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Search Results: 1 - 10 of 612492 matches for " Ciro Leite;Réa-Neto "
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Avalia??o da variabilidade de interven??es baseadas no cateter de artéria pulmonar: experiência brasileira
Mendes, Ciro Leite;Rezende, Ederlon;Dias, Fernando Suparregui;Réa-Neto, álvaro;
Revista Brasileira de Terapia Intensiva , 2006, DOI: 10.1590/S0103-507X2006000200006
Abstract: background and objectives: use of pulmonary artery catheter (pac) is still a debatable issue, mainly due to questions raised about its security and efficacy. this study reproduced in a sample of brazilian physicians, another one conducted amidst american doctors, in which was pointed out the heterogeneity of clinical decisions guided by data obtained from pac. methods: during the brazilian congress of intensive care medicine (curitiba 2004), doctors were asked to answer a survey form with three vignettes. each of them contained pac data and one half of the surveys contained echocardiographic information. every doctor was asked to select one of six interventions for each vignette. a homogeneous answer was considered when it was selected by at least 80% of the respondents. results: two hundred and thirty seven doctors answered the questionnaires. they selected completely different therapeutic interventions in all three vignettes and none of the interventions achieved more than 80% agreement. variability persisted with the choices guided by echocardiography. conclusions: as in the original study, we observed total heterogeneity of therapeutic interventions guided by cap and echocardiography. these results could be caused by lack of knowledge about basic pathophysiologic concepts and maybe we had to improve its teaching at the medical school benches.
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.
Parte II: monitoriza??o hemodinamica básica e cateter de artéria pulmonar
Dias, Fernando Suparregui;Rezende, Ederlon;Mendes, Ciro Leite;Réa-Neto, álvaro;David, Cid Marcos;Schettino, Guilherme;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;Félix Pinto, Sérgio;Ferreira, Sérgio;Mitushima, Simone Mattoso;Agareno, Sydney;Brilhante, Yuzeth Nóbrega de Assis;
Revista Brasileira de Terapia Intensiva , 2006, DOI: 10.1590/S0103-507X2006000100012
Abstract: background and objectives: monitoring of vital functions is one of the most important tools in the management of critically ill patients. nowadays is possible to detect and analyze a great deal of physiologic data using a lot of invasive and non-invasive methods. the intensivist must be able to select and carry out the most appropriate monitoring technique according to the patient requirements and taking into account the benefit/risk ratio. despite the fast development of non invasive monitoring techniques, invasive hemodynamic monitoring using pulmonary artery catheter still is one of the basic procedures in critical care. the aim was to define recommendations about clinical utility of basic hemodynamic monitoring methods and the use of pulmonary artery catheter. 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 physicians and 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 made based on 55 questions about the use of central venous pressure, invasive arterial pressure, pulmonary artery catheter and its indications in different settings. conclusions: evaluation of central venous pressure and invasive arterial pressure, besides variables obtained by the pac allow the understanding of cardiovascular physiology that is of great value to the care of critically ill patients. however, the correct use of these tools is fundamental to achieve the benefits due to its use.
Raciocínio clínico -- o processo de decis?o diagnóstica e terapêutica
Réa-Neto, A.;
Revista da Associa??o Médica Brasileira , 1998, DOI: 10.1590/S0104-42301998000400009
Abstract: the goal of this review is to demonstrate the steps and the main items of the cognitive process used by doctors in clinical reasoning of diagnostic and therapeutic decisions. the clinical problem- solving process makes use of the hypothetic deductive scientific method to solve problems. as soon as the doctor meets his (her) patient, many diagnostic hypotheses emerge in his (her) mind, which are evaluated and refuted or corroborated. the diagnostic decision occurs when a hypothesis reach a certain degree of likelihood. the therapeutic decision is based on the intended objectives and the waited efectiveness among many available alternatives.
Raciocínio clínico o processo de decis o diagnóstica e terapêutica
Réa-Neto A.
Revista da Associa??o Médica Brasileira , 1998,
Abstract: O objetivo desta revis o é expor as fases e os principais constituintes do processo cognitivo que os médicos empregam no raciocínio clínico das decis es diagnósticas e terapêuticas. O processo de solu o dos problemas clínicos utiliza-se do método científico hipotético-dedutivo de resolver problemas. T o logo um médico encontra um paciente, várias hipóteses diagnósticas surgem-lhe na mente, as quais s o avaliadas e refutadas ou corroboradas. A decis o diagnóstica é realizada quando uma hipótese atinge um certo grau de verossimilhan a. A decis o terapêutica depende dos objetivos pretendidos e da efetividade esperada entre as diversas alternativas disponíveis.
Reef fish community structure on three islands of Itaipu, Southeast Brazil
Mendon?a-Neto, José Policarpo de;Monteiro-Neto, Cassiano;Moraes, Luiz Eduardo;
Neotropical Ichthyology , 2008, DOI: 10.1590/S1679-62252008000200015
Abstract: we provide here the first assessment of the composition, abundance and distribution of rocky reef fishes of itaipu sound, rio de janeiro, off the southeastern brazilian coast. monthly visual censuses, benthic quadrats and chain link transects were conducted over one year on rocky reefs at three islands (menina, m?e and pai). a total of 2466 individual fish, belonging to 29 families and 42 species were recorded. the most abundant fish species were parablennius pilicornis, haemulon steindachneri, orthopristis ruber and diplodus argenteus. sheltered and complex habitats showed the most abundant and diverse fish populations. there was a major significant separation between sampling sites and a secondary seasonal pattern. the three sites showed similar fish communities with locally structured environmental gradients according to their inherent habitat characteristics.
