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

Effect Of Induction Therapy And The Movement Restriction In Patients With Chronic Hemiparesis Post-stroke [efeito Da Terapia De Restrição E Indução Ao Movimento Em Pacientes Hemiparéticos Crônicos Pós-avc]

Stroke often causes hemiparesis with body asymmetry and difficulty in movement. The Constraint-Induced Movement Therapy (CIMT) aims to recover the function of the upper limb in after stroke patients. Objective. To evaluate the effect of CIMT in the recovery of the motor function, as well as of the quality and ability of the upper limb's movements in after stroke patients with chronic hemiparesis. Method. The study was conducted with five patients having medically diagnosed stroke, with chronic upper limb hemiparesis. The patients were evaluated before and after the treatment by the Fugl-Meyer rating scale (FM) and upper limb Motor Ability Test (ULMAT). The treatment consisted of applying a modified protocol of CIMT, for a period of 2 weeks, 5 sessions/day per week, lasting 3 hours each, totaling 10 sessions. Results. In the ULMAT a significant improvement in the functional quality and ability of the upper limb's movement was observed in all analyzed subjects (p=0,00). The results also showed an increase in scores on the FM scale (p=0,00). Conclusion. It was concluded that the CIMT is an effective treatment for patients with chronic hemiplegia secondary to stroke, since an improvement in the functionality of the affected upper limb has been observed after intervention.213333338Silva, F.P.P., Gonçalves, S.P., Silva, S.B., Rios, D.F.C.R., Silva, A.T., Terapia de Contensão Induzida associada á eletroestimulação funcional na paresia de membro superior (2012) Rev Neurocienc, 20, pp. 187-193Brol, A.M., Bortoloto, F., Magagnin, N.M.S., Tratamento de Restrição e Indução do Movimento na reabilitação funcional de pacientes pós Acidente Vascular Encefálico: Uma revisão bibliográfica (2009) Fisioter Mov, 22, pp. 497-509Polese, J.C., Tonial, A., Fung, F.K., Mazuco, R., Oliveira, S.G., Schuster, R.C., Avaliação da funcionalidade de indivíduos acometidos por acidente vascular encefálico (2008) Rev Neurocienc, 16, pp. 175-178Gamba, R.T., Cruz, D.M.C., Efeitos da terapia de contensão induzida em longo prazo em pacientes pós- AVC (2011) Rev Neurocienc, 19, pp. 735-740Cesário, C.M.M., Penasso, P., Oliveira, A.P.R., Impacto da disfunção motora na qualidade de vida em pacientes com Acidente Vascular Encefálico (2006) Rev Neurocienc, 14, pp. 6-9Freitas, A.G., Sutani, J., Pires, M.A., Prada, S.H.F., Protocolo modificado da terapia de restrição em paciente hemiplégico (2010) Rev Neurocienc, 18, pp. 199-203Riberto, M., Monroy, H.M., Kaihami, H.N., Otsubo, P.P.S., Battistella, L.R., A terapia de restrição como forma de aprimoramento da função do membro superior em pacientes com hemiplegia (2005) Rev Acta Fisiatr, 12, pp. 15-19Silva, L.A., Tamashiro, V., Assis, R.D., Terapia por Contensão Induzida: Revisão de ensaios clínicos (2010) Fisioter Mov, 23 (1), pp. 153-159. , http://dx.doi.org/10.1590/S0103-51502010000100015Vaz, D.V., Alvarenga, R.F., Mancini, M.C., Pinto, T.P.S., Furtado, S.R.C., Tirado, M.G.A., Terapia de movimento induzido pela restrição na hemiplegia: Um estudo de caso único (2008) Rev Fisioter Pesq, 15 (3), pp. 298-303Meneghetti, C.H.Z., Silva, J.