RESUMEN
IMPORTANCE: Maneuvers assessing fluid responsiveness before an intravascular volume expansion may limit useless fluid administration, which in turn may improve outcomes. OBJECTIVE: To describe maneuvers for assessing fluid responsiveness in mechanically ventilated patients. REGISTRATION: The protocol was registered at PROSPERO: CRD42019146781. INFORMATION SOURCES AND SEARCH: PubMed, EMBASE, CINAHL, SCOPUS, and Web of Science were search from inception to 08/08/2023. STUDY SELECTION AND DATA COLLECTION: Prospective and intervention studies were selected. STATISTICAL ANALYSIS: Data for each maneuver were reported individually and data from the five most employed maneuvers were aggregated. A traditional and a Bayesian meta-analysis approach were performed. RESULTS: A total of 69 studies, encompassing 3185 fluid challenges and 2711 patients were analyzed. The prevalence of fluid responsiveness was 49.9%. Pulse pressure variation (PPV) was studied in 40 studies, mean threshold with 95% confidence intervals (95% CI) = 11.5 (10.5-12.4)%, and area under the receiver operating characteristics curve (AUC) with 95% CI was 0.87 (0.84-0.90). Stroke volume variation (SVV) was studied in 24 studies, mean threshold with 95% CI = 12.1 (10.9-13.3)%, and AUC with 95% CI was 0.87 (0.84-0.91). The plethysmographic variability index (PVI) was studied in 17 studies, mean threshold = 13.8 (12.3-15.3)%, and AUC was 0.88 (0.82-0.94). Central venous pressure (CVP) was studied in 12 studies, mean threshold with 95% CI = 9.0 (7.7-10.1) mmHg, and AUC with 95% CI was 0.77 (0.69-0.87). Inferior vena cava variation (∆IVC) was studied in 8 studies, mean threshold = 15.4 (13.3-17.6)%, and AUC with 95% CI was 0.83 (0.78-0.89). CONCLUSIONS: Fluid responsiveness can be reliably assessed in adult patients under mechanical ventilation. Among the five maneuvers compared in predicting fluid responsiveness, PPV, SVV, and PVI were superior to CVP and ∆IVC. However, there is no data supporting any of the above mentioned as being the best maneuver. Additionally, other well-established tests, such as the passive leg raising test, end-expiratory occlusion test, and tidal volume challenge, are also reliable.
Asunto(s)
Presión Venosa Central , Fluidoterapia , Pletismografía , Respiración Artificial , Volumen Sistólico , Vena Cava Inferior , Humanos , Respiración Artificial/métodos , Respiración Artificial/estadística & datos numéricos , Presión Venosa Central/fisiología , Fluidoterapia/métodos , Fluidoterapia/normas , Fluidoterapia/estadística & datos numéricos , Vena Cava Inferior/fisiología , Volumen Sistólico/fisiología , Pletismografía/métodos , Presión Sanguínea/fisiologíaRESUMEN
En la actualidad, las guías basadas en la evidencia constituyen una de las herramientas más útiles para mejorar la salud pública y la práctica clínica. Su finalidad es formular intervenciones con sólidas pruebas de eficacia, evitar riesgos innecesarios, utilizar los recursos de forma eficiente, disminuir la variabilidad clínica y, en esencia, mejorar la salud y garantizar una atención de calidad, razón de ser de los sistemas y servicios de salud. Las presentes directrices se elaboraron siguiendo la metodología GRADE con el apoyo de un panel de expertos clínicos de distintos países, todos ellos convocados por la Organización Panamericana de la Salud. Por medio de la respuesta a doce preguntas clave sobre el diagnóstico clínico y el tratamiento del dengue, el chikunguña y el zika, se formulan recomendaciones basadas en evidencia para pacientes pediátricos, jóvenes, adultos, personas mayores y embarazadas expuestos a estas enfermedades o con sospecha o diagnóstico confirmado de infección. La finalidad de las directrices es evitar la progresión a las formas graves y a los eventos mortales que puedan causar. Las recomendaciones están dirigidas a profesionales de la salud, incluidos el personal médico general, residente y especialista; y los profesionales de enfermería, así como a estudiantes de medicina y enfermería, quienes de una u otra forma participan en la atención de pacientes con sospecha de dengue, chikunguña o zika. También se dirige a los administradores de las unidades de salud y a los equipos directivos de los programas nacionales de prevención y control de enfermedades arbovirales, quienes tienen la responsabilidad de facilitar el proceso de aplicación de estas directrices. Esperamos que esta publicación beneficie no solo al personal de salud, que dispondrá de información científica actualizada y de la mejor calidad posible, sino a los menores, los adultos, las embarazadas, las personas mayores y la población en general, quienes recibirán una mejor atención de salud prestada por personal médico debidamente capacitado.
