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Rev. colomb. anestesiol ; 49(4): e200, Oct.-Dec. 2021. tab, graf
Article in English | LILACS, COLNAL | ID: biblio-1341236


Abstract Introduction Vasopressors are essential in the management of various types of shock. Objective To establish the trend of vasopressors use in the intensive care units (ICU) in a population of patients affiliated with the Colombian Health System, 2010-2017. Methods Observational trial using a population database of patients hospitalized in eleven ICUs in various cities in Colombia. The drugs dispensed to hospitalized patients over 18 years old, from January 2010 until December 2017 were considered. A review and analysis of the vasopressors dispensed per month was conducted, taking into account sociodemographic and pharmacological variables (vasopressor used and daily doses defined per 100/beds/day (DBD). Results 81,348 dispensations of vasopressors, equivalent to 26,414 treatments in 19,186 patients receiving care in 11 hospitals from 7 cities were reviewed. The mean age of patients was 66.3±18.1 years and 52.6 % were males. Of the total number of treatments recorded, 17,658 (66.8 %) were with just one vasopressor. Norepinephrine was the most frequently prescribed drug (75.9 % of the prescriptions dispensed; 60.5 DBD), followed by adrenaline (26.6 %; 41.6 DBD), dopamine (19.4%), dobutamine (16.0 %), vasopressin (8.5 %) and phenylephrine (0.9 %). The use of norepinephrine increased from 2010 to 2017 (+6.19 DBD), whilst the use of other drugs decreased, particularly the use of adrenaline (-60.6 DBD) and dopamine (-10.8 DBD). Conclusions Norepinephrine is the most widely used vasopressor showing a growing trend in terms of its use during the study period, which is supported by evidence in favor of its effectiveness and safety in patients with shock.

Resumen Introducción Los fármacos vasopresores son fundamentales en el manejo de los diferentes tipos de choque. Objetivo Determinar la tendencia de utilización de fármacos vasopresores en unidades de cuidados intensivos (UCI) en una población de pacientes afiliados al Sistema de Salud de Colombia, 2010-2017. Métodos Estudio observacional, a partir de una base de datos poblacional con pacientes hospitalizados en once UCI de diferentes ciudades de Colombia. Se obtuvieron las dispensaciones de pacientes mayores de 18 años hospitalizados desde enero de 2010 hasta diciembre de 2017. Se hizo revisión y análisis de la dispensación mensual de vasopresores. Se consideraron variables sociodemográficas y farmacológicas (medicamento vasopresor usado y dosis diarias definidas por 100 camas/día [DCD]). Resultados Se revisaron 81.348 dispensaciones de vasopresores, equivalentes a 26.414 terapias en 19.186 pacientes atendidos en 11 hospitales de 7 ciudades, cuya edad promedio fue 66,3±18,1 años y el 52,6 % eran hombres. Del total de terapias registradas, 17.658 (66,8 %) fueron con un solo vasopresor. La norepinefrina fue el más comúnmente prescrito (75,9 % de las dispensaciones; 60,5 DCD), seguido por adrenalina (26,6 %; 41,6 DCD), dopamina (19,4 %), dobutamina (16,0 %), vasopresina (8,5 %) y fenilefrina (0,9 %). El uso de norepinefrina se incrementó de 2010 a 2017 (+6,19 DCD), mientras que el de otros fármacos disminuyó, especialmente adrenalina (-60,6 DCD) y dopamina (-10,8 DCD). Conclusiones La norepinefrina es el fármaco vasopresor más utilizado y el que ha demostrado una tendencia de uso incremental durante el periodo de estudio, lo cual está respaldado por evidencia a favor de su efectividad y seguridad en pacientes con choque.

