RESUMEN
BACKGROUND: There was no scientific evidence about the initial treatment of hypertonic saline solution (HSS) in acutely decompensated heart failure (ADHF). OBJECTIVES: This study assessed the impact of using HSS along with a loop diuretic (LD) as the first diuretic treatment for ADHF, focusing on renal function, electrolyte levels, and clinical outcomes. METHODS: In this retrospective case-control study, 171 adult patients (93 females/78 males) with ADHF were included between January 1, 2022, and December 31, 2022. Patients were allocated into two groups: upfront combo HSS+LD and standardized LD. The primary endpoint was worsening renal function (WRF). Hospitalization for HF and all-cause mortality were evaluated during 6 months of follow-up. The significance level adopted in the statistical analysis was 5%. RESULTS: The groups exhibited similarities in baseline characteristics.A significantly higher diuresis on the 1st day (3975 [3000-5150] vs. 2583 [2000-3250], p=0.001) and natriuresis on the 2nd hour (116.00 [82.75-126.00] vs. 68.50 [54.00-89.75], p=0.001) in the initial upfront combo HSS+LD were found in comparison with the standardized LD.When compared to the standardized LD, the utilization of HSS led to an increase in serum Na+ (137.00 [131.75-140.00] vs. 140.00 [136.00-142.25], p=0.001 for upfront combo HSS, 139.00 [137.00-141.00] vs. 139.00 [136.00-140.00], p=.0470 for standardized LD), while chloride (99.00 [94.00-103.25] vs. 99.00[96.00-103.00], p=0.295), GFR (48.50 [29.75-72.50 vs. 50.00 [35.50-63.50, p=0.616), and creatinine (1.20 [0.90-1.70] vs. 1.20 [1.00-1.50], p=0.218) remained stable in the upfront combo HSS group when compared to standardized LD group (Cl-: 102.00 [99.00-106.00] vs. 98.00 [95.00-103.00], p=0.001, eGFR: 56.00 [41.00-71.00] vs. 55.00 [35.00-71.00], p=0.050, creatinine:1.10 [0.90-1.40] vs. 1.20 [0.90-1.70], p=0.009). Worsening renal function (16.1% vs 35.5%, p=0.007), and length of stay in the hospital (4 days [3-7] vs. 5 days [4-7], p=0.004) were lower in the upfront combo HSS+LD in comparison with the standardized LD. In-hospital mortality, hospitalization for HF, and all-cause mortality were similar between the two groups. CONCLUSION: HSS as an initial therapy, when combined with LD, may provide a safe and effective diuresis without impairing renal function in ADHF. Therefore, HSS may lead to a shorter length of stay in the hospital for these patients.
FUNDAMENTO: Não houve evidência científica sobre o tratamento inicial com solução salina hipertônica (SSH) na insuficiência cardíaca agudamente descompensada (ICAD). OBJETIVOS: Este estudo avaliou o impacto do uso de SSH junto com um diurético de alça (DA) como o primeiro tratamento diurético para ICAD, com foco na função renal, níveis de eletrólitos e resultados clínicos. MÉTODOS: Neste estudo retrospectivo de caso-controle, 171 pacientes adultos (93 mulheres/78 homens) com ICAD foram incluídos entre 1º de janeiro de 2022 e 31 de dezembro de 2022. Os pacientes foram alocados em dois grupos: combinação inicial de SSH+DA e DA padronizada. O desfecho primário foi piora da função renal (PFR). A hospitalização por IC e a mortalidade por todas as causas foram avaliadas durante 6 meses de acompanhamento. O nível de significância adotado na análise estatística foi de 5%. RESULTADOS: Os grupos exibiram semelhanças nas características basais. Diurese significativamente maior no 1º dia (3975 [3000-5150] vs. 2583 [2000-3250], p=0,001) e natriurese na 2ª hora (116,00 [82,75-126,00] vs. 131,75-140,00] vs. 94,00-103,25] vs. 99,00 [96,00-103,00], p=0,295), TFG (48,50 [29,75-72,50 vs. 50,00[35,50-63,50, p=0,616) e creatinina (1,20 [0,90-1,70] vs. 1,20 [1,00-1,50], p=0,218) permaneceu estável no grupo SSH combinado inicial quando comparado ao grupo DA padronizado (Cl-: 102,00[99,00-106,00] vs. 98,00[95,00-103,00], p=0,001, TFGe: 56,00 [41,00-71,00] vs. 55,00[35,00-71,00], p=0,050, creatinina: 1,10[0,90-1,40] vs. 1,20 [0,90-1,70], p=0,009). A piora da função renal (16,1% vs. 35,5%, p = 0,007) e o tempo de internação hospitalar (4 dias [3-7] vs. 5 dias [4-7], p = 0,004) foram menores na combinação inicial SSH+DA em comparação com o DA padronizado. A mortalidade hospitalar, a hospitalização por IC e a mortalidade por todas as causas foram semelhantes entre os dois grupos. CONCLUSÃO: SSH como terapia inicial, quando combinada com DA, pode proporcionar uma diurese segura e eficaz sem prejudicar a função renal na ICAD. Portanto, a SSH pode levar a um menor tempo de internação hospitalar para esses pacientes.
Asunto(s)
Insuficiencia Cardíaca , Humanos , Insuficiencia Cardíaca/tratamiento farmacológico , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/mortalidad , Femenino , Masculino , Solución Salina Hipertónica/administración & dosificación , Estudios Retrospectivos , Anciano , Estudios de Casos y Controles , Persona de Mediana Edad , Resultado del Tratamiento , Enfermedad Aguda , Inhibidores del Simportador de Cloruro Sódico y Cloruro Potásico/administración & dosificación , Inhibidores del Simportador de Cloruro Sódico y Cloruro Potásico/uso terapéutico , Anciano de 80 o más Años , Factores de Tiempo , Hospitalización/estadística & datos numéricos , Sodio/sangreRESUMEN
BACKGROUND AND OBJECTIVES: The preferred osmotic agent used for brain relaxation during craniotomies remains unclear, either mannitol (MAN) or hypertonic saline (HTS). Hence, we sought to compare these solutions in this population. METHODS: MEDLINE, Embase, and Cochrane databases were systematically searched until August 02, 2023. Data were examined using the Mantel-Haenszel method and 95% CIs. Heterogeneity was assessed using I2 statistics. Meta-regression analysis was conducted to evaluate a possible link between Brain Relaxation Score and tumor volume. R, version 4.2.3, was used for statistical analysis. RESULTS: A total of 16 randomized controlled trials and 1031 patients were included, of whom 631 (61%) underwent surgery for supratentorial tumor resection. Compared with MAN, HTS achieved better rates of brain relaxation (80% vs 71%; odds ratio [OR] 1.68; 95% CI 1.22-2.33; P = .001; I2 = 0%), which was also demonstrated in the subgroup analysis of patients with supratentorial brain tumor (78% vs 65%; OR 2.02; 95% CI 1.36-2.99; P = .0005; I2 = 0%); a minor number of patients requiring a second dose of osmotic agent (14% vs 28%; OR 0.43; 95% CI 0.27-0.69; P = .0003; I2 = 0%); a lower fluid intake (mean difference -475.9341 mL; 95% CI -818.8952 to -132.9730; P = .007; I2 = 88%); and lower urine output (mean difference -462.0941 mL; 95% CI -585.3020 to -338.8862; P = <.001; I2 = 96%). Hospital length of stay and focal neurological deficits did not reach a statistically significant difference between groups. CONCLUSION: In this updated meta-analysis, consistent results suggest that HTS is associated with more beneficial outcomes than MAN in patients undergoing craniotomy.
