ABSTRACT
Introdução: A incidência de queimaduras em gestantes não é bem estabelecida na literatura mundial, mas estima-se que varie entre 3% e 7%. Os cuidados da gestante queimada representam um grande desafio com impacto significante nos resultados e prognóstico materno-fetais. Relato de Caso: No presente estudo relatamos dois casos de gestantes vítimas de queimaduras que foram tratadas na unidade de tratamento de queimaduras na Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM/UNIFESP), uma no primeiro trimestre e a outra no terceiro trimestre. Conclusão: Em ambos os casos, as gestantes receberam tratamento especializado para queimaduras em conjunto com acompanhamento clínico da equipe da obstetrícia, com boa evolução materno-fetal.
Introduction: The incidence of burns involving pregnant women is not well established in the literature, but is estimated to be between 3% and 7%. The management of burns in pregnancy represents a great challenge with significant impact on outcomes and maternal-fetal prognosis. Case Report: In the present study, we report two cases of pregnant burn victims who were treated in the burn unit in the Paulista School of Medicine, Federal University of São Paulo (EPM/UNIFESP). One patient was treated in the first trimester and the other in the third trimester. Conclusion: In both cases, the pregnant women received specialized treatment for burns in conjunction with clinical follow-up by the obstetrics team, with good maternal-fetal outcomes.
Subject(s)
Humans , Female , Adult , Pregnancy Complications/surgery , Surgical Procedures, Operative/methods , Surgical Procedures, Operative/rehabilitation , Transplantation/methods , Wounds and Injuries , Hypovolemia/diagnosis , Fetus/surgery , Patients , Burn Units , Pregnancy , Pregnancy, High-RiskABSTRACT
Este trabajo informa acerca del proceso y los resultados del Segundo Consenso Clínico de la SIBEN (Sociedad Iberoamericana de Neonatología), en el cual 80 neonatólogos de 23 países fueron invitados a participar y colaborar. Se desarrollaron varias preguntas de importancia clínico-fisiológica sobre el manejo hemodinámico del recién nacido. Los participantes fueron distribuidos en grupos, facilitando así la interacción y el trabajo conjunto, con la consigna de responder de tres a cinco preguntas mediante el análisis de bibliografía y factores locales. El Grupo de Consenso se reunió en Mar del Plata, Argentina, donde se llevaron a cabo diversas ponencias, debates y presentaciones. En total participaron 54 neonatólogos de 21 países, con el objetivo de desarrollar un consenso sobre aspectos que incluyeron conceptos y definiciones de inestabilidad hemodinámica, la fisiopatología del cuadro de compromiso hemodinámico, las estrategias terapéuticas recomendadas y el monitoreo hemodinámico. Se espera que esta experiencia internacional sirva como una iniciativa útil tanto para la búsqueda de futuros consensos como para reducir las disparidades existentes entre los tratamientos y resultados de los diferentes países de la Región.
This study reports on the process and results of the Second Clinical Consensus of the Ibero-American Society of Neonatology. Eighty neonatologists from 23 countries were invited to collaborate and participate in the event. Several questions of clinical-physiological importance in the hemodynamic management of newborns were addressed. Participants were divided into groups to facilitate interaction and teamwork, with instructions to respond to three to five questions by analyzing the literature and local factors. Meeting in Mar del Plata, Argentina, the Consensus Group served as a form for various presentations and discussions. In all, 54 neonatologists from 21 countries attended, with the objective of reaching a consensus on such matters as concepts and definitions of hemodynamic instability, the physiopathology of hemodynamic compromise, recommended therapy strategies, and hemodynamic monitoring. It is hoped that this international experience will serve as a useful initiative for future consensus building and reduction of the existing disparities among the countries of the Region in terms of treatment and outcomes.
Subject(s)
Humans , Infant, Newborn , Hypotension/diagnosis , Hypotension/therapy , Heart Diseases/congenital , Heart Diseases/diagnosis , Heart Diseases/therapy , Hemodynamics , Hypotension/physiopathology , Hypovolemia/diagnosis , Shock/diagnosis , Shock/therapyABSTRACT
Maintaining an adequate tissue oxygen delivery (DO) and consumption (VO) is crucial in the treatment of septic patients. A fall in V02 is associated with a higher mortality. The early recognition of shock or tissue hypo perfusion impacts on patient prognosis. In occasions, hypovolemia or important regional oxygen debts are not recognized, since macro homodynamic variables have been compensated. In this situation, the use of metabolic hypo perfusion markers such as lactate, central venous oxygen saturation and gastric goniometry, can be helpful. However, interpretation of these markers should be cautious and always considering the overall clinical status of the patient. In the initial stages of sepsis, the dependency ofV02 on DO 2predominates as histopathological mechanism of multiple organic failure. In late stages, other factors predominate as determinants of multiple organic failure and mortality, such as hyper or hypo immune response, microcirculatory alterations and cytopathic hypoxia.
