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Resumen: La anestesiología cuenta con una nueva generación de monitores de la profundidad anestésica como Narcotrend, SedLine y el índice biespectral; con un procesador del electroencefalograma llamado espectrograma o espectrografía. Tras la obtención del electroencefalograma, se procesa para graficar en tres dimensiones: la frecuencia, el tiempo y la potencia en una escala de colores, con lo que se obtiene la matriz de densidad espectral (DSA, por sus siglas en inglés). El objetivo de esta revisión narrativa es ilustrar los efectos de los anestésicos más comunes en el espectrograma y hacer una breve revisión de su huella en el electroencefalograma.
Abstract: Anesthesiology has a new generation of anesthetic depth monitors such as Narcotrend, SedLine and Bispectral Index; with an electroencephalogram processor called a spectrogram or spectrograph. After obtaining the electroencephalogram, it is processed to graph three dimensions: frequency, time, and power on a color scale, obtaining the DSA (density spectral array). The objective of this narrative review is to illustrate the effects of the most common anesthetics on the spectrogram and to briefly review their signature on the electroencephalogram.
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Background: Chronic Venous Disease (CVD) can seriously impact physical fitness. Certain measures and aptitude tests can be employed to evaluate this condition in people with CVD that are simple, quick, and less expensive alternatives when compared to laboratory methods. Objectives: To evaluate the applicability of the 4-minute step test, correlating its results with those of other measures and tests used with people with CVD symptoms. Methods: Cross-sectional descriptive study carried out with 47 active women with CVD symptoms who participate in public physical exercise programs and were recruited by spontaneous demand. After clinical evaluation of disease stage, sociodemographic data were collected and calf circumference measurements, ankle goniometry, the tiptoe test, and the 4-minute step test were conducted. The women were already familiar with the apparatus used. Results: The step test showed significant correlations (p<0.05) with calf measurements (r=0.31 and 0.32), flexibility (r=0.48 and 0.47), and the tiptoe test (r=0.33 for number of repetitions and 0.42 for speed of execution), in addition to an inverse correlation with disease severity (r=-0.29). Significant correlations were also found by age group (r=0.60 and 0.54, for calf circumference in the elderly) and by classification in tests and measurements (r=0.19 for the tiptoe test, and r=0 .29, for ankle flexibility). Conclusions: The step test proved applicable and its use in conjunction with other aptitude tests offers a more complete evaluation of active women with CVD symptoms.
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BACKGROUND: Bedrest is toxic for inpatients and consumer grade physical activity monitors offer an economical solution to monitor patient ambulation. But these devices may not be accurate in debilitated hospitalized patients who frequently ambulate very slowly. OBJECTIVE: To determine whether measures of physical capacity can help identify inpatients for whom wearable physical activity monitors may accurately measure step count. METHODS: Prospective observational study of 54 adult inpatients with acute neurological diagnoses. Patients were assessed using 2 physical capacity assessments (Activity Measure for Post-Acute Care Inpatient Mobility Short Form [AM-PAC IMSF] and Katz Activities of Daily Living [ADL] scale). They also completed a 2-minute walk test (2MWT) wearing a consumer grade physical activity monitor. RESULTS: The wearable activity monitor recorded steps (initiated) in 33 (61%) of the inpatients, and for 94% of inpatients with gait speeds >0.43 m/s. Physical capacity assessments correlated well with gait speed, AM-PAC IMSF r = 0.7, and Katz ADL r = 0.6, p < 0.05. When the physical activity monitor initiated, the mean absolute percent error (SD) comparing device calculated steps to observed steps, was 10% (13). AM-PAC IMSF (T-score >45) and Katz ADL (>5) cutoff scores identified inpatients for whom physical activity monitors initiated with a sensitivity of 94 and 91%, respectively. CONCLUSIONS: Physical capacity assessments, such as AM-PAC, and Katz ADL, may be a useful and feasible screening strategy to help identify inpatients where wearable physical activity monitors can measure their mobility.
