RESUMO
BACKGROUND: Intracranial pressure (ICP) monitoring plays a key role in patients with traumatic brain injury (TBI), however, cerebral hypoxia can occur without intracranial hypertension. Aiming to improve neuroprotection in these patients, a possible alternative is the association of Brain Tissue Oxygen Pressure (PbtO2) monitoring, used to detect PbtO2 tension. METHOD: We systematically searched PubMed, Embase and Cochrane Central for RCTs comparing combined PbtO2 + ICP monitoring with ICP monitoring alone in patients with severe or moderate TBI. The outcomes analyzed were mortality at 6 months, favorable outcome (GOS ≥ 4 or GOSE ≥ 5) at 6 months, pulmonary events, cardiovascular events and sepsis rate. RESULTS: We included 4 RCTs in the analysis, totaling 505 patients. Combined PbtO2 + ICP monitoring was used in 241 (47.72%) patients. There was no significant difference between the groups in relation to favorable outcome at 6 months (RR 1.17; 95% CI 0.95-1.43; p = 0.134; I2 = 0%), mortality at 6 months (RR 0.82; 95% CI 0.57-1.18; p = 0.281; I2 = 34%), cardiovascular events (RR 1.75; 95% CI 0.86-3.52; p = 0.120; I2 = 0%) or sepsis (RR 0.75; 95% CI 0.25-2.22; p = 0.604; I2 = 0%). The risk of pulmonary events was significantly higher in the group with combined PbtO2 + ICP monitoring (RR 1.44; 95% CI 1.11-1.87; p = 0.006; I2 = 0%). CONCLUSIONS: Our findings suggest that combined PbtO2 + ICP monitoring does not change outcomes such as mortality, functional recovery, cardiovascular events or sepsis. Furthermore, we found a higher risk of pulmonary events in patients undergoing combined monitoring.
Assuntos
Lesões Encefálicas Traumáticas , Pressão Intracraniana , Ensaios Clínicos Controlados Aleatórios como Assunto , Humanos , Encéfalo/fisiopatologia , Lesões Encefálicas Traumáticas/mortalidade , Lesões Encefálicas Traumáticas/terapia , Lesões Encefálicas Traumáticas/fisiopatologia , Hipertensão Intracraniana/etiologia , Hipertensão Intracraniana/diagnóstico , Pressão Intracraniana/fisiologia , Monitorização Fisiológica/métodos , Monitorização Neurofisiológica/métodos , Oxigênio/análise , Oxigênio/metabolismoRESUMO
Monitoring intracranial pressure (ICP) is pivotal in the management of severe traumatic brain injury (TBI), but secondary brain injuries can arise despite normal ICP levels. Cerebral tissue oxygenation monitoring (PbtO2) may detect neuronal tissue infarction thresholds, enhancing neuroprotection. We performed a systematic review and meta-analysis to evaluate the effects of combined cerebral tissue oxygenation (PbtO2) and ICP compared to isolated ICP monitoring in patients with TBI. PubMed, Embase, Cochrane, and Web of Sciences databases were searched for trials published up to June 2023. A total of 16 studies comprising 37,820 patients were included. ICP monitoring was universal, with additional placement of PbtO2 in 2222 individuals (5.8%). The meta-analysis revealed a reduction in mortality (OR 0.57, 95% CI 0.37-0.89, p = 0.01), a greater likelihood of favorable outcomes (OR 2.28, 95% CI 1.66-3.14, p < 0.01), and a lower chance of poor outcomes (OR 0.51, 95% CI 0.34-0.79, p < 0.01) at 6 months for the PbtO2 plus ICP group. However, these patients experienced a longer length of hospital stay (MD 2.35, 95% CI 0.50-4.20, p = 0.01). No significant difference was found in hospital mortality rates (OR 0.81, 95% CI 0.61-1.08, p = 0.16) or intensive care unit length of stay (MD 2.46, 95% CI - 0.11-5.04, p = 0.06). The integration of PbtO2 to ICP monitoring improved mortality outcomes and functional recovery at 6 months in patients with TBI. PROSPERO (International Prospective Register of Systematic Reviews) CRD42022383937; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=383937.