Evidence-based guidelines are one of the most useful tools for improving public health and clinical practice. Their purpose is to formulate interventions based on strong evidence of efficacy, avoid unnecessary risks, use resources efficiently, reduce clinical variability and, in essence, improve health and ensure quality care, which is the purpose of health systems and services. These guidelines were developed following the GRADE methodology, with the support of a panel of clinical experts from different countries, all convened by the Pan American Health Organization. By responding to twelve key questions about the clinical diagnosis and treatment of dengue, chikungunya, and Zika, evidence-based recommendations were formulated for pediatric, youth, adult, older adult, and pregnant patients who are exposed to these diseases or have a suspected or confirmed diagnosis of infection. The purpose of the guidelines is to prevent progression to severe forms of these diseases and the fatal events they may cause. The recommendations are intended for health professionals, including general, resident, and specialist physicians, nursing professionals, and medical and nursing students, who participate in caring for patients with suspected dengue, chikungunya, or Zika. They are also intended for health unit managers and the executive teams of national arboviral disease prevention and control programs, who are responsible for facilitating the process of implementing these guidelines.
Asunto(s)
Humanos , Masculino , Femenino , Embarazo , Niño , Adolescente , Adulto , Persona de Mediana Edad , Infecciones por Arbovirus/diagnóstico , Fluidoterapia/normas , Infecciones por Arbovirus/tratamiento farmacológico , Esteroides/uso terapéutico , Antagonistas de los Receptores Histamínicos/uso terapéuticoRESUMEN
BACKGROUND: Fluid boluses are administered to septic shock patients with the purpose of increasing cardiac output as a means to restore tissue perfusion. Unfortunately, fluid therapy has a narrow therapeutic index, and therefore, several approaches to increase safety have been proposed. Fluid responsiveness (FR) assessment might predict which patients will effectively increase cardiac output after a fluid bolus (FR+), thus preventing potentially harmful fluid administration in non-fluid responsive (FR-) patients. However, there are scarce data on the impact of assessing FR on major outcomes. The recent ANDROMEDA-SHOCK trial included systematic per-protocol assessment of FR. We performed a post hoc analysis of the study dataset with the aim of exploring the relationship between FR status at baseline, attainment of specific targets, and clinically relevant outcomes. METHODS: ANDROMEDA-SHOCK compared the effect of peripheral perfusion- vs. lactate-targeted resuscitation on 28-day mortality. FR was assessed before each fluid bolus and periodically thereafter. FR+ and FR- subgroups, independent of the original randomization, were compared for fluid administration, achievement of resuscitation targets, vasoactive agents use, and major outcomes such as organ dysfunction and support, length of stay, and 28-day mortality. RESULTS: FR could be determined in 348 patients at baseline. Two hundred and forty-two patients (70%) were categorized as fluid responders. Both groups achieved comparable successful resuscitation targets, although non-fluid responders received less resuscitation fluids (0 [0-500] vs. 1500 [1000-2500] mL; p 0.0001), exhibited less positive fluid balances, but received more vasopressor testing. No difference in clinically relevant outcomes between FR+ and FR- patients was found, including 24-h SOFA score (9 [5-12] vs. 8 [5-11], p = 0.4), need for MV (78% vs. 72%, p = 0.16), need for RRT (18% vs. 21%, p = 0.7), ICU-LOS (6 [3-11] vs. 6 [3-16] days, p = 0.2), and 28-day mortality (40% vs. 36%, p = 0.5). Only thirteen patients remained fluid responsive along the intervention period. CONCLUSIONS: Systematic assessment allowed determination of fluid responsiveness status in more than 80% of patients with early septic shock. Fluid boluses could be stopped in non-fluid responsive patients without any negative impact on clinical relevant outcomes. Our results suggest that fluid resuscitation might be safely guided by FR assessment in septic shock patients. TRIAL REGISTRATION: ClinicalTrials.gov identifier, NCT03078712. Registered retrospectively on March 13, 2017.
Asunto(s)
Gasto Cardíaco/fisiología , Fluidoterapia/métodos , Choque Séptico/terapia , Factores de Tiempo , Anciano , Femenino , Fluidoterapia/instrumentación , Fluidoterapia/normas , Humanos , Masculino , Persona de Mediana Edad , Resucitación/instrumentación , Resucitación/métodos , Estudios Retrospectivos , Choque Séptico/fisiopatología , Vasoconstrictores/uso terapéuticoRESUMEN
OBJECTIVE: To construct a Standard Operating Procedure (SOP) about the water balance, to be used by the health team in the care of children hospitalized in a pediatric nephrology unit. METHOD: The study was carried out in two stages: integrative review of the literature for the development of SOP and validation by specialists. The search for literature occurred in the electronic databases PUBMED, SCOPUS, LILACS, BDENF. After the bibliographic survey the construction of the SOP was performed, which was evaluated by specialists. The analysis was performed by calculating the Content Validity Index (CVI). RESULTS: nine studies were selected as results of the integrative review. The sample of specialists was composed of nine professionals. The study was evaluated in six items, five of which presented CVI = 1 and one obtained CVI = 0.77. CONCLUSION: the evaluation of specialists culminated in the validation of SOP, suggesting changes that were accepted and discussed with the literature.
