Aspectos éticos na abordagem do paciente terminal em unidade de terapia intensiva pediátrica

OBJETIVO: Identificar a prevalência das condutas e o processo de decisão na abordagem do paciente terminal na UTI pediátrica. METODOLOGIA: Revisão sistemática da literatura. seguindo os critérios da medicina baseada em evidências. nas seguintes bases de dados: LILACS (1982-2000) e MEDLINE (1966-2000). usando os descritores abaixos limitados para a idade (0 a 18 anos). RESULTADOS: Foram selecionados 183 artigos e após análise dos critérios de exclusão / inclusão e os objetivos restaram 17 artigos. As condutas mais prevalentes foram: ordem de não ressuscitar. omissão e/ou suspensão de suporte de vida. As justificativas mais encontradas para tais condutas foram: "morte iminente" e "qualidade de vida insatisfatória". CONCLUSÃO: A abordagem tem base nos princípios éticos e visa maximizar o benefício e evitar a distanásia. se possível. respeitando a autonomia do paciente terminal.OBJECTIVE: To identify the prevalence of management plans and decision-making processes for terminal care patients in pediatric intensive care units. METHODOLOGY: Evidence-based medicine was done by a systematic review using an electronic data base (LILACS, 1982 through 2000) and (MEDLINE, 1966 through 2000). The key words used are listed and age limits (0 to 18 years) were used. RESULTS: One hundred and eighty two articles were found and after selection according to the exclusion/inclusion criteria and objectives 17 relevant papers were identified. The most common decisions found were do-not-resuscitation orders and withdrawal or withholding life support care. The justifications for these were "imminent death" and "unsatisfatory quality of life". CONCLUSION: Care management was based on ethical principles aiming at improving benefits, avoiding harm, and when possible, respecting the autonomy of the terminally ill patient

Influence of student participation in academic leagues in the choice of specialty for the Bahia 2017 Medical Residency Program

Introdução: A participação em Ligas Acadêmicas (LAs), hoje, é um importante componente do processo formativo do estudante de Medicina. No entanto, esta participação pode estar propiciando precocemente a escolha da especialidade futura, limitando a atuação e a busca por conhecimento amplo e generalizado. Objetivo: Avaliar a influência da participação em LAs sobre a escolha da especialidade por recém-ingressos no Programa de Residência Médica da Bahia 2017 (PRM/BA/2017). Métodos: Estudo epidemiológico observacional transversal, no qual residentes do PRM/BA/2017, durante matrícula, foram convidados a responder questionário contendo informações sobre a participação em LAs e a escolha da especialização médica. Resultados: Dos 339 entrevistados, 79,8% participaram de LAs. Destes, 45,4% consideraram que a participação em LAs influenciou a escolha da especialidade. A correlação geral entre participação em LAs e escolha de especialidade na mesma área (correlação L-E) atingiu 30,9% e foi encontrada aumentada de maneira significativa no grupo que considerou que a participação em LAs influenciou o processo decisório, que participou da LA durante mais de 3 semestres, que ocupou 3 ou 4 cargos em uma mesma liga, que participou de “Estágios” e que alegou “Afinidade/Curiosidade” como principal motivo para entrada na LA. Das grandes áreas da Medicina, o grupo que optou por Cirurgia Geral apresentou maior correlação L-E (53,1%) e o que optou pela Pediatria menor (12,5%) Conclusões: Apesar de estar presente no processo formativo da maioria dos estudantes, a participação em LAs não pareceu representar a especialização precoce destes. O fator mais associado à correlação L-E foi a percepção de que esta participação influenciou a escolha da especialidade.Introduction: Participating in Academic Leagues (LAs) nowadays is an important component of the medical student’s graduation process. However, this participation may be prematurely promoting specialty choice, limiting the performance and the search for ample and widespread knowledge. Objective: Evaluate the influence of participating in LAs with regards to the choice of specialty by new entrants in the Medical Residency Program of Bahia 2017 (PRM/BA/2017). Methodology: This is an observational cross-sectional epidemiological study in which residents from the PRM/BA/2017, during the enrollment, were invited to respond a questionnaire containing information about the participation in LAs and the choice of medical specialization. Results: 339 individuals were interviewed. 79.8% of interviewed participated in LAs. From those, 45.4% considered that participating in LAs influenced the choice of specialty. The general correlation between participation in LAs and the choice of a specialty at the same area (L-E correlation) reached 30.9%. A higher and significant L-E correlation was found in group that considered participation in LA as a influence in the decision making process, that participated in LA for more than 3 semesters, that occupied 3 or 4 positions at the same league, that participated on “Internship” and that claimed “Affinity/Curiosity” as the main reason for get into LA. Within all the medical specialties, the group that have chosen General Surgery had higher L-E correlation and the one that chose Pediatrics had lower. Conclusions: Despite being present in the training process of most students, participating in LAs did not seem to represent their premature specialization. The most associated factor with the L-E correlation was the perception that this participation influenced the choice of the specialization

