Comparação entre a pressão inspiratória máxima aferida pelo manovacuômetro digital e pelo dispositivo eletrônico de treinamento muscular inspiratório

Aims: To compare maximum inspiratory pressure (MIP) measured by a digital manometer and by an inspiratory muscle training (IMT) device and to evaluate hemodynamic changes after measurements. Methods: The sample included male and female individuals older than 18 years admitted to an intensive care unit who were hemodynamically stable, not being treated with vasoactive drugs or sedated, intubated or tracheostomized, and who were in the process of being weaned from mechanical ventilation. MIP was measured by both devices on three different occasions, with an occlusion time of 20 seconds and a 5-minute interval between measurements. The following parameters were assessed: respiratory rate, mean arterial pressure, and respiratory rate before and after each measurement by each device. The statistical analysis was made in the Statistical Analysis System and the R Project for Statistical Computing V. 3.1.2 softwares, using the ANOVA and the Wilcoxon tests. Results: Fifty-eight patients were included in the study. The mean value obtained for MIP was -46.22 centimeters of water (cmH2O) in the digital manometer and -13.15 cmH2O (p<0.001) in the IMT device. Heart rate showed a significant increase (p<0.0001) both before and after all measurements in both devices. Mean arterial pressure showed a statistically significant difference only before and after the first measurement by the digital manometer and before and after the second measurement by the IMT device (p<0.001). The respiratory rate oscillated significantly before and after the three measurements by both devices (p<0.0001). The hemodynamic parameters remained within reference values after MIP measurements. Conclusions: The digital manometer recorded a higher MIP than that measured by the IMT device. The hemodynamic parameter values oscillated in both devices, but they remained within the normal range and were not clinically significant.To compare maximum inspiratory pressure (MIP) measured by a digital manometer and by an inspiratory muscle training (IMT) device and to evaluate hemodynamic changes after measurements. Methods: The sample included male and female individuals older than 182616Comparar valores de pressão inspiratória máxima (PImáx) aferidos por um manovacuômetro digital e por um dispositivo eletrônico de treinamento muscular inspiratório e avaliar as repercussões hemodinâmicas após as medidas. MÉTODOS: A amostra foi composta p

Atrial Natriuretic Factor: Is It Responsible For Hyponatremia And Natriuresis In Neurosurgery?

To evaluate the presence of hyponatremia and natriuresis and their association with atrial natriuretic factor in neurosurgery patients. Methods: The study included 30 patients who had been submitted to intracranial tumor resection and cerebral aneurism clipping. Both plasma and urinary sodium and plasma atrial natriuretic factor were measured during the preoperative and postoperative time periods. Results: Hyponatremia was present in 63.33% of the patients, particularly on the first postoperative day. Natriuresis was present in 93.33% of the patients, particularly on the second postoperative day. Plasma atrial natriuretic factor was increased in 92.60% of the patients in at least one of the postoperative days; however, there was no statistically significant association between the atrial natriuretic factor and plasma sodium and between the atrial natriuretic factor and urinary sodium. Conclusion: Hyponatremia and natriuresis were present in most patients after neurosurgery; however, the atrial natriuretic factor cannot be considered to be directly responsible for these alterations in neurosurgery patients. Other natriuretic factors are likely to be involved.28215416

Fatores de risco para disfunção transitória da troca gasosa após a cirurgia cardíaca

A retrospective cohort study was preformed aiming to verify the presence of transient dysfunction of gas exchange in the postoperative period of cardiac surgery and determine if this disorder is linked to cardiorespiratory events. We included 942 consecutive patients undergoing cardiac surgery and cardiac procedures who were referred to the Intensive Care Unit between June 2007 and November 2011. Fifteen patients had acute respiratory distress syndrome (2%), 199 (27.75%) had mild transient dysfunction of gas exchange, 402 (56.1%) had moderate transient dysfunction of gas exchange, and 39 (5.4%) had severe transient dysfunction of gas exchange. Hypertension and cardiogenic shock were associated with the emergence of moderate transient dysfunction of gas exchange postoperatively (P=0.02 and P=0.019, respectively) and were risk factors for this dysfunction (P=0.0023 and P=0.0017, respectively). Diabetes mellitus was also a risk factor for transient dysfunction of gas exchange (P=0.03). Pneumonia was present in 8.9% of cases and correlated with the presence of moderate transient dysfunction of gas exchange (P=0.001). Severe transient dysfunction of gas exchange was associated with patients who had renal replacement therapy (P=0.0005), hemotherapy (P=0.0001), enteral nutrition (P=0.0012), or cardiac arrhythmia (P=0.0451). Preoperative hypertension and cardiogenic shock were associated with the occurrence of postoperative transient dysfunction of gas exchange. The preoperative risk factors included hypertension, cardiogenic shock, and diabetes. Postoperatively, pneumonia, ventilator-associated pneumonia, renal replacement therapy, hemotherapy, and cardiac arrhythmia were associated with the appearance of some degree of transient dysfunction of gas exchange, which was a risk factor for reintubation, pneumonia, ventilator-associated pneumonia, and renal replacement therapy in the postoperative period of cardiac surgery and cardiac procedures.A retrospective cohort study was preformed aiming to verify the presence of transient dysfunction of gas exchange in the postoperative period of cardiac surgery and determine if this disorder is linked to cardiorespiratory events. We included 942 consecut3012432The authors acknowledge the work done by the Office of Biostatistics, School of Medical Sciences, State University of Campinas. In particular, we would like to thank Cleide Aparecida Moreira Silva for his dedication to this work. We also appreciate nu