Asunto(s)
Fluidoterapia/enfermería , Nefrología/métodos , Pediatría/métodos , Nivel de Atención , Fluidoterapia/normas , Hemodinámica/fisiología , Humanos , Encuestas y CuestionariosRESUMEN
ABSTRACT Objective: To construct a Standard Operating Procedure (SOP) about the water balance, to be used by the health team in the care of children hospitalized in a pediatric nephrology unit. Method: The study was carried out in two stages: integrative review of the literature for the development of SOP and validation by specialists. The search for literature occurred in the electronic databases PUBMED, SCOPUS, LILACS, BDENF. After the bibliographic survey the construction of the SOP was performed, which was evaluated by specialists. The analysis was performed by calculating the Content Validity Index (CVI). Results: nine studies were selected as results of the integrative review. The sample of specialists was composed of nine professionals. The study was evaluated in six items, five of which presented CVI = 1 and one obtained CVI = 0.77. Conclusion: the evaluation of specialists culminated in the validation of SOP, suggesting changes that were accepted and discussed with the literature.
RESUMEN Objetivo: construir un Procedimiento Operativo Estándar (POE) sobre el balance hídrico, para ser utilizado por el equipo de salud en el cuidado al niño internado en una unidad de nefrología pediátrica. Método: el estudio fue realizado en dos etapas: revisión integradora de la literatura para la elaboración del POE y validación por especialistas. La búsqueda de la literatura ocurrió en las bases de datos electrónicos: PUBMED, SCOPUS, LILACS, BDENF. Después del levantamiento bibliográfico se dio la construcción del POE que fue evaluado por especialistas. El análisis fue realizado por medio del cálculo del Índice de Validez de Contenido (CVI). Resultados: como resultados de la revisión integradora fueron seleccionados nueve estudios. La muestra de los especialistas fue compuesta por nueve profesionales. El estudio fue evaluado en seis ítems, de los cuales cinco presentaron CVI=1 y uno obtuvo CVI=0,77. Conclusión: la evaluación de los especialistas culminó en la validación del POE, siendo sugeridas alteraciones que fueron acatadas y discutidas con la literatura.
RESUMO Objetivo: construir um Procedimento Operacional Padrão (POP) acerca do balanço hídrico, para ser utilizado pela equipe de saúde no cuidado à criança internada em uma unidade de nefrologia pediátrica. Método: o estudo foi realizado em duas etapas: revisão integrativa da literatura para elaboração do POP e validação por especialistas. A busca da literatura ocorreu nas bases de dados eletrônicas: PUBMED, SCOPUS, LILACS, BDENF. Após o levantamento bibliográfico deu-se a construção do POP que foi avaliado por especialistas. A análise foi realizada por meio do cálculo do Índice de Validade de Conteúdo (CVI). Resultados: como resultados da revisão integrativa foram selecionados nove estudos. A amostra dos especialistas foi composta por nove profissionais. O estudo foi avaliado em seis itens, os quais cinco apresentaram CVI=1 e um obteve CVI=0,77. Conclusão: a avaliação dos especialistas culminou na validação do POP, sendo sugeridas alterações que foram acatadas e discutidas com a literatura.
Asunto(s)
Humanos , Pediatría/métodos , Nivel de Atención , Fluidoterapia/enfermería , Nefrología/métodos , Encuestas y Cuestionarios , Fluidoterapia/normas , Hemodinámica/fisiologíaRESUMEN
OBJECTIVE:: To describe the evidence in the literature regarding the knowledge and practices of the nursing team about subcutaneous administration of drugs and fluids in adults. METHOD:: Integrative review of the literature using the descriptors "nursing", "hypodermoclysis", "drug administration routes", "adult health," and "knowledge," in English, Spanish, and Portuguese, with no publication deadline. Of the 569 articles found, eight made up the sample. RESULTS:: A predominance of international journals (75%) with more than five years of publication (62.5%). The analysis of the methodological characteristics showed a predominance of literature reviews (25%), quantitative studies (62.5%), cross-sectional studies (50%), and non-experimental studies (50%). CONCLUSION:: Although it is an old technique with proven efficacy, hypodermoclysis is still little used, a puzzling fact due to its advantages and indications for any age. OBJETIVO:: descrever as evidências, na literatura, sobre os conhecimentos e as práticas da equipe de enfermagem na administração de medicamentos e de fluidos por via subcutânea no adulto. MÉTODO:: revisão integrativa da literatura utilizando os descritores enfermagem, hipodermóclise, vias de administração de medicamentos, saúde do adulto e conhecimento; nos idiomas inglês, espanhol e português, sem data limite de publicação. Dos 569 artigos encontrados, oito compuseram a amostra. RESULTADOS:: predomínio de revistas internacionais (75%) e com mais de cinco anos de publicação (62,5%). Ao analisarem-se as características metodológicas, predominaram: revisões de literatura (25%), estudos quantitativos (62,5%), estudos transversais (50%) e não-experimentais (50%). CONCLUSÃO:: apesar de se tratar de uma técnica antiga com eficácia comprovada, a hipodermóclise ainda é pouco utilizada, fato incoerente pelas suas vantagens e suas indicações para qualquer idade.