Assuntos
Lesões Encefálicas Traumáticas , Pressão Intracraniana , Humanos , Lesões Encefálicas Traumáticas/terapia , Lesões Encefálicas Traumáticas/mortalidade , Lesões Encefálicas Traumáticas/fisiopatologia , Pressão Intracraniana/fisiologia , Monitorização Neurofisiológica/métodos , Oxigênio/metabolismo , Oxigênio/sangue , Encéfalo/metabolismo , Encéfalo/fisiopatologia , Monitorização Fisiológica/métodosRESUMO
BACKGROUND: High electrode temperature during transcutaneous monitoring is associated with skin burns in extremely premature infants. We evaluated the accuracy and precision of CO2 and O2 measurements using lower transcutaneous electrode temperatures below 42°C. METHODS: We enrolled 20 neonates. Two transcutaneous monitors were placed simultaneously on each neonate, with one electrode maintained at 42°C and the other randomized to temperatures of 38, 39, 40, 41, and 42°C. Arterial blood was collected twice at each temperature. RESULTS: At the time of arterial blood sampling, values for transcutaneously measured partial pressure of CO2 (PtcCO2 ) were not significantly different among test temperatures. There was no evidence of skin burning at any temperature. For PtcCO2 , Bland-Altman analyses of all test temperatures versus 42°C showed good precision and low bias. Transcutaneously measured partial pressure of O2 (PtcO2 ) values trended arterial values but had large negative bias. CONCLUSION: Transcutaneous electrode temperatures as low as 38°C allow an assessment of PtcCO2 as accurate as that with electrodes at 42°C.
Assuntos
Monitorização Transcutânea dos Gases Sanguíneos/instrumentação , Eletrodos , Recém-Nascido Prematuro , Temperatura , Monitorização Transcutânea dos Gases Sanguíneos/métodos , Feminino , Humanos , Recém-Nascido , MasculinoRESUMO
ABSTRACT Oligonychus ilicis (McGregor, 1917), is one of the main phytophagous mites of the coffee plant ( Coffea spp.), although it is not reported among the primary pests. They live on the upper surface of the leaves, puncturing the epidermis and mesophyll cells to absorb and feed on the extravasated cellular content. In consequence, the leaves lose their natural shine and become tan. The objective of this work was to quantify the photosynthetic rate of coffee-plant leaves presenting different infestation levels of O. ilicis. The study was carried out in potted three-year-old coffee plants ( Coffea arabica L., Catuaí cultivar), kept in a greenhouse. Infestations were accomplished at five different levels (0, 15, 30, 60 and 120 adult mite females/leaf), with mites coming from a stock rearing, on leaves of the third pair starting from the apex and totally expanded, located in branches from the middle third of the plant, with five repetitions. The potential photosynthesis was measured through the photosynthetic oxygen produced, using an oxygen monitor with a Clark type electrode coupled to a CB1 electric flow control box. The evaluations were made 7 and 21 days after the infestation with the mites, and the data obtained were submitted to regression analysis. There was a negative correlation between levels of infestation and potential photosynthesis, whereas at levels 15, 30, 60 and 120 mites/leaf, the photosynthetic rates were reduced in relation to the control treatment, in 37.2, 38.7; 46.0 and 50.1% respectively.
RESUMO Oligonychus ilicis (McGregor, 1917) é um dos principais ácaros fitófagos do cafeeiro ( Coffea spp.), embora não esteja relacionado entre as pragas primárias. Esses ácaros vivem na superfície superior das folhas e, para se alimentar, perfuram as células da epiderme e do mesófilo e absorvem o conteúdo celular extravasado. Em consequência, as folhas perdem o brilho natural e tornam-se bronzeadas. O objetivo deste trabalho foi quantificar a taxa de fotossíntese de folhas de cafeeiro apresentando diferentes níveis de infestação de O. ilicis. O estudo foi realizado em plantas de cafeeiro (Coffea arabica L., cultivar Catuaí) envasadas e com três anos de idade, mantidas em casa de vegetação. Foram realizadas infestações em cinco diferentes níveis (0, 15, 30, 60 e 120 fêmeas adultas do ácaro/folha), com ácaros provenientes da criação de manutenção, em folhas do terceiro par, a partir do ápice e totalmente expandidas, localizadas em ramos do terço médio da planta, com cinco repetições. A medição da fotossíntese potencial foi realizada por meio do oxigênio fotossintético produzido, utilizando-se de um monitor de oxigênio com eletrodo tipo Clark acoplado a uma caixa de controle de fluxo elétrico CB1. As avaliações foram realizadas 7 e 21 dias após a infestação com os ácaros, e os dados obtidos foram submetidos a uma análise de regressão. Houve correlação negativa entre os diferentes níveis de infestação e a fotossíntese potencial, sendo que, nos níveis 15, 30, 60 e 120 ácaros/folha, as taxas de fotossíntese foram reduzidas, em relação ao tratamento-testemunha, em 37,2; 38,7; 46,0 e 50,1%, respectivamente.