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Craneotomía , Manitol , Humanos , Solución Salina Hipertónica/administración & dosificación , Manitol/administración & dosificación , Manitol/uso terapéutico , Craneotomía/métodos , Neoplasias Supratentoriales/cirugía , Encéfalo/cirugía , Encéfalo/efectos de los fármacos , Ensayos Clínicos Controlados Aleatorios como Asunto/métodos , Neoplasias Encefálicas/cirugíaRESUMEN
OBJECTIVE: To analyze clinical and demographic variables possibly associated with the prescriptions of non-recommended but routinely used therapies for infants with acute viral bronchiolitis. METHODS: A cross-sectional study included hospitalized infants with bronchiolitis caused by the respiratory syncytial virus. Those with other associated infections and/or morbidities were excluded. The data were collected from medical records. RESULTS: Among 120 cases, 90% used inhaled beta-agonists, 72.5% corticosteroids, 40% antibiotics, and 66.7% inhaled hypertonic saline solution. The use of bronchodilators did not present an independent association with another variable. More frequent use of corticosteroids was associated with low oximetry, longer hospitalization time, and age>3 months. Antibiotic therapy was associated with the presence of fever, longer hospitalization, and age>3 months. Inhaled hypertonic saline solution was associated with longer hospitalization time. CONCLUSIONS: Non-recommended prescriptions were frequent. Corticosteroid and antibiotic therapy were associated with signs of severity, as expected, but interestingly, they were more frequently used in infants above 3m, which suggested less safety in the diagnosis of viral bronchiolitis in these patients. The use of bronchodilators was even more worrying since they were indiscriminately used, without association with another variable related to the severity or characteristics of the host. The use of the inhaled hypertonic solution, although not associated with severity, seems to have implied a longer hospitalization time. The identification of these conditions of greater vulnerability to the prescription of inappropriate therapies contributes to the implantation of protocols for the bronchiolitis treatment, for continuing education and for analysis of the effectiveness of the strategies employed.
Asunto(s)
Bronquiolitis Viral/tratamiento farmacológico , Prescripción Inadecuada/estadística & datos numéricos , Infecciones por Virus Sincitial Respiratorio/tratamiento farmacológico , Enfermedad Aguda , Corticoesteroides/administración & dosificación , Antibacterianos/administración & dosificación , Broncodilatadores/administración & dosificación , Preescolar , Estudios Transversales , Femenino , Hospitalización , Humanos , Lactante , Recién Nacido , Modelos Logísticos , Masculino , Análisis Multivariante , Solución Salina Hipertónica/administración & dosificación , Estadísticas no ParamétricasRESUMEN
BACKGROUND: Chronic degeneration of the zygapophyseal joints in the cervical or lumbar spine are common causes of axial back pain. Radiofrequency (RF) ablation is a treatment modality in the denervation of facet joint-related pain. Although multiple factors have been theorized to contribute to the size of the optimal RF lesion, the addition of hypertonic saline solution has been posited to create larger RF lesion sizes. OBJECTIVES: This study compares lesion of 20-gauge RF monopolar probe using 2% lidocaine, 0.9% normal saline solution, and 3% saline solution administered through the RF needle prior to ablation, with subsequent lesion sizes recorded. STUDY DESIGN: Randomized, double-blinded, ex vivo study using clinically relevant conditions. SETTING: Procedural laboratory in an academic institution. METHODS: RF ablation lesions were reproduced in room temperature (21°C ± 2°C) chicken breast specimens with 20-gauge monopolar RF probes inserted. RF was applied for 90 seconds at 80°C after injection of 1 mL of either 2% lidocaine, 2% lidocaine and 0.9% normal saline solution in a 1:1 ratio, or 2% lidocaine and 3% saline solution in a 1:1 ratio. Tissues were dissected, measured, and ellipsoid volumes of burn calculated. Homogeneity of variances was assessed via the Bartlett's test, and heteroskedasticity with the studentized Breusch-Pagan test. One-way analysis of variance (ANOVA) (alpha of 0.05) was used to evaluate statistical significance between volume means across groups. When the null hypothesis of no difference in burn volume between samples could not be rejected, a predefined equivalence volume of ± 0.05 cm3 was used with Welch's 2 one-sided t-tests (TOST) with a Bonferroni adjusted alpha of 0.0167 to evaluate for null acceptance. RESULTS: The mean lesion volume for monopolar RF with 1 mL 2% lidocaine was 0.16 cm3. Monopolar RF with 1 mL 2% lidocaine + 0.9% normal saline solution had a mean lesion volume of 0.15 cm3, and treatment with 1 mL 2% lidocaine + 3% saline solution measured 0.17 cm3. ANOVA failed to reject the null, and TOST accepted as equivalent all 3 comparisons. LIMITATIONS: In vivo anatomy and physiology of a human organism was not used for this study. Samples were not warmed to physiologic temperature. Randomization resulted in slightly unequal sample sizes, although all groups were of sufficient size that the central limit theorem should apply. CONCLUSIONS: Three commonly used solutions were found to have equivalent lesion sizes from monopolar probe RF ablation. KEY WORDS: Radiofrequency, ablation, lesion shape, lesion size, monopolar RF, hypertonic saline solution.