Subject(s)
Animals , Humans , Oxygen Consumption/physiology , Oxygen/blood , Sepsis/physiopathology , Biomarkers/blood , Hypovolemia/diagnosis , Lactates/blood , Oxygen/metabolism , Sepsis/blood , Severity of Illness IndexABSTRACT
A volemia e a função renal de bovinos com acidose láctica ruminal (ALR) foram estudadas em cinco garrotes Jersey (J) (Bos taurus) e cinco Gir (G) (Bos indicus). Amostras de sangue, urina e conteúdo ruminal foram coletadas durante 24h após a indução experimental da ALR. Os bovinos G apresentaram maior grau de hipovolemia (p < 0,00001) e volume ruminal (p <0,05) e menor taxa de filtração glomerular (p < 0,003) e volume urinário (p< 0,05), porém excretaram mais eficientemente íons H+ (p < 0,00001); embora apresentassem maior porcentagem média de excreção fracionada urinária de lactato-D (p < 0,032) não existiu diferença racial (p > 0,47) na excreção total diária deste isômero; garrotes G excretaram menor quantidade de lactato-L na urina (p < 0,05). Independente da raça, quanto menor foi o pH urinário maior a porcentagem de excreção fracionada urinária de lactato total e de lactato-D (r = - 0,69)
To study volemia and renal function in cattle with acute rumen lactic acidosis (RLA) five Jersey (J) (Bos taurus) and five Gir (G) (Bos indicus) steers were used. Blood, urine and ruminal fluid samples were collected throughout 24h after RLA induction. Higher levels of hipovolemia (p < 0.00001), and total rumen volume (p < 0.05), lower glomerular filtration (p < 0.003) and urinary volume (p < 0.05) were detected in the G steers. Nevertheless, these steers excreted more efficiently H+(p < 0.0001); although higher urinary D-lactate fractional excretion was seen in the G steers similar amounts of D-lactate were excreted by both breeds throughout the trial. Lower urinary levels of L-lactate were excreted by G steers. The higher the urinary pH, the lower the D-lactate fractional excretion in both breeds
Subject(s)
Animals , Acidosis, Lactic/blood , Cattle , Hypovolemia/diagnosis , Kidney/physiologyABSTRACT
Estudaram-se possíveis alterações hemodinâmicas e intracranianas em cães submetidos à hemorragia aguda e anestesiados pelo isofluorano. Verificou-se também a influência do anestésico no mecanismo de auto-regulação cerebral. Utilizaram-se 20 cães adultos que foram induzidos à anestesia geral com isofluorano por máscara naso-oral a 3,5V por cento (volume por cento). Após a intubação orotraqueal, reajustou-se o vaporizador para 2,1V por cento. Induziu-se a hipovolemia retirando-se volume total de 35ml/kg de sangue. Avaliaram-se pressão intracraniana (PIC), temperaturas intracraniana (TIC) e corpórea (T), pressão de perfusão cerebral (PPC), pressões arteriais sistólica (PAS), diastólica (PAD) e média (PAM), freqüências cardíaca (FC) e respiratória (FR), índices cardíaco (IC) e sistólico (IS), pressão venosa central (PVC), pressão da artéria pulmonar (PAP), concentração de dióxido de carbono ao final da expiração (ETCO2) e saturação de oxihemoglobina (SpO2). Imediatamente após a hipovolemia, houve redução significativa da PIC, PPC, PAS, PAD, PAM, IC, IS e PAP. Após 10 minutos, houve aumento gradativo das médias, permanecendo neste patamar até o final do período experimental. Concluiu-se que a hemorragia aguda promoveu redução das variáveis hemodinâmicas, sendo possível verificar a ativação de mecanismos compensatórios. Além disso, houve redução da perfusão sangüínea e ativação do mecanismo de auto-regulação cerebral, conseqüentes à hipovolemia associada à anestesia com isofluorano.
Intracranial and hemodynamic alterations in 20 adult dogs anesthetized with isoflurane and submitted to acute hemorrhage were studied. Anesthetic influence on cerebral auto-regulation mechanism was also observed. General anesthesia was induced with at 3.5V percent (volume percent) isoflurane. Thereafter, orotracheal intubation was performed and vaporizer was calibrated to 2.1V percent. To induce hypovolemia, a total amount of 35 ml/kg-1 of blood was taken from each dog. Intracranial pressure (ICP); intracranial (ICT) and body temperatures (BT); cerebral perfusion pressure (CPP); systolic (SAP), diastolic (DAP) and mean arterial pressures (MAP); heart (HR) and respiratory rates (RR); cardiac (CI) and stroke indexes (SI); central venous pressure (CVP); pulmonary arterial pressure (PAP); end tidal dioxide carbon (ETCO2); and oxyhemoglobin saturation (SpO2) were evaluated. Immediately after hypovolemia, there was significative reduction of ICP, CPP, SAP, DAP, MAP, CI, SI, and PAP. Ten minutes after, the values increased gradually until the end of the experimental period. Indeed, acute hemorrhage caused reduction of hemodynamic variables and activation of the compensatory mechanisms. Cerebral blood perfusion was reduced and cerebral auto-regulation mechanism was activated due to hypovolemia associated to isoflurane anesthesia.
Subject(s)
Animals , Male , Female , Anesthesia, General/methods , Anesthesia, General/veterinary , Dogs , Intracranial Hemorrhages/chemically induced , Hypovolemia/diagnosisSubject(s)
Humans , Male , Female , Child , Adrenal Insufficiency/diagnosis , Pharmaceutical Preparations/adverse effects , Inappropriate ADH Syndrome/diagnosis , Inappropriate ADH Syndrome/physiopathology , Inappropriate ADH Syndrome/therapy , Signs and Symptoms/classification , Tomography Scanners, X-Ray Computed , Diuresis , Hypovolemia/diagnosis , Miller Fisher Syndrome/etiology , Vasopressins/analysisABSTRACT
Exposición de viceras con gran superficie de evaporación que puede llevar a producir hipotermia, hipovolemia, hipoxia y acidosis y la cantidad de intestinos y viceras que se encuentran en el saco y de si existe en el abdomen un espacio para introducirlas ya que si esta masa es excesiva puede producir compromiso respiratorios por compresión, obturación de vena cava con la consecuente reducción del retorno venoso.