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Search Results: 1 - 10 of 21861 matches for " Jefferson Pedro;Xavier "
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Controle glicêmico e terapia insulínica em sepse e doen?a crítica
Branco, Ricardo Garcia;Tasker, Robert Charles;Garcia, Pedro Celiny Ramos;Piva, Jefferson Pedro;Xavier, Lisandra Dias;
Jornal de Pediatria , 2007, DOI: 10.1590/S0021-75572007000700003
Abstract: objective:to review the literature about the pathophysiology of hyperglycemia and glycemic control in children and adults with sepsis and critical illness. sources: non-systematic survey of the medical literature using medline and terms hyperglycemia, glycemic control, intensive insulin therapy, sepsis and intensive care. articles were selected according to their relevance based on the authors' opinion. summary of the findings: hyperglycemia is frequent in critically ill children and it is associated with worsened outcome. in adults, there is no consensus on the efficacy and safety of glycemic control. we describe the possible mechanisms involved in glucose toxicity and the beneficial effects of glycemic control. initial studies showed that use of insulin to achieve glycemic control reduced morbidity and mortality in adult intensive care; however, recent studies have failed to confirm these findings. importantly, it is evident that glycemic control is associated with increased incidence of hypoglycemia. the efficacy of glycemic control has not yet been studied in critically ill children. conclusion: glycemic control is a novel therapeutic option in critical care. conflicting evidence in adults means that before we apply this approach to pediatrics it will need to be assessed in clinical trial.
Preditores de falha da extuba??o em crian?as no pós-operatório de cirurgia cardíaca submetidas à ventila??o pulmonar mecanica
Johnston, Cíntia;Piva, Jefferson Pedro;Carvalho, Werther Brunow de;Garcia, Pedro Celiny;Fonseca, Marcelo Cunio;Hommerding, Patrícia Xavier;
Revista Brasileira de Terapia Intensiva , 2008, DOI: 10.1590/S0103-507X2008000100009
Abstract: background and objectives: it is important to know the risk factors for extubation failure (ef) in children submitted to cardiac surgery in order to avoid inherent events due to reintubation (airways injury, usage of medications, cardiovascular changes) and because of prolonged ventilatory support (pneumonias, reduction of the ventilatory muscles strength). the objective of this study is to evaluate mechanical ventilation (mv) parameters, ventilatory mechanics [rapid shallow breathing index (rsbi), ventilatory muscles force [the maximum inspiratory pressure (mip), the maximum expiratory pressure (mep) and the load/force balance (lfb)] and blood gases before and after extubation in pediatric patients undergoing cardiac surgery. methods: prospective (march 2004 to march 2006) observational cross sectional study, enrolling children submitted to cardiac surgery admitted to an university picu hospital and considered able to be extubated. with the tracheal tube in situ and maintaining the children spontaneously breathing we evaluate: expiratory minute volume (ve), mip and mep. we calculated the rsbi [(rr/vt)/weight)], lfb [15x [(3xmap)/mip] + 0.03 x rsbi-5], the mean airway pressure (map) [map={(pip-peep)x[ti/(te+ti)]}+peep] and the oxygenation index (oi) [oi=(fio2 x map/pao2)x100]. arterial blood gas was collected one hour before extubation. if after 48 hours there was no need to reintubate the patient the extubation was considered successful (se). results: 59 children were included. ef was observed in 19% (11/59). median (qi25%-75%) for age, weight, map, oi, duration of mv after cardiac surgery (dmv) were respectively, 36 (12-82) months, 12 (8-20) kg, 8 (6-9), 2 (2-5), 1 (1-3) days. median (qi25-75%) of ef in relation to se for oi, lfb and dmv were respectively 5(3-8) versus 2(2-4), p = 0.005; [8(6-11) versus 5(4-6), p =0.002 and 3(2-5) versus 1(1-2) days, p = 0.026. mean ± sd of ef in relation to se for ve, pao2 and mip were respectively 1.7 ± 0.82 versus 3 ± 2.7 ml/kg
