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BACKGROUND: Congestion is central to the pathophysiology of heart failure (HF); thus, tracking congestion is crucial for the management of patients with HF. In this study we aimed to compare changes in inferior vena cava diameter (IVCD) with venous pressure following manipulation of volume status during ultrafiltration in patients with cardiac dysfunction. METHODS AND RESULTS: Patients with stable hemodialysis and with systolic or diastolic dysfunction were studied. Central venous pressure (CVP) and peripheral venous pressure (PVP) were measured before and after hemodialysis. IVCD and PVP were measured simultaneously just before dialysis, 3 times during dialysis and immediately after dialysis. Changes in IVCD and PVP were compared at each timepoint with ultrafiltration volumes. We analyzed 30 hemodialysis sessions from 20 patients. PVP was validated as a surrogate for CVP. Mean ultrafiltration volume was 2102 ± 667 mL. IVCD discriminated better ultrafiltration volumes ≤ 500 mL or ≤ 750 mL than PVP (AUC 0.80 vs 0.62, and 0.80 vs 0.56, respectively; both P< 0.01). IVCD appeared to track better ultrafiltration volume (P< 0.01) and hemoconcentration (P< 0.05) than PVP. Changes in IVCD were of greater magnitude than those of PVP (average change from predialysis: -58 ± 30% vs -28 ± 21%; P< 0.001). CONCLUSIONS: In patients undergoing ultrafiltration, changes in IVCD tracked changes in volume status better than venous pressure.

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Pressão Central, como o nome indica, é uma medida hemodinâmica semelhante a pressão arterial convencional porém avaliada de forma indireta por equipamento especifico, que avalia estes parâmetros na saída do sangue na raiz da aorta. Esta medida tem uma maior confiabilidade pois prediz de forma mais acurada os riscos de adoecimento e morte cardiovascular. Isto ocorre, pois a a onda de pulso (OP) ao percorrer os trajetos arteriais sofrem ampliações e importantes modificações no seu contorno deformando o valor original. Embora seja mais precisa em valores, ainda não é usado de rotina na pratica clinica por razoes de custos dos seus equipamentos e provavelmente por exigir habilidades maiores que as medidas captadas pelo equipamentos de mensuração periférica

Central pressure, as the name implies, is a hemodynamic measure similar to conventional blood pressure, but indirectly assessed by specific equipment, which evaluates these parameters at the blood outlet at the root of the aorta. This measure has greater confidence because it more accurately predicts the risks of cardiovascular disease and death. This occurs because the pulse wave (OP) when traversing the arterial paths provides enlargements and modifications in its contour, deforming the original value. Although it is more precise in terms of values, it is not yet routinely used in clinical practice for reasons of the cost of its equipment and probably because it requires greater needs than measures captured by peripheral measurement equipment

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The objective of this study was to calculate the collapsibility index (CI) in a group of 15 healthy adult mixed breed cats via right hepatic intercostal ultrasound view. The minimal and the maximal diameters of the caudal vena cava (CVC) were obtained during inspiration and expiration, respectively, then CI was calculated. The mean diameter of the CVC was 0.5cm. The mean CI was 28±3% and CI was not significantly associated with gender. As in human medicine, there is a growing need for less invasive monitoring in small animal practice. The CI enables the assessment of estimated volemia without the need for a central venous catheter. This is the first reported study investigating CI in cats.(AU)

O objetivo deste estudo foi calcular o índice de colapsabilidade (IC) em um grupo de 15 gatos adultos, saudáveis e SRD, por meio da janela ultrassonográfica hepática intercostal direita. Os diâmetros mínimo e máximo da veia cava caudal (VCC) foram obtidos durante a inspiração e a expiração, respectivamente. O IC foi calculado, posteriormente. O diâmetro médio da VCC foi de 0,5cm. O diâmetro médio do IC foi de 28±3%, e o IC não foi significativamente associado ao gênero. Como na medicina humana, há uma necessidade crescente de monitoramento menos invasivo na prática de pequenos animais. O IC possibilita a avaliação da volemia estimada sem a necessidade de um cateter venoso central. Este é o primeiro estudo relatado sobre IC em gatos domésticos.(AU)