Asunto(s)
Ablación por Catéter/efectos adversos , Ablación por Catéter/métodos , Lidocaína/toxicidad , Solución Salina Hipertónica/toxicidad , Solución Salina/toxicidad , Animales , Pollos , Método Doble Ciego , Electrodos , Femenino , Inyecciones , Lidocaína/administración & dosificación , Glándulas Mamarias Animales/efectos de los fármacos , Glándulas Mamarias Animales/patología , Distribución Aleatoria , Solución Salina/administración & dosificación , Solución Salina Hipertónica/administración & dosificaciónRESUMEN
SUMMARY OBJECTIVE To analyze clinical and demographic variables possibly associated with the prescriptions of non-recommended but routinely used therapies for infants with acute viral bronchiolitis. METHODS A cross-sectional study included hospitalized infants with bronchiolitis caused by the respiratory syncytial virus. Those with other associated infections and/or morbidities were excluded. The data were collected from medical records. RESULTS Among 120 cases, 90% used inhaled beta-agonists, 72.5% corticosteroids, 40% antibiotics, and 66.7% inhaled hypertonic saline solution. The use of bronchodilators did not present an independent association with another variable. More frequent use of corticosteroids was associated with low oximetry, longer hospitalization time, and age>3 months. Antibiotic therapy was associated with the presence of fever, longer hospitalization, and age>3 months. Inhaled hypertonic saline solution was associated with longer hospitalization time. CONCLUSIONS Non-recommended prescriptions were frequent. Corticosteroid and antibiotic therapy were associated with signs of severity, as expected, but interestingly, they were more frequently used in infants above 3m, which suggested less safety in the diagnosis of viral bronchiolitis in these patients. The use of bronchodilators was even more worrying since they were indiscriminately used, without association with another variable related to the severity or characteristics of the host. The use of the inhaled hypertonic solution, although not associated with severity, seems to have implied a longer hospitalization time. The identification of these conditions of greater vulnerability to the prescription of inappropriate therapies contributes to the implantation of protocols for the bronchiolitis treatment, for continuing education and for analysis of the effectiveness of the strategies employed.
RESUMO OBJETIVOS Analisar variáveis clínicas e demográficas possivelmente associadas às prescrições de terapêuticas não recomendadas, porém rotineiramente utilizadas, para lactentes com bronquiolite viral aguda. MÉTODOS Estudo transversal incluiu lactentes hospitalizados com bronquiolite por vírus sincicial respiratório. Excluídos aqueles com outras infecções e/ou morbidades. Dados coletados de prontuários. RESULTADOS Analisados 120 casos, para os quais foram prescritos: beta-agonistas inalatórios a 90%; corticosteroides a 72,5%, antibióticos a 40% e solução salina hipertônica inalatória a 66,7%. O uso de broncodilatadores não apresentou associação independente com outra variável. Maior uso de corticosteroide associou-se à baixa oximetria, maior tempo de internação e idade >3 meses. Antibioticoterapia associou-se à presença de febre, maior tempo de internação e idade >3 meses. Solução salina hipertônica inalatória associou-se a maior tempo de internação. CONCLUSÕES A frequência das prescrições não recomendadas foi elevada. Corticosteroide e antibioticoterapia foram associados a sinais de gravidade, como esperado, porém, interessantemente, foram mais utilizados nos lactentes com idade acima de 3 meses, o que sugeriu menor segurança no diagnóstico de bronquiolite viral nesses pacientes. O uso de broncodilatadores foi ainda mais preocupante, uma vez que foram indiscriminadamente utilizados, sem associação com outra variável, seja relacionada à gravidade, seja a características do hospedeiro. O uso de solução hipertônica inalatória, apesar de não associado à gravidade, parece ter implicado maior tempo de internação. A identificação dessas condições de maior vulnerabilidade à prescrição de terapêuticas inadequadas contribui para a implantação de protocolos para o tratamento da BVA, para educação continuada e para posteriores comparações e análises de eficácia das estratégias empregadas.
Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Lactante , Bronquiolitis Viral/tratamiento farmacológico , Infecciones por Virus Sincitial Respiratorio/tratamiento farmacológico , Prescripción Inadecuada/estadística & datos numéricos , Solución Salina Hipertónica/administración & dosificación , Broncodilatadores/administración & dosificación , Modelos Logísticos , Enfermedad Aguda , Estudios Transversales , Análisis Multivariante , Corticoesteroides/administración & dosificación , Estadísticas no Paramétricas , Hospitalización , Antibacterianos/administración & dosificaciónRESUMEN
BACKGROUND AND OBJECTIVES: Emphasis has been placed on methods to enlarge monopolar radiofrequency (RF) lesion size for pain management. Ex vivo research has suggested that fluid modulation may be an effective method to enlarge lesion zone. To date, these findings have not been confirmed in vivo. The purpose of this study was to determine the effect of hypertonic saline on in vivo lesion size through both histological and magnetic resonance imaging (MRI) analysis. A secondary purpose was to validate in vivo characterization of RF lesions using contrast-enhanced MRI. METHODS: Monopolar RF was performed in an in vivo porcine model in 3 groups: (1) without fluid preinjection, (2) with preinjection of 1% lidocaine, or (3) with preinjection of 1% lidocaine and 8% sodium chloride. Following lesioning, MRI processing with gadolinium-enhanced, T1-weighted imaging and histological analysis was performed. RESULTS: The addition of 8% sodium chloride significantly increased the size of RF lesion in comparison to the addition of 1% lidocaine alone and to the absence of fluid injection, as assessed by histological and MRI analysis. Three distinct histological lesion zones were identified. In comparison to the no-fluid group, the addition of hypertonic saline significantly altered the shape and histological composition of the lesion. There was a significant correlation of lesion volume as assessed by MRI and by histology measurements. Peak power and total energy delivery also correlated with lesion size. CONCLUSIONS: This study validates the ability of hypertonic saline to increase in vivo RF lesion size. With further refinement, MRI may be a viable method to assess RF lesion size.