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Atividades Cotidianas , Exercício Físico , Adulto , Humanos , Seleção de Pacientes , Caminhada , HospitaisRESUMO
Resumo Contexto A doença venosa crônica (DVC) pode impactar a aptidão física dos indivíduos. Algumas medidas e testes de aptidão são aplicados para avaliar essa condição em pessoas com DVC, sendo alternativas simples, rápidas e menos dispendiosas de avaliação comparadas a métodos laboratoriais. Objetivos Avaliar a aplicabilidade do teste do degrau de 4 minutos, correlacionando seus resultados com os de outras medidas e testes aplicados a pessoas com sintomas de DVC. Métodos Estudo descritivo transversal realizado com 47 mulheres ativas com sintomas de DVC, participantes de programas públicos de exercícios físicos e recrutadas por demanda espontânea. Foi realizada avaliação clínica da doença, e foram coletados dados sociodemográficos, medidas de perimetria de panturrilha e goniometria de tornozelo, teste ponta do pé e teste do degrau de 4 minutos. As mulheres já eram familiarizadas com o implemento utilizado. Resultados O teste do degrau apresentou correlações significativas (p < 0,05) com as medidas de panturrilha (r = 0,31 e 0,32), flexibilidade (r =0,48 e 0,47) e teste ponta do pé (r = 0,33 para n.º de repetições e 0,42 para velocidade de execução), além de correlação inversa com a gravidade da doença (r = -0,29). Correlações significativas também foram encontradas por faixa etária (r = 0,60 e 0,54, para perimetria de panturrilha em idosos) e por classificação nos testes e medidas (r = 0,19 para o teste ponta do pé e r = 0,29 para flexibilidade de tornozelo). Conclusões O teste do degrau se mostra aplicável, e sua utilização, em conjunto com outros testes de aptidão, permite uma avaliação mais completa de mulheres ativas com sintomas de DVC.
Abstract Background Chronic Venous Disease (CVD) can seriously impact physical fitness. Certain measures and aptitude tests can be employed to evaluate this condition in people with CVD that are simple, quick, and less expensive alternatives when compared to laboratory methods. Objectives To evaluate the applicability of the 4-minute step test, correlating its results with those of other measures and tests used with people with CVD symptoms. Methods Cross-sectional descriptive study carried out with 47 active women with CVD symptoms who participate in public physical exercise programs and were recruited by spontaneous demand. After clinical evaluation of disease stage, sociodemographic data were collected and calf circumference measurements, ankle goniometry, the tiptoe test, and the 4-minute step test were conducted. The women were already familiar with the apparatus used. Results The step test showed significant correlations (p<0.05) with calf measurements (r=0.31 and 0.32), flexibility (r=0.48 and 0.47), and the tiptoe test (r=0.33 for number of repetitions and 0.42 for speed of execution), in addition to an inverse correlation with disease severity (r=-0.29). Significant correlations were also found by age group (r=0.60 and 0.54, for calf circumference in the elderly) and by classification in tests and measurements (r=0.19 for the tiptoe test, and r=0 .29, for ankle flexibility). Conclusions The step test proved applicable and its use in conjunction with other aptitude tests offers a more complete evaluation of active women with CVD symptoms.
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ABSTRACT Objectives: to characterize oscillometric blood pressure measurement devices for sale in the virtual market and identify which ones have undergone a validation study. Methods: this was a cross sectional study. The search for devices for sale was conducted on websites, and the sample was composed of 137 devices obtained from 644 ads. We conducted a bibliographic survey in five databases and web pages enlisting devices submitted for validation. The Kolmogorov-Smirnov test was used to check data distribution, followed by Mann-Whitney and Kruskal-Wallis tests for comparisons, using the SAS 9.4 program. Results: only 16.7% of the devices were validated. The home devices ranged from USD 10.57 to USD 275.67. Only 102 ads informed the cuff size, with different nomenclatures. Conclusions: most ads contained non-validated devices, which were cheaper. We identified some ads falsely informing validation.
RESUMEN Objetivos: caracterizar aparatos oscilométricos de medición de la presión sanguínea a la venta en el mercado virtual e identificar cuales pasaron por estudio de validación. Métodos: discorre de un estudio transversal. La búsqueda de equipos a la venta fue realizada en páginas de internet, y la muestra fue composta por 137 equipos, obtenidos en 644 anuncios. Realizado levantamiento bibliográfico en cinco bases de datos y consultadas páginas de internet que registran equipos sometidos a validación. Utilizadas las pruebas Kolmogorov-Smirnov para verificación de la distribución de los datos, seguidos de Mann-Whitney y Kruskal-Wallis para comparaciones, mediante el programa SAS 9.4. Resultados: solamente 16,7% de los aparatos eran validados. Equipos domiciliares presentaron variancia de R$ 58,70 a R$ 1.531. Solo 102 anuncios informaron las dimensiones del brazalete, con nomenclaturas diferentes. Conclusiones: la mayoría de los anuncios contenía equipos no validados, que eran más baratos. Fueron identificados anuncios con informaciones falsas sobre validación.
RESUMO Objetivos: caracterizar os dispositivos oscilométricos de medida da pressão arterial à venda no mercado virtual e identificar quais passaram por estudo de validação. Métodos: trata-se de um estudo transversal. A busca dos aparelhos à venda foi realizada em páginas da internet, e a amostra foi composta por 137 aparelhos, obtidos em 644 anúncios. Foi realizado levantamento bibliográfico em cinco bases de dados e consultadas páginas da internet que registram aparelhos submetidos à validação. Utilizaram-se os testes Kolmogorov-Smirnov para verificação da distribuição dos dados, seguidos de Mann-Whitney e Kruskal-Wallis para comparações, por meio do programa SAS 9.4. Resultados: somente 16,7% dos dispositivos eram validados. Os aparelhos domiciliares apresentaram variação de R$ 58,70 a R$ 1.531. Apenas 102 anúncios informaram as dimensões da braçadeira, com nomenclaturas diferentes. Conclusões: a maioria dos anúncios continha aparelhos não validados, que eram mais baratos. Foram identificados anúncios com informações falsas sobre validação.