Á., Guedes, C.A.V., Terapia de restrição e indução ao movimento no paciente com AVC: Relato de caso (2010) Rev Neurocienc, 18 (1), pp. 18-23Bueno, G.D.P., Lúcio, A.C., Oberg, T.D., Cacho, E.W.A., Terapia de Restrição e Indução Modificada do Movimento em pacientes hemiparéticos crônicos: Um estudo piloto (2008) Fisioter Mov, 21 (3), pp. 37-44Maki, T., Quagliato, E.M.A.B., Cacho, E.W.A., Paz, L.P.S., Nascimento, N.H., Inoue, M.M.E.A., Estudo de confiabilidade da aplicação da escala de Fugl- Meyer no Brasil (2006) Rev Bras Fisioter, 10 (2), pp. 177-183. , http://dx.doi.org/10.1590/S1413-35552006000200007Cavaco, N.S., Alouche, S.R., Instrumentos de avaliação da função de membros superiores após acidente vascular encefálico: Uma revisão sistemática (2010) Fisioter Pesq, 17 (2), pp. 178-183Morlin, A.C.G., Delattre, A.M., Cacho, E.W.A., Oberg, T.D., Oliveira, R., Concordância e tradução para o português do Teste de Habilidade Motora do Membro Superior- THMMS (2006) Rev Neurocienc, 14 (2), pp. 006-009Lee, J.H.V.D., Constraint-induced movement therapy: Some thoughts about theories and eviden (2003) J Rehabil Med, 41, pp. 41-45Grotta, J.C., Noser, E.A., Ro, T., Boake, C., Levin, H., Aronowski, J., Constraint-induced movement therapy (2004) Stroke, 35, pp. 2699-2701. , http://dx.doi.org/10.1161/01.STR.0000143320.64953.c4Page, S.J., Levine, P., Leonard, A., Szaflarski, J.P., Kissela, B.M., Modified constraint-induced therapy in chronic stroke:Results of a single-blinded randomized controlled trial (2008) Phs Ther, 88, pp. 333-340. , http://dx.doi.org/10.2522/ptj.20060029Lierpert, J., Bauder, H., Miltner, W.H.R., Taub, E., Weiller, C., Treatment-Induced Cortical Reorganization After Stroke in Humans (2000) Stroke, 31, pp. 1210-1216. , http://dx.doi.org/10.1161/01.STR.31.6.121

Mirror Therapy In Rehabilitation Of The Upper Limb Paretic - A Case Report [terapia Espelho Na Reabilitação Do Membro Superior Parético - Relato De Caso]

Objective. The aim of this study was to analyze the effect of mirror therapy on the paretic upper limb of a chronic phase stroke patient. Method. It is an experimental design of an only one case study, where a, 65 years old, slightly to the right, spastic hemiparetic female patient, with a brachial predomination due to an 84 month ischemic stroke, as well as a good cognitive capacity, was selected. The intervention protocol consisted of 15 one hour sessions, for 3 times a week, where mirror therapy was applied associated with the shaping protocol and task performance time was measured. The assessment instruments were: Motor Activity Log (MAL) scale and Fugl Meyer Motor Function Assessment (FMMF). The Wilcoxon statistical test was used to compare data. Results. There was a statistical difference for the MAL scale for the movement quantity and quality items (p=0,00).There was no statistical difference for the FMMF (p=0,06). There was improvement in the functional task performance time. Conclusion. It was concluded that mirror therapy brought positive effects on the stroke patient's motor function.214587592Carr, J., Shepherd, R., Acidente Vascular Cerebral (2008) Reabilitação Neurológica: Otimizando O Desempenho Motor, pp. 253-588. , Carr J, Shepherd R., São Paulo: ManoleLeite, H.R., Nunes, A.P.N., Corrêa, C.L., Perfil epidemiológico de pacientes acometidos por acidente vascular encefálico cadastrados na Estratégia de Saúde da Família em Diamantina, MG (2009) Fisioter Pesq, 16 (1), pp. 34-39Pires, S.L., Gagliard, R.J., Gorzoni, M.L., Estudo das frequências dos principais fatores de risco para Acidente Vascular Cerebral em idosos (2004) Arq Neuropsiquiatr, 62 (3), pp. 844-851. , http://dx.doi.org/10.1590/S0004-282X2004000500020Mazzola, D., Polese, J.C., Schuster, P.C., Oliveira, S.G., Perfil