Revista de Ciências Médicas e Biológicas

p. 139-145Abdominal trauma by accidents may induce life risk, because of the bleeding of solid organs or the development of sepsis due to perforation of empty viscera. Spleen and liver lesions in children are more frequent. The aim was to describe the epidemiological and clinical characteristics of children with abdominal trauma. A retrospective study was conducted in a general hospital in Salvador, Bahia, Brazil. This retrospective profile study with collected data describes the epidemiological and clinical characteristics of children with serious abdominal trauma, admitted in one Pediatric Intensive Care Unit (PICU) during 5 years and it compares the results with those of other patients with trauma without abdominal lesion. During this period 29 children were admitted with abdominal trauma; 125 children had trauma without abdominal lesion and represented the group in comparison. Abdominal trauma was more frequent in boys (p = 0.01) with an average age of 8.7 years. The main cause of abdominal trauma was car accident. The most affected organs were: spleen (51.7%) and liver (24.1%). Children with abdominal lesion presented more paleness (p = 0.002) and tachycardia (p = 0.007). At the PICU, hemodynamic, hematological and electrolytic dysfunctions were more common for children with abdominal trauma (p < 0.05). Children with abdominal trauma were treated with hemoderivatives, invasive hemodynamic monitoring and infusion of vasoactive drugs (p < 0.05). It was concluded that intensive therapy care must be necessary for a better evolution of the cases.Salvado

Comparative study on clinical and evolutionary aspects of children with abdominal trauma in intensive therapy unity

Trauma abdominal por acidentes pode provocar risco de vida, devido ao sangramento de órgãos sólidos ou ao desenvolvimento de sepse, devido à perfuração de vísceras ocas. Lesões de baço e fígado são mais frequentes em crianças. O objetivo foi descrever as características epidemiológicas e clínicas da criança com trauma abdominal. Foi realizado um estudo retrospectivo em um hospital geral em Salvador, Bahia, Brasil, descrevendo-se as características clínicas e epidemiológicas de crianças com trauma abdominal grave e comparando-se os resultados com os de outros pacientes com trauma, sem lesão abdominal, em uma Unidade de Terapia Intensiva Pediátrica (UTIP), durante cinco anos. Durante esse período, 29 crianças foram internadas com traumatismo abdominal, 125 crianças tiveram trauma sem lesão abdominal e representaram o grupo de controle. O trauma abdominal foi mais freqüente em meninos (p = 0,01) com média de idade de 8,7 anos. A principal causa de trauma abdominal foi o acidente de carro. Os órgãos mais afetados foram: baço (51,7%) e fígado (24,1%). Crianças com lesão abdominal apresentaram mais frequentemente palidez (p = 0,002) e taquicardia (p = 0,007). Na UTI, distúrbios hemodinâmicos, hematológicos e eletrolíticos foram mais comuns em crianças com trauma abdominal (pAbdominal trauma by accidents may induce life risk, because of the bleeding of solid organs or the development of sepsis due to perforation of empty viscera. Spleen and liver lesions in children are more frequent. The aim was to describe the epidemiological and clinical characteristics of children with abdominal trauma. A retrospective study was conducted in a general hospital in Salvador, Bahia, Brazil. This retrospective profile study with collected data describes the epidemiological and clinical characteristics of children with serious abdominal trauma, admitted in one Pediatric Intensive Care Unit (PICU) during 5 years and it compares the results with those of other patients with trauma without abdominal lesion. During this period 29 children were admitted with abdominal trauma; 125 children had trauma without abdominal lesion and represented the group in comparison. Abdominal trauma was more frequent in boys (p = 0.01) with an average age of 8.7 years. The main cause of abdominal trauma was car accident. The most  affected organs were: spleen (51.7%) and liver (24.1%). Children with abdominal lesion presented more paleness (p = 0.002) and tachycardia (p = 0.007). At the PICU, hemodynamic, hematological and electrolytic dysfunctions were more common for childre