Desfecho de pacientes com cancer internados em unidades de terapia intensiva brasileiras com les?o renal aguda
Soares, Márcio;Lobo, Suzana Margarete Ajeje;Torelly, André Peretti;Mello, Patricia Veiga de Carvalho;Silva, Ulisses;Teles, José Mário Meira;Silva, Eliézer;Caruso, Pedro;Friedman, Gilberto;Souza, Paulo César Pereira de;Réa-Neto, álvaro;Vianna, Arthur Oswaldo;Azevedo, José Raimundo;Vale, érico;Rezegue, Leila;Godoy, Michele;Maia, Marcelo Oliveira;Salluh, Jorge Ibrain Figueira;,;
Revista Brasileira de Terapia Intensiva , 2010, DOI: 10.1590/S0103-507X2010000300004
Abstract: objectives: critically ill cancer patients are at increased risk for acute kidney injury, but studies on these patients are scarce and were all single centered conducted in specialized intensive care units. the objective was to evaluate the characteristics and outcomes in a prospective cohort of cancer patients admitted to several intensive care units with acute kidney injury. methods: prospective multicenter cohort study conducted in intensive care units from 28 hospitals in brazil over a two-month period. univariate and multivariate logistic regression were used to identify factors associated with hospital mortality. results: out of all 717 intensive care unit admissions, 87 (12%) had acute kidney injury and 36% of them received renal replacement therapy. kidney injury developed more frequently in patients with hematological malignancies than in patients with solid tumors (26% vs. 11%, p=0.003). ischemia/shock (76%) and sepsis (67%) were the main contributing factor for and kidney injury was multifactorial in 79% of the patients. hospital mortality was 71%. general and renal-specific severity-of-illness scores were inaccurate in predicting outcomes for these patients. in a multivariate analysis, length of hospital stay prior to intensive care unit, acute organ dysfunctions, need for mechanical ventilation and a poor performance status were associated with increased mortality. moreover, cancer-related characteristics were not associated with outcomes. conclusions: the present study demonstrates that intensive care units admission and advanced life-support should be considered in selected critically ill cancer patients with kidney injury.
Pacientes com infec??o por vírus A (H1N1) admitidos em unidades de terapia intensiva do Estado do Paraná, Brasil
Duarte, Péricles Almeida Delfino;Venazzi, Alisson;Youssef, Nazah Cherif Mohamad;Oliveira, Mirella Cristine de;Tannous, Luana Alves;Duarte, César Barros;Grion, Cíntia Magalh?es Carvalho;Germano, Almir;Schiavetto, Paulo Marcelo;Lins, Alexandre Luiz de Gonzaga Pinho;Campos, Marcos Menezes Freitas;Miúra, Cecília Keiko;Bredt, Carla Sakuma de Oliveira;Toso, Luiz Carlos;Réa-Neto, álvaro;
Revista Brasileira de Terapia Intensiva , 2009, DOI: 10.1590/S0103-507X2009000300001
Abstract: objective: this study aimed to analyze outcome, clinical and epidemiological characteristics and severity factors in adult patients admitted with a diagnosis of infection by virus a (h1n1) to public and private intensive care units, in paraná, brazil. methods: cohort study of medical charts of patients older than 12 years admitted to 11 intensive care units in 6 cities in the state of parana, brazil, during a period of 45 days, with diagnosis of swine influenza. the diagnosis of infection with a (h1n1) was made by real time polymerase chain reaction (rt-pcr) of nasopharyngeal secretion, or strong clinical suspicion when other causes had been ruled out (even with negative rt-pcr). descriptive statistics were performed, analysis by the chi square test was used to compare percentages and the student's t test for continuous variables with univariate analysis, assuming a significance level of p <0.05. results: there were 63 adult patients admitted with a diagnosis of h1n1, 37 (58.7%) being rt-pcr positive. most patients were young adults (65% under 40 years of age) with no gender predominance and high incidence of obesity (27.0% with body mass index > 30). mean of the acute physiologic chronic health evaluation ii (apache ii) score was 15.0 + 8.1. mortality in the intensive care unit was 39.7%. the main factors associated with mortality were: positive rt-pcr, low levels of initial pao2/fio2, high initial levels of urea and lactate dehydrogenase, required level of positive end expiratory pressure, need for the prone position and vasopressors. conclusions: adult patients with a (h1n1) virus infection admitted to intensive care units had a high risk of death, particularly due to respiratory impairment. positive rt-pcr, urea and lactic dehydrogenase, low initial pao2/fio2 and high levels of peep were correlated with higher mortality.
Qualidade fisiológica de sementes de soja colhidas em duas épocas após desseca??o com glyphosate
Toledo, Mariana Zampar;Cavariani, Cláudio;Fran?a-Neto, José de Barros;
Revista Brasileira de Sementes , 2012, DOI: 10.1590/S0101-31222012000100017
Abstract: pre-harvest desiccation of soybean plants with glyphosate has been routinely conducted by seed producers, although it is not recommended because it may reduce seed physiological quality. the objective of this study was to evaluate the effects of the pre-harvest desiccation of plants with glyphosate on the physiological quality of soybean seeds harvested at two different periods after application. the experimental design was completely randomized blocks, with four replications and subdivided plots. main plots consisted of the presence and absence of a pre-harvest desiccation of soybean plants with glyphosate at the r7 stage, and subplots of seeds harvested 7 and 14 days after application. moisture content, mechanical damage, viability, weight of 100 seeds, protein content and accumulation of glyphosate residues were determined after harvest. physiological quality was evaluated by tests for germination, accelerated aging, electrical conductivity, seedling length and seedling dry matter. pre-harvest desiccation of soybean plants with glyphosate reduces seed germination and seedling development. delayed harvesting reduces the germination of soybean seeds produced by plants desiccated with glyphosate, but minimizes phytotoxicity in seedling development.
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