Asunto(s)
Fluidoterapia/normas , Conocimientos, Actitudes y Práctica en Salud , Infusiones Subcutáneas/normas , Enfermeras y Enfermeros/normas , HumanosRESUMEN
ABSTRACT Objective: To describe the evidence in the literature regarding the knowledge and practices of the nursing team about subcutaneous administration of drugs and fluids in adults. Method: Integrative review of the literature using the descriptors "nursing", "hypodermoclysis", "drug administration routes", "adult health," and "knowledge," in English, Spanish, and Portuguese, with no publication deadline. Of the 569 articles found, eight made up the sample. Results: A predominance of international journals (75%) with more than five years of publication (62.5%). The analysis of the methodological characteristics showed a predominance of literature reviews (25%), quantitative studies (62.5%), cross-sectional studies (50%), and non-experimental studies (50%). Conclusion: Although it is an old technique with proven efficacy, hypodermoclysis is still little used, a puzzling fact due to its advantages and indications for any age.
RESUMEN Objetivo: Describir las evidencias, en la literatura, acerca de los conocimientos y prácticas del equipo de enfermería sobre administración de medicamentos y fluidos por vía subcutánea en adultos. Método: Revisión integrativa de la literatura, utilizando los descriptores: enfermería, hipodermoclisis, vías de administración de medicamentos, salud del adulto y conocimiento; en idiomas inglés, español y portugués, sin fecha límite de publicación. Fueron encontrados 569 artículos, de los cuales 8 integraron la muestra. Resultados: Predominio de revistas internacionales (75%), y con más de cinco años de publicación (62,5%). Al analizarse las características metodológicas, predominaron: revisiones de literatura (25%), estudios cuantitativos (62,5%), estudios transversales (50%) y no experimentales (50%). Conclusión: A pesar de tratarse de una técnica antigua de comprobada eficacia, la hipodermoclisis es aún poco utilizada, hecho inexplicable, dadas sus ventajas e indicaciones para cualquier edad.
RESUMO Objetivo: descrever as evidências, na literatura, sobre os conhecimentos e as práticas da equipe de enfermagem na administração de medicamentos e de fluidos por via subcutânea no adulto. Método: revisão integrativa da literatura utilizando os descritores enfermagem, hipodermóclise, vias de administração de medicamentos, saúde do adulto e conhecimento; nos idiomas inglês, espanhol e português, sem data limite de publicação. Dos 569 artigos encontrados, oito compuseram a amostra. Resultados: predomínio de revistas internacionais (75%) e com mais de cinco anos de publicação (62,5%). Ao analisarem-se as características metodológicas, predominaram: revisões de literatura (25%), estudos quantitativos (62,5%), estudos transversais (50%) e não-experimentais (50%). Conclusão: apesar de se tratar de uma técnica antiga com eficácia comprovada, a hipodermóclise ainda é pouco utilizada, fato incoerente pelas suas vantagens e suas indicações para qualquer idade.
Asunto(s)
Humanos , Conocimientos, Actitudes y Práctica en Salud , Infusiones Subcutáneas/normas , Fluidoterapia/normas , Enfermeras y Enfermeros/normasRESUMEN
The hydration pattern associated with the physiological quality of seeds can be an early indicator for the evaluation of seed quality. The present study aimed to evaluate the hydration pattern of seeds subjected, or not, to water restriction, and to relate these patterns to their physiological quality. The physiological quality of seeds from five maize lines (L1, L2, L3, L4, and L5) and four hybrids (HT1, HT2, HS1, and HS2) was initially determined using seed germination and vigor tests (accelerated ageing and electric conductivity). A completely randomized experimental design was used with four repeats for the physiological analyses and a regression analysis was performed in order to assess the behavior of the seeds over time. The hydration curve was determined by imbibing the seeds in distilled water 0,0 MPa (control) and in a 0.9 MPa osmotic solution of polyethylene glycol 6000. Water uptake by the seeds was found to follow a triphasic pattern in the absence of water stress (0.0 MPa), however, when exposed to a 0.9 MPa osmotic potential, an extended phase II was observed. Diversity was observed between the lines in terms of the hydration pattern of the seeds, which can influence the physiological quality of the hybrid seeds. Regarding the hybrids, a positive relationship was observed between the shortest time to root protrusion and the quality of the seeds, both with or without water restriction, which allows us to conclude that hydration pattern can be used as a parameter for the early evaluation of physiological quality in hybrid maize seeds.