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The objective of this study was to calculate the collapsibility index (CI) in a group of 15 healthy adult mixed breed cats via right hepatic intercostal ultrasound view. The minimal and the maximal diameters of the caudal vena cava (CVC) were obtained during inspiration and expiration, respectively, then CI was calculated. The mean diameter of the CVC was 0.5cm. The mean CI was 28±3% and CI was not significantly associated with gender. As in human medicine, there is a growing need for less invasive monitoring in small animal practice. The CI enables the assessment of estimated volemia without the need for a central venous catheter. This is the first reported study investigating CI in cats.(AU)

O objetivo deste estudo foi calcular o índice de colapsabilidade (IC) em um grupo de 15 gatos adultos, saudáveis e SRD, por meio da janela ultrassonográfica hepática intercostal direita. Os diâmetros mínimo e máximo da veia cava caudal (VCC) foram obtidos durante a inspiração e a expiração, respectivamente. O IC foi calculado, posteriormente. O diâmetro médio da VCC foi de 0,5cm. O diâmetro médio do IC foi de 28±3%, e o IC não foi significativamente associado ao gênero. Como na medicina humana, há uma necessidade crescente de monitoramento menos invasivo na prática de pequenos animais. O IC possibilita a avaliação da volemia estimada sem a necessidade de um cateter venoso central. Este é o primeiro estudo relatado sobre IC em gatos domésticos.(AU)

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BACKGROUND: The spontaneous breathing trial (SBT) assesses the risk of weaning failure by evaluating some physiological responses to the massive venous return increase imposed by discontinuing positive pressure ventilation. This trial can be very demanding for some critically ill patients, inducing excessive physical and cardiovascular stress, including muscle fatigue, heart ischemia and eventually cardiac dysfunction. Extubation failure with emergency reintubation is a serious adverse consequence of a failed weaning process. Some data suggest that as many as 50% of patients that fail weaning do so because of cardiac dysfunction. Unfortunately, monitoring cardiovascular function at the time of the SBT is complex. The aim of our study was to explore if central venous pressure (CVP) changes were related to weaning failure after starting an SBT. We hypothesized that an early rise on CVP could signal a cardiac failure when handling a massive increase on venous return following a discontinuation of positive pressure ventilation. This CVP rise could identify a subset of patients at high risk for extubation failure. METHODS: Two-hundred and four mechanically ventilated patients in whom an SBT was decided were subjected to a monitoring protocol that included blinded assessment of CVP at baseline, and at 2 minutes after starting the trial (CVP-test). Weaning failure was defined as reintubation within 48-hours following extubation. Comparisons between two parametric or non-parametric variables were performed with student T test or Mann Whitney U test, respectively. A logistic multivariate regression was performed to determine the predictive value on extubation failure of usual clinical variables and CVP at 2-min after starting the SBT. RESULTS: One-hundred and sixty-five patients were extubated after the SBT, 11 of whom were reintubated within 48h. Absolute CVP values at 2-minutes, and the change from baseline (dCVP) were significantly higher in patients with extubation failure as compared to those successfully weaned. dCVP was an early predictor for reintubation (OR: 1.70 [1.31,2.19], p<0.001). CONCLUSIONS: An early rise in CVP after starting an SBT was associated with an increased risk of extubation failure. This might represent a warning signal not captured by usual SBT monitoring and could have relevant clinical implications.

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BACKGROUND: The latest World Society of the Abdominal Compartment (WSACS) guideline published in 2013 states that risk factors are the most reliable predictors for the diagnosis of intra-abdominal hypertension (IAH) and the bottom line to guide propaedeutic and clinical practice. The objective of this study is to search for clinical, laboratory, and ventilator-associated factors in order to warn medical staff for prompt IAH diagnosis in septic shock patients beyond risk factors simply. METHODS: This is a prospective, observational study, involving all admitted intensive care unit septic shock patients of a single teaching hospital between April and October 2016. All enrolled patients met Sepsis III and Surviving Sepsis Campaign diagnostic criteria. Patients with primary abdominal conditions were excluded, in order to avoid possible bias. Intra-abdominal pressure (IAP) was measured every 6 hours in accordance with WSACS guidelines. RESULTS: 25 sequential patients were included and followed for 10 days after admission. Median age was 51.13 ± 16.52 years old, 64% male. Pulmonary infection was the most frequent etiology of sepsis, representing 76% of the cases. Elevated IAP correlated with higher central venous pressure (CVP) (P = 0.0421); positive end-expiratory pressure (PEEP) (P = 0.0056); elevated airway pressure (P = 0.0015); accumulated fluid balance (P = 0.0273), and elevated SOFA (P = 0.0393) in all septic patients. Reduction of acidosis (P = 0.0096) and increase of serum bicarbonate (P = 0.0247) correlated with lower IAP values. CONCLUSIONS: Elevated CVP, PEEP, SOFA, airway pressure and accumulated fluid balance are correlated with elevated IAP in septic shock patients. Acidosis correction appears to decrease the risk for IAH. Multicentric randomized studies are needed to confirm this hypothesis in a large population.