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RESUMO Objetivo: Investigar a viabilidade do índice bispectral na avaliação do sono de pacientes criticamente enfermos lúcidos e a associação entre os parâmetros do sono aferidos por esse índice, pelo Questionário de Sono de Richards-Campbell e pelo ruído ambiental. Métodos: Estudo observacional transversal que avaliou indivíduos adultos criticamente enfermos com doenças de gravidades baixa ou moderada. Foram aferidos: volume e tempo total de sono, volume e tempo de sono profundo, volume e tempo de sono contínuo, latência para o início do sono e pressão sonora ambiental. A percepção subjetiva do sono foi registrada com o Questionário de Sono de Richards-Campbell nas manhãs subsequentes às noites de observação. Resultados: Os pacientes apresentaram tempo total de sono reduzido (234 minutos), predominância dos estágios superficiais e pouco sono profundo (1,7 minutos). Os volumes de sono total, profundo e contínuo foram 3.679, 9,4 e 3.143 índice bispectral versus minutos, respectivamente. A latência para o sono foi de 94 minutos. O escore médio do Questionário de Sono de Richards-Campbell foi 57,9. Foram observadas correlações de magnitudes fracas entre volume total, tempo total, volume contínuo e os domínios do Questionário de Sono de Richards-Campbell profundidade do sono, qualidade geral de sono e escore total; e correlações de magnitudes moderadas entre volume total, tempo total, volume contínuo e o domínio ocorrência de despertares. Conclusão: O índice bispectral é um instrumento com viabilidade limitada para monitorar o sono de pacientes lúcidos e com enfermidades de gravidades baixa e moderada na unidade de terapia intensiva, e pacientes que apresentaram maior volume, tempo total e volume de sono contínuo tiveram melhor percepção global do sono.
Abstract Objective: To investigate the viability of the bispectral index in the sleep evaluation of critically ill patients and to quantify the associations of sleep parameters measured by this index with the Richards-Campbell Sleep Questionnaire and environmental noise. Methods: This was a cross-sectional observational study that evaluated critically ill adults with diseases of low or moderate severity. The following were measured: total sleep volume and time, deep sleep volume and time, continuous sleep volume and time, sleep onset latency, and environmental sound pressure level. The subjective perception of sleep was evaluated with the Richards-Campbell Sleep Questionnaire the morning after each night of observation. Results: Patients had a low total sleep time (234 minutes), a predominance of superficial sleep stages, and little deep sleep (1.7 minutes). The total, deep, and continuous sleep volumes were 3,679, 9.4, and 3,143 (bispectral index units × minutes), respectively. The sleep latency was 94 minutes. The mean score of the Richards-Campbell Sleep Questionnaire was 57.9. Total sleep volume, total sleep time, and continuous sleep volume were weakly correlated with the Richards-Campbell Sleep Questionnaire depth of sleep domain score, overall sleep quality domain score, and total score. Total volume, total time, and continuous volume were moderately correlated with the occurrence of awakenings domain score. Conclusion: The bispectral index is an instrument with limited viability to monitor the sleep of lucid patients and patients with low to moderate disease severity in the intensive care unit. Patients with higher total sleep volume, total sleep time, and continuous sleep volume had better overall sleep perception.
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Humanos , Sono , Unidades de Terapia Intensiva , Estudos Transversais , Inquéritos e Questionários , Estado TerminalRESUMO
Although automated monitors for blood pressure (BP) measurement are used increasingly worldwide, understanding of how such devices are used in Brazil is low. This study analyzed the status of BP measurement by Brazilian health professionals. A questionnaire regarding experience with BP measurement was sent electronically to Brazilian nurses, nursing assistants, and doctors. It had 2004 responses. Previous experience with use of automated monitors was most frequent in men (71.2%), nursing technicians (65.5%), specialists (61.1%), secondary care (71.9%), emergency care (70.6%), or the private sector (66.3%). The least complied aspects of the standardized measurement protocol were availability of various cuff sizes (53.9% and 72.9% for auscultatory and oscillometric methods, respectively) and proper calibration checks (21.5% and 46.8% for auscultatory and oscillometric methods, respectively). Brazilian health professionals report not adequately performing all the necessary aspects to measure BP in accordance with the standardized protocol in both methods, but mainly regarding the oscillometric.