dos pacientes acometidos por acidente vascular encefálico assistidos na clínica de fisioterapia neurológica da universidade de passo fundo (2007) Rev Bras Prom Saúde, 20 (1), pp. 22-27. , http://dx.doi.org/10.5020/18061230.2007.p22O'Sullivan, S.B., Acidente Vascular Encefálico (2004) Fisioterapia: Avaliação E Tratamento, pp. 519-564. , O' Sullivan SB, Schmitz TJ., 4 edição. São Paulo: ManoleSoares, A.V., Fronza, D., Hochmuller, A.C.O.L., Woellner, S.S., Noveletto, F., Biofeedback por eletromiografia na recuperação do membro superior de pacientes hemiparéticos por acidente vascular encefálico (2011) Rev Bras Med, 68 (11), pp. 336-341Barreca, S., Wolf, S.L., Fasoli, S., Bohannon, R., Treatment interventions for the paretic upper limb of stroke survivors: A critical review (2003) Neurorehab Neural Rep, 17 (4), pp. 220-226. , http://dx.doi.org/10.1177/0888439003259415Ryerson, S.D., Hemiplegia (2004) Reabilitação Neurológica, pp. 782-830. , Umphred, DA., 4 ed. São Paulo: ManoleGordon, N.F., Gulanick, M., Costa, F., Fletcher, G., Franklin, B.A., Roth, E.J., (2004) Circulation, 109, pp. 2031-2041. , http://dx.doi.org/10.1161/01.CIR.0000126280.65777.A4, Physical Activity and Exercise Recommendations for Stroke Survivors: An American Heart Association Scientific Statement From the Council on Clinical Cardiology, Subcommittee on Exercise, Cardiac Rehabilitation, and Preventionthe Council on Cardiovascular Nursingthe Council on Nutrition, Physical Activity, and Metabolismand the Stroke CouncilStudenski, S., Duncan, P.W., Perera, S., Reker, D., Lai, S.M., Richards, L., Daily Functioning and Quality of Life in a Randomized Controlled Trial of The rapeutic Exercise for Subacute Stroke Survivors (2005) Stroke, 36, pp. 1764-1770. , http://dx.doi.org/10.1161/01.STR.0000174192.87887.70Enst, E., A review of stroke rehabilitation and physiotherapy (1990) Stroke, 21, pp. 1081-1085. , http://dx.doi.org/10.1161/01.STR.21.7.1081Green, J., Forster, A., Bogle, S., Young, J., Physiotherapy for patients with mobility problems more than 1 year after stroke: A randomised controlled trial Stroke2002, 359, pp. 199-203Kandel, E.R., Schwartz, J.H., Jessell, T.M., (2003) Princípios Da Neurociência, p. 843. , 4 ed. Barueri: MonoleDohle, C., Püllen, J., Nakaten, A., Küst, J., Rietz, C., Karbe, H., Mirror Therapy Promotes Recovery From Severe Hemiparesis: A Randomized Controlled Trial (2009) Neurorehabil Neural Repair, 23 (3), pp. 209-217. , http://dx.doi.org/10.1177/1545968308324786Di Pellegrino, G., Fadiga, L., Fogassi, L., Gallese, V., Rizzolatti, G., Understanding motor events: A neurophysiological study (1992) Exp Brain Res, 91, pp. 176-180. , http://dx.doi.org/10.1007/BF00230027Sathian, K., Greenspan, A.I., Wolf, S.L., Doing It with Mirrors: A Case Study of a Novel Approach to Neurorehabilitation (2000) Neurorehab Neural Rep, 14 (1), pp. 173-176. , http://dx.doi.org/10.1177/154596830001400109Folstein, M.F., Folstein, S.E., McHugh, P.R., Mini-mental state: A practical method for grading the cognitive state of patients for the clinician (1975) J Psychiatric Res, 12, pp. 189-198. , http://dx.doi.org/10.1016/0022-3956(75)90026-6Maki, T., Quagliato, E., Cacho, E.W.A., Paz, L.P.S., Nascimento, N.H., Inoue, M.M.E.A., Viana, M.A., Estudo de confiabilidade da aplicação da escala de Fugl-meyer no Brasil (2006) Rev Bras Fisioter, 10 (2), pp. 177-183. , http://dx.doi.org/10.1590/S1413-35552006000200007Saliba, V.A., Magalhães, L.C., Farias, C.D.C.M., Laurentino, G.E.C., Cassiano, J.G.C., Teixeira-Salmela, L.F., Adaptação