O padrão de hidratação associado à qualidade fisiológica das sementes pode ser um indicativo para avaliação da qualidade de forma precoce. Objetivou-se neste trabalho avaliar o padrão de hidratação das sementes, submetidas ou não à restrição hídrica e relacioná-lo com a qualidade fisiológica das sementes. Inicialmente, determinou-se a qualidade fisiológica das sementes de cinco linhagens (L1, L2, L3, L4 e L5) e quatro híbridos de milho (HT1, HT2, HS1 e HS2) através do teste de germinação e testes de vigor (envelhecimento acelerado e condutividade elétrica). Utilizou-se o delineamento experimental inteiramente casualizado, com quatro repetições para as análises fisiológicas e análise de regressão a fim de analisar o comportamento das sementes ao longo tempo. A curva de hidratação foi realizada com embebição das sementes em água destilada 0,0 MPa (controle) e em solução de PEG 6000 à 0,9 MPa. Verificou-se que a absorção de água nas sementes apresentou o padrão trifásico na condição sem estresse hídrico (0,0 Mpa), no entanto, quando expostas à condição de potencial 0,9 MPa, apresentou alongamento da fase II. Houve diversidade entre as linhagens com relação ao padrão de hidratação das sementes, sendo que estas podem influenciar na qualidade fisiológica das sementes dos híbridos. Nos híbridos, tanto com ou sem restrição hídrica, constatou-se uma relação positiva entre o menor tempo para ocorrência da protrusão radicular e a qualidade das sementes, o que permite concluir que o padrão de hidratação pode ser um parâmetro para avaliação precoce da qualidade fisiológica de sementes de milho híbrido.
Asunto(s)
Fluidoterapia , Fluidoterapia/normas , Semillas/crecimiento & desarrollo , Semillas/fisiología , Zea mays/fisiologíaRESUMEN
The hydration pattern associated with the physiological quality of seeds can be an early indicator for the evaluation of seed quality. The present study aimed to evaluate the hydration pattern of seeds subjected, or not, to water restriction, and to relate these patterns to their physiological quality. The physiological quality of seeds from five maize lines (L1, L2, L3, L4, and L5) and four hybrids (HT1, HT2, HS1, and HS2) was initially determined using seed germination and vigor tests (accelerated ageing and electric conductivity). A completely randomized experimental design was used with four repeats for the physiological analyses and a regression analysis was performed in order to assess the behavior of the seeds over time. The hydration curve was determined by imbibing the seeds in distilled water 0,0 MPa (control) and in a 0.9 MPa osmotic solution of polyethylene glycol 6000. Water uptake by the seeds was found to follow a triphasic pattern in the absence of water stress (0.0 MPa), however, when exposed to a 0.9 MPa osmotic potential, an extended phase II was observed. Diversity was observed between the lines in terms of the hydration pattern of the seeds, which can influence the physiological quality of the hybrid seeds. Regarding the hybrids, a positive relationship was observed between the shortest time to root protrusion and the quality of the seeds, both with or without water restriction, which allows us to conclude that hydration pattern can be used as a parameter for the early evaluation of physiological quality in hybrid maize seeds.(AU)
O padrão de hidratação associado à qualidade fisiológica das sementes pode ser um indicativo para avaliação da qualidade de forma precoce. Objetivou-se neste trabalho avaliar o padrão de hidratação das sementes, submetidas ou não à restrição hídrica e relacioná-lo com a qualidade fisiológica das sementes. Inicialmente, determinou-se a qualidade fisiológica das sementes de cinco linhagens (L1, L2, L3, L4 e L5) e quatro híbridos de milho (HT1, HT2, HS1 e HS2) através do teste de germinação e testes de vigor (envelhecimento acelerado e condutividade elétrica). Utilizou-se o delineamento experimental inteiramente casualizado, com quatro repetições para as análises fisiológicas e análise de regressão a fim de analisar o comportamento das sementes ao longo tempo. A curva de hidratação foi realizada com embebição das sementes em água destilada 0,0 MPa (controle) e em solução de PEG 6000 à 0,9 MPa. Verificou-se que a absorção de água nas sementes apresentou o padrão trifásico na condição sem estresse hídrico (0,0 Mpa), no entanto, quando expostas à condição de potencial 0,9 MPa, apresentou alongamento da fase II. Houve diversidade entre as linhagens com relação ao padrão de hidratação das sementes, sendo que estas podem influenciar na qualidade fisiológica das sementes dos híbridos. Nos híbridos, tanto com ou sem restrição hídrica, constatou-se uma relação positiva entre o menor tempo para ocorrência da protrusão radicular e a qualidade das sementes, o que permite concluir que o padrão de hidratação pode ser um parâmetro para avaliação precoce da qualidade fisiológica de sementes de milho híbrido.(AU)
Asunto(s)
Semillas/crecimiento & desarrollo , Semillas/fisiología , Fluidoterapia/normas , Fluidoterapia , Zea mays/fisiologíaRESUMEN
OBJECTIVE: Diarrhea remains a leading cause of morbidity and mortality for children in low- and middle-income countries throughout the Americas. The World Health Organization (WHO) has developed guidelines on incorporating zinc supplementation (ZS) with traditional oral rehydration therapy (ORT) in order to shorten the duration of diarrheal episodes and to reduce poor health outcomes. Guatemala adopted these guidelines in 2011, but they have not yet been fully implemented at the community level. The objectives of this study were: (1) to co-design an ORT/ZS training program for community members with local health promoters that is appropriate to the local context and (2) to understand how attitudes and behaviors of community members changed after receiving training from the study promoters. METHODS: In an observational study, community health promoters in rural Guatemala were trained according to WHO guidelines, and they worked collaboratively with the study team to develop a training curriculum to implement in their community. Community-based surveys, interviews, and focus group discussions were used to assess acceptability, accessibility, and availability of oral rehydration therapy and zinc supplementation. RESULTS: Use of ORT increased from 63% to 95% among community members following training by local health promoters. Satisfaction with the service offered by health promoters increased from 63% to 90% amongst community members trained by the study promoters. However, knowledge and use of zinc supplementation remained low, which was attributable to unavailability of zinc in the study community. CONCLUSIONS: Use of trained community health promoters is an effective way to translate WHO guidelines to local contexts and overcome sociocultural barriers to care. However, the health system's structure must support availability of essential medicines in order to effectively implement those guidelines.
