this debate 85 questions came out and were assigned to the members of the panel. during the consensus meeting 22 experts debated and voted 85 answers. consensus was reached for several clinical scenarios for which the impact of endoscopic ultrasonography findings were supported by level 1 evidences: differential diagnosis of subepithelial lesions and thickening of gastric folds, staging and diagnosis of unresectable esophageal cancer, indirect signs of peritoneal involvemen
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