transcultural e análise das propriedades psicométricas da versão brasileira do instrumento Motor Activity Log (2011) Rev Panam Salud Publica, 30 (3), pp. 262-271. , http://dx.doi.org/10.1590/S1020-49892011000900011Taub, E., Crago, J.E., Burgio, L.D., Groomes, T.E., Cook, E.W., Deluca, S.C., An operant approach to rehabilitation medicine: Overcoming learned nonuse by shaping (1994) J Exp Anal Beh, 61 (2), pp. 281-293. , http://dx.doi.org/10.1901/jeab.1994.61-281Ramachandran, V.S., Altschuler, E.L., The use of visual feedback, in particular mirror visual feedback, in restoring brain function (2009) Brain, 132 (7), pp. 1693-1710. , http://dx.doi.org/10.1093/brain/awp135Wu, C.Y., Huang, P.C., Chen, Y.T., Lin, K.C., Yang, H.W., Effects of Mirror Therapy on Motor and Sensory Recovery in Chronic Stroke: A Randomized Controlled Trial (2013) ArcPhys Med Rehab, 94, pp. 1023-1030. , http://dx.doi.org/10.1016/j.apmr.2013.02.007Stevens, J.A., Stoykov, M.E.P., Using motor imagery in the rehabilitation of hemiparesis (2003) Arch Phys Med Rehab, 84 (7), pp. 1090-1092. , http://dx.doi.org/10.1016/S0003-9993(03)00042-XRamachandran, V.S., Rogers, R.D., Cobb, S., Touching the phantom limb (1995) Nature, 377, pp. 489-490. , http://dx.doi.org/10.1038/377489a0Stevens, J.A., Stoykov, M.E.P., Simulation of Bilateral Movement Training Through Mirror Reflection: A Case Report Demonstrating an Occupational Therapy Technique for Hemiparesis (2004) Top Stroke Rehabil, 11 (1), pp. 59-66. , http://dx.doi.org/10.1310/GCFE-QA7A-2D24-KHRULin, K.C., Chen, Y.T., Huang, P.C., Wu, C.Y., Huang, W.L., Yang, H.W., Effect of mirror therapy combined with somatosensory stimulation on motor recovery and daily function in stroke patients: A pilot study (2012) J Form MedAssoc, pp. 1-7. , http://dx.doi.org/10.1016/j.jfma.2012.08.008Grefkes, C., Fink, G.R., Reorganization of cerebral networks after stroke: New insights form neuroimaging with connectivity approaches (2011) Brain, 134, pp. 1264-1276. , http://dx.doi.org/10.1093/brain/awr033James, G.A., Lu, Z.L., Vanmeter, J.W., Sathian, K., Hu, X.P., Butler, A.J., Changes in resting state effective connectivity in the motor network following rehabilitation of upper extremity poststroke paresis (2009) Top Stroke Rehabil, 16, pp. 270-281. , http://dx.doi.org/10.1310/tsr1604-270Rosen, B., Lundborg, G., Training with a mirror in rehabilitation of the hand (2005) Scand J PlastReconstrSurg Hand Surg, 39, pp. 104-108. , http://dx.doi.org/10.1080/02844310510006187Nudo, R.J., Plautz, E.J., Frost, S.B., Role of adaptative plasticity in recovery of function after damage to motor cortex (2001) Muscle Nerve, 24, pp. 1000-1019. , http://dx.doi.org/10.1002/mus.1104Hickmott, P.W., Merzenich, M.M., Local circuit properties underlying cortical reorganization (2002) J Neurophysiol, 88, pp. 1288-1301. , http://dx.doi.org/10.1152/jn.00994.2001Magill, R.A., Aprendizagem Motora Conceitos e Aplicações (2000) Motriz, 6 (1), pp. 35-36Smorenburg, A.R.P., Ledebt, A., Deconinck, F.J.A., Savelsbergh, G.J.P., Matching accuracy in hemiparetic cerebral palsy during unimanual and bimanual movements with (mirror) visual feedback (2012) Res Dev Disabil, 33, pp. 2088-2098. , http://dx.doi.org/10.1016/j.ridd.2012.06.004Page, S.J., Levi, P., Sisto, S., Johnston, M., A randomized efficacy and feasibility study of imagery in acute stroke (2001) Clin Rehab, 15 (3), pp. 233-240. , http://dx.doi.org/10.1191/026921501672063235Tecchio, F., Rossini, P.M., Pizzella, V., Cassetta, E., Pasqualetti, P., Romani, G.L., A neuromagnetic normative data set for hemispheric sensory hand cortical representations and their interhemispheric diferences (1998) Brain Res Prot, 2, pp. 306-31