Asunto(s)
Diarrea/terapia , Suplementos Dietéticos , Fluidoterapia , Zinc/uso terapéutico , Niño , Fluidoterapia/normas , Guatemala , Humanos , Guías de Práctica Clínica como AsuntoRESUMEN
Resumo Objetivos: Descrever as recomendações atuais sobre a melhor maneira de conduzir o paciente pediátrico com doença diarreica aguda. Fonte dos dados: PubMed, Scopus, Scholar Google. Síntese dos dados: Houve pouco avanço no uso dos sais de reidratação oral (SRO) nas últimas décadas apesar de ser amplamente divulgado por meio de diretrizes internacionais. Vários estudos vêm sendo feitos na tentativa de melhorar a eficácia do SRO. Hidratação venosa com solução salina isotônica, infundida de forma rápida, deve ser indicada em casos de desidratação grave. A nutrição deve ser assegurada logo após a resolução da desidratação e é primordial para a saúde intestinal e imunológica. Restrições alimentares usualmente não são benéficas e podem ser prejudiciais. As medicações sintomáticas têm indicação restrita e antibióticos são indicados em casos específicos, cólera e shiguelose moderada a grave. Conclusões: A hidratação e a nutrição continuam a ser as intervenções com melhor impacto sobre o curso da diarreia aguda.
Abstract Objectives: To describe the current recommendations on the best management of pediatric patients with acute diarrheal disease. Data source: PubMed, Scopus, Google Scholar. Data summary: There has been little progress in the use of oral rehydration salts (ORS) in recent decades, despite being widely reported by international guidelines. Several studies have been performed to improve the effectiveness of ORS. Intravenous hydration with isotonic saline solution, quickly infused, should be given in cases of severe dehydration. Nutrition should be ensured after the dehydration resolution, and is essential for intestinal and immune health. Dietary restrictions are usually not beneficial and may be harmful. Symptomatic medications have limited indication and antibiotics are indicated in specific cases, such as cholera and moderate to severe shigellosis. Conclusions: Hydration and nutrition are the interventions with the greatest impact on the course of acute diarrhea.
Asunto(s)
Niño , Humanos , Diarrea/terapia , Práctica Clínica Basada en la Evidencia/normas , Fluidoterapia/normas , Soluciones para Rehidratación/administración & dosificación , Enfermedad Aguda , Pautas de la Práctica en Medicina , Sales (Química)/administración & dosificaciónRESUMEN
OBJECTIVES: To describe the current recommendations on the best management of pediatric patients with acute diarrheal disease. DATA SOURCE: PubMed, Scopus, Google Scholar. DATA SUMMARY: There has been little progress in the use of oral rehydration salts (ORS) in recent decades, despite being widely reported by international guidelines. Several studies have been performed to improve the effectiveness of ORS. Intravenous hydration with isotonic saline solution, quickly infused, should be given in cases of severe dehydration. Nutrition should be ensured after the dehydration resolution, and is essential for intestinal and immune health. Dietary restrictions are usually not beneficial and may be harmful. Symptomatic medications have limited indication and antibiotics are indicated in specific cases, such as cholera and moderate to severe shigellosis. CONCLUSIONS: Hydration and nutrition are the interventions with the greatest impact on the course of acute diarrhea.
