Lactate and base deficit are predictors of mortality in critically ill patients with cancer

Cancer patients frequently require admission to intensive care unit. However, there are a few data regarding predictive factors for mortality in this group of patients. The aim of this study was to evaluate whether arterial lactate or standard base deficit on admission and after 24 hours can predict mortality for patients with cancer.Journal ArticleSCOPUS: ar.jinfo:eu-repo/semantics/publishe

Aplicação do cuidado baseado na teoria de Orem ao paciente ostomizado

Estomia intestinal é realizada para desviar o trânsito intestinal para o exterior do corpo, o autocuidado do sujeito é fundamental para o seu processo de bem-estar físico e psicossocial, visto que ocorre mudança na imagem corporal. Objetivo: relatar a experiência da prática da sistematização da assistência de enfermagem, com base nas demandas terapêuticas de autocuidado de acordo com a teoria de Orem. Método: Trata-se de um estudo descritivo, tipo relato de experiência das residentes do Programa de Residência Multiprofissional em Cuidados continuados integrados na área de concentração em atenção à saúde do idoso no estado de Mato Grosso do Sul (MS). Relato de Caso: Cliente 58 anos, branco, casado, profissão vendedor, com diagnóstico médico de choque séptico de foco abdominal. Discussão: A equipe multiprofissional nesse âmbito insere no contexto hospitalar uma nova visão do cuidado, tendo como uma das funções costurar o sujeito fragmentado pela medicina, e romper o modelo cartesiano ainda existente no imaginário dos profissionais. Considerações finais: O conhecimento da equipe multiprofissional acerca da legislação que regulamenta o atendimento das pessoas com estomias é de extrema importância, uma vez que, essa equipe deve desempenhar suas ações com eficiência e eficácia à luz do que a legislação preconiza.La estomía intestinal se realiza para desviar el tránsito intestinal hacia el exterior del cuerpo, el autocuidado del sujeto es fundamental para su proceso de bienestar físico y psicosocial, ya que ocurre un cambio en la imagen corporal. Objetivo: relatar la experiencia de la práctica de la sistematización de la asistencia de enfermería, con base en las demandas terapéuticas de autocuidado de acuerdo con la teoría de Orem. Método: Se trata de un estudio descriptivo, tipo relato de experiencia de las residentes en el Programa de Residencia Multiprofesional en Cuidados continuados integrados en el área de concentración en atención a la salud del paciente en el estado de Mato Grosso do Sul (MS). Relato del caso: Paciente 58 años, blanco, casado, profesión vendedor, con diagnóstico médico de choque séptico de foco abdominal. Discusión: El equipo multiprofesional en ese ámbito inserta en el contexto hospitalario una nueva visión del cuidado, teniendo como una de las funciones coser el sujeto fragmentado por la medicina, y romper el modelo cartesiano aún existente en el imaginario de los profesionales. Consideraciones finales: El conocimiento del equipo multiprofesional acerca de la legislación que regula la atención de las personas con estomias es de extrema importancia, una vez que ese equipo debe desempeñar sus acciones con eficiencia y eficacia a la luz de lo que la legislación indica.Intestinal stomies are performed to divert intestinal transit to the outside of the body, self-care of the subject is fundamental to the process of physical and psychosocial well-being, since there is a change in the body image. Objective: to report the experience of the practice of the systematization of nursing care, based on the therapeutic demands of self care according to Orem's theory. Method: This is a descriptive study, a experience’s report of the experience of the Residents of the Multiprofessional Residency Program in Continuing Care integrated into the area of attention to elderly health care in the state of Mato Grosso do Sul (MS). Case report: Client, 58 years old, white, married, salesman profession, with medical diagnosis of septic shock of abdominal focus. Discussion: The multiprofessional team in this context inserts in the hospital context a new vision of care, it having as one of the functions to see the subject fragmented by medicine, and to break the Cartesian’s model still existing in the professionals' imaginary. Final considerations: The knowledge of the multiprofessional team about the legislation that regulates the care of people with stomies is of extreme importance, since, this team must carry out its actions with efficiency and effectiveness in light of what the law recommends, in addition, it is also the socialization of information with patients and family members about the guarantee of rights