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Ablación por Catéter/métodos , Imagen por Resonancia Magnética/métodos , Músculo Esquelético/efectos de los fármacos , Músculo Esquelético/diagnóstico por imagen , Solución Salina Hipertónica/administración & dosificación , Animales , Ablación por Catéter/efectos adversos , Masculino , Músculo Esquelético/patología , Ondas de Radio/efectos adversos , PorcinosRESUMEN
Abstract Background: The postoperative care of patients subjected to cardiac surgery frequently require a complete recovery with intravenous fluids, but crystalloid solutions like normal saline may increase the interstitial oedema, and it is also well known that fluid overload increases mortality. Objective: To compare the effect of 7.5% hypertonic saline (HS) with 0.9% normal saline (NS) on lactate clearance, as well as the haemodynamic response of patients during the first day after cardiovascular bypass surgery. Methods: The study included patients 18 years of age and older with coronary artery disease and/or heart valve disease, and who underwent bypass surgery and/or cardiac valve replacement and were randomly assigned to receive 4 mL/kg of HS or NS intravenously for 30 min once they were admitted to the ICU. Lactate, arterial blood gases, heart rate, central venous pressure, and pulmonary wedge pressure were measured at 0, 6, 12, and 24 h after being admitted to the ICU. The analyses were carried out with an intention-to-treat principle. Results: Out of a total of 494 patients evaluated, 102 were included and assigned to the HS groups (51 patients) or NS (51 patients). The mean age of the participants was 59 ± 14 years, and 59.8% were male. No statistically significant differences were observed between two groups in the lactate clearance, or in any of the secondary outcomes. Conclusions: Our study failed to show a better lactate clearance in the group on hypertonic saline, and with no evidence of a higher incidence of adverse effects in that group. © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Resumen Introducción: El cuidado postoperatorio de pacientes sometidos a cirugía cardíaca requiere frecuentemente una reanimación completa con líquidos intravenosos, pero las soluciones cristaloides pueden incrementar el edema intersticial y la sobrecarga de líquidos incrementa la mortalidad. Objetivo: Comparar el efecto del salino hipertónico (SH) al 7.5% con respecto al salino normal (SN) del 0.9% en la depuración de lactato y la respuesta hemodinámica durante el primer día postoperatorio de pacientes con cirugía cardiovascular con circulación extracorpórea. Métodos: Pacientes mayores de 18 años con cirugía de arterias coronarias o de enfermedad valvular cardíaca fueron aleatorizados a recibir 4 ml/kg de SH o SN intravenosos en los primeros 30min de admisión a UCI. Se midieron los valores de lactato, estado ácido-base, frecuencia cardíaca, presión venosa central y presión en cuña pulmonar a las horas 0, 6, 12 y 24 después del ingreso a UCI. Se hizo un análisis con el principio de intención de tratar para un modelo de datos longitudinales. Resultados: Se evaluaron 494 pacientes y se aleatorizaron 102 a los grupos de SH (n = 51) o SN (n = 51). El promedio de edad fue 59 ± 14 años y el 59.8% fueron hombres. No se observó ninguna diferencia estadísticamente significativa entre los 2 grupos en la depuración de lactato o en cualquiera de los desenlaces secundarios. Conclusiones: Nuestro estudio no mostró mejor depuración de lactato con el uso de una dosis de SH ni mayor frecuencia de efectos adversos en ese grupo. © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. Este es un artículo Open Access bajo la licencia CC BY-NC-ND (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Cuidados Posoperatorios/métodos , Solución Salina Hipertónica/administración & dosificación , Puente Cardiopulmonar , Ácido Láctico/metabolismo , Solución Salina/administración & dosificación , Procedimientos Quirúrgicos Cardíacos , Método Doble Ciego , Hemodinámica/efectos de los fármacosRESUMEN
Abstract Introduction Nasal irrigation solutions are widely used following endonasal surgery. These irrigation solutions remove infective debris and crusts, reducing the probability of synechia formation, and accelerate mucosal healing. Objective The aim of the present study was to compare the effects of nasal irrigation solutions with different contents following septoplasty and concha radiofrequency. Methods The present study was a prospective, randomized, controlled simple blind study of 120 patients who underwent septoplasty and bilateral concha radiofrequency. Patients were divided into four groups according to the nasal irrigation solution used: tap water, buffered isotonic saline, saline with xylitol, and hypertonic sea water. Patients were examined on the 7th and 15th postoperative days. A saccharine test was applied to determine mucociliary activity preoperatively and on the 7th and 15th postoperative days. Patients were asked about drying and obstruction using a 10 cm visual analog scale. In addition, patients were examined to determine the crusting score. Results There was no significant difference found in the preoperative and 7th and 15th postoperative days' mucociliary clearance times among the four groups. The crusting score was found to be significantly lower in the hypertonic sea water group (p < 0.001). Drying and obstruction on the 7th and 15th postoperative days were found to be significantly more comfortable in the hypertonic sea water group (p < 0.001). Conclusion Hypertonic sea water is the recommended irrigation solution, as it is associated with less crusting, drying, and obstruction in the nose for the postoperative period following septoplasty and concha radiofrequency.
Resumo Introdução Soluções para irrigação nasal são amplamente usadas após cirurgias endonasais. Essas soluções removem os resíduos e crostas, reduzem a probabilidade de formação de sinéquias e aceleram a cicatrização da mucosa. Objetivo O objetivo do presente estudo foi comparar os efeitos das soluçoes para irrigaçao nasal com diferentes conteudos apos septoplastia e turbinoplastia com radiofrequencia. Método O presente estudo foi um estudo cego simples, randomizado, controlado e prospectivo de 120 pacientes submetidos a septoplastia e turbinoplastia bilateral com radiofrequencia. Os pacientes foram divididos em quatro grupos de acordo com a soluçao nasal utilizada: agua da torneira, soluçao salina isotonica tamponada, soluçao salina com xilitol e agua do mar hipertonica. Os pacientes foram examinados no 7° e 15° dias do pos-operatorio. O teste de sacarina foi utilizado para determinar a atividade mucociliar pre-operatoria e no 7° e 15° dias do pos-operatorio. Os pacientes foram questionados sobre a sensaçao de secura e obstruçao nasais utilizando uma escala visual analógica de 10 cm. Alem disso, os pacientes foram examinados para determinar o escore em relaçao a crostas. Resultados Não houve diferença significativa entre o pré-operatório e o sétimo e 15° dias do pós-operatório dos tempos de clearance mucociliar entre os quatro grupos. Verificou-se que o escore em relação a crostas foi significativamente menor no grupo que usou água do mar hipertônica (p < 0,001). As sensações de secura e obstrução nasais no sétimo e 15° dias do pós-operatório mostraram-se significativamente mais confortáveis no grupo água do mar hipertônica (p < 0,001). Conclusão A água de mar hipertônica é a solução de irrigação recomendada, pois está associada a menor incidência de crostas, secura e obstrução nasais no pós-operatório de cirurgia de septoplastia e das conchas nasais com radiofrequência.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Adulto Joven , Rinoplastia/efectos adversos , Depuración Mucociliar/efectos de los fármacos , Lavado Nasal (Proceso) , Agua Dulce , Mucosa Nasal/efectos de los fármacos , Tabique Nasal/cirugía , Complicaciones Posoperatorias/prevención & control , Solución Salina Hipertónica/administración & dosificación , Agua de Mar , Administración Intranasal , Método Doble Ciego , Estudios Prospectivos , Ablación por Catéter/efectos adversos , Ablación por Catéter/métodos , Irrigación TerapéuticaRESUMEN
INTRODUCTION: Nasal irrigation solutions are widely used following endonasal surgery. These irrigation solutions remove infective debris and crusts, reducing the probability of synechia formation, and accelerate mucosal healing. OBJECTIVE: The aim of the present study was to compare the effects of nasal irrigation solutions with different contents following septoplasty and concha radiofrequency. METHODS: The present study was a prospective, randomized, controlled simple blind study of 120 patients who underwent septoplasty and bilateral concha radiofrequency. Patients were divided into four groups according to the nasal irrigation solution used: tap water, buffered isotonic saline, saline with xylitol, and hypertonic sea water. Patients were examined on the 7th and 15th postoperative days. A saccharine test was applied to determine mucociliary activity preoperatively and on the 7th and 15th postoperative days. Patients were asked about drying and obstruction using a 10cm visual analog scale. In addition, patients were examined to determine the crusting score. RESULTS: There was no significant difference found in the preoperative and 7th and 15th postoperative days' mucociliary clearance times among the four groups. The crusting score was found to be significantly lower in the hypertonic sea water group (p<0.001). Drying and obstruction on the 7th and 15th postoperative days were found to be significantly more comfortable in the hypertonic sea water group (p<0.001). CONCLUSION: Hypertonic sea water is the recommended irrigation solution, as it is associated with less crusting, drying, and obstruction in the nose for the postoperative period following septoplasty and concha radiofrequency.