Asunto(s)
Diarrea/terapia , Práctica Clínica Basada en la Evidencia/normas , Fluidoterapia/normas , Soluciones para Rehidratación/administración & dosificación , Enfermedad Aguda , Niño , Humanos , Pautas de la Práctica en Medicina , Sales (Química)/administración & dosificaciónRESUMEN
Early resuscitation of septic shock patients reduces the sepsis-related morbidity and mortality. The main goals of septic shock resuscitation include volemic expansion, maintenance of adequate tissue perfusion and oxygen delivery, guided by central venous pressure, mean arterial pressure, mixed or central venous oxygen saturation and arterial lactate levels. An aggressive fluid resuscitation, possibly in association with vasopressors, inotropes and red blood cell concentrate transfusion may be necessary to achieve those hemodynamic goals. Nonetheless, even though fluid administration is one of the most common interventions offered to critically ill patients, the most appropriate type of fluid to be used remains controversial. According to recently published clinical trials, crystalloid solutions seem to be the most appropriate type of fluids for initial resuscitation of septic shock patients. Balanced crystalloids have theoretical advantages over the classic solutions, but there is not enough evidence to indicate it as first-line treatment. Additionally, when large amounts of fluids are necessary to restore the hemodynamic stability, albumin solutions may be a safe and effective alternative. Hydroxyethyl starches solutions must be avoided in septic patients due to the increased risk of acute renal failure, increased need for renal replacement therapy and increased mortality. Our objective was to present a narrative review of the literature regarding the major types of fluids and their main drawbacks in the initial resuscitation of the septic shock patients.
A ressuscitação precoce de pacientes com choque séptico tem o potencial de reduzir sua morbidade e mortalidade. Os objetivos principais da ressuscitação no choque séptico incluem expansão volêmica, manutenção da perfusão tecidual e da oferta de oxigênio para os tecidos, guiados pela pressão venosa central, pressão arterial média, saturação venosa mista ou central de oxigênio e lactato arterial. Uma ressuscitação agressiva com fluidos, possivelmente em associação com vasopressores, inotrópicos e transfusão de concentrado de hemácias, pode ser necessária para atingir estes objetivos hemodinâmicos. Todavia, embora a administração de fluidos seja uma das intervenções mais comumente realizada em pacientes graves, o tipo de fluido mais apropriado para ser utilizado permanece controverso e incerto. De acordo com os estudos clínicos mais recentes, os cristaloides são os fluidos de escolha para serem utilizados na ressuscitação inicial de pacientes com choque séptico. As soluções cristaloides balanceadas possuem vantagens teóricas em relação as não balanceadas, porém ainda não há evidências suficientes para indicá-las como tratamento de primeira escolha. Além disso, albumina humana parece ser uma alternativa segura e efetiva quando grandes quantidades de fluidos são necessárias para o restabelecimento da estabilidade hemodinâmica. O uso de soluções de hidroxetilamido deve ser evitado em pacientes sépticos, devido ao maior risco de desenvolvimento de insuficiência renal aguda, necessidade de terapia de substituição renal e aumento de mortalidade. O objetivo deste estudo foi apresentar uma revisão narrativa da literatura sobre os principais tipos de fluidos e os problemas mais importantes na ressuscitação inicial de pacientes com choque séptico.
Asunto(s)
Humanos , Fluidoterapia/normas , Choque Séptico/terapia , Cuidados Críticos , Medicina Basada en la Evidencia , Fluidoterapia/efectos adversos , Fluidoterapia/métodos , Soluciones Isotónicas/uso terapéutico , Resucitación/métodosRESUMEN
Early resuscitation of septic shock patients reduces the sepsis-related morbidity and mortality. The main goals of septic shock resuscitation include volemic expansion, maintenance of adequate tissue perfusion and oxygen delivery, guided by central venous pressure, mean arterial pressure, mixed or central venous oxygen saturation and arterial lactate levels. An aggressive fluid resuscitation, possibly in association with vasopressors, inotropes and red blood cell concentrate transfusion may be necessary to achieve those hemodynamic goals. Nonetheless, even though fluid administration is one of the most common interventions offered to critically ill patients, the most appropriate type of fluid to be used remains controversial. According to recently published clinical trials, crystalloid solutions seem to be the most appropriate type of fluids for initial resuscitation of septic shock patients. Balanced crystalloids have theoretical advantages over the classic solutions, but there is not enough evidence to indicate it as first-line treatment. Additionally, when large amounts of fluids are necessary to restore the hemodynamic stability, albumin solutions may be a safe and effective alternative. Hydroxyethyl starches solutions must be avoided in septic patients due to the increased risk of acute renal failure, increased need for renal replacement therapy and increased mortality. Our objective was to present a narrative review of the literature regarding the major types of fluids and their main drawbacks in the initial resuscitation of the septic shock patients.