Diaphragmatic pacing stimulation in spinal cord injury: anesthetic and perioperative management

OBJECTIVE: The standard therapy for patients with high-level spinal cord injury is long-term mechanical ventilation through a tracheostomy. However, in some cases, this approach results in death or disability. The aim of this study is to highlight the anesthetics and perioperative aspects of patients undergoing insertion of a diaphragmatic pacemaker. METHODS: Five patients with quadriplegia following high cervical traumatic spinal cord injury and ventilator-dependent chronic respiratory failure were implanted with a laparoscopic diaphragmatic pacemaker after preoperative assessments of their phrenic nerve function and diaphragm contractility through transcutaneous nerve stimulation. ClinicalTrials.gov: NCT01385384. RESULTS: The diaphragmatic pacemaker placement was successful in all of the patients. Two patients presented with capnothorax during the perioperative period, which resolved without consequences. After six months, three patients achieved continuous use of the diaphragm pacing system, and one patient could be removed from mechanical ventilation for more than 4 hours per day. CONCLUSIONS: The implantation of a diaphragmatic phrenic system is a new and safe technique with potential to improve the quality of life of patients who are dependent on mechanical ventilation because of spinal cord injuries. Appropriate indication and adequate perioperative care are fundamental to achieving better results

High levels of B-type natriuretic peptide predict weaning failure from mechanical ventilation in adult patients after cardiac surgery

OBJECTIVE: The failure to wean from mechanical ventilation is related to worse outcomes after cardiac surgery. The aim of this study was to evaluate whether the serum level of B-type natriuretic peptide is a predictor of weaning failure from mechanical ventilation after cardiac surgery. METHODS: We conducted a prospective, observational cohort study of 101 patients who underwent on-pump coronary artery bypass grafting. B-type natriuretic peptide was measured postoperatively after intensive care unit admission and at the end of a 60-min spontaneous breathing test. The demographic data, hemodynamic and respiratory parameters, fluid balance, need for vasopressor or inotropic support, and length of the intensive care unit and hospital stays were recorded. Weaning failure was considered as either the inability to sustain spontaneous breathing after 60 min or the need for reintubation within 48 h. RESULTS: Of the 101 patients studied, 12 patients failed the weaning trial. There were no differences between the groups in the baseline or intraoperative characteristics, including left ventricular function, EuroSCORE and lengths of the cardiac procedure and cardiopulmonary bypass. The B-type natriuretic peptide levels were significantly higher at intensive care unit admission and at the end of the breathing test in the patients with weaning failure compared with the patients who were successfully weaned. In a multivariate model, a high B-type natriuretic peptide level at the end of a spontaneous breathing trial was the only independent predictor of weaning failure from mechanical ventilation. CONCLUSIONS: A high B-type natriuretic peptide level is a predictive factor for the failure to wean from mechanical ventilation after cardiac surgery. These findings suggest that optimizing ventricular function should be a goal during the perioperative period

Effect of restrictive versus liberal transfusion strategies on outcomes in patients with cardiovascular disease in a non-cardiac surgery setting:systematic review and meta-analysis