Asunto(s)
Agua Dulce , Depuración Mucociliar/efectos de los fármacos , Lavado Nasal (Proceso) , Mucosa Nasal/efectos de los fármacos , Tabique Nasal/cirugía , Rinoplastia , Solución Salina Hipertónica/administración & dosificación , Agua de Mar , Administración Intranasal , Adolescente , Adulto , Ablación por Catéter/efectos adversos , Ablación por Catéter/métodos , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/prevención & control , Estudios Prospectivos , Rinoplastia/efectos adversos , Irrigación Terapéutica , Adulto JovenRESUMEN
BACKGROUND: The postoperative care of patients subjected to cardiac surgery frequently require a complete recovery with intravenous fluids, but crystalloid solutions like normal saline may increase the interstitial oedema, and it is also well known that fluid overload increases mortality. OBJECTIVE: To compare the effect of 7.5% hypertonic saline (HS) with 0.9% normal saline (NS) on lactate clearance, as well as the haemodynamic response of patients during the first day after cardiovascular bypass surgery. METHODS: The study included patients 18 years of age and older with coronary artery disease and/or heart valve disease, and who underwent bypass surgery and/or cardiac valve replacement and were randomly assigned to receive 4mL/kg of HS or NS intravenously for 30min once they were admitted to the ICU. Lactate, arterial blood gases, heart rate, central venous pressure, and pulmonary wedge pressure were measured at 0, 6, 12, and 24h after being admitted to the ICU. The analyses were carried out with an intention-to-treat principle. RESULTS: Out of a total of 494 patients evaluated, 102 were included and assigned to the HS groups (51 patients) or NS (51 patients). The mean age of the participants was 59±14 years, and 59.8% were male. No statistically significant differences were observed between two groups in the lactate clearance, or in any of the secondary outcomes. CONCLUSIONS: Our study failed to show a better lactate clearance in the group on hypertonic saline, and with no evidence of a higher incidence of adverse effects in that group.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Puente Cardiopulmonar , Ácido Láctico/metabolismo , Cuidados Posoperatorios/métodos , Solución Salina Hipertónica/administración & dosificación , Solución Salina/administración & dosificación , Anciano , Método Doble Ciego , Femenino , Hemodinámica/efectos de los fármacos , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Purpose: To evaluate the effects of hypertonic saline solution associated to remote ischemic perconditioning in liver ischemia/reperfusion injury in rats. Methods: 25 male rats (Wistar) were distributed into five groups: Sham group (S); Ischemia/Reperfusion group (I/R) with 30 minutes of liver ischemia; Remote ischemic perconditioning group (Per) with three cycles of 10 minutes of I/R performed during liver ischemia; Hypertonic saline solution group (HSS) treated with hypertonic saline solution (4ml/kg); Remote ischemic perconditioning + Hypertonic saline solution group (Per+HSS) with both treatments. Results: Per+HSS group showed a lower degree of liver dysfunction in relation to I/R group, whereas the technique of remote ischemic perconditioning isolated or associated with saline solution significantly improved liver function and reduced histological damage. Conclusion: Remote ischemic perconditioning associated or not to saline solution promoted reduction of acute liver injury induced by ischemia/reperfusion.(AU)
Asunto(s)
Animales , Masculino , Adulto , Ratas , Daño por Reperfusión/inducido químicamente , Daño por Reperfusión/terapia , Hígado/patología , Solución Salina Hipertónica/administración & dosificación , Solución Salina Hipertónica/uso terapéutico , Modelos Animales , Ratas WistarRESUMEN
Na clínica de animais de companhia é frequente cães com síndrome da diarreia hemorrágica aguda associada a quadros de sepse, o que acarreta alta mortalidade. Nesse contexto, objetivou-se, em um ensaio clínico controlado aleatorizado de centro único, estudar os efeitos tardios da solução salina hipertônica a 7,5% em aplicações seriadas, sobre variáveis hemodinâmicas, clínicas e laboratoriais em cães com quadro de sepse grave decorrente desta síndrome. Para tal, 12 cães foram aleatoriamente distribuídos em dois grupos de igual número, sendo um controle (CON) e o outro, solução salina hipertônica 7,5% (SSH). Variáveis clínicas e laboratoriais foram avaliadas imediatamente após a admissão do paciente (T0), 24 (T24), 48 (T48) e 72 (T72) horas após a admissão. O grupo SSH recebeu Ringer com lactato, antibioticoterapia, analgésico e SSH 7,5% em bolus (5mL kg-1 em 4 minutos) no T24 e no T48. O grupo CON recebeu a mesma terapia acima, porém ao invés da utilização de SSH a 7,5%, administrou-se bolus de solução de Ringer lactato na mesma dose e tempos utilizado. As avaliações em cada tempo foram realizadas anteriormente à administração dos bolus, nos dois grupos. Avaliaram-se hemograma completo e as variáveis clínicas (escala AVDN, grau de desidratação, frequência respiratória e temperatura retal), frequência cardíaca (FC), pressão arterial sistólica (PAS). Os dados paramétricos foram avaliados pelos testes Student Newman Keuls e teste t de Student, e os não paramétricos pelo teste de Friedman e Mann Whitney, com nível de significância de P≥0,05. Nas variáveis clínicas estudadas não se observou diferença entre os grupos e entre os momentos avaliados. Observou-se diferença significativa no grupo SSH no T72, com elevação da PAS e redução da FC, fato não observado no grupo CON, onde esses parâmetros não se alteraram. O hematócrito e a concentração de hemoglobina diminuíram em ambos os grupos com o tempo. As contagens dos leucócitos totais e dos monócitos apresentaram uma elevação significativa no grupo SSH, estando os leucócitos dentro da faixa de normalidade no T72. Não houve diferenças significativas em relação aos neutrófilos segmentados, porém no grupo SSH verificou-se aumento de 9,5 vezes no T72 comparado com o T24 (P=0,09), enquanto que este aumento foi de apenas 2,5 vezes no grupo CON (P=0,30). Observou-se ainda redução nas contagens de plaquetas e na concentração de globulinas no grupo COM, enquanto essas variáveis se mantiveram estáveis no grupo SSH. Conclui-se que a administração seriada de SSH 7,5% se mostrou promissora no tratamento de cães com síndrome da diarreia hemorrágica aguda, pois auxilia na estabilização dos leucócitos, plaquetas e globulinas de cães com sepse grave decorrente da síndrome da diarreia hemorrágica aguda.(AU)