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Objetivos durante a punção venosa periférica, recomenda-se o uso de um garrote acima do local da punção para potencializar a distensão venosa. Dadas as suas características e o uso em ambientes clínicos, os garrotes podem representar uma fonte de disseminação de micro-organismos. Entretanto, os resultados de estudos científicos nessa área estão dispersos na literatura. Esta revisão de escopo tem como objetivo mapear as evidências disponíveis a respeito das práticas dos profissionais de saúde no que concerne ao uso do garrote durante a punção venosa periférica e à contaminação microbiológica associada. Método revisão de escopo de acordo com a metodologia do Instituto Joanna Briggs. Dois revisores independentes analisaram a relevância dos estudos, extraíram e sintetizaram dados. Resultados quinze estudos foram incluídos na revisão. Em geral, os garrotes foram reutilizados sem processos de descontaminação recorrentes. Verificou-se que os profissionais compartilham esses dispositivos entre si e os usaram continuamente por períodos entre duas semanas e sete anos e meio. Conclusão as práticas de enfermagem relacionadas ao uso do garrote durante a punção venosa periférica não são uniformes. A reutilização de garrotes pode colocar em risco a segurança do paciente se o reprocessamento (limpeza e desinfecção/esterilização) não for adequado, dado o tipo de material do garrote e a microbiota encontrada. Novos estudos são necessários para avaliar o impacto de vários tipos de práticas de reprocessamento na descontaminação de garrotes e na segurança do paciente.

Objectives during peripheral venipuncture, health professionals are recommended to use a tourniquet above the puncture site in order to potentiate venous distension. Given its characteristics and use in clinical settings, tourniquets may represent a source of microorganism dissemination. However, the results of scientific studies in this area are scattered in the literature. This scoping review aims to map the available evidence on health professionals' practices related with tourniquet use during peripheral venipuncture and associated microbiological contamination. Methods scoping review following the Joanna Briggs Institute methodology. Two independent reviewers analyzed the relevance of the studies, extracted and synthesized data. Results fifteen studies were included in the review. Overall, tourniquets were reused without being subject to recurring decontamination processes. It has been found that practitioners share these devices among themselves and use them successively for periods between two weeks and seven and half years. Conclusion nursing practices related to tourniquet use during peripheral venipuncture are not standard. Reuse of tourniquets may jeopardize the patient's safety if reprocessing (cleaning and disinfection/sterilization) is not adequate, given the type of tourniquet material and microbiota found. New studies are needed to assess the impact of various types of reprocessing practices on tourniquet decontamination and patient safety.

Objetivos durante la punción venosa periférica, se recomienda el uso de un garrote arriba del sitio de la punción para potenciar la distensión venosa. Dadas sus características y uso en ambientes clínicos, los garrotes pueden representar una fuente de diseminación de microorganismos. Sin embargo, los resultados de estudios científicos en esta área están dispersos en la literatura. Esta revisión de alcance tiene como objetivo mapear las evidencias disponibles acerca de las prácticas de los profesionales de salud en lo que concierne al uso del garrote durante la punción venosa periférica y la contaminación microbiológica asociada. Método revisión de alcance de acuerdo con la metodología del Instituto Joanna Briggs. Dos revisores independientes analizaron la relevancia de los estudios, extrajeron y sintetizaron datos. Resultados quince estudios se incluyeron en la revisión. En general, los garrotes fueron reutilizados sin procesos de descontaminación recurrentes. Se verificó que los profesionales comparten estos dispositivos entre sí y los utilizaron continuamente por períodos entre dos semanas y siete años y medio. Conclusión las prácticas de enfermería relacionadas al uso del garrote durante la punción venosa periférica no son uniformes. La reutilización de garrotes puede poner en riesgo la seguridad del paciente si el reprocesamiento (limpieza y desinfección/esterilización) no es adecuado, dado el tipo de material del garrote y la microbiota encontrada. Nuevos estudios son necesarios para evaluar el impacto de varios tipos de prácticas de reprocesamiento en la descontaminación de garrotes y en la seguridad del paciente.