Use Of Non-invasive Ventilation In Acute Pulmonary Edema And Chronic Obstructive Pulmonary Disease Exacerbation In Emergency Medicine: Predictors Of Failure

Objective: This study analyzed acute respiratory failure caused by acute pulmonary edema, as well as chronic obstructive pulmonary disease exacerbation, that was treated with non-invasive mechanical ventilation to identify the factors that are associated with the success or failure non-invasive mechanical ventilation in urgent and emergency service. Methods: This study was a prospective, descriptive and analytical study. We included patients of both genders aged ≥18 years who used noninvasive mechanical ventilation due to acute respiratory failure that was secondary to acute pulmonary edema or chronic obstructive pulmonary disease exacerbation. Patients with acute respiratory failure that was secondary to pathologies other than acute pulmonary edema and chronic obstructive pulmonary disease or who presented with contraindications for the technique were excluded. Expiratory pressures between 5 and 8 cmH2O and inspiratory pressures between 10 and 12 cmH2O were used. Supplemental oxygen maintained peripheral oxygen saturation at >90%. The primary outcome was endotracheal intubation. Results: A total of 152 patients were included. The median non-invasive mechanical ventilation time was 6 hours (range 1, 32 hours) for chronic obstructive pulmonary disease patients (n=60) and 5 hours (range 2, 32 hours) for acute pulmonary edema patients (n=92). Most (75.7%) patients progressed successfully. However, reduced APACHE II scores and lower peripheral oxygen saturation were observed. These results were statistically significant in patients who progressed to intubation (p<0.001). BiPAP (Bilevel Positive Airway Pressure portable ventilator), as continuous positive airway pressure use increased the probability of endotracheal intubation 2.3 times (p=0.032). Patients with acute pulmonary edema and elevated GCS scores also increased the probability of success. Conclusion: Respiratory frequency >25 rpm, higher APACHE II scores, BiPAP use and chronic obstructive pulmonary disease diagnosis were associated with endotracheal intubation. Higher GCS and SpO2 values were associated with NIV success. Noninvasive mechanical ventilation can be used in emergency services in acute respiratory failure cases caused by acute pulmonary edema and chronic obstructive pulmonary disease exacerbation, but patients with variables related to a higher percentage of endotracheal intubation should be specially monitored.243278283Schettino, G.P., Reis, M.A., Galas, F., Park, M., Franca, S.A., Okamoto, V.N., Ventilação mecânica não-invasiva com pressão positiva (2007) Rev Bras ter Intensiva., 19 (2), pp. 245-257Kaya, A., Çileda, A., Cayli, I., Onen, Z.P., Sen, E., Gülbay, B., Associated factors with noninvasive mechanical ventilation failure in acute hypercapnic respiratory failure (2010) Tuberk Toraks., 58 (2), pp. 128-134Hess, D.R., The evidence for noninvasive positive-pressure ventilation in the care of patients in acute respiratory failure: A systematic review of the literature (2004) Respir Care., 49 (7), pp. 810-829. , ReviewCollins, S.P., Mielniczuk, L.M., Whittingham, H.A., Boseley, M.E., Schramm, D.R., Storrow, A.B., The use