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Search Results: 1 - 10 of 16734 matches for " Jefferson Pedro Piva "
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A importancia da independência editorial na credibilidade e no reconhecimento de uma revista científica
Piva Jefferson Pedro
Jornal de Pediatria , 2002,
Abstract:
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
Abstract:
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.
Suporte farmacológico a lactentes e crian?as com choque séptico
Irazuzta, José;Sullivan, Kevin J.;Garcia, Pedro Celiny R.;Piva, Jefferson Pedro;
Jornal de Pediatria , 2007, DOI: 10.1590/S0021-75572007000300005
Abstract: objectives: septic shock (ss) is a frequent cause for admission to the pediatric intensive care unit, requiring prompt recognition and intervention to improve outcome. our aim is to review the relevant literature related to the diagnosis and management of ss and present a sequential management for its treatment. sources: non-systematic review of medical literature using the medline database. articles were selected according to their relevance to the objective and according to the authors’ opinions. summary of the findings: the outcome of sepsis and ss is dependent on the early recognition and implementation of time-sensitive goal-directed therapies. these include rapid aggressive fluid resuscitation followed by a well-designed pharmacotherapy. the goals of the resuscitation are the restoration of microcirculation and improved organ tissue perfusion. clinical and laboratory markers are needed to assess the adequacy of the treatments. altered pharmacokinetic and pharmacodynamic responses dictate that vasoactive agents should be adjusted to achieve the predetermined goals. in initial resuscitation with isotonic solutions (> 60 ml/kg), either crystalloid (normal saline) or colloid infusion could be used. despite adequate fluid resuscitation, if: (a) wide pulse pressure, low blood pressure, or bounding pulses (high cardiac output, low systemic vascular resistance - svr) are present, norepinephrine should be considered; (b) prolonged capillary refill, weak pulses, narrow pulse pressure, normotensive (low cardiac output, high svr), dopamine, epinephrine or dobutamine should be considered. adjunctive therapy with stress dose of corticosteroid is indicated in selected populations. conclusions: septic shock hemodynamics is a changing process that requires frequent assessment and therapeutic adjustments.
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.
Estudo controlado do uso endovenoso de sulfato de magnésio ou de salbutamol no tratamento precoce da crise de asma aguda grave em crian?as
Santana, Jo?o Carlos;Barreto, Sérgio Saldanha Menna;Piva, Jefferson Pedro;Garcia, Pedro Celiny;
Jornal de Pediatria , 2001, DOI: 10.1590/S0021-75572001000400009
Abstract: objective: to study the efficacy of intravenous magnesium sulfate and intravenous salbutamol in the treatment of severe asthma in children. methods: randomized, double-blind, placebo-controlled clinical trial, including children above 2 years of age with severe acute asthma admitted to the observation ward of the pediatric intensive care unit of hospital s?o lucas. all patients received conventional treatment (oxygen, corticoids, beta-adrenergics) on admission, and later received one of the following solutions: a) ivmg (50 mg/kg); b) intravenous salbutamol (20 μg/kg); c) saline solution (1 ml/kg/min). clinical assessments, electrolyte concentration, and arterial blood gas analyses were recorded before intravenous infusion and one hour after that. results: fifty patients participated in this study (of whom 53% were females, mean age = 4.5 years). there were no significant differences among the three groups. the group that received ivmg presented lower blood pressure during administration, which reached normal levels one hour afterwards, along with an increase in serum magnesium (p < 0,001) and serum ph, and reduction of paco2. the group that received intravenous salbutamol had lower respiratory rate (p = 0.05) and higher blood pressure (p = 0.01), and one hour after administration, these patients showed decreased respiratory rate (p = 0.02); lower levels of serum potassium (p = 0.009); higher ph, and reduced paco2. this group required fewer nebulizations (p = 0.009), fewer nebulizations per day (p<0.001) and less oxygen therapy than the ivmg and placebo groups. acidosis was more persistent (p < 0.01) in the placebo group. no difference as to the length of hospital stay was observed in any of the three groups. artificial ventilation was necessary in 10% of the patients. conclusions:the early intravenous administration of magnesium sulfate, especially salbutamol, achieved a rapid clinical response with excellent prognosis and no significant side effects.
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.
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