Objective To compare patient outcomes of restrictive versus liberal blood transfusion strategies in patients with cardiovascular disease not undergoing cardiac surgery. Design Systematic review and meta-analysis. Data sources Randomised controlled trials involving a threshold for red blood cell transfusion in hospital. We searched (to 2 November 2015) CENTRAL, Medline, Embase, CINAHL, PubMed, LILACS, NHSBT Transfusion Evidence Library, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, ISRCTN Register, and EU Clinical Trials Register. Authors were contacted for data whenever possible. Trial selection Published and unpublished randomised controlled trials comparing a restrictive with liberal transfusion threshold and that included patients with cardiovascular disease. Data extraction and synthesis Data extraction was completed in duplicate. Risk of bias was assessed using Cochrane methods. Relative risk ratios with 95% confidence intervals were presented in all meta-analyses. Mantel-Haenszel random effects models were used to pool risk ratios. Main outcome measures 30 day mortality, and cardiovascular events. Results 41 trials were identified; of these, seven included data on patients with cardiovascular disease. Data from a further four trials enrolling patients with cardiovascular disease were obtained from the authors. In total, 11 trials enrolling patients with cardiovascular disease (n=3033) were included for meta-analysis (restrictive transfusion, n=1514 patients; liberal transfusion, n=1519). The pooled risk ratio for the association between transfusion thresholds and 30 day mortality was 1.15 (95% confidence interval 0.88 to 1.50, P=0.50), with little heterogeneity (I(2)=14%). The risk of acute coronary syndrome in patients managed with restrictive compared with liberal transfusion was increased (nine trials; risk ratio 1.78, 95% confidence interval 1.18 to 2.70, P=0.01, I(2)=0%). Conclusions The results show that it may not be safe to use a restrictive transfusion threshold of less than 80 g/L in patients with ongoing acute coronary syndrome or chronic cardiovascular disease. Effects on mortality and other outcomes are uncertain. These data support the use of a more liberal transfusion threshold (>80 g/L) for patients with both acute and chronic cardiovascular disease until adequately powered high quality randomised trials have been undertaken in patients with cardiovascular disease. Registration PROSPERO CRD42014014251

Blood transfusion in cardiac surgery is a risk factor for increased hospital length of stay in adult patients

Abstract\ud \ud \ud \ud Background\ud \ud Allogeneic red blood cell (RBC) transfusion has been proposed as a negative indicator of quality in cardiac surgery. Hospital length of stay (LOS) may be a surrogate of poor outcome in transfused patients.\ud \ud \ud \ud Methods\ud \ud Data from 502 patients included in Transfusion Requirements After Cardiac Surgery (TRACS) study were analyzed to assess the relationship between RBC transfusion and hospital LOS in patients undergoing cardiac surgery and enrolled in the TRACS study.\ud \ud \ud \ud Results\ud \ud According to the status of RBC transfusion, patients were categorized into the following three groups: 1) 199 patients (40%) who did not receive RBC, 2) 241 patients (48%) who received 3 RBC units or fewer (low transfusion requirement group), and 3) 62 patients (12%) who received more than 3 RBC units (high transfusion requirement group). In a multivariable Cox proportional hazards model, the following factors were predictive of a prolonged hospital length of stay: age higher than 65 years, EuroSCORE, valvular surgery, combined procedure, LVEF lower than 40% and RBC transfusion of > 3 units.\ud \ud \ud \ud Conclusion\ud \ud RBC transfusion is an independent risk factor for increased LOS in patients undergoing cardiac surgery. This finding highlights the adequacy of a restrictive transfusion therapy in patients undergoing cardiac surgery.\ud \ud \ud \ud Trial registration\ud \ud Clinicaltrials.gov identifier: http://NCT01021631.The authors would like to thank Suelly Zeferino and Lígia Camara for their assistance with data extraction. There was no external funding source for this research.This work was supported by the Department of Anaesthesiology, InCor, University of Sao Paulo

The Heart and COVID-19: What Cardiologists Need to Know

In face of the pandemic of the novel coronavirus disease 2019 (COVID-19), the management of patients with cardiovascular risk factors and/or disease is challenging. The cardiovascular complications evidenced in patients with COVID-19 derive from several mechanisms, ranging from direct viral injury to complications secondary to the inflammatory and thrombotic responses to the infection. The proper care of patients with COVID-19 requires special attention to the cardiovascular system aimed at better outcomes

O Coração e a COVID-19: O que o Cardiologista Precisa Saber

Frente à pandemia da doença causada pelo novo coronavírus (COVID-19), o manejo do paciente com fator de risco e/ou doença cardiovascular é desafiador nos dias de hoje. As complicações cardiovasculares evidenciadas nos pacientes com COVID-19 resultam de vários mecanismos, que vão desde lesão direta pelo vírus até complicações secundárias à resposta inflamatória e trombótica desencadeada pela infecção. O cuidado adequado do paciente com COVID-19 exige atenção ao sistema cardiovascular em busca de melhores desfechos