Humans , Male , Middle Aged , Aged , Shock , Vasoconstrictor Agents , Vasopressins , Intensive Care Units , Phenylephrine , Pharmaceutical Preparations , Dopamine , Epinephrine , Norepinephrine , Dobutamine , Drug Utilization , Dosage , Prescriptions
Chinese Medical Journal ; (24): 1043-1051, 2021.
Article in English | WPRIM | ID: wpr-878147


BACKGROUND@#Hypotension is a common complication caused by spinal anesthesia (SA), which may have adverse impacts on the condition of the parturient and fetus. Liquid infusion was found to be relatively effective for reducing the incidence of hypotension. However, the question of whether colloid preload can optimize hemodynamic variables in the cesarean section remains controversial. This study aims to determine the effects of colloid preload on the incidence of hypotension induced by SA in elective cesarean section.@*METHODS@#Related keywords were searched on PubMed, EMBASE, and Cochrane Library from inception dates to May 2020. Studies included were evaluated for eligibility and quality. The primary outcome was the intra-operative incidence of hypotension and severe hypotension. The secondary outcomes included the lowest intra-operative systolic blood pressure, the maximal intra-operative heart rate, the intra-operative needs of ephedrine and phenylephrine, the incidence of maternal nausea and/or vomiting, and neonatal outcomes (umbilical artery pH and Apgar scores). Apart from the above, RevMan 5.3 was used for the data analysis.@*RESULTS@#Altogether nine randomized controlled trials were included in the meta-analysis. There were no significant differences in the incidence of intra-operative hypotension, severe hypotension, or neonatal outcomes between the colloid preload group and control group, except for the umbilical artery pH.@*CONCLUSION@#This meta-analysis suggests that colloid preload does not significantly reduce the incidence of hypotension associated with SA in elective cesarean section.

Anesthesia, Spinal/adverse effects , Cesarean Section/adverse effects , Colloids , Female , Humans , Hypotension/etiology , Incidence , Infant, Newborn , Pregnancy , Vasoconstrictor Agents/therapeutic use
Chinese Medical Journal ; (24): 792-799, 2021.
Article in English | WPRIM | ID: wpr-878087


BACKGROUND@#Norepinephrine infusion decreases hypotension after spinal anesthesia during cesarean section. This study aimed to compare the efficacy of norepinephrine infusion and ephedrine bolus against post-spinal hypotension in parturients.@*METHODS@#In this double-blinded, randomized controlled clinical trial, parturients scheduled for elective cesarean section were randomly allocated to receive norepinephrine infusion (0.05 μg·kg-1·min-1) just before spinal anesthesia continuing for 30 min or ephedrine bolus (0.15 mg/kg) just before spinal anesthesia. A rescue bolus (5 μg norepinephrine for the norepinephrine group, and 5 mg ephedrine for the ephedrine group) was administered whenever hypotension occurred. Our primary outcome was the incidence of hypotension within 30 min of spinal anesthesia administration. Secondary outcomes included maternal and neonatal outcomes 30 min after spinal block, and neonatal cerebral oxygenation 10 min after birth.@*RESULTS@#In total, 190 patients were enrolled; of these patients, 177 were included in the final analysis. Fewer patients suffered hypotension in the norepinephrine group than in the ephedrine group (29.5% vs. 44.9%, odds ratio [OR]: 0.51, 95% confidence interval [CI]: 0.28-0.95, P = 0.034). Moreover, the tachycardia frequency was lower in the norepinephrine group than in the ephedrine group (OR: 0.22, 95% CI: 0.11-0.44, P < 0.001), and patients suffered less nausea and vomiting (OR: 0.28, 95% CI: 0.11-0.70, P = 0.004). There was no difference in Apgar scores and umbilical arterial blood gas analysis between the two groups. However, neonatal cerebral regional saturations were significantly higher after birth in the norepinephrine group than in the ephedrine group (mean difference: 2.0%, 95% CI: 0.55%-3.45%, P = 0.008).@*CONCLUSION@#In patients undergoing elective cesarean section with spinal anesthesia, norepinephrine infusion compared to ephedrine bolus resulted in less hypotension and tachycardia, and exhibited potential neonatal benefits.@*TRIAL, NCT02542748;

