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Search Results: 1 - 10 of 25332 matches for " Pedro Celiny Ramos;Piva "
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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.
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.
Controvérsias no manejo farmacológico da asma aguda infantil
Amantéa, Sérgio Luís;Sánchez, Ignacio;Piva, Jefferson Pedro;Garcia, Pedro Celiny Ramos;
Jornal de Pediatria , 2002, DOI: 10.1590/S0021-75572002000800006
Abstract: objective: to present a review of controversial issues related to the pharmacological management of the treatment of acute asthma in children. sources: articles published in national and international scientific journals. data were selected from lilacs and medline databases. summary of the findings: the article was organized into topics, presenting aspects on which there is consensus regarding the pharmacological treatment of asthma in children. issues related to the use of metered dose inhaler versus nebulizers, the role of ?2-adrenergic drugs administered intravenously as well as the role of methylxanthine and magnesium sulfate are approached critically. conclusions: inhaled ?2-agonist drugs combined with corticosteroids remain the treatment of choice for acute episodes of asthma in children. either nebulizers or metered dose inhalers connected to spacers are efficient for the relief of acute symptoms. patients who are refractory to conventional treatment and develop severe acute asthma should receive ?2-agonist drugs intravenously, provided they are properly monitored. methylxanthine and magnesium sulfate should be considered a second choice for selected patients.
Dilemas e dificuldades envolvendo decis?es de final de vida e oferta de cuidados paliativos em pediatria
Piva, Jefferson Pedro;Garcia, Pedro Celiny Ramos;Lago, Patrícia Miranda;
Revista Brasileira de Terapia Intensiva , 2011, DOI: 10.1590/S0103-507X2011000100013
Abstract: this review discusses the main dilemmas and difficulties related to end-of-life decision's in children with terminal and irreversible diseases and propose a rational sequence for delivering palliative care to this patients' group. the medline and lilacs databases were searched using the terms 'end of life', 'palliative care', 'death' and 'terminal disease' for articles published in recent years. the most relevant articles and those enrolling pediatric patients were selected and compared to previous authors' studies in this field. the current brazilian medical ethics code (2010) was analyzed regarding end-oflife practices and palliative care for terminal patients. lack of knowledge, insufficient specific training, and legal concerns are the main reasons why end-of-life decisions in terminal children are based on medical opinion with scarce family participation. the current brazilian medical ethics code (2010) fully supports end-of-life decisions made consensually with active family participation. honest dialogue with the family regarding diagnostic, prognostic, therapeutic and palliative care measures should be established gradually to identify the best strategy to meet the child's end-of-life needs. treatment focused on the child's welfare combined with the family's participation is the basis for successful palliative care of children with terminal diseases.
Controvérsias no manejo farmacológico da asma aguda infantil
Amantéa Sérgio Luís,Sánchez Ignacio,Piva Jefferson Pedro,Garcia Pedro Celiny Ramos
Jornal de Pediatria , 2002,
Abstract: Objetivos: apresentar uma revis o acerca de quest es controversas, relativas ao manejo farmacológico utilizado nos pacientes pediátricos portadores de asma aguda. Fontes dos dados: foram utilizadas informa es de artigos publicados em revistas científicas nacionais e internacionais, selecionadas das bases de dados Lilacs e Medline. Síntese dos dados: o artigo foi estruturado em tópicos, apresentando aspectos consensuais no tratamento farmacológico da asma infantil. Quest es relacionadas à utiliza o de inaladores dosimetrados versus nebulizadores, o papel das drogas 2-adrenérgicas utilizadas pela via endovenosa, bem como das metilxantinas e do sulfato de magnésio, s o abordados de maneira crítica. Conclus es: os 2-agonistas administrados pela via inalatória, associados aos coricosteróides, permanecem o tratamento de elei o para episódios agudos de asma na popula o pediátrica. Tanto os nebulizadores quanto os inaladores dosimetrados, acoplados a espa adores, s o efetivos para alívio dos sintomas agudos. Pacientes refratários ao tratamento convencional, que evoluem para quadros de asma aguda grave, devem ter considerada a utiliza o de drogas 2-agonistas pela via endovenosa, desde que adequadamente monitorizados. Quanto às metilxantinas e ao sulfato de magnésio, devem ser considerados alternativas secundárias para pacientes selecionados.