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We performed brain magnetic resonance imaging in 40 patients after the Fontan procedure and 40 control subjects. Pituitary volumes in patients after Fontan were significantly larger than those in the control subjects (472 [425-527] vs 257 [182-311]; P < .0001), and were significantly related to central venous pressure.

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Introducción: La disminución de la presión venosa central (PVC) a menos de 5mmHg ha sido recomendada para disminuir el sangrado durante la cirugía hepática. No se conoce el efecto de esto en el llenado ventricular e índice cardíaco (IC). Objetivo: Medir el efecto en el volumen de fin de diástole del ventrículo izquierdo indexado (VFDVII) e IC de la disminución a 3-4mmHg de la PVC. Método: Se estudiaron pacientes sometidos a cirugía general en los cuales se monitorizó presión arterial directa, PVC, y ecocardiografía transesofágica (ETE). Posterior a la inducción anestésica, y después de 5min de estabilidad hemodinámica, se midieron VFDVII e IC, los cuales se repitieron 5 min después de disminuir la PVC a 3-4 mmHg. Resultados: Se estudiaron 32 pacientes; 12 cumplían criterios de disfunción diastólica (DD). Los valores basales y posteriores a la reducción de la PVC de VFDVII e IC fueron respectivamente 49,4 ± 13 y 40,1 ±13 ml/m², y 2,8 ± 0,56 y 2,5 ± 0,7 l/m² (ambos p < 0,01). Todas las variaciones fueron mayores en los pacientes con DD. Conclusiones: La disminución de la PVC a los niveles recomendados para disminuir el sangrado produce una moderada pero significativa reducción del IC. Esto debe ser considerado en pacientes con condiciones que pudieran hacer más importante el efecto de la disminución de la PVC.

Introduction: The reduction of central venous pressure (CVP) below 5mmHg has been recommended to decrease bleeding during hepatic surgery. The effect of this practice on cardiac function has not been quantified. Objective: To measure the repercussion of the decrease of CVP on left ventricular end diastolic volume (LVEDV) and cardiac index (CI). Method: Patients undergoing general anaesthesia for major surgery were studied. Monitoring included direct arterial pressure, CVP, and transesophageal echocardiography (TEE). During a stable period of anaesthesia, all of these parameters were measured before and after lowering CVP to 3-4mmHg. Results: Thirty-two patients were studied. Twelve patients met TEE diagnostic criteria for diastolic dysfunction (DD). Basal and post CVP reduction values of LVEDVI and CI were 49.4 ± 13 and 40.1 ±13ml/m², 2.8±0.56 and 2.5±0.7l/m² respectively (both P< .01). All these variations were greater in patients with DD. Conclusions: Reduction of CVP produced a moderate but significant decrease in LVEDV and CI This should be considered in patients with conditions that may increase the effect of decreasing the CVP.