of noninvasive ventilation in emergency department patients with acute cardiogenic pulmonary edema: A systematic review (2006) Ann Emerg Med., 48 (3), pp. 260-269. , 269.e1-4. ReviewAntonelli, M., Conti, G., Moro, M.L., Esquinas, A., Gonzalez-Diaz, G., Confalonieri, M., Predictors of failure of noninvasive positive pressure ventilation in patients with acute hypoxemic respiratory failure: A multi-center study (2001) Intensive Care Med., 27 (11), pp. 1718-1728Antón, A., Güell, R., Gómez, J., Serrano, J., Castellano, A., Carrasco, J.L., Predicting the result of noninvasive ventilation in severe acute exacerbations of patients with chronic airflow limitation (2000) Chest., 117 (3), pp. 828-833Pladeck, T., Hader, C., Von Orde, A., Rasche, K., Wiechmann, H.W., Non-invasive ventilation: Comparison of effectiveness, safety, and management in acute heart failure syndromes and acute exacerbations of chronic obstructive pulmonary disease (2007) J Physiol Pharmacol., 58 (SUPPL. 5), pp. 539-549. , Pt 2Schönhofer, B., Kuhlen, R., Neumann, P., Westhoff, M., Berndt, C., Sitter, H., Clinical practice guideline: Non-invasive mechanical ventilation as treatment of acute respiratory failure (2008) Dtsch Arztebl Int., 105 (24), pp. 424-433Crummy, F., Naughton, M.T., Non-invasive positive pressure ventilation for acute respiratory failure: Justified or just hot air (2007) Intern Med J, 37 (2), pp. 112-118Keenan, S.P., Sinuff, T., Burns, K.E., Muscedere, J., Kutsogiannis, J., Mehta, S., Cook, D.J., Dodek, P., Clinical practice guidelines for the use of noninvasive positive-pressure ventilation and noninvasive continuous positive airway pressure in the acute care setting (2011) CMAJ, 183 (3), pp. E195-214. , Canadian Critical Care Trials Group/Canadian Critical Care Society Noninvasive Ventilation Guidelines GroupNouira, S., Boukef, R., Bouida, W., Kerkeni, W., Beltaief, K., Boubaker, H., Noninvasive pressure support ventilation and CPAP in cardiogenic pulmonary edema: A multicenter randomized study in the emergency department (2011) Intensive Care Med., 37 (2), pp. 249-256Shirakabe, A., Hata, N., Yokoyama, S., Shinada, T., Kobayashi, N., Tomita, K., Predicting the success of noninvasive positive pressure ventilation in emergency room for patients with acute heart failure (2011) J Cardiol., 57 (1), pp. 107-114Gray, A.J., Goodacre, S., Newby, D.E., Masson, M.A., Sampson, F., Dixon, S., Crane, S., Nicholl, J., A multicentre randomised controlled trial of the use of continuous positive airway pressure and non-invasive positive pressure ventilation in the early treatment of patients presenting to the emergency department with severe acute cardiogenic pulmonary oedema: The 3CPO trial (2009) Health Technol Assess., 13 (33), pp. 1-106. , 3CPO Study InvestigatorsTomii, K., Seo, R., Tachikawa, R., Harada, Y., Murase, K., Kaji, R., Impact of noninvasisve ventilation (NIV) trial for various types of acute respiratory failure in the emergency departmentDecreased mortality and use of the ICU (2009) Respir Med., 103 (1), pp. 67-73Nápolis, L.M., Jeronimo, L.M., Baldini, D.V., MacHado, M.P., De Souza, V.A., Caruso, P., Availability and use of noninvasive ventilation in the intensive care units of public, private and teaching hospitals in the greater metropolitan area of São Paulo, Brazil (2006) J Bras Pneumol., 32 (1), pp. 29-34Non-invasive ventilation in acute respiratory failure (2002) Thorax., 57 (3), pp. 192-211Rocha, E., Carneiro, E.M., Benefícios e complicações da ventilação mecânica nãoinvasiva na