Efeitos hemodinamicos e metabólicos da infus?o de vasopressina em crian?as com choque
Baldasso, Elisa;Garcia, Pedro Celiny Ramos;Piva, Jefferson P.;Einloft, Paulo Roberto;
Jornal de Pediatria , 2007, DOI: 10.1590/S0021-75572007000700004
Abstract: objective:vasopressin is a neuropeptide hormone which has been used clinically for more than 50 years and plays a major role in circulatory homeostasis and in the regulation of serum osmolality. recent work has emphasized its role in the treatment of septic shock. this paper reviews the physiology of this neurohormone and the available evidence in favor of its use as a vasodilator for children in shock. sources: medline, using the terms vasopressin, vasodilation, shock and septic shock, plus synonyms and related terms. classic publications on the topic were also reviewed and selected depending on their relevance to the study objectives. summary of the findings: vasopressin is synthesized in the neurohypophysis and released in response to a decrease in plasma volume or an increase in serum osmolality. the action of vasopressin is mediated by the activation of oxytocin receptors and of several g protein-coupled receptors, which are classified according to their location and intracellular transmission routes as v1 receptors (or v1b), v2 and v3 receptors (or v1b). the main role of vasopressin is to induce vasoconstriction. however, in certain organs, it can also induce selective vasodilation. several clinical studies in adults and children have reported that the effects of vasopressin for the treatment of vasodilatory septic shock, due to a variety of causes, are both beneficial and safe. conclusions: the evidence is restricted. most studies are retrospective and include a small number of patients. nevertheless, there is significant experience concerning the use of vasopressin in pediatrics. vasopressin has a beneficial clinical effect in children and can be indicated in the treatment of refractory vasodilatory shock, after adequate volume resuscitation and when high doses of other vasopressors are not effective.
A influência da desnutri??o na utiliza??o de ventila??o mecanica em crian?as admitidas em UTI pediátrica
Mota, Elaine Martins;Garcia, Pedro Celiny Ramos;Piva, Jefferson P.;Fritscher, Carlos Cezar;
Jornal de Pediatria , 2002, DOI: 10.1590/S0021-75572002000200014
Abstract: objective: to determine the relation between children's nutritional status when they are admitted to the pediatric intensive care unit, the necessity and length of mechanical ventilation and the mortality rate. methods: a cohort study was conducted between july 1st, 1995 and june 30th, 1996. this study involved all children (28 days old to 48 months old) admitted to the pediatric intensive care unit of hospital s?o lucas, who stayed there longer than 8 hours. exclusion criteria were complex cardiac disease, admission to the pediatric intensive care unit for elective procedure (regardless of pediatric intensive care unit admission criteria) or elective mechanical ventilation (cardiac, thoracic or other postoperative period). the staff responsible for the daily data collection were not involved with patient care or assistance decisions. on the day of admission to the pediatric intensive care unit, patients were evaluated regarding their nutritional status through the z score and the severity of the disease using the pediatric risk mortality score. demographic data, necessity and length of mechanical ventilation as well as main diagnosis and evolution of each patient were evaluated every day.results: malnourishment increased significantly the need for mechanical ventilation, especially when associated with (a) age under one year old (rr= 2.4; 1.4-3.8); (b) children admitted to the pediatric intensive care unit with low pediatric risk mortality score (less than 10) (rr=2.5; 1.3-4.7); (c) presence of respiratory disease (rr=2.1; 1.3-4.7). otherwise, malnourishment did not show any influence on the mortality rate. conclusion: in our study, we could demonstrate that malnourishment in children under 4 years old admitted to the pediatric intensive care unit represented a decisive factor on evolution, increasing significantly the necessity and the length of mechanical ventilation as well as the length of stay at the pediatric intensive care unit.
