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Search Results: 1 - 10 of 179085 matches for " Carvalho Werther Brunow de "
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Solu??es hipert?nicas em pediatria
Carvalho, Werther Brunow de;
Jornal de Pediatria , 2003, DOI: 10.1590/S0021-75572003000800008
Abstract: objective: to describe the current knowledge and indications for use of hypertonic saline solutions in pediatrics patients. source of data: medline recent review articles and personal files. summary of the findings: basic physiologic principles were reviewed concerning the distribution of fluid inside the intravascular, interstitial and intracellular compartments. we also reviewed the findings concerning the mechanisms responsible for the rapid onset of cardiocirculatory effects and the additional effect of the colloid component. finally, we present the medical terms used in the context of small-volume resuscitation, the indications for clinical use, the evidence from clinical research (hemorrhagic shock, preclinical trauma care, septic shock, and head trauma), and the disadvantages and potential adverse effects of small-volume resuscitation. conclusions: resuscitation by means of hypertonic saline solutions associated or not with colloid solutions is one of the most innovative concepts for primary resuscitation from trauma and shock established in the past decade. currently, the spectrum of potential indications involves not only prehospital trauma care, but also perioperative and intensive care therapy. however, additional randomized double-blind studies are required with both children and adult patients to confirm the advantages of the method in terms of survival.
Hipertens o arterial pulmonar em crian as
Carvalho Werther Brunow de
Revista da Associa??o Médica Brasileira , 2003,
Utiliza o de sedativos e analgésicos em unidade de cuidados intensivos
Revista da Associa??o Médica Brasileira , 2002,
Riscos de se for ar a diurese na insuficiência renal aguda
Carvalho Werther Brunow de,Souza Nivaldo de
Revista da Associa??o Médica Brasileira , 2003,
Acidentes vasculares encefálicos em pediatria
Mekitarian Filho, Eduardo;Carvalho, Werther Brunow de;
Jornal de Pediatria , 2009, DOI: 10.1590/S0021-75572009000600002
Abstract: objectives: to summarize 1) the definitions and epidemiological features of stroke in children; 2) the main risk factors that can lead to stroke in pediatrics and neonatology; 3) the main pathophysiological features involved in the genesis of brain injury in stroke; 4) the clinical manifestations and imaging diagnosis; and 5) the latest recommendations concerning the support measures, treatment, and prophylaxis of stroke in children. sources: a review of the literature published in pubmed, embase, and scielo databases using the search terms stroke, pediatrics, and neonatology was performed, including relevant references from the chosen texts. summary of the findings: stroke in children are rare conditions, with incidence rates among two and eight per 100,000 children up to 14 years, and most cases show an underlying disease such as heart diseases, prothrombotic conditions, sickle-cell disease, and vascular malformations. there are no specific guidelines currently in place for the treatment of stroke in children, although central elements include support treatment, monitoring, and anticoagulation as secondary prevention in certain cases. prognosis depends on the extent of brain damage and the underlying disease but recurrence rates are high in most cases. conclusions: early diagnosis of stroke in children is very important and pediatricians should be aware of the lack of specificity of the symptoms to avoid late sequelae and improve life quality.
Intuba??o traqueal
Matsumoto, Toshio;Carvalho, Werther Brunow de;
Jornal de Pediatria , 2007, DOI: 10.1590/S0021-75572007000300010
Abstract: objective: to review current concepts related to the procedure of tracheal intubation in children. sources: relevant articles published from 1968 to 2006 were selected from the medline, lilacs and scielo databases, using the keywords intubation, tracheal intubation, child, rapid sequence intubation and pediatric airway. summary of the findings: airway management in children is related to their physiology and anatomy, in addition to specific factors (inherent pathological conditions, such as malformations or acquired conditions) which have a decisive influence on success. principal indications are in order to maintain the airway patent and to control ventilation. laryngoscopy and tracheal intubation cause cardiovascular alterations and affect airway reactivity. the use of tubes with cuffs is not prohibited, as long as the correct size for the child is chosen. a difficult airway can be identified against the mallampati scale and by direct laryngoscopy. rapid sequence intubation is being recommended more and more often in pediatrics, since it facilitates the procedure and presents fewer complications. tracheal intubation should be carried out in an adequate manner in special circumstances (eaten recently, neurological dysfunction, unstable spinal column, upper airway obstruction, laryngotracheal injuries, injuries to the eyeball). extubation should be meticulously planned, since there is chance of failure and a need for reintubation. conclusions: tracheal intubation of children requires knowledge, skill and experience, since, if the procedure is carried out by inexperienced pediatricians, it can result in life-threatening complications.