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BACKGROUND:: Atrial fibrillation (AF) takes place in 10-40% of patients undergoing coronary artery bypass grafting (CABG), and increases cardiovascular mortality. Enlargement of atrial chambers is associated with increased AF incidence, so patients with higher central venous pressure (CVP) are expected to have larger atrial distension, which increases AF incidence. OBJECTIVE:: To compare post-CABG AF incidence, following two CVP control strategies. METHODS:: Interventional, randomized, controlled clinical study. The sample comprised 140 patients undergoing CABG between 2011 and 2015. They were randomized into two groups, G15 and G20, with CVP maintained ≤ 15 cmH2O and ≤ 20 cmH2O, respectively. RESULTS:: 70 patients were included in each group. The AF incidence in G15 was 8.57%, and in G20, 22.86%, with absolute risk reduction of 14.28%, and number needed to treat (NNT) of 7 (p = 0.03). Mortality (G15 = 5.71%; G20 = 11.42%; p = 0.07), hospital length of stay (G15 = 7.14 days; G20 = 8.21 days; p = 0.36), number of grafts (median: G15 = 3, G2 = 2; p = 0.22) and cardiopulmonary bypass use (G15 = 67.10%; G20 = 55.70%; p = 0.22) were statistically similar. Age (p = 0.04) and hospital length of stay (p = 0.001) were significantly higher in patients who developed AF in both groups. CONCLUSION:: Keeping CVP low in the first 72 post-CABG hours reduces the relative risk of AF, and may be useful to prevent AF after CABG. FUNDAMENTO:: A fibrilação atrial (FA) ocorre em 10-40% dos pacientes submetidos a cirurgia de revascularização miocárdica (RM), e eleva a mortalidade cardiovascular. Como o aumento dos átrios está associado ao aumento da incidência de FA, espera-se que pacientes com pressão venosa central (PVC) mais alta tenham maior distensão atrial, o que eleva a incidência dessa arritmia. OBJETIVO:: Comparar a incidência de FA em pós-operatório de RM, seguindo duas estratégias de controle de PVC. MÉTODOS:: Estudo clínico randomizado controlado intervencionista. A amostra foi composta por 140 pacientes submetidos a RM entre 2011 e 2015. Os pacientes foram randomizados em dois grupos, G15 e G20, mantidos com PVC máxima de 15 cmH2O e 20 cmH2O, respectivamente. RESULTADOS:: Foram incluídos 70 pacientes em cada grupo. A incidência da arritmia em G15 foi de 8,57% e, no G20, de 22,86%, com redução de risco absoluto de 14,28% e número necessário para tratar (NNT) de 7 (p = 0,03). Mortalidade (G15 = 5,71%; G20 = 11,42%; p = 0,07), tempo de internamento (G15 = 7,14 dias; G20 = 8,21 dias; p = 0,36), número de enxertos (medianas: G15 = 3, G2 = 2; p = 0,22) e uso de circulação extracorpórea (G15 = 67,10%; G20 = 55,70%; p = 0,22) mostraram-se estatisticamente semelhantes. A idade (p = 0,04) e o tempo de internamento (p = 0,001) foram significativamente maiores nos pacientes que desenvolveram FA nos dois grupos. CONCLUSÃO:: Manter a PVC com valores mais baixos nas primeiras 72h após a cirurgia de RM reduz o risco relativo de FA e pode ser uma ferramenta útil na prevenção da FA após RM.

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Abstract Background: Atrial fibrillation (AF) takes place in 10-40% of patients undergoing coronary artery bypass grafting (CABG), and increases cardiovascular mortality. Enlargement of atrial chambers is associated with increased AF incidence, so patients with higher central venous pressure (CVP) are expected to have larger atrial distension, which increases AF incidence. Objective: To compare post-CABG AF incidence, following two CVP control strategies. Methods: Interventional, randomized, controlled clinical study. The sample comprised 140 patients undergoing CABG between 2011 and 2015. They were randomized into two groups, G15 and G20, with CVP maintained ≤ 15 cmH2O and ≤ 20 cmH2O, respectively. Results: 70 patients were included in each group. The AF incidence in G15 was 8.57%, and in G20, 22.86%, with absolute risk reduction of 14.28%, and number needed to treat (NNT) of 7 (p = 0.03). Mortality (G15 = 5.71%; G20 = 11.42%; p = 0.07), hospital length of stay (G15 = 7.14 days; G20 = 8.21 days; p = 0.36), number of grafts (median: G15 = 3, G2 = 2; p = 0.22) and cardiopulmonary bypass use (G15 = 67.10%; G20 = 55.70%; p = 0.22) were statistically similar. Age (p = 0.04) and hospital length of stay (p = 0.001) were significantly higher in patients who developed AF in both groups. Conclusion: Keeping CVP low in the first 72 post-CABG hours reduces the relative risk of AF, and may be useful to prevent AF after CABG.