Adjustable inspiratory occlusion valve In experimental bronchopleural fistula. A new therapeutic perspective

To assess the efficacy of an adjustable inspiratory occlusion valve in experimental bronchopleural fistula during mechanical ventilation. We studied six mechanically ventilated pigs in a surgically created, reproducible model of bronchopleural fistula managed with mechanical ventilation and water-sealed thoracic drainage. An adjustable inspiratory occlusion valve was placed between the thoracic drain and the endotracheal tube. Hemodynamic data, capnography and blood gases were recorded before and after the creation of the bronchopleural fistula as well as after every adjustment of the inspiratory occlusion valve. When compared with the standard water-sealed drainage treatment, the use of an adjustable inspiratory occlusion valve improved the alveolar tidal volume and reduced bronchopleural air leak (p<0.001), without hemodynamic compromise when compared with conventional water sealed drainage. The use of an adjustable inspiratory occlusion valve improved the alveolar tidal volume, reduced alveolar leak, in an experimental reproducible model of bronchopleural fistula, without causing any hemodynamic derangements when compared with conventional water sealed drainage.To assess the efficacy of an adjustable inspiratory occlusion valve in experimental bronchopleural fistula during mechanical ventilation. METHODS: We studied six mechanically ventilated pigs in a surgically created, reproducible model of bronchopleural fi308561567To the team of the Center for Experimental Medicine and Surgery, Faculty of Medical Sciences, UNICAMP, especially to biologists Willian Adalberto Silva and Ana Cristina Morae

Comparação Entre A Pressão Inspiratória Máxima Aferida Pelo Manovacuômetro Digital E Pelo Dispositivo Eletrônico De Treinamento Muscular Inspiratório

To compare maximum inspiratory pressure (MIP) measured by a digital manometer and by an inspiratory muscle training (IMT) device and to evaluate hemodynamic changes after measurements. Methods: The sample included male and female individuals older than 18 years admitted to an intensive care unit who were hemodynamically stable, not being treated with vasoactive drugs or sedated, intubated or tracheostomized, and who were in the process of being weaned from mechanical ventilation. MIP was measured by both devices on three different occasions, with an occlusion time of 20 seconds and a 5-minute interval between measurements. The following parameters were assessed: respiratory rate, mean arterial pressure, and respiratory rate before and after each measurement by each device. The statistical analysis was made in the Statistical Analysis System and the R Project for Statistical Computing V. 3.1.2 softwares, using the ANOVA and the Wilcoxon tests. Results: Fifty-eight patients were included in the study. The mean value obtained for MIP was -46.22 centimeters of water (cmH2O) in the digital manometer and -13.15 cmH2O (p<0.001) in the IMT device. Heart rate showed a significant increase (p<0.0001) both before and after all measurements in both devices. Mean arterial pressure showed a statistically significant difference only before and after the first measurement by the digital manometer and before and after the second measurement by the IMT device (p<0.001). The respiratory rate oscillated significantly before and after the three measurements by both devices (p<0.0001). The hemodynamic parameters remained within reference values after MIP measurements. Conclusions: The digital manometer recorded a higher MIP than that measured by the IMT device. The hemodynamic parameter values oscillated in both devices, but they remained within the normal range and were not clinically significant.2611

Hemodynamic, ventilatory and gasometric evaluation of an experimental bronchopleural fistula

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)PURPOSE: To investigate the hemodynamic and ventilatory changes associated with the creation of an experimental bronchopleural fistula (BPF) treated by mechanical ventilation and thoracic drainage with or without a water seal. METHODS: Six large white pigs weighing 25 kg each which, after general anesthesia, underwent endotracheal intubation (6mm), and mechanically ventilation. Through a left thoracotomy, a resection of the lingula was performed in order to create a BPF with an output exceeding 50% of the inspired volume. The chest cavity was closed and drained into the water sealed system for initial observation of the high output BPF. RESULTS: Significant reduction in BPF output and PaCO2 was related after insertion of a water-sealed thoracic drain, p<0.05. CONCLUSION: Insertion of a water-sealed thoracic drain resulted in reduction in bronchopleural fistula output and better CO2 clearance without any drop in cardiac output or significant changes in mean arterial pressure.To investigate the hemodynamic and ventilatory changes associated with the creation of an experimental bronchopleural fistula (BPF) treated by mechanical ventilation and thoracic drainage with or without a water seal. METHODS : Six large white pigs weighi30115Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)FAPESP [04610-2/2009