The association between acute hemorrhagic diarrhea syndrome and sepsis is frequent in dogs and causes high mortality. In this context we investigated in a randomized single-center controlled trial the late effects of 7.5% hypertonic saline solution in serial applications on hemodynamic, clinical and laboratory variables in dogs with severe sepsis due to the syndrome. Twelve dogs were randomly distributed into two groups of equal numbers, control (CON) and 7.5% hypertonic saline solution (SSH). Clinical and laboratory variables were evaluated immediately after admission of patients (T0), 24 (T24), 48 (T48) and 72 (T72) hours after the admission. The SSH group received Ringer with lactate, antibiotic therapy, analgesic and 5mL/kg-1 bolus of 7.5% SSH over 4 minutes on T24 and T48. The CON group received the same therapy, but instead of 7.5% SSH, Ringer with lactate bolus was given at the same dosis and times. All evaluations were performed prior to the administration of the bolus in both groups. Data collection included complete blood count and clinical variables (AVDN scale, degree of dehydration, respiratory rate and rectal temperature), heart rate (HR) and systolic blood pressure (SBP). Parametric data were evaluated by the Student Newman Keuls and Student t tests, and the nonparametric ones by the Friedman and Mann Whitney test, with a significance level of 0.05. There were no significant differences between the groups and moments in clinical variables. Nevertheless, the SSH group presented a significant elevation of SBP and HR reduction at T72. Hematocrit and hemoglobin concentration decreased in both groups over time. Total leukocyte and monocyte counts showed a significant elevation in the SSH group, however the leukocytes were within the normal range at T72. There were no significant differences in the segmental neutrophils, but a 9.5-fold increase in T72 compared to T24 (P=0.09) in the SSH group was observed, whereas this increase was only 2.5-fold in the CON group (P=0.30). A decrease in platelet counts and globulin concentration was observed in the CON group, while these variables remained stable in the SSH group. In conclusion, serial administration of 7.5% SSH is promising in the therapy of dogs with acute hemorrhagic diarrhea syndrome, since it assists in the stabilization of leukocytes, platelets and globulins in dogs with severe sepsis due to this syndrome.(AU)
Asunto(s)
Animales , Perros , Solución Salina Hipertónica/administración & dosificación , Solución Salina Hipertónica/uso terapéutico , Sepsis/veterinaria , Disentería/veterinariaRESUMEN
Na clínica de animais de companhia é frequente cães com síndrome da diarreia hemorrágica aguda associada a quadros de sepse, o que acarreta alta mortalidade. Nesse contexto, objetivou-se, em um ensaio clínico controlado aleatorizado de centro único, estudar os efeitos tardios da solução salina hipertônica a 7,5% em aplicações seriadas, sobre variáveis hemodinâmicas, clínicas e laboratoriais em cães com quadro de sepse grave decorrente desta síndrome. Para tal, 12 cães foram aleatoriamente distribuídos em dois grupos de igual número, sendo um controle (CON) e o outro, solução salina hipertônica 7,5% (SSH). Variáveis clínicas e laboratoriais foram avaliadas imediatamente após a admissão do paciente (T0), 24 (T24), 48 (T48) e 72 (T72) horas após a admissão. O grupo SSH recebeu Ringer com lactato, antibioticoterapia, analgésico e SSH 7,5% em bolus (5mL kg-1 em 4 minutos) no T24 e no T48. O grupo CON recebeu a mesma terapia acima, porém ao invés da utilização de SSH a 7,5%, administrou-se bolus de solução de Ringer lactato na mesma dose e tempos utilizado. As avaliações em cada tempo foram realizadas anteriormente à administração dos bolus, nos dois grupos. Avaliaram-se hemograma completo e as variáveis clínicas (escala AVDN, grau de desidratação, frequência respiratória e temperatura retal), frequência cardíaca (FC), pressão arterial sistólica (PAS). Os dados paramétricos foram avaliados pelos testes Student Newman Keuls e teste t de Student, e os não paramétricos pelo teste de Friedman e Mann Whitney, com nível de significância de P≥0,05. Nas variáveis clínicas estudadas não se observou diferença entre os grupos e entre os momentos avaliados. Observou-se diferença significativa no grupo SSH no T72, com elevação da PAS e redução da FC, fato não observado no grupo CON, onde esses parâmetros não se alteraram. O hematócrito e a concentração de hemoglobina diminuíram em ambos os grupos com o tempo. As contagens dos leucócitos totais e dos monócitos apresentaram uma elevação significativa no grupo SSH, estando os leucócitos dentro da faixa de normalidade no T72. Não houve diferenças significativas em relação aos neutrófilos segmentados, porém no grupo SSH verificou-se aumento de 9,5 vezes no T72 comparado com o T24 (P=0,09), enquanto que este aumento foi de apenas 2,5 vezes no grupo CON (P=0,30). Observou-se ainda redução nas contagens de plaquetas e na concentração de globulinas no grupo COM, enquanto essas variáveis se mantiveram estáveis no grupo SSH. Conclui-se que a administração seriada de SSH 7,5% se mostrou promissora no tratamento de cães com síndrome da diarreia hemorrágica aguda, pois auxilia na estabilização dos leucócitos, plaquetas e globulinas de cães com sepse grave decorrente da síndrome da diarreia hemorrágica aguda.(AU)
The association between acute hemorrhagic diarrhea syndrome and sepsis is frequent in dogs and causes high mortality. In this context we investigated in a randomized single-center controlled trial the late effects of 7.5% hypertonic saline solution in serial applications on hemodynamic, clinical and laboratory variables in dogs with severe sepsis due to the syndrome. Twelve dogs were randomly distributed into two groups of equal numbers, control (CON) and 7.5% hypertonic saline solution (SSH). Clinical and laboratory variables were evaluated immediately after admission of patients (T0), 24 (T24), 48 (T48) and 72 (T72) hours after the admission. The SSH group received Ringer with lactate, antibiotic therapy, analgesic and 5mL/kg-1 bolus of 7.5% SSH over 4 minutes on T24 and T48. The CON group received the same therapy, but instead of 7.5% SSH, Ringer with lactate bolus was given at the same dosis and times. All evaluations were performed prior to the administration of the bolus in both groups. Data collection included complete blood count and clinical variables (AVDN scale, degree of dehydration, respiratory rate and rectal temperature), heart rate (HR) and systolic blood pressure (SBP). Parametric data were evaluated by the Student Newman Keuls and Student t tests, and the nonparametric ones by the Friedman and Mann Whitney test, with a significance level of 0.05. There were no significant differences between the groups and moments in clinical variables. Nevertheless, the SSH group presented a significant elevation of SBP and HR reduction at T72. Hematocrit and hemoglobin concentration decreased in both groups over time. Total leukocyte and monocyte counts showed a significant elevation in the SSH group, however the leukocytes were within the normal range at T72. There were no significant differences in the segmental neutrophils, but a 9.5-fold increase in T72 compared to T24 (P=0.09) in the SSH group was observed, whereas this increase was only 2.5-fold in the CON group (P=0.30). A decrease in platelet counts and globulin concentration was observed in the CON group, while these variables remained stable in the SSH group. In conclusion, serial administration of 7.5% SSH is promising in the therapy of dogs with acute hemorrhagic diarrhea syndrome, since it assists in the stabilization of leukocytes, platelets and globulins in dogs with severe sepsis due to this syndrome.(AU)