Anesthesia, Spinal/adverse effects , Cesarean Section/adverse effects , Double-Blind Method , Female , Humans , Hypotension/prevention & control , Infant, Newborn , Phenylephrine , Pregnancy , Randomized Controlled Trials as Topic , Vasoconstrictor Agents/therapeutic use
Rev. bras. anestesiol ; 70(6): 588-594, Nov.-Dec. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1155777


Abstract Background and objectives: In shoulder arthroscopy, on an outpatient basis, the patient needs a good control of the postoperative pain that can be achieved through regional blocks. Perineural dexamethasone may prolong the effect of these blocks. The aim of this study was to evaluate the effect of perineural dexamethasone on the prolongation of the sensory block in the postoperative period for arthroscopic shoulder surgery in outpatient setting. Methods: After approval by the Research Ethics Committee and informed consent, patients undergoing arthroscopic shoulder surgery under general anesthesia and ultrasound-guided interscalene brachial plexus block were randomized into Group D - blockade performed with 30 mL of 0.5% levobupivacaine with vasoconstrictor and 6 mg (1.5 mL) of dexamethasone and Group C - 30 mL of 0.5% levobupivacaine with vasoconstrictor and 1.5 mL of 0.9% saline. The duration of the sensory block was evaluated in 4 postoperative moments (0, 4, 12 and 24 hours) as well as the need for rescue analgesia, nausea and vomiting incidence, and Visual Analog Pain Scale (VAS). Results: Seventy-four patients were recruited and 71 completed the study (Group C, n = 37; Group D, n = 34). Our findings showed a prolongation of the mean time of the sensitive blockade in Group D (1440 ± 0 min vs. 1267 ± 164 min, p < 0.001). It was observed that Group C had a higher mean pain score according to VAS (2.08 ± 1.72 vs. 0.02 ± 0.17, p < 0.001) and a greater number of patients (68.4% vs. 0%, p < 0.001) required rescue analgesia in the first 24 hours. The incidence of postoperative nausea and vomiting was not statistically significant. Conclusion: Perineural dexamethasone significantly prolonged the sensory blockade promoted by levobupivacaine in interscalene brachial plexus block, reduced pain intensity and rescue analgesia needs in the postoperative period.

Resumo Justificativa e objetivos: Na artroscopia de ombro em regime ambulatorial, o paciente necessita de um bom controle da dor pós-operatória, que pode ser conseguido por meio de bloqueios regionais. A dexametasona perineural pode prolongar o efeito desses bloqueios. O objetivo deste estudo foi avaliar o efeito da dexametasona perineural quanto ao prolongamento do bloqueio sensitivo no período pós-operatório para cirurgia artroscópica de ombro em regime ambulatorial. Métodos: Após aprovação do Comitê de Ética em Pesquisa e consentimento informado, foram incluídos no estudo pacientes submetidos a cirurgia artroscópica de ombro sob anestesia geral e bloqueio de plexo braquial interescalênico guiado por ultrassonografia. Eles foram randomizados nos Grupo D - bloqueio com 30 mL de levobupivacaína 0,5% com vasoconstritor e 6 mg (1,5 mL) de dexametasona, e Grupo C - bloqueio com 30 mL de levobupivacaína 0,5% com vasoconstritor e 1,5 mL solução salina. A duração do bloqueio sensitivo foi avaliada em quatro momentos pós-operatórios (0, 4, 12 e 24 horas), assim como a necessidade de analgesia de resgate, incidência de náuseas e vômitos e Escala Visual Analógica de Dor (EVA). Resultados: Setenta e quatro pacientes foram randomizados e 71 completaram o estudo (Grupo C, n = 37; Grupo D, n = 34). Observou-se um prolongamento do tempo médio de bloqueio sensitivo no Grupo D (1440 ± 0 min vs. 1267 ± 164 min; p< 0,001). Pacientes do Grupo C apresentaram maior média de escore de dor de acordo com a EVA (2,08 ± 1,72vs. 0,02 ± 0,17; p< 0,001) e um maior número de pacientes solicitou analgesia de resgate nas primeiras 24 horas (68,4%vs.0%; p< 0,001). A incidência de náuseas e vômitos não foi estatisticamente significante. Conclusão: A dexametasona perineural prolongou significativamente o bloqueio sensitivo da levobupivacaína no bloqueio de plexo braquial interescalênico, reduziu a intensidade de dor e a necessidade de analgesia de resgate pelo paciente no período pós-operatório.