A importancia da independência editorial na credibilidade e no reconhecimento de uma revista científica
Piva Jefferson Pedro
Jornal de Pediatria , 2002,
Cuidados de final de vida nas UTIs brasileiras, certamente n o é apenas uma quest o legal: treinamento e conhecimento adequados s o essenciais para melhorar estes cuidados End-of-life care in Brazilian ICUs is not just a legal issue: adequate training and knowledge are essential to improve care
Jefferson Pedro Piva,Márcio Soares
Revista Brasileira de Terapia Intensiva , 2011, DOI: 10.1590/s0103-507x2011000400002
Midazolam versus diazepam para tratamento de estado de mal epiléptico em emergência pediátrica =Midazolam versus diazepam for the treatment of status epilepticus in pediatric emergency
Portela, Janete de Lourdes,Piva, Jefferson Pedro
Scientia Medica , 2011,
Abstract: Objetivos: realizar uma revis o da literatura avaliando o uso de midazolam administrado por diversas vias e do diazepam administrado por via endovenosa e retal no tratamento do estado de mal epiléptico. Fonte de Dados: a pesquisa bibliográfica foi feita nas bases de dados Google Acadêmico, LILACS, PubMed e SciELO, usando os descritores status epilepticus, seizures, benzodiazepines, midazolam, diazepam, children. Síntese dos Dados: o tratamento rápido do estado de mal epiléptico está associado com melhores resultados. Diazepam endovenoso tem sido o tratamento de primeira linha nos últimos 30 anos, apesar da conhecida dificuldade de pun o venosa em crian as pequenas. Midazolam parece representar um avan o importante para o tratamento convulsivo rápido em emergência, pela facilidade de administra o e rapidez de a o. A droga ideal e a via de administra o para o controle das crises nessas situa es permanecem incertas. Conclus es: se o acesso intravenoso n o estiver disponível, há evidências de que o midazolam por via intramuscular, bucal ou nasal pode ser a alternativa ao diazepam endovenoso ou retal, para tratamento de convuls o em emergência pediátrica. Aims: To conduct a review article evaluating midazolam administered by different routes as well as diazepam administered through intravenous and rectal route for treating status epilepticus in children. Source of Data: Bibliographic search was conducted on Google Scholar, LILACS, PubMed and SciELO databases, using the key words status epilepticus, seizure, benzodiazepines, midazolam, diazepam, children. Summary of Findings: Rapid onset treatment of status epilepticus is associated with better results. Diazepam has been the first-line treatment in the last 30 years, despite of known difficulties of venipuncture in infants. Midazolam appears to be an important advance for the quick seizure emergency treatment for its ease administration and rapid action. The ideal drug and route of administration for seizure control in these situations remain uncertain. Conclusions: If intravenous access is not available, there is evidence that intramuscular, oral or nasal midazolam can be an alternative to diazepam (rectal or intravenous) for treatment of seizures in pediatric emergency.