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Determinação da Pressão Arterial/normas , Competência Profissional , Pressão Sanguínea , Monitores de Pressão Arterial , Brasil , Feminino , Humanos , Hipertensão , Masculino , Enfermeiras e Enfermeiros , Assistentes de Enfermagem , Oscilometria , MédicosRESUMO
Initiated in response to community concerns about high levels of air pollution and asthma, the Imperial County Community Air Monitoring Project was conducted as a collaboration between a community-based organization, a non-governmental environmental health program, and academic researchers. This community-engaged research project aimed to produce real-time, community-level air quality information through the establishment of a community air monitoring network (CAMN) of 40 low-cost particulate matter (PM) monitors in Imperial County, California. Methods used to involve the community partner organization and residents in the development, operation, and use of the CAMN included the following: (1) establishing equitable partnerships among the project collaborators; (2) forming a community steering committee to guide project activities; (3) engaging residents in data collection to determine monitor sites; (4) providing hands-on training to assemble and operate the air monitors; (5) conducting focus groups to guide display and dissemination of monitoring data; and (6) conducting trainings on community action planning. This robust community engagement in the project resulted in increased awareness, knowledge, capacity, infrastructure, and influence for the community partner organization and among community participants. Even after the conclusion of the original research grant funding for this project, the CAMN continues to be operated and sustained by the community partner, serving as a community resource used by residents, schools, researchers, and others to better understand and address air pollution and its impacts on community health, while strengthening the ability of the community to prepare for, respond to, and recover from harmful air pollution.
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Poluentes Atmosféricos/análise , Poluição do Ar/estatística & dados numéricos , Monitoramento Ambiental/métodos , Material Particulado/análise , Poluição do Ar/análise , California , Participação da Comunidade , Pesquisa Participativa Baseada na Comunidade , Humanos , MéxicoRESUMO
Abstract We present the case of an adult with an extensive left frontal meningioma. He was scheduled for resection by craniotomy. During the surgery we used the density spectral array (DSA) and asymmetry obtained from Bispectral Index VISTA Monitoring System Bilateral. We observed a power increase in low frequency (0.1-1 Hz) and alpha bands (8-12 Hz) in the left hemisphere, where the meningioma was located. In this case, DSA was useful during and after the surgery because it provided information about the hemisphere with maximum brain activity and its subsequent normalization, which may reflect the effectiveness of the surgery.
Resumen Presentamos el caso de un paciente adulto con diagnóstico de un meningioma extenso a nivel frontal izquierdo, que fue programado para exéresis mediante craneotomía. Durante la cirugía se utilizó la Matriz de Densidad Espectral (MDE) y la asimetría obtenida del Sistema de Monitorización VISTATM del Índice Biespectral Bilateral (BVMS). Se observó un aumento de potencia en las bandas de baja frecuencia (0.1-1Hz) y en las bandas alfa (812 Hz) del hemisferio cerebral izquierdo, donde se encontraba el meningioma. En este caso la MDE demostró su utilidad durante y después de la cirugía, al proporcionar información sobre el hemisferio con registro de máxima actividad cerebral y su posterior normalización, reflejando así la efectividad de la cirugía.
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Humanos , Masculino , Idoso de 80 Anos ou mais , Cuidados Pós-Operatórios , Craniotomia , Meningioma , Procedimentos Neurocirúrgicos , Eletroencefalografia , Monitores de ConsciênciaRESUMO
ABSTRACT BACKGROUND: Bispectral index (BIS) monitoring can positively affect cognitive performance through decreasing the use of sedative agents. We aimed to evaluate the effect of BIS monitoring on early cognitive performance among patients undergoing sedation for colonoscopy. DESIGN AND SETTING: Randomized, controlled trial in a university hospital. METHODS: 100 patients were randomized into two groups. In the monitored group (n = 50), the depth of anesthesia was monitored using the BIS, and BIS scores were maintained between 60 and 80. In the usual care group (n = 50), BIS monitoring was not performed. To determine the patients' baseline cognitive performance levels, the mini-mental state examination (MMSE), Trieger dot test (TDT) and clock drawing test (CDT) were used. The patients' post-procedure cognitive performance levels were determined when they were classified as ready for discharge. RESULTS: The total volume (mg) of propofol used [median (range) IQR] in the sedation procedure was lower in the monitored group [100 (50-200) 100-140] than in the usual care group [150 (75-200) 100-200] (P < 0.001). The discharge scores [mean (SD)] using MMSE and CDT were higher in the monitored group [26 (3) and 3 (1), respectively] than in the usual care group [23 (3) and 2 (1), respectively] (P = 0.002 and P = 0.002, respectively). The discharge scores using TDT [mean (SD)] were lower in the monitored group [11 (7)] than in the usual care group [15 (11)] (P = 0.033). CONCLUSION: BIS monitoring among sedated patients was associated with lower propofol use and smaller decline in cognitive performance. CLINICAL TRIAL REGISTRATION: This trial was registered in the Australian New Zealand Clinical Trial Registry (ACTRN12617000134325).