Asunto(s)
Fluidoterapia/normas , Choque Séptico/terapia , Cuidados Críticos , Soluciones Cristaloides , Medicina Basada en la Evidencia , Fluidoterapia/efectos adversos , Fluidoterapia/métodos , Humanos , Soluciones Isotónicas/uso terapéutico , Resucitación/métodosRESUMEN
INTRODUCTION: The organ shortage for transplantation, the principal factor that increases waiting lists, has become a serious public health problem. In this scenario, the intensivist occupies a prominent position as one of the professionals that first has a chance to identify brain death and to be responsible for the maintenance of the potential deceased donor. OBJECTIVE: This report attempts to establish guidelines for care and maintenance of adult deceased donor organs guiding and standardizing care provided to patients with brain death. METHOD: These guidelines were composed by intensivists, transplant coordinators, professionals from various transplant teams, and used transplant center. The formulated questions were forwarded to all members and recommendations were constructed after an extensive literature review selecting articles with the highest degree of evidence. RESULTS: Guidelines were developed in the form of questions reflecting frequent experiences in clinical intensive care practices. The main questions were: Is there an optimal interval for keeping organs of deceased donors viable? What actions are considered essential for maintaining deceased donors in this period? What are the limits of body temperature? How should the patient be warmed? Which laboratory tests should be performed? What is the collection interval? What are the limits in the laboratory and the capture scenario? What are the limits of blood pressure? When and how should one use catecholamines? CONCLUSIONS: This pioneer project involved a multidisciplinary team working in organ transplantation seeking to provide treatment guidance to increase the number of viable organs from deceased adult donors.
Asunto(s)
Muerte Encefálica , Cuidados Críticos/normas , Trasplante de Órganos/normas , Donantes de Tejidos/provisión & distribución , Recolección de Tejidos y Órganos/normas , Obtención de Tejidos y Órganos/normas , Adulto , Biomarcadores/sangre , Presión Sanguínea , Determinación de la Presión Sanguínea/normas , Volumen Sanguíneo , Temperatura Corporal , Muerte Encefálica/sangre , Muerte Encefálica/diagnóstico , Muerte Encefálica/fisiopatología , Brasil , Dióxido de Carbono/sangre , Cardiotónicos/uso terapéutico , Ecocardiografía/normas , Transfusión de Eritrocitos/normas , Medicina Basada en la Evidencia , Fluidoterapia/normas , Humanos , Presión Intracraneal , Ácido Láctico/sangre , Oxígeno/sangre , Recalentamiento/normas , Factores de Tiempo , Supervivencia Tisular , Vasoconstrictores/uso terapéuticoRESUMEN
A diarreia infantil é importante causa de morbimortalidade, sendo indicativo para terapia de reidratação oral (TRO). Este estudo objetivou avaliar o teor de sódio e glicose em soro de reidratação oral preparado por Agentes Comunitários de Saúde (ACS) que atuam em Unidades Básicas de Saúde (UBS), caracterizando o perfil e o conhecimento destes sobre a TRO. Após responderem questionário com informações profissionais e sobre a TRO, os ACS a prepararam por três métodos. O teor de glicose e de sódio das TRO foi determinado e comparado ao proposto pela OMS. Na análise estatística foram utilizados ANOVA, Tukey e odds ratio. Participaram do estudo 52 ACS, majoritariamente mulheres e com ensino médio completo (90,4 por cento). A adequação da TRO foi de 3,9; 9,8 e 28,9 por cento para a colher caseira, colher medida e punhado pitada, respectivamente. O preparo da TRO com a colher caseira resultou em 88,0 por cento das amostras com teor de sódio perigoso à saúde (>101 mmol/L). Entre os ACS, 38,5 por cento tinham menos de 2 anos de trabalho, com risco 4,8 vezes maior de preparar TRO inadequada em sódio. Os ACS referiram indicar a TRO no tratamento da diarreia infantil, desconhecendo efeitos colaterais do preparo inadequado. A composição da TRO produzida pelos ACS foi inadequada em todos os métodos. É recomendável treinamento dos ACS no preparo da TRO.
Infant Diarrhea is a major cause of morbidity and mortality in children and oral rehydration therapy (ORT) is required. This study evaluates the composition of ORT prepared by Community Health Agents (CHAs) working in Basic Health Units, assessing their profile and knowledge about ORT. After the CHAs answer specific questions, they are invited to prepare ORT using three methods. Glucose and sodium levels were then quantified and compared with WHO recommendations. ANOVA, Tukey and odds ratio were used for statistical analysis. 52 CHAs participated, mainly females, and 90.4 percent with full high school education. The adequacy of the ORT was 3.9; 9.8 and 28.9 percent for table spoon, measuring spoon and pinch and scoop, respectively. The ORT preparation by table spoon resulted in 88 percent of samples with dangerous levels of sodium (>101mmol/L). 38.5 percent of the CHAs had less than 2 years experience, leading to a 4.8 times greater risk of preparing ORT with high sodium. The CHAs indicated ORT as a treatment for diarrhea, though they were unaware of the side effects of inadequate preparation. The composition of the ORT produced by the CHAs was inadequate in all methods tested. The CHAs revealed a lack of knowledge of the side effects iof ORT with inadequate salt levels. The recommendation is to train the CHAs in ORT preparation.