Extravascular Lung Water Correlates Multiorgan Dysfunction Syndrome and Mortality in Sepsis

BACKGROUND: This study was designated to investigate whether increased extravascular lung water index (EVLWI) may correlate multiple organ dysfunction syndrome (MODS) and mortality in sepsis. METHODS: We designed a prospective cohort study in an intensive care unit of a tertiary care hospital. Sixty-seven patients with severe sepsis were included. Data were used to determine an association between EVLWI and the development of MODS and mortality. These connections were determined by the multiple logistic regression, plotting the receiver operating characteristic (ROC) curve and by Spearman test. RESULTS: EVLWI levels were higher in MODS patients on day 1 (median (IQR), 18(12.8-23.9) ml/kg, n = 38, p<0.0001) than in those without (median (IQR), 12.4 (7.9-16.3) ml/kg, n = 29) and day 3 (median (IQR), 17.8 (11.2-22.8) ml/kg, n = 29, p = 0.004) than in those without (median (IQR), 12.4 (8.0-16.3) ml/kg, n = 29). EVLWI was used as an independent predictor of the development of MODS (odds ratio, 1.6; p = 0.005; 95% confidence interval, 1.2∼2.2) during ICU stay. The area under the ROC curve showed that EVLWI levels could predict MODS (0.866) and mortality (0.881) during ICU stay. Meanwhile, the higher of SOFA score, the more EVLWI was found on day 1 (r = 0.7041, p<0.0001) and day 3 (r = 0.7732, p<0.0001). CONCLUSIONS: Increased EVLWI levels correlates development of MODS and mortality during the patients' ICU stay. Further more, the potential of novel treatment in severe sepsis with lung injury may develop

Vídeo educativo como recurso para educação em saúde a pessoas com colostomia e familiares

RESUMO Objetivo Conhecer as percepções de participantes de um grupo de apoio para pessoas com colostomia sobre a utilização de um vídeo educativo como recurso para atividade de educação em saúde. Método Pesquisa qualitativa com 16 participantes em um grupo de apoio a pessoas colostomizadas de Santa Maria, Rio Grande do Sul, Brasil. Os dados foram coletados em abril e maio de 2016, por meio de grupo focal, submetidos à análise temática proposta por Minayo. Resultados Emergiram três categorias: O cuidar e o cuidar-se aprendido sozinho: a realidade vivida; Educação em saúde e aprendizagem por meio do vídeo educativo: possibilidades percebidas; As singularidades do vídeo educativo na ótica de pessoas colostomizadas e seus familiares. Conclusão A exiguidade de orientações posterga a independência e dificulta a autonomia para o cuidado e o autocuidado. A aplicabilidade da tecnologia audiovisual desenvolvida complementa as orientações educativas, possibilitando transformar e repensar as práticas pedagógicas na enfermagem

Chapter: Primary Care of the Adult Heart Transplant Recipient

Heart transplantation for end-stage heart failure is an option in select patients for progressive cardiac pump failure, uncontrolled angina, or refractory ventricular tachycardia. With evolving surgical techniques and advances in immunosuppression since the first heart transplant in 1967, post-heart transplant survival has improved to approximately 90% at 1 year, with a median survival of greater than 15 years (Lund et al., J Heart Lung Transplant 35(10):1158–1169, 2016; McKellar, N Engl J Med 377(23):2211–2213, 2017; Bengel et al., Circulation 106(7):831–835, 2002). The most common causes of early mortality following heart transplantation are graft failure and infection, whereas long-term morbidity stems from multi-organ failure, malignancy, and cardiac allograft vasculopathy (CAV). Heart transplantation volumes have grown in recent years with over 5000 transplantations performed worldwide in 2016 (Khush et al., J Heart Lung Transplant 37(10):1155–1168, 2018). Mechanical circulatory support (MCS) device systems have been developed as a method of bridging patients to heart transplantation while waiting for a suitable donor. In this chapter, we review the indications, immunosuppression, and both short- and long-term complications of heart transplantation that are important for primary care providers