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Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Midazolam/administração & dosagem , Propofol/administração & dosagem , Colonoscopia/métodos , Cognição/efeitos dos fármacos , Hipnóticos e Sedativos/administração & dosagem , Monitorização Fisiológica/métodos , Período de Recuperação da Anestesia , Satisfação do Paciente , EletroencefalografiaRESUMO
Abstract Introduction: Intravenous general anesthesia is an anesthetic technique that can be administered with TCI (target-controlled infusion) or closed-loop systems. The authors designed an automatic delivery system using clinical variables such as bispectral index (BIS), heart rate, and blood pressure. Objective: To evaluate the clinical and technical performance of this controller by comparing it to a TCI system. Methods: This was a single-blind, randomized, controlled clinical trial in which 150 patients were recruited: 75 for the TCI group and 75 for the closed loop with BIS. Clinical performance was determined according to the mean percentage of time spent in the BIS range of 40 to 60 during anesthetic maintenance. In addition, adequate intraoperative analgesia, technical performance, intraoperative awakening, and intraoperative recall were evaluated. Results: The primary outcome showed a mean BIS time between 40 and 60 for the closed loop of 75.24% (± 15.78) versus 59.5% (± 20.3) for the TCI system, with an absolute difference of 15.8%, 95% confidence interval (CI): 9.9 to 21.65, P < 0.0001. The mean time in intraoperative analgesia was 82.4% (25.1) in closed loop and 70.77% (± 32.8) in TCI, with a difference of 4.76 (95% CI: 2.23-21.06), P = 0.016. There was no difference in intraoperative recall. Conclusion: The closed-loop system was better at maintaining a BIS in the range of 40 to 60 during a general anesthetic than the open system or TCI.
Resumen Introducción: La anestesia total endovenosa es una técnica anestésica que puede administrarse con sistemas de TCI (Target Controlled Infusión) o de lazo cerrado. Los autores diseñaron un sistema de administración automática empleando variables clínicas como índice biespectral (BIS), frecuencia cardiaca y presión arterial. Objetivo: Evaluar el desempeño clínico y técnico de este controlador, comparándolo con un sistema de TCI. Métodos: Este fue un ensayo clínico controlado, aleatorizado y de ciego único, en el cual se reclutaron 150 pacientes: 75 en el grupo de TCI y 75 en lazo cerrado con BIS. El desempeño clínico fue determinado de acuerdo al porcentaje promedio de tiempo de permanencia en el rango de BIS entre 40-60 durante el mantenimiento anestésico. Adicionalmente se evaluó analgesia intraoperatoria adecuada, desempeño técnico, despertar intraoperatorio y recuerdo intraoperatorio. Resultados: Para el desenlace primario se encontró un tiempo promedio de BIS entre 40-60 para el lazo cerrado de un 75.24% (+/-15.78) vs. 59.5% (+/- 20.3) para el sistema TCI, con una diferencia del 15.8%, IC del 95%: 9.9 a 21.65, p < 0.0001. El promedio de tiempo en analgesia intraoperatoria adecuada fue del 82.4% (25.1) en lazo cerrado y 70.77% (+/- 32.8) en TCI, con una diferencia de 4.76 (IC del 95%: 2.23 a 21.06), p=0.016. No hubo diferencias en recuerdo intraoperatorio. Conclusión: El sistema de lazo cerrado fue mejor para mantener un BIS en rango de 40-60 durante un acto anestésico que el sistema abierto o TCI.
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Humanos , Masculino , Feminino , Gravidez , Adulto , Pessoa de Meia-Idade , Anestésicos Intravenosos , Propofol , Ensaio Clínico Controlado , Monitores de Consciência , Analgesia , Anestesia Geral , AnestésicosRESUMO
ABSTRACT Objective: To measure the magnitude of the effect of an individualized parameterization protocol for hemodynamic alarms in patients with acute myocardial infarction. Method: Pragmatic clinical trial, open label and single arm, whose intervention was performed through a protocol validated and tested in 32 patients using multiparametric monitors. The heart rate, blood pressure, respiratory rate, oxygen saturation and ST segment-monitoring were measured and classified for clinical consistency one hour before and after the intervention, for 64 hours. Results: The protocol obtained Content Validity Index of 0.92. Of the 460 registered alarms, 261 were considered inconsistent before the intervention and 47 after it. The Relative Risk of inconsistent alarms after the protocol was 0.32 (95% CI 0.23-0.43, p <0.0001). Conclusion: The protocol proved to be a protective factor to the appearance of inconsistent clinical alarms of multiparametric monitors.
