RESUMO
OBJECTIVE: To evaluate the association of early continuous infusions of opioids and/or midazolam with survival and sensorimotor outcomes at age 2 years in very premature infants who were ventilated. STUDY DESIGN: This national observational study included premature infants born before 32 weeks of gestation intubated within 1 hour after birth and still intubated at 24 hours from the French EPIPAGE 2 cohort. Infants only treated with bolus were excluded. Treated infants received continuous opioid and/or midazolam infusion started before 7 days of life and before the first extubation. Naive infants did not receive these treatments before the first extubation, or received them after the first week of life, or never received them. This study compared treated (n = 450) vs naive (n = 472) infants by using inverse probability of treatment weighting after multiple imputation in chained equations. The primary outcomes were survival and survival without moderate or severe neuromotor or sensory impairment at age 2 years. RESULTS: Survival at age 2 years was significantly higher in the treated group (92.5% vs 87.9%, risk difference, 4.7%; 95% CI, 0.3-9.1; P = .037), but treated and naive infants did not significantly differ for survival without moderate or severe neuromotor or sensory impairment (86.6% vs 81.3%; risk difference, 5.3%; 95% CI -0.3 to 11.0; P = .063). These results were confirmed by sensitivity analyses using 5 alternative models. CONCLUSIONS: Continuous opioid and/or midazolam infusions in very premature infants during initial mechanical ventilation that continued past 24 hours of life were associated with improved survival without any difference in moderate or severe sensorimotor impairments at age 2 years.
Assuntos
Analgésicos Opioides/administração & dosagem , Recém-Nascido Prematuro , Midazolam/administração & dosagem , Transtornos do Neurodesenvolvimento/epidemiologia , Respiração Artificial , Estudos de Coortes , Feminino , França/epidemiologia , Humanos , Hipnóticos e Sedativos/administração & dosagem , Lactente , Recém-Nascido , Infusões Intravenosas , Estudos Longitudinais , Masculino , Taxa de SobrevidaRESUMO
BACKGROUND: The relationships between soil and coffee beans variables were evaluated and then the influence of bean composition on cup quality attributes was computed by means of relation studies. A total of 139 coffee and soil samples were collected directly from the same number of coffee plantations in Chiapas, Mexico. RESULTS: In the elemental composition, only phosphorus, potassium, calcium, and copper in coffee beans had a significant (P < 0.05) relationship with the content of the same elements in soil. The level of macro- and microelements in the coffee bean affected some of the cup quality attributes, but variables such as texture, titratable acidity, and pH of water in soil had a major influence on those attributes. Caffeine, trigonelline, and 5-caffeoylquinic acid in green coffee beans also had a significant influence (P < 0.05) on the sensory attributes of the beverage. CONCLUSION: The elemental composition of soil and coffee beans was important in explaining the cup quality attributes, but the most important variables influencing the sensory quality of coffee were altitude of plantations and moisture of coffee beans. © 2020 Society of Chemical Industry.
Assuntos
Coffea/crescimento & desenvolvimento , Café/química , Sementes/química , Solo/química , Altitude , Cálcio/análise , Cálcio/metabolismo , Coffea/química , Coffea/metabolismo , Cobre/análise , Cobre/metabolismo , Qualidade dos Alimentos , Humanos , México , Fósforo/análise , Fósforo/metabolismo , Potássio/análise , Potássio/metabolismo , Sementes/crescimento & desenvolvimento , Sementes/metabolismo , PaladarRESUMO
Abstract One-third of the population in intensive care units is in a state of circulatory shock, whose rapid recognition and mechanism differentiation are of great importance. The clinical context and physical examination are of great value, but in complex situations as in cardiac care units, it is mandatory the use of advanced hemodynamic monitorization devices, both to determine the main mechanism of shock, as to decide management and guide response to treatment, these devices include pulmonary flotation catheter as the gold standard, as well as more recent techniques including echocardiography and pulmonary ultrasound, among others. This article emphasizes the different shock mechanisms observed in the cardiac care units, with a proposal for approach and treatment.
Resumen Un tercio de la población de pacientes en unidades de cuidados intensivos se encuentran en choque circulatorio, el identificarlo y determinar su mecanismo de manera rápida y eficaz es de gran importancia. El contexto clínico y el examen físico son de gran utilidad, sin embargo existen situaciones de alta complejidad en las que se requiere del uso de las distintas modalidades de monitorización hemodinámica avanzada, tanto para determinar la causa, como para decidir el manejo y guiar respuesta al tratamiento, incluyendo el catéter de flotación pulmonar como gold standard, así como técnicas más recientes incluyendo ecocardiografía y ultrasonido pulmonar, entre otros. Este artículo enfatiza los distintos mecanismos de choque observados en las unidades de cuidados cardiacos, con propuesta de abordaje y tratamiento.
Assuntos
Humanos , Choque/fisiopatologia , Unidades de Cuidados Coronarianos , Hemodinâmica/fisiologia , Choque/terapia , Choque Cardiogênico/fisiopatologia , Choque Cardiogênico/terapia , Ecocardiografia/métodos , Ultrassonografia/métodosRESUMO
One-third of the population in intensive care units is in a state of circulatory shock, whose rapid recognition and mechanism differentiation are of great importance. The clinical context and physical examination are of great value, but in complex situations as in cardiac care units, it is mandatory the use of advanced hemodynamic monitorization devices, both to determine the main mechanism of shock, as to decide management and guide response to treatment, these devices include pulmonary flotation catheter as the gold standard, as well as more recent techniques including echocardiography and pulmonary ultrasound, among others. This article emphasizes the different shock mechanisms observed in the cardiac care units, with a proposal for approach and treatment.
Un tercio de la población de pacientes en unidades de cuidados intensivos se encuentran en choque circulatorio, el identificarlo y determinar su mecanismo de manera rápida y eficaz es de gran importancia. El contexto clínico y el examen físico son de gran utilidad, sin embargo existen situaciones de alta complejidad en las que se requiere del uso de las distintas modalidades de monitorización hemodinámica avanzada, tanto para determinar la causa, como para decidir el manejo y guiar respuesta al tratamiento, incluyendo el catéter de flotación pulmonar como gold standard, así como técnicas más recientes incluyendo ecocardiografía y ultrasonido pulmonar, entre otros. Este artículo enfatiza los distintos mecanismos de choque observados en las unidades de cuidados cardiacos, con propuesta de abordaje y tratamiento.