Dexmedetomidine in anesthesia of children submitted to videolaparoscopic appendectomy: a double-blind, randomized and placebo-controlled study
Smania, Maria Cristina;Piva, Jefferson Pedro;Garcia, Pedro Celiny R;
Revista da Associa??o Médica Brasileira , 2008, DOI: 10.1590/S0104-42302008000400015
Abstract: objectives: to evaluate the hemodynamic responses to nociceptive stimuli in children submitted to videolaparoscopic appendectomy under balanced anesthesia with isoflurane and dexmedetomidine. methods: randomized, double-blind and placebo-controlled study involving 26 children submitted to videolaparoscopic appendectomy carried out at hospital s?o lucas (pucrs) between may 2004 and february 2005. patients were assigned to two groups: (a) dexmedetomidine group (n=13): infusion of 1μg/kg over 10 minutes and maintenance dose of 0.5μg/kg/h) as an adjuvant to inhaled isoflurane anesthesia; (b) control group (n=13): normal saline infusion at a similar rate and volume of the dexmedetomidine infusion. during the different surgical and anesthetic periods, groups were compared regarding heart rate, systolic and diastolic arterial blood pressures as well as need of supplemental fentanyl infusion. student's t test, anova, and finner's procedure were used for statistical analysis. results: during the strongest nociceptive stimuli (airway access and abdominal catheter placement), the heart rate and systolic blood pressure increased significantly (p<0.001) in the control group compared to the dexmedetomidine group. compared to baseline levels, the hemodynamic responses to nociceptive stimuli were more stable when dexmedetomidine was used in combination with inhaled isoflurane anesthesia. the need for supplemental doses of fentanyl and the hemodynamic parameters were similar for both groups. conclusion: dexmedetomidine combined with inhaled isoflurane for anesthesia of children submitted to videolaparoscopic appendectomy, efficiently blocks the hemodynamic responses to nociceptive stimuli. when compared to placebo, the use of dexmedetomidine did not change the need for supplemental doses of fentanyl for maintenance of hemodynamic parameters during the intraoperative period.
Umidifica o dos gases inspirados na ventila o mecanica em crian as =Humidification of inspired gases in mechanical ventilation in children
Gatiboni, Silvia,Piva, Jefferson Pedro,Garcia, Pedro Celiny Ramos
Scientia Medica , 2008,
Abstract: Objetivos: apresentar os tipos de umidificadores mais utilizados em circuitos de ventila o mecanica, principalmente em pacientes pediátricos, e analisar suas vantagens e desvantagens. Fonte de dados: revis o da literatura científica através de artigos pertinentes incluídos na base de dados PubMed/Medline, enfatizando as palavras umidifica o, ventila o mecanica, crian as, umidificadores aquecidos e trocadores de calor e umidade. Também foram incluídos capítulos de livros sobre o assunto. Síntese dos dados: durante a ventila o mecanica, a umidifica o e o aquecimento dos gases inspirados s o necessários para prevenir os efeitos do frio e dos gases secos no epitélio traqueobr nquico. Os dispositivos mais utilizados s o os Umidificadores Aquecidos e os Filtros Trocadores de Calor e Umidade. Conclus es: n o existe consenso quanto ao melhor dispositivo para aquecimento e umidifica o dos gases inspirados, principalmente em pediatria, porém observamos a tendência ao uso de filtros trocadores de calor e umidade, pela facilidade e menor custo. Novas pesquisas s o necessárias para otimizar os filtros trocadores de calor e umidade, diminuindo a resistência e o espa o morto e aumentando a eficácia dos mesmos. Aims: To present the more utilized types of humidifiers in mechanical ventilation circuits, mainly in pediatric patients, and to analyze their advantages and disadvantages. Source of data: Review of the scientific literature through a PubMed/Medline search, emphasizing the words humidification, mechanical ventilation, children, heated humidifiers and heat and moisture exchangers. Also included were book chapters about the subject. Summary of the findings: During mechanical ventilation, humidification and warming of inspired gases are required to prevent the effects of cool and dry gases on the tracheobronquial epithelium. The most used devices are heated humidifiers and heat and moisture exchangers. Conclusions: There are no consensus about the better device to humidification and warming of gases, mainly in pediatrics, but we observed the trend to use the heat and moisture exchangers, because of simplicity and low expense. New research is needed to optimize the heat and moisture exchangers, reducing the resistance and dead-space and increasing their efficacy.