exacerbação aguda da doença pulmonar obstrutiva crônica (2008) Rev Bras ter Intensiva., 20 (2), pp. 184-189Ram, S.F., Picot, J., Lightowler, J., Wedzicha, J.A., Non-invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease (2004) Cochrane Database Syst Rev., (3), pp. CD004104. , Update of Cochrane Database Syst Rev. 2004;(1):CD004104Plant, P.K., Owen, J.L., Elliott, M.W., Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: A multicentre randomised controlled trial (2000) Lancet., 355 (9219), pp. 1931-1935Lightowler, J.V., Wedzicha, J.A., Elliott, M.W., Ram, F.S., Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: Cochrane systematic review and metaanalysis (2003) BMJ, 326 (7382), p. 185Harris, C., Saskin, R., Burns, K.E., Noninvasive ventilation initiation in clinical practice: A six-year prospective, observational study (2010) Can Respir J., 17 (3), pp. 123-131Winck, J.C., Azevedo, L.F., Costa-Pereira, A., Antonelli, M., Wyatt, J.C., Efficacy and safety of non-invasive ventilation in the treatment of acute cardiogenic pulmonary edema-a systematic review and meta-analysis (2006) Crit Care., 10 (2), pp. R69Schettino, G., Altobelli, N., Kacmarek, R.M., Noninvasive positive-pressure ventilation in acute respiratory failure outside clinical trials: Experience at the Massachusetts General Hospital (2008) Crit Care Med., 36 (2), pp. 441-447Confalonieri, M., Garuti, G., Cattaruzza, M.S., Osborn, J.F., Antonelli, M., Conti, G., Kodric, M., Rossi, A., A chart of failure risk for noninvasive ventilation in patients with COPD exacerbation (2005) Eur Respir J., 25 (2), pp. 348-355. , Italian noninvasive positive pressure ventilation (NPPV) study groupSpada, C., Gandhi, R., Patel, S.R., Nuccio, P., Weinhouse, G.L., Lee, P.S., Oxygen saturation/fraction of inspired oxygen ratio is a simple predictor of noninvasive positive pressure ventilation failure in critically ill patients (2011) J Crit Care., 26 (5), pp. 510-51

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

Glasgow Outcome Scale At Hospital Discharge As A Prognostic Index In Patients With Severe Traumatic Brain Injury [escala De Resultados De Glasgow Por Ocasião Da Alta Hospitalar Como Indicador Prognóstico Em Pacientes Com Traumatismo Cranioencefálico Grave]

Objective: Evaluate the Glasgow outcome scale (GOS) at discharge (GOS-HD) as a prognostic indicator in patients with traumatic brain injury (TBI). Method: Retrospective data were collected of 45 patients, with Glasgow coma scale ≤8, age 25±10 years, 36 men, from medical records. Later, at home visit, two measures were scored: GOS-HD (according to information from family members) and GOS LATE (12 months after TBI). Results: At discharge, the ERG showed: vegetative state (VS) in 2 (4%), severe disability (SD) in 27 (60%), moderate disability (MD) in 15 (33%) and good recovery (GR) in 1 (2%). After 12 months: death in 5 (11%), VS in 1 (2%), SD in 7 (16%), MD in 9 (20%) and GR in 23 (51%). Variables associated with poor outcome were: worse GOS-HD (p=0.03), neurosurgical procedures (p=0.008) and the kind of brain injury (p=0.009). 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Hemodynamic, Ventilatory And Gasometric Evaluation Of An Experimental Bronchopleural Fistula1