RESUMEN Objetivo: Medir la magnitud del efecto de un protocolo de parametrización individualizada de alarmas hemodinámicas en pacientes con infarto agudo de miocardio. Método: Ensayo clínico pragmático, open label y single arm cuya intervención ocurrió por medio de un protocolo validado y testado en 32 pacientes, utilizándose monitores multiparamétricos. Las alarmas de frecuencia cardíaca, presión arterial, frecuencia respiratoria, saturación de oxígeno y segmento ST fueron valorados y clasificados según su consistencia clínica, una hora antes y después de la intervención, durante 64 horas. Resultados: El protocolo obtuvo un índice de Validez de Contenido de 0,92. De las 460 alarmas registradas, 261 fueron consideradas inconsistentes antes de la intervención y 47 después. El Riesgo Relativo de las alarmas incoherentes después del protocolo fue de 0,32 (IC 95% 0.23-0.43, p <0,0001). Conclusión: El protocolo se mostró un factor protector al surgimiento de alarmas clínicas inconsistentes de monitores multiparamétricos.
RESUMO Objetivo: Medir a magnitude do efeito de um protocolo de parametrização individualizada de alarmes hemodinâmicos em pacientes com infarto agudo do miocárdio. Método: Ensaio clínico pragmático, open label e single arm, cuja intervenção ocorreu por meio de um protocolo validado e testado em 32 pacientes usando monitores multiparamétricos. Os alarmes de frequência cardíaca, pressão arterial, frequência respiratória, saturação de oxigênio e segmento ST foram mensurados e classificados quanto à consistência clínica uma hora antes e após a intervenção, durante 64 horas. Resultados: O protocolo obteve Índice de Validade de Conteúdo de 0,92. Dos 460 alarmes registrados, 261 foram considerados inconsistentes antes da intervenção e 47 após. O Risco Relativo de alarmes inconsistentes após o protocolo foi de 0,32 (IC 95% 0.23-0.43, p<0,0001). Conclusão: O protocolo mostrou-se um fator protetor ao surgimento de alarmes clínicos inconsistentes de monitores multiparamétricos.
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Humanos , Masculino , Feminino , Idoso , Monitorização Fisiológica/enfermagem , Infarto do Miocárdio/enfermagem , Pressão Sanguínea/fisiologia , Eletrocardiografia/enfermagem , Eletrocardiografia/normas , Alarmes Clínicos , Frequência Cardíaca/fisiologia , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Pessoa de Meia-Idade , Monitorização Fisiológica/normasRESUMO
INTRODUCTION: Main cardiovascular parameters such as heart rate (HR), blood pressure, and myocardial oxygen consumption (MOC) are tightly regulated by a multifactorial, nonlinear control system. Increased HR because of physical activity is often accompanied by an increase in blood pressure. Postural changes have an effect on the baroreceptors, and stretching exercises and isometric contractions modulate muscle mechanoreceptors eliciting increases in blood pressure. However, a hot environment increases the core temperature inducing vasodilation and plasma volume changes that might contribute to a drop in blood pressure. During the practice of Bikram yoga, all these factors converge and little is known about the resulting changes in blood pressure and MOC. METHODS: Sixteen apparently healthy female volunteers, regular practitioners of Bikram yoga, were evaluated during a 90 min session. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured immediately after each posture and HR was measured continuously during the practice. RESULTS: HR and estimated MOC increased significantly over baseline during the exercise (+62.3% and +63.6%, respectively). HR mean value across the entire Bikram yoga session was 126.6 ± 14.3 bpm reaching a maximum of 168.1 ± 20.2 bpm. SBP was not significantly increased over baseline at any time during the practice with a mean value of 117.0 ± 10.1 mmHg and DBP was significantly decreased over baseline most of the time (-10.1%, mean 71.2 ± 7.3 mmHg) with particular decline toward the end of the practice during the floor postures. CONCLUSIONS: DBP during the practice of Bikram yoga was significantly different from that previously reported for nonheated Hatha yoga for normotensive subjects. Further studies evaluating the same group at both conditions are needed to better characterize the magnitude of the changes in HR, SBP, DBP, and MOC.