Resumo Fundamento: A fibrilação atrial (FA) ocorre em 10-40% dos pacientes submetidos a cirurgia de revascularização miocárdica (RM), e eleva a mortalidade cardiovascular. Como o aumento dos átrios está associado ao aumento da incidência de FA, espera-se que pacientes com pressão venosa central (PVC) mais alta tenham maior distensão atrial, o que eleva a incidência dessa arritmia. Objetivo: Comparar a incidência de FA em pós-operatório de RM, seguindo duas estratégias de controle de PVC. Métodos: Estudo clínico randomizado controlado intervencionista. A amostra foi composta por 140 pacientes submetidos a RM entre 2011 e 2015. Os pacientes foram randomizados em dois grupos, G15 e G20, mantidos com PVC máxima de 15 cmH2O e 20 cmH2O, respectivamente. Resultados: Foram incluídos 70 pacientes em cada grupo. A incidência da arritmia em G15 foi de 8,57% e, no G20, de 22,86%, com redução de risco absoluto de 14,28% e número necessário para tratar (NNT) de 7 (p = 0,03). Mortalidade (G15 = 5,71%; G20 = 11,42%; p = 0,07), tempo de internamento (G15 = 7,14 dias; G20 = 8,21 dias; p = 0,36), número de enxertos (medianas: G15 = 3, G2 = 2; p = 0,22) e uso de circulação extracorpórea (G15 = 67,10%; G20 = 55,70%; p = 0,22) mostraram-se estatisticamente semelhantes. A idade (p = 0,04) e o tempo de internamento (p = 0,001) foram significativamente maiores nos pacientes que desenvolveram FA nos dois grupos. Conclusão: Manter a PVC com valores mais baixos nas primeiras 72h após a cirurgia de RM reduz o risco relativo de FA e pode ser uma ferramenta útil na prevenção da FA após RM.

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OBJECTIVE: Many studies have indicated that intra-abdominal pressure (IAP) is positively correlated with central venous pressure (CVP) in severe cases. However, although elevated IAP is common in patients with severe acute pancreatitis (SAP), its relationship with CVP remains unclear. Our study aimed to investigate the association of IAP with CVP in early-phase SAP patients. METHODS: In total, 116 SAP patients were included in this retrospective study. On the first day of hospitalization, blood samples were collected for biochemical examination and cytokine concentration monitoring. Additionally, a urinary catheter and right subclavian vein catheter were inserted for IAP and CVP measurement, respectively. Other routine clinical data were also recorded. RESULTS: Within 24 hours after hospitalization, CVP fluctuated and increased with increasing IAP up to 15.7 mmHg (P = 0.054) but decreased with increasing IAP when the IAP was > 15.7 mmHg (P < 0.001). After adjusting for abdominal perfusion pressure (APP) and mean arterial pressure (MAP), a similar distribution was observed. An inverted U-shaped trend between IAP and CVP was also present in the groups classified according to the patient's sex, local complications, ascites, and serum amylase levels. CONCLUSIONS: CVP and IAP have an inverted U-shaped relationship, with a peak at an IAP of 15.7 mmHg in the early phase of SAP. After this peak, CVP decreases as IAP increases. These results have crucial implications for clinical fluid resuscitation in SAP patients. In particular, because one CVP value might be correlated with different IAP values in patients with the same CVP, the volume of fluid needed might be different.

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Introdução: Este estudo teve como objetivo comparar a incidência de fibrilação atrial apósrevascularização do miocárdio entre pacientes que tiveram a pressão venosa central rigorosamente controladanas primeiras 48-72 horas de pós-operatório e pacientes que não tiveram controle rigoroso. Método: Estudoobservacional, do tipo caso-controle, realizado na Santa Casa de Misericórdia de Ponta Grossa. O caso foicomposto por 80 pacientes avaliados prospectivamente submetidos a revascularização miocárdica entre 2012e 2014, os quais tiveram a pressão venosa central avaliada de duas em duas horas, nas primeiras 72 horas depós-operatório, sendo administrada uma ampola de furosemida cada vez que a pressão atingiu o ponto de cortepreestabelecido de forma randomizada em 15 cmH2O ou 20 cmH2O. Já o controle foi composto por 184 pacientesavaliados retrospectivamente submetidos a revascularização miocárdica entre 2009 e 2012, antes do início darandomização, nos quais o controle da pressão venosa central foi menos rigoroso, ficando a necessidade de usode diurético a critério dos intensivistas. Avaliou-se a incidência de fibrilação atrial nas primeiras 72 horas depós-operatório nos dois grupos. Resultados: A incidência de fibrilação atrial foi menor no grupo caso (11,25%, 9em 80), comparativamente ao grupo controle (23,35%, 43 em 184) (P = 0,03). Outras variáveis estudadas foramsemelhantes entre os grupos, exceto o clearance de creatinina, que foi maior no grupo controle. Conclusão: Opresente estudo demonstra que o controle da pressão venosa central nas primeiras 72 horas de pós-operatório écapaz de reduzir a incidência de fibrilação atrial após revascularização do miocárdio.