Asunto(s)
Animales , Perros , Solución Salina Hipertónica/administración & dosificación , Solución Salina Hipertónica/uso terapéutico , Sepsis/veterinaria , Disentería/veterinariaRESUMEN
PURPOSE: The aim of this study was to compare the qualitative and semi-quantitative detection of pathogens in the airway secretions of patients with cystic fibrosis (CF) and the sputum induction capacity before and after inhalation of 7% hypertonic saline solution (HSS). METHODS: The study enrolled 64 patients with CF. Airway secretions were collected from all enrolled patients with CF before and after inhalation of 7% HSS, and the samples were screened for pathogens. RESULTS: Inhalation of 7% HSS increased the probability of producing sputum from 36 to 52% (p = 0.002) in children with CF. The effect was most in children under 11 years. Inhalation of 7% HSS improved qualitative pathogen identification (p = 0.008). Inhalation of 7% HSS increased the mucoid Pseudomonas aeruginosa (p = 0.002) and non-mucoid P. aeruginosa in the semi-quantitative analysis (p = 0.035). Four new pathogens (Aspergillus fumigatus, Achromobacter xylosoxidans, Ochrobactrum anthropi, and Elizabethkingia meningoseptica) were identified in the sputum samples collected from the airways of patients with CF following 7% HSS. CONCLUSIONS: Inhalation of 7% HSS increased sputum production and pathogen identification in children with CF. The inhalation of 7% HSS was feasible and should be implemented for routine pathogen detection in the airways of patients with CF, particularly in those patients who do not produce sputum.
Asunto(s)
Bacterias/aislamiento & purificación , Fibrosis Quística/microbiología , Pulmón/microbiología , Infecciones del Sistema Respiratorio/microbiología , Solución Salina Hipertónica/administración & dosificación , Esputo/microbiología , Administración por Inhalación , Adolescente , Adulto , Bacterias/clasificación , Técnicas Bacteriológicas , Brasil , Niño , Preescolar , Estudios Transversales , Fibrosis Quística/diagnóstico , Fibrosis Quística/fisiopatología , Estudios de Factibilidad , Femenino , Humanos , Pulmón/fisiopatología , Masculino , Valor Predictivo de las Pruebas , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/fisiopatología , Adulto JovenRESUMEN
Intratesticular injection (ITI) of sodium chloride (NaCl) is efficient for chemical castration of young calves, but its effects on calves welfare are unknown. Two experiments were conducted to evaluate the effects of ITI of 20% NaCl on stress and inflammatory markers in calves less than 20 days old and to assess the efficiency of ITI of 30% NaCl in 5 months old calves. In Experiment 1, control calves were only restrained and compared to calves submitted to castration through surgery (SC) and ITI with 20% NaCl (n = 9/group). No differences were observed for the eye corner temperature measured by thermography from 60 s before to 60 s after the procedures (P > 0.05). In the SC group, acute serum cortisol levels increased at 30 and 60 min after the procedure, but increased levels in the ITI group occurred only at 30 min (P < 0.05). Chronic discomfort markers were measured at 0, 24, 48, 72 and 96 h after the procedures (D0, D1, D2, D3 and D4, respectively). The serum levels of the paraoxonase 1 (PON1) enzyme and cortisol did not differ among groups (P > 0.05). Scrotal temperature was higher at D1 in the SC group than for the other groups, but lowest at D4 compared to the control (both P < 0.05). In Experiment 2, histological sections of testes were compared after ITI with either 30% NaCl or 30% calcium chloride (CaCl2), to intact calves (control). After 60 days, intact seminiferous tubules and mediastinum were observed after ITI with 30% NaCl, whereas coagulative necrosis, inflammatory infiltration and calcification occurred after ITI with 30% CaCl2. Efficient chemical castration through ITI of 20% NaCl in young calves was followed by slight stress and inflammatory responses compared to surgical castration. However, ITI of 30% NaCl was ineffective for chemical castration of 5 months old calves.
Asunto(s)
Bovinos , Orquiectomía/veterinaria , Solución Salina Hipertónica/administración & dosificación , Animales , Arildialquilfosfatasa/sangre , Temperatura Corporal , Cloruro de Calcio/farmacología , Hidrocortisona/sangre , Masculino , Orquiectomía/métodos , Solución Salina Hipertónica/farmacología , Escroto/efectos de los fármacos , Escroto/fisiología , Testículo/efectos de los fármacos , Testículo/metabolismoRESUMEN
BACKGROUND Current clinical treatment methods for refractory intracranial hypertension include elevation of the decubitus, ventilation adjustment, and use of hypertonic solutions such as hypertonic saline and mannitol solutions. Previous studies have shown that hypertonic solutions are particularly effective. Although several concentrations of saline solution have been proposed, a 3% solution is the most widely used. The aim of this study was to evaluate the maintained efficacy of a 3% hypertonic saline solution in an experimental model of intracranial hypertension. MATERIAL AND METHODS A porcine model of reversible intracranial hypertension was created by inserting a balloon catheter into the brain parenchyma, which was inflated and deflated to simulate intracranial hypertension and its surgical correction. The experiment included 3 groups of animals (A, B, and C) with different balloon inflation volumes. In group B, balloons were inflated 2 times to simulate reexpansion. A 20 mL/kg bolus of 3% saline solution was infused using a pump 90 minutes after the start of balloon inflation, and the effects of intracranial pressure were evaluated 60 minutes after infusion. RESULTS No increases outside of the normal range were observed in mean serum sodium concentrations (p=0.09). In addition, we identified no differences within each group in serum sodium levels measured during hypertonic saline infusion (p=0.21). No significant reductions in intracranial pressure were observed in any of the 3 groups. CONCLUSIONS Bolus infusion of 3% hypertonic saline solution with the aid of a pump does not significantly reduce intracranial pressure in an animal model of intracranial hypertension.