Noradrenalina na terapêutica do choque: recomenda es atuais e novas perspectivas
Alquati, Tamila,Piva, Jefferson Pedro,Garcia, Pedro Celiny Ramos
Scientia Medica , 2008,
Abstract: Objetivos: revisar os principais aspectos do uso de noradrenalina no tratamento do choque, em especial nos pacientes pediátricos. Fonte de dados: revis o bibliográfica no banco de dados MEDLINE, utilizando os termos norepinefrina/ noradrenalina, sepse, choque e uso precoce. Síntese dos dados: a noradrenalina vem sendo utilizada como tratamento adjuvante do choque em pacientes nos quais a resposta à ressuscita o volumétrica n o seja satisfatória. Estudos experimentais da última década apontaram para o uso precoce dessa droga no tratamento do choque, com resultados satisfatórios no que diz respeito à melhor perfus o de órg os e menor necessidade de volume para manter a fun o renal. Conclus es: restam muitas dúvidas acerca da repercuss o clínica do uso precoce de noradrenalina no choque, principalmente na popula o pediátrica. S o necessários mais estudos sobre o assunto, em especial prospectivos e randomizados. Contudo, já há evidências sobre a seguran a do uso dessa droga, que n o aumenta o risco de isquemia renal. Objectives: To review the main aspects of the use of norepinephrine for treatment of shock, especially in children. Source of data: Bibliographic review in the database MEDLINE using the terms norepinephrine, shock, sepsis and early use. Summary of the findings: Norepinephrine has been used as complementary treatment of shock, in patients in whom the response to the volumetric expansion was not satisfactory. Experimental studies from the last decade have encouraged the early use of this drug for shock treatment, with satisfactory results concerning the best perfusion of organs and lesser need of fluids to maintain renal function. Conclusions: Many doubts remain about the clinical utility of the early use of norepinephrine in shock, especially in the pediatric population. More studies are requested, in special prospective and randomized trials. Nevertheless, there is already evidence about the security of the use of norepinephrine, which do not increase the risk of renal ischemia.
Cultivares de milho (Zea mays L.) e sorgo (Sorghum bicolor (L.) Moench.) para ensilagem no Alto Vale do Itajaí, Santa Catarina
Flaresso, Jefferson Araujo;Gross, Celomar Daison;Almeida, Edison Xavier de;
Revista Brasileira de Zootecnia , 2000, DOI: 10.1590/S1516-35982000000600003
Abstract: a 3-year study was conducted at epagri - experimental station of ituporanga, sc - brazil, to select corn and sorghum cultivars suitability for silage production. thirteen and eight corn and sorghum cultivars were tested and allotted to a complete randomized block experimental design, with three replications. the planting was done in 6m x 6m plot area. the harvest was done when the plant presented a dough stage of maturity. the evaluated characteristics included dry matter yield, crude protein, and total digestible nutrient and ear/whole plant weight ratio. the corn cultivars with the best results for dry matter yield, ears/ panicles composition and quality were: corn - ag-1051, ag-5011, p-3069, xl-330, xl-678, c-805, c-808 and c-901, and sorghum were ag-2002, ag-2005, ag-2006, c-51, p-8118 and br-700.
Cultivares de milho (Zea mays L.) e sorgo (Sorghum bicolor (L.) Moench.) para ensilagem no Alto Vale do Itajaí, Santa Catarina
Flaresso Jefferson Araujo,Gross Celomar Daison,Almeida Edison Xavier de
Revista Brasileira de Zootecnia , 2000,
Abstract: O experimento foi conduzido por três anos na EPAGRI - Esta o Experimental de Ituporanga, SC, com o objetivo de selecionar cultivares de milho e sorgo para ensilagem. Foram testados treze cultivares de milho e oito de sorgo, utilizando-se um delineamento em blocos completos casualizados com três repeti es. O plantio foi realizado em parcelas de 6,0 m x 6,0 m. A colheita foi efetuada quando a planta atingia o estádio de gr o farináceo. Os cultivares que se destacaram por rendimento, composi o de espigas/panículas e qualidade foram: milho, AG-1051, AG-5011, P-3069, XL-330, XL-678, C-805, C-808 e C-901, e sorgo -AG-2002, AG-2005, AG-2006, C-51, P-8118 e BR-700.
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