Background: This study was aimed at comparing the incidence of atrial fibrillation after coronaryartery bypass grafting among patients who have had central venous pressure strictly controlled within thefirst 48-72 hours after surgery and patients who did not have a strict control. Method: Observational, casecontrolstudy, performed at Santa Casa de Misericórdia de Ponta Grossa. The case included 80 prospectivelyevaluated patients submitted to myocardial revascularization between 2012 and 2014, who had central venouspressure evaluated every two hours, in the first 72 hours after surgery. Patients received a vial of furosemide everytime the pressure reached the pre-established cutoff randomly set as 15 or 20 cmH2O. The control included 184retrospectively evaluated patients undergoing myocardial revascularization between 2009 and 2011 prior to thebeginning of randomization; in this group central venous pressure control was less rigorous, requiring use ofdiuretics at the discretion of the intensivists. The incidence of atrial fibrillation in the first 72 hours after surgerywas evaluated in both groups. Results: The incidence of atrial fibrillation was lower in the case group (11.25%,9 in 80) than in the control group, (23.35%, 43 in 184) (P = 0.03). Other studied variables were similar betweenthe groups except for the creatinine clearance, which was higher in the control group. Conclusion: The presentstudy demonstrates that the central venous pressure control within the first 72 hours after surgery reduces theincidence of atrial fibrillation after coronary artery bypass grafting.

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Introducción: se presenta un trabajo de revisión sobre las diferencias entre la presión aórtica central (PAC) y la presión arterial periférica (PAP), y sobre la importancia biomédica de la PAC. Adicionalmente, se presenta un trabajo de investigación original que permitió determinar curvas por edad para la PAC de una población uruguaya y determinar los porcentajes de individuos (discriminando por edad, sexo y nivel de PAP) que presentan niveles de PAC hipertensivos. Material y método: en 785 uruguayos (edad: 6-79 años), sin enfermedad cardiovascular, hipertensión arterial, diabetes e insuficiencia renal, y sin empleo de fármacos vasoactivos, se midió la PAC y parámetros de reflexión de onda (índice de aumento, presión de aumento aórtica) mediante tonometría de aplanamiento radial y aplicación de una función transferencia generalizada. Resultados: se obtuvieron las tendencias por edad esperables de encontrar para los parámetros de PAC y reflexiones de onda. El 3% y 24% de personas con PAP normal/normal alta, respectivamente, presentaron PAC sistólica mayor del valor deseado. El 32% de personas con PAP clasificable como HTA 1 no presentarían PAC hipertensiva. El 11%-17% de las personas con niveles de PAP óptimos presentaron presión de pulso (PP) aórticas hipertensivas. El 22% y 35% de las personas con PAP normal/normal alta, respectivamente, presentaron PP aórtica hipertensivas. El 43% de personas con niveles de PAP clasificable como HTA 1 no presentaron PP aórtica hipertensiva. Conclusión: medir la PAC contribuiría en la evaluación y clasificación de estados hipertensivos, la valoración de la respuesta al tratamiento y en la determinación del riesgo vascular del paciente.