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Pressão Sanguínea/fisiologia , Frequência Cardíaca/fisiologia , Yoga , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Projetos Piloto , VasodilataçãoRESUMO
Hemodynamic and depth of anesthesia (DOA) monitoring are used in many high-risk surgical patients without well-defined indications and objectives. We implemented monitoring guidelines to rationalize hemodynamic and anesthesia management during major cancer surgery. In early 2014, we developed guidelines with specific targets (Mean arterial pressure > 65 mmHg, stroke volume variation < 12%, cardiac index > 2.5 l min-1 m-2, central venous oxygen saturation > 70%, 40 < bispectral index < 60) for open abdominal cancer surgeries > 2 h. Pre-, intra-, and post-operative data were collected from our electronic medical record database and compared before (March-August 2013) and after (March-August 2014) guideline implementation. A total of 596 patients were studied, 313 before (Before group) and 283 after (After group) guideline implementation. The two groups were comparable for age, ASA score, physiological P-POSSUM score, and surgery duration, but the operative P-POSSUM score was higher in the after group (20 vs. 18, p = 0.009). The use of cardiac output, central venous oxygen saturation and DOA monitoring increased from 40 to 61%, 20 to 29%, and 60 to 88%, respectively (all p-values < 0.05). Intraoperative fluid volumes decreased (16.0 vs. 14.5 ml kg-1 h-1, p = 0.002), whereas the use of inotropes increased (6 vs. 11%, p = 0.022). Postoperative delirium (16 vs. 8%, p = 0.005), urinary tract infections (6 vs. 2%, p = 0.012) and median hospital length of stay (9.6 vs. 8.8 days, p = 0.032) decreased. In patients undergoing major open abdominal surgery for cancer, despite an increase in surgical risk, the implementation of guidelines with predefined targets for hemodynamic and DOA monitoring was associated with a significant improvement in postoperative outcome.
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Neoplasias Abdominais/cirurgia , Anestesia/métodos , Hemodinâmica , Monitorização Fisiológica/métodos , Neoplasias/cirurgia , Abdome/cirurgia , Idoso , Pressão Arterial , Débito Cardíaco , Estudos Controlados Antes e Depois , Feminino , Mortalidade Hospitalar , Humanos , Período Intraoperatório , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Período Perioperatório , Complicações Pós-Operatórias , Período Pós-Operatório , Estudos Retrospectivos , Risco , Volume Sistólico , Volume de Ventilação Pulmonar , Resultado do TratamentoRESUMO
ABSTRACT Objective: to compare blood pressure values obtained by auscultatory and oscillometric methods in different gestational periods, considering cuff width. Method: it is a cross-sectional and quasi-experimental study approved by the Research Ethics Committee. The sample consisted of 108 low-risk pregnant women. Blood pressure measurements were performed in gestational periods of 10-14, 19-22 and 27-30 weeks. Results: The oscillometric device presented values similar to the auscultatory method in systolic blood pressure, but overestimated diastolic blood pressure. Underestimation of blood pressure occurred when using the standard width cuff rather than the correct width cuff in both measuring methods. Conclusion: Verification of brachial circumference and use of adequate cuffs in both methods are indispensable to obtain reliable blood pressure values in pregnant women. We recommend performance of additional studies to evaluate diastolic blood pressure overestimation by the Microlife 3BTO-A.
RESUMEN Objetivo: Comparar los valores de presión arterial obtenidos por los métodos auscultatorio e oscilométrico en distintos períodos del embarazo, en función del ancho del manguito. Método: Se trata de un estudio transversal y cuasiexperimental aprobado por el Comité de Ética en Investigación. Se analizó una muestra compuesta por 108 embarazadas de bajo riesgo. Las medidas de presión arterial se obtuvieron en los períodos gestacionales de 10-14, 19-22 y 27-30 semanas. Resultados: El aparato oscilométrico presentó valores similares al método auscultatorio en la presión arterial sistólica, sin embargo sobreestimó la presión arterial diastólica. Hubo subestimación de la presión arterial al utilizar el manguito de anchura estándar en lugar del manguito de anchura adecuada, en los dos métodos de medida. Conclusión: La verificación de la circunferencia braquial y el uso de manguitos adecuados en los dos métodos son indispensables para obtener valores confiables de la presión arterial en embarazadas. Recomendamos que se realicen nuevos estudios para evaluar la sobreestimación de la presión arterial diastólica por el aparato Microlife 3BTO-A.
RESUMO Objetivo: Comparar os valores de pressão arterial, obtidos pelos métodos auscultatório e oscilométrico em diferentes períodos gestacionais, em função da largura do manguito. Método: Trata-se de um estudo transversal e quase-experimental aprovado pelo Comitê de Ética em Pesquisa. A amostra foi composta por 108 gestantes de baixo risco. As medidas de pressão arterial foram realizadas nos períodos gestacionais de 10-14, 19-22 e 27-30 semanas. Resultados: O aparelho oscilométrico apresentou valores similares ao método auscultatório na pressão arterial sistólica, porém superestimou a pressão arterial diastólica. Houve subestimação da pressão arterial ao utilizar o manguito de largura padrão ao invés do manguito de largura correta, nos dois métodos. Conclusão: A verificação da circunferência braquial e o uso de manguitos adequados nos dois métodos são indispensáveis para obter valores confiáveis da pressão arterial em gestantes. Recomendamos que novos estudos sejam realizados para avaliar a superestimação da pressão arterial diastólica pelo aparelho Microlife 3BTO-A.