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.301115Pierson, D.J., Horton, C.A., Bates, P.W., Persistent bronchopleural air leak during mechanical ventilation (1986) Chest, 90 (3), pp. 321-323Bishop, M.J., Benson, M.S., Sato, P., Pierson, D.J., Comparison of high-frequency jet ventilation with conventional mechanical ventilation for bronchopleural fistula (1987) Anesth Analg, 66, pp. 833-838. , PMID: 3304022Kempainen, R.R., Pierson, D.J., Persistent air leaks in patients receiving mechanical ventilation (2001) Semin Respir Crit Care Med, 22 (6), pp. 675-684. , PMID: 16088712Shekar, K., Foot, C., Fraser, J., Ziegenfuss, M., Hopkins P,Windsor M. Bronchopleural fistula: An update for intensivists (2010) J Crit Care, 25, pp. 47-55Baumann, M., Sahn, S., Medical management and therapy of bronchopleural fistulas in the mechanically ventilated patient (1990) Chest, 97, pp. 721-728. , PMID: 2407455Martins, W.R., Siefkin, A.P., Allen, R., Closure of a bronchopleural fistula with bronchoscopic instillation of tetracycline (1991) Chest, 99, pp. 1040-1042. , PMID: 2009764Zimmerman, J.E., Colgan, D.L., Mills, M., Management of bronchopleural fistula complicating therapy with positive end expiratory pressure (PEEP) (1973) Chest, 64 (4), pp. 526-529. , PMID: 4582828Downs, J.B., Chapman, R.L., Treatment of bronchopleural fistula during continuous positive pressure ventilation (1976) Chest, 69 (3), pp. 363-366. , PMID: 786563Powner, D.J., Grenvik, A., Ventilatory management of life-threatening bronchopleural fistulae: A summary (1981) Crit Care Med, 9 (1), pp. 54-58. , PMID: 7006912Phillips, Y.Y., Lonigan Rm Joyner, L.R., A simple technique for managing a bronchopleural fistula while maintaining positive pressure ventilation (1979) Crit Care Med, 7 (8), pp. 351-353. , PMID: 378544Pruit, R.F., Messick, W.J., Thomason, M.H., Respiratory alkalosis caused by assist control mechanical ventilation in a patient with a bronchopleural fistula (1996) J Trauma, 40 (3), pp. 481-482. , PMID: 8601875Sager, J.S., Eiger, G., Fuchs, B.D., Ventilator auto-triggering in a patient with tuberculous bronchopleural fistula (2003) Resp Care, 48 (5), pp. 519-521. , PMID: 12729469Gallagher, T.J., Smith, A.R., Kirby, R.R., Civetta, J.M., Intermittent inspiratory chest tube occlusion to limit bronchopleural cutaneous airleaks (1976) Crit Care Med, 4 (6), pp. 328-332. , PMID: 803091Litmamovitch, M., Joynt, G.M., Bates, P.W., Persistent bronchopleural fistula in a patient with adult respiratory distress syndrome. Treatment with pressure-controlled ventilation (1993) Chest, 104 (6), pp. 1901-1902. , PMID: 8252982Bevelaqua, F.A., Kay, S., A modified technique for the management of bronchopleural fistula in ventilator – dependent patients: A report of two cases (1986) Respir Care, 31 (10), pp. 904-908. , PMID: 2493107Sarkar, P., Chandak, T., Shah, R., Talwar, A., Diagnosis and management bronchopleural fistula (2010) Indian J Chest Dis Allied Sci, 52 (2), pp. 97-104. , Apr- Jun, PMID: 20578402Andreetti, C., D’andrilli, A., Ibrahim, M., Ciccone, A.M., Maurizi, G., Mattia, A., Venuta, F., Rendina, E.A., Effective treatment of post-pneumonectomy bronchopleural fistual by conical fully covered self-expandable stent (2012) Interact Cardiovasc Thorac Surg, 14 (4), pp. 420-423. , PMID: 22268070Wang, H., Li, D., Zhang, N., Zou, H., Luo, L., Ma, H., Zhou, Y., Liang, S., Sealing of airway fistulas for metallic covered z-type stents (2011) Zhongguo Fei Ai Za Zhi, 14 (8), pp. 679-684Leo, F., Solli, P., Veronesi, G., Galetta, D., Petrella, F., Gasparri, R., Borri, A., Spaggiari, L., Review on bronchopleural fistula. Did a surgeon review it (2006) Chest, 129, pp. 1731-1732. , PMID: 16778298Maung, A.A., Kaplan, L.J., Mechanical ventilation after injury (2012) J Intensive Care Med, 29 (3), pp. 128-137. , May-Ju