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Introducción: se presenta un trabajo de revisión sobre las diferencias entre la presión aórtica central (PAC) y la presión arterial periférica (PAP), y sobre la importancia biomédica de la PAC. Adicionalmente, se presenta un trabajo de investigación original que permitió determinar curvas por edad para la PAC de una población uruguaya y determinar los porcentajes de individuos (discriminando por edad, sexo y nivel de PAP) que presentan niveles de PAC hipertensivos. Material y método: en 785 uruguayos (edad: 6-79 años), sin enfermedad cardiovascular, hipertensión arterial, diabetes e insuficiencia renal, y sin empleo de fármacos vasoactivos, se midió la PAC y parámetros de reflexión de onda (índice de aumento, presión de aumento aórtica) mediante tonometría de aplanamiento radial y aplicación de una función transferencia generalizada. Resultados: se obtuvieron las tendencias por edad esperables de encontrar para los parámetros de PAC y reflexiones de onda. El 3% y 24% de personas con PAP normal/normal alta, respectivamente, presentaron PAC sistólica mayor del valor deseado. El 32% de personas con PAP clasificable como HTA 1 no presentarían PAC hipertensiva. El 11%-17% de las personas con niveles de PAP óptimos presentaron presión de pulso (PP) aórticas hipertensivas. El 22% y 35% de las personas con PAP normal/normal alta, respectivamente, presentaron PP aórtica hipertensivas. El 43% de personas con niveles de PAP clasificable como HTA 1 no presentaron PP aórtica hipertensiva. Conclusión: medir la PAC contribuiría en la evaluación y clasificación de estados hipertensivos, la valoración de la respuesta al tratamiento y en la determinación del riesgo vascular del paciente.

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BACKGROUND: Acute normovolemic hemodilution (ANH) is an alternative to blood transfusion in surgeries involving blood loss. This experimental study was designed to evaluate whether pulse pressure variation (PPV) would be an adequate tool for monitoring changes in preload during ANH, as assessed by transesophageal echocardiography. METHODS: Twenty-one anesthetized and mechanically ventilated pigs were randomized into three groups: CTL (control), HES (hemodilution with 6% hydroxyethyl starch at a 1:1 ratio) or NS (hemodilution with saline 0.9% at a 3:1 ratio). Hemodilution was performed in animals of groups NS and HES in two stages, with target hematocrits 22% and 15%, achieved at 30-minute intervals. After two hours, 50% of the blood volume withdrawn was transfused and animals were monitored for another hour. Statistical analysis was based on ANOVA for repeated measures followed by multiple comparison test (P<0.05). Pearson's correlations were performed between changes in left ventricular end-diastolic volume (LVEDV) and PPV, central venous pressure (CVP) and pulmonary artery occlusion pressure (PAOP). RESULTS: Group NS received a significantly greater amount of fluids during ANH (NS, 900 ± 168 mL vs. HES, 200 ± 50 mL, P<0.05) and presented greater urine output (NS, 2643 ± 1097 mL vs. HES, 641 ± 338 mL, P<0.001). Significant decreases in LVEDV were observed in group NS from completion of ANH until transfusion. In group HES, only increases in LVEDV were observed, at the end of ANH and at transfusion. Such changes in LVEDV (∆LVEDV) were better reflected by changes in PPV (∆PPV, R=-0.62) than changes in CVP (∆CVP, R=0.32) or in PAOP (∆PAOP, R=0.42, respectively). CONCLUSION: Changes in preload during ANH were detected by changes in PPV. ∆PPV was superior to ∆PAOP and ∆CVP to this end.

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REASONS FOR PERFORMING STUDY: Standing surgical procedures are being employed to an ever-greater extent in horses. Pneumoperitoneum during abdominal surgery might adversely affect the work of breathing. OBJECTIVES: To determine whether development of pneumoperitoneum during abdominal surgery adversely influences the work of breathing. METHODS: Eight healthy mature horses were equipped with carotid artery and thoracic vena cava catheters and an intraluminal manometry system. The following measurements were obtained before and at +5, +10, +15 and +30 min following establishment of pneumoperitoneum by paralumbar puncture using an 8 gauge needle: vital signs, oesophageal pressure, gastric pressure, arterial and central venous blood pressures, and arterial and mixed venous blood gas analyses. RESULTS: Significant changes in oesophageal pressure, central venous pressure and results of arterial and mixed venous blood gas analysis were not detected. Arterial diastolic and mean pressures and rectal temperature increased slightly (P ≤ 0.05). CONCLUSIONS: Passive pneumoperitoneum did not adversely affect breathing mechanics or haemodynamic variables under experimental conditions. Changes in arterial pressure could have occurred as a response to the passive pneumoperitoneum or be related to handling stress. Subtle variations in rectal temperature were not clinically relevant and likely resulted from stress associated with restraint. POTENTIAL RELEVANCE: It is unlikely that mature horses will develop signs of respiratory difficulty as a result of the development of passive pneumoperitoneum during standing laparoscopy.

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