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Humanos , Feminino , Gravidez , Adulto , Oscilometria/instrumentação , Determinação da Pressão Arterial/instrumentação , Gestantes , Oscilometria/métodos , Oscilometria/normas , Auscultação/instrumentação , Auscultação/métodos , Determinação da Pressão Arterial/métodos , Determinação da Pressão Arterial/normas , Estudos Transversais , Idade Gestacional , Pessoa de Meia-IdadeRESUMO
Resumen OBJETIVO: definir el tamaño de muestra necesario para evaluar la intercambiabilidad entre el método por auscultación y por dispositivo electrónico automático de la presión arterial media en mujeres embarazadas sin hipertensión. MATERIALES Y MÉTODOS: estudio piloto, observacional, efectuado en mujeres embarazadas sin hipertensión. La medición estandarizada de la presión arterial se efectuó por los dos métodos en ambos brazos y se calculó el coeficiente de correlación entre las presiones arteriales medias combinadas; el IC95% inferior se utilizó para el cálculo necesario de la muestra final. RESULTADOS: se estudiaron 30 pacientes en quienes la correlación entre métodos tuvo una r = 0.557 (IC95% 0.246; 0.763, p = 0.001 y r2 = 0.3097). CONCLUSIONES: la correlación entre métodos, aunque estadísticamente significativa, podría ser clínicamente inaceptable para fines de intercambiabilidad. Para probarlo se requiere un tamaño de muestra con n = 127.
Abstract OBJECTIVE: To define the sample size needed to evaluate exchangeability between the auscultation method and the automated electronic device for MAP measurement in pregnancies without hypertension. MATERIALS AND METHODS: A standardized blood pressure measurement on both arms, and by both methods was performed on 30 pregnancies without hypertension; the combined MAP correlation coefficient was calculated, using the lower CI95% for final sample size needed. RESULTS: Correlation between methods was r = 0.557 (CI95% = 0.246; 0.763, p = 0.001 and r2 = 0.3097). CONCLUSIONS: The statistically significant correlation between methods could be clinically unacceptable for exchangeability; a sample size of n = 127 is needed to prove it.
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Assessing physical activity (PA) in manual wheelchair users (MWUs) is challenging because of their different movement patterns in comparison to the ambulatory population. The aim of this review was to investigate the validity of portable monitors in quantifying PA in MWUs. A systematic literature search was performed. The data source was full reports of validation and evaluation studies in peer-reviewed journals and conference proceedings. Eligible articles between January 1, 1999, and September 18, 2015, were identified in three databases: PubMed, Institute of Electrical and Electronics Engineers, and Scopus. A total of 164 articles (158 from the databases and 6 from the citation/reference tracking) were identified, and 29 met the eligibility criteria. Two investigators independently extracted the characteristics from each selected article following a predetermined protocol and completed seven summary tables describing the study characteristics and key outcomes. In the identified studies, the monitors were used to assess three types of PA measures: energy cost, user movement, and wheelchair movement. The customized algorithms/monitors did not estimate energy cost in MWUs as well as the commercial monitors did in the ambulatory population; however, they showed fair accuracy in measuring both wheelchair and user movements.
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Exercício Físico , Monitorização Ambulatorial/instrumentação , Movimento , Cadeiras de Rodas , Algoritmos , Pessoas com Deficiência , Metabolismo Energético , HumanosRESUMO
Las técnicas de control de riesgo, actualmente disponibles, no satisfacen la inmediatez necesaria para la vigilancia de los efectos, de los frecuentes fallos de equipos y errores humanos asociados a las prácticas de radioterapia. La metodología propuesta, en el artículo, integra las bases de datos sobre las secuencias accidentales posibles en prácticas médicas, con empleo de radiaciones ionizantes, con una herramienta desarrollada para la actualización dinámica del riesgo, en condiciones operacionales variables. Un resultado inmediato del análisis es el conocimiento de los nuevos escenarios de peligro en los que se trabaja, bajo cualquier combinación de indisponibilidades de contribuyentes al riesgo, el que se basa en múltiples capacidades de estudios detallados y mímicos de procesos y de secuencias accidentales. Estas capacidades garantizan el monitoreo dinámico del riesgo para cualquier estado de los escenarios de estudio.
The techniques of risk control at the moment available they don't satisfy the necessary speed to the surveillance of the effects from the equipment failures and human errors during practical of radiotherapy. The methodology proposed in this paper integrates databases on possible accident sequences in medical practices using ionizing radiation with a tool for dynamic updating of operational conditions risk variables. An immediate result of the analysis is the knowledge of the new scenarios of danger, under any combination of unavailability to the risk, based on multiple study capacities and mimics for the processes and sequences. These capacities guarantee the instantaneous risk monitoring for any state of the studied scenarios.