Humans , Male , Female , Arthroscopy/methods , Shoulder Joint/surgery , Dexamethasone/administration & dosage , Ultrasonography, Interventional/methods , Brachial Plexus Block/methods , Anti-Inflammatory Agents/administration & dosage , Pain, Postoperative/diagnosis , Pain, Postoperative/drug therapy , Arthroscopy/adverse effects , Time Factors , Vasoconstrictor Agents/administration & dosage , Pain Measurement , Double-Blind Method , Prospective Studies , Analysis of Variance , Postoperative Nausea and Vomiting/epidemiology , Saline Solution/administration & dosage , Levobupivacaine , Analgesia , Anesthetics, Local , Middle Aged
Rev. bras. anestesiol ; 70(5): 500-507, Sept.-Oct. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1143955


Abstract Background and objectives: Limited data are present on safety and efficiency of epinephrine for the prophylaxis and treatment of spinal-hypotension. This study was conducted to compare the effect of epinephrine with norepinephrine and phenylephrine on the treatment of spinal-hypotension and ephedrine requirement during cesarean delivery. Methods: One hundred and sixty parturients with uncomplicated pregnancies undergoing elective cesarean delivery under spinal anesthesia were recruited. They were allocated randomly to receive norepinephrine 5 µg.mL−1 (n = 40), epinephrine 5 µg.mL−1 (n = 40), phenylephrine 100 µg.mL−1 (n = 40) or 0.9% saline infusions (n = 40) immediately after induction of spinal anesthesia. Whenever systolic blood pressure drops to less than 80% of baseline, 5 mg of intravenous ephedrine was administered as rescue vasopressor. The incidence of hypotension, total number of hypotension episodes, the number of patients requiring ephedrine, the mean amount of ephedrine consumption and side effects were recorded. Results: There was no statistically significant difference in incidence of maternal hypotension between groups. The number of patients requiring ephedrine was significantly greater in group saline than in group phenylephrine (p< 0.001). However, it was similar between phenylephrine, norepinephrine, and epinephrine groups. The mean ephedrine consumption was significantly higher in group saline than in norepinephrine, epinephrine, phenylephrine groups (p= 0.001). Conclusion: There is no statistically significant difference in incidence of hypotension and ephedrine consumption during spinal anesthesia for cesarean delivery with the use of epinephrine when compared to norepinephrine or phenylephrine. Epinephrine can be considered an alternative agent for management of spinal hypotension.

Resumo Justificativa e objetivos: Existem dados limitados sobre segurança e eficiência da epinefrina na profilaxia e tratamento da hipotensão arterial associada à raquianestesia. O presente estudo foi realizado para comparar o efeito da epinefrina com norepinefrina e fenilefrina no tratamento da hipotensão após raquianestesia e necessidade de efedrina durante o parto cesáreo. Método: Foram recrutadas 160 parturientes com gestações não complicadas, submetidas a cesariana eletiva sob raquianestesia. Elas foram alocadas aleatoriamente para receber norepinefrina 5 µg.mL-1 (n = 40), epinefrina 5 µg.mL-1 (n = 40), fenilefrina 100 µg.mL-1 (n = 40) ou infusão de solução fisiológica NaCl a 0,9% (n = 40) imediatamente após a indução da raquianestesia. Sempre que houvesse redução da pressão arterial sistólica para valor inferior a