Asunto(s)
Hipertensión Intracraneal/terapia , Solución Salina Hipertónica/administración & dosificación , Animales , Encéfalo/fisiopatología , Modelos Animales de Enfermedad , Femenino , Hipertensión Intracraneal/fisiopatología , Hipertensión Intracraneal/rehabilitación , Presión Intracraneal/fisiología , Masculino , PorcinosRESUMEN
Nebulized hypertonic saline solution is useful in pediatric diseases such as bronchiolitis and cystic fibrosis. However its usefulness in pediatric patients with tracheostomy has not been studied. Our aim was to determine the usefulness of nebulized hypertonic solution 5% (SSH5%) in this population. Methods: Prospective cross over, double-blind, randomized, placebo-controlled study It was approved by ethics committee. 34 out of 37 tracheostomized pediatric patients hospitalized from February to May 2013, were selected for this study. They underwent a period of wash out a month later They were randomly divided into a treatment group and a placebo group. Treatment group received hypertonic saline solution 5% (SSH5%) and placebo group saline solution 0.9% (SSF). Both groups received nebulization once daily for 30 days. Then there was a second washout with subsequent crossover Data collected were: patients identification, number of aspirations per day, type of aspirated secretions, mucus plug, fever, oxygen flow supplied and pressure of mechanical ventilator The first nebulization on group SSH5% was defined as a tolerance test. Data analysis was performed using chi-square, Mann-Whitney and t Student tests. The main measured effect was presence and number of respiratory exacerbations, evaluated with Prescott test. Results: 50% of patients were female, their mean age was 3.94 years-old and 82% were with mechanical ventilation. We did not find significant differences between both groups in age, sex or mechanical ventilation. Treatment group SSH5% had less number of respiratory exacerbations than SSF group (p = 0.00595). No adverse effects were observed with the use of SSH5%. Conclusions: Nebulized SSH5% decreased pulmonary exacerbations in patients with tracheostomy with or without mechanical ventilation, being safe its application.
El uso de nebulizaciones de solución salina hipertónica es beneficioso en enfermedades pediátricas, como bronquiolitis y fibrosis quística, sin embargo, no se ha estudiado su efecto en pacientes pediátricos traqueostomizados. Nuestro propósito fue determinar la utilidad de las nebulizaciones con solución hipertónica al 5% (SSH5%) en esta población. Pacientes y Método: Estudio prospectivo ‘cross over’, doble ciego, aleatorizado, controlado por placebo. Aprobado por comité de ética. De 37 pacientes traqueostomizados internados en el Hospital Josefina Martínez desde febrero a mayo de 2013, se seleccionaron 34 que fueron sometidos a un período de ‘wash out’ de un mes, posteriormente se dividieron en forma aleatoria, en grupo tratamiento y grupo placebo. El grupo tratamiento recibió solución salina hipertónica al 5% (SSH5%) y el grupo placebo solución salina al 0,9% (SSF). Ambos grupos recibieron nebulización una vez al día durante 30 días. Luego, hubo un segundo período de ‘wash out’ con posterior cross over. Los datos recolectados fueron: identificación del paciente, número de aspiraciones/día, tipo de secreciones aspiradas, tapón mucoso, fiebre, flujo de oxígeno suministrado y presiones del ventilador mecánico. La primera nebulización grupo SSH5% se definió como prueba de tolerancia. El análisis de datos se realizó con pruebas chi cuadrado, Mann-Whitney y t de Student. El efecto principal medido fue presencia y número de exacerbaciones respiratorias, evaluado con test de Prescott. Resultados: 50% de los pacientes fueron de sexo femenino, su media de edad fue 3,94 años y 82% de ellos estaban con ventilación mecánica. No encontramos diferencias significativas en edad, sexo o uso de ventilación mecánica entre ambos grupos. El grupo tratamiento SSH5% presentó menor número de exacerbaciones respiratorias que el grupo SSF (p = 0,00595). No se observaron efectos adversos con el uso de SSH5%. Conclusiones: Las nebulizaciones SSH5% disminuyeron las exacerbaciones respiratorias en pacientes traqueostomizados con y sin ventilación mecánica, siendo segura su aplicación.
Asunto(s)
Humanos , Masculino , Femenino , Preescolar , Respiración Artificial , Solución Salina Hipertónica/administración & dosificación , Traqueostomía/métodos , Método Doble Ciego , Nebulizadores y Vaporizadores , Estudios ProspectivosRESUMEN
In search of new therapies to solve diuretic resistance in acute heart failure, the addition of hypertonic saline has been proposed. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified two systematic reviews including nine pertinent randomized controlled trials. We combined the evidence and generated a summary of findings following the GRADE approach. We concluded hypertonic saline associated with furosemide probably decrease mortality, length of hospital stay and hospital readmission in patients with acute decompensated heart failure.
En la búsqueda de nuevas terapias para resolver la resistencia a los diuréticos en insuficiencia cardiaca aguda se ha planteado la adición de suero hipertónico. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos dos revisiones sistemáticas que en conjunto incluyen nueve estudios aleatorizados. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Se concluye que el suero hipertónico asociado a furosemida probablemente disminuye la mortalidad, estadía y reingreso hospitalario en pacientes con insuficiencia cardiaca descompensada.
Asunto(s)
Furosemida/administración & dosificación , Insuficiencia Cardíaca/tratamiento farmacológico , Solución Salina Hipertónica/administración & dosificación , Enfermedad Aguda , Diuréticos/administración & dosificación , Diuréticos/uso terapéutico , Furosemida/uso terapéutico , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/fisiopatología , Humanos , Tiempo de Internación , Readmisión del Paciente , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Previous studies from our laboratory have shown that methysergide, a serotonergic antagonist, injected into the lateral parabrachial nucleus (LPBN) combined with a pre-load of 2 M NaCl, given by gavage, induces 0.3 M NaCl intake. The mechanisms involved in this paradoxical behavior are still unknown. In the present work, we investigated the effect of serotonergic blockade into the LPBN on hindbrain and hypothalamic activity, gastric emptying and arterial blood pressure in cell-dehydrated rats. Methysergide plus 2 M NaCl infused intragastrically or intravenously promoted 0.3 M NaCl intake in two-bottle tests. In cell-dehydrated rats with no access to fluids, methysergide compared to vehicle increased Fos immunoreactivity in the medial nucleus of the solitary tract, area postrema and non-oxytocinergic cells of the ventral portion of the hypothalamic paraventricular nucleus (PVN). There was no alteration in the number of neurons double-labeled for Fos-ir and oxytocin in the PVN and supraoptic nuclei. There was also no alteration in plasma oxytocin and vasopressin, or arterial pressure. In rats cell-dehydrated by i.v. 2 M NaCl, methysergide also did not change the amount of an intragastric load of 0.3 M NaCl retained in the stomach or intestine. The results suggest that methysergide injected into the LPBN of cell-dehydrated rat does not alter primary inhibitory signals that control sodium intake. The inhibitory signals blocked by methysergide in the LPBN possibly originated from activation of brain osmoreceptors, second order visceral/hormonal signals or a combination of both.