óxido nítrico inalatório: considera??es sobre sua aplica??o clínica
Gurgueira, Gisele Limongeli;Carvalho, Werther Brunow de;
Jornal de Pneumologia , 2003, DOI: 10.1590/S0102-35862003000500012
Abstract: the objective of this paper is to report some clinical and therapeutic aspects of inhaled nitric oxide in pediatrics. some references were obtained from medline? using the keywords: inhaled nitric oxide and pediatrics, and critical care. other sources were the university library and personal files. along the last decade, clinical trials with inhaled nitric oxide demonstrated only a few specific areas of proven efficacy and a variety of possible adverse events. toxicity related to inhaled nitric oxide included metahemoglobinemia, cytotoxic pulmonary effects, excess production of nitrogen dioxide and peroxynitrite, and injury to the pulmonary surfactant system. the administration of inhaled nitric oxide to patients with severe left ventricular dysfunction and pulmonary hypertension should be cautious, since vasodilatation may increase pulmonary blood flow and lead to excessive preload. some studies showed the clinical effects related to abrupt nitric oxide withdrawal, including rebound pulmonary hypertension. current literature supports the therapeutic use of inhaled nitric oxide in persistent pulmonary hypertension of the newborn (gestational age > 34 weeks) to improve oxygenation and avoid extracorporeal oxygenation; and in congenital cardiopathy accompanied by pulmonary hypertension, especially in the immediate postoperative period. to date, research in pediatrics and multicentre trials in adults with inhaled nitric oxide therapy have failed to show mortality reduction or decrease the amount of time under mechanical ventilation for acute respiratory distress syndrome and acute lung injury. this indication needs further investigations. persistent pulmonary hypertension is the most important indication for inhaled nitric oxide. the food and drug administration has not approved inhaled nitric oxide in acute respiratory distress syndrome for adults and children.
Atelectasias em pediatria: mecanismos, diagnóstico e tratamento
Johnston, Cíntia;Carvalho, Werther Brunow de;
Revista da Associa??o Médica Brasileira , 2008, DOI: 10.1590/S0104-42302008000500021
Abstract: objective: to review the literature about mechanisms, diagnosis and treatment of atelectasis in the pediatric patient. methods: an electronic data search was carried out in medline and scielo using the following inclusion criteria for articles published between 1960 and 2007 about: atelectasis etiology, physiopathology, functional consequences, evaluation, prevention, treatment and complications, in pediatrics. the used key words were atelectasis, children, pediatrics, mucus plugs, chest physiotherapy; results: 45 pulmonary atelectasis articles were analyzed, 17 of them in pediatrics. of the pediatric, 13 were case series, 3 literature reviews and one a case report. this demonstrates that there were few articles on atelectasis during the reviewed period and that these articles were at the d and e evidence level. conclusion: no clinical trials were performed to identify s the most efficient treatment for atelectasis in the pediatric patient. although clinical practice for treatment of atelectasis has evolved, mostly due to improvement of bronchoscopy and chest physiotherapy techniques, there is still a need to perform randomized clinical trials to address treatment of atelectasis in the pediatric patient.
Protocolos para desmame da ventila o mecanica em pediatria
Carvalho Werther Brunow de,Oliveira Nilton Ferraro
Revista da Associa??o Médica Brasileira , 2003,
Utiliza o de máscara laríngea. Uma prática habitual em pediatria?
Carvalho Werther Brunow de,Gurgueira Gisele Limongeli
Revista da Associa??o Médica Brasileira , 2004,
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