Insuficiência adrenal na crian?a com choque séptico
Casartelli, Carlos H.;Garcia, Pedro Celiny Ramos;Piva, Jefferson P.;Branco, Ricardo Garcia;
Jornal de Pediatria , 2003, DOI: 10.1590/S0021-75572003000800006
Abstract: objective: to review the criteria for diagnosing and treating adrenal insufficiency in patients with septic shock. sources of data: articles published in brazilian and foreign journals selected through these publications' websites and medline, as well as references cited in key articles. summary of the findings: the literature reports a range betwen 17 and 54 % for the finding of adrenal insufficiency in patients with septic shock. there is no consensus for diagnosing adrenal insufficiency in patients suffering from critical diseases, particularly in patients with septic shock. the presence of volume-refractory and catecholamine-resistant septic shock suggests this condition, while basal cortisol under 25 μg/dl is a diagnostic criterion indicating adrenal insufficiency. the adrenal stimulation test is a useful resource for identifying patients with relative adrenal insufficiency. our testing option for adrenal stimulation in children is the use of corticotropin in low doses (0.5 μg/1,73 m2). an increase of less than 9 μg/dl in the value of postcorticotropin-stimulated cortisol suggests the presence of occult (relative) adrenal insufficiency. in patients with septic shock presenting adrenal insufficiency, either suspected or confirmed, the administration of hydrocortisone in shock or stress doses can be vital for a favorable clinical outcome. conclusions: the existing data, although controversial, already provides a basis to determine when to begin hormone replacement therapy, the serum level of cortisol accepted as adequate, and the choice of corticotropin doses for performing the adrenal stimulation test and diagnosing occult or relative adrenal insufficiency in patients with septic shock.
A influência da desnutri o na utiliza o de ventila o mecanica em crian as admitidas em UTI pediátrica
Mota Elaine Martins,Garcia Pedro Celiny Ramos,Piva Jefferson P.,Fritscher Carlos Cezar
Jornal de Pediatria , 2002,
Abstract: Objetivo: determinar a rela o entre a influência do estado nutricional de crian as no dia de sua admiss o na unidade de terapia intensiva pediátrica (UTIP), com a necessidade, o tempo de ventila o mecanica durante a interna o, e a mortalidade em UTIP.Métodos: estudo de coorte, entre 01/07/1995 e 30/06/1999, envolvendo todas as crian as (entre 28 dias e 48 meses de idade), admitidas na UTIP do Hospital S o Lucas da PUCRS, e com um tempo de permanência superior a 8 horas. Foram excluídas as crian as com cardiopatias complexas, ou aquelas admitidas para realizar procedimentos eletivos, ou por falta de vaga em outra unidade (ausência de critérios de admiss o em UTIP), ou, ainda, quando a ventila o mecanica foi considerada eletiva (pós-operatório cardíaco, torácico ou outra grande cirurgia). Os dados foram colhidos diari-amente no período de estudo, por uma equipe especialmente treinada para este estudo e n o envolvida com a rotina assistencial da unidade. No dia da admiss o, os pacientes eram classificados quanto ao grau de nutri o através do escore Z e quanto à gravidade através do escore de PRISM (Pediatric Risk Mortality). No acompanhamento diário, eram coletados dados referentes aos aspectos demográficos, necessidade de ventila o mecanica com o respectivo tempo total, diagnóstico principal e evolu o (desfecho clínico).Resultados: a desnutri o promoveu um significativo aumento no uso de ventila o mecanica, principalmente quando associado com: (i) idade inferior a um ano (RR= 2,4; 1,4-3,8), (ii) crian as admitidas na UTI pediátrica com baixos escores de gravidade - PRISM inferior a 10 - (RR=2,5; 1,3-4,7), (iii) pacientes admitidos por problemas respiratórios (RR=2,1; 1,3-4,7). O tempo de ventila o mecanica, independentemente da causa básica, foi significativamente maior no grupo de cri-an as definidas como desnutridas (RR=1,5; 1,1-2,3). Entretanto, a mortalidade n o foi afetada sig-nificativamente pela presen a de desnutri o.Conclus es: em nosso estudo, tivemos oportunidade de documentar que a presen a de desnutri o em crian as menores de 4 anos admitidas em UTI pediátrica representa um fator decisivo na sua evolu o, aumentando significativamente a necessidade de ventila o mecanica, o tempo de ventila o e o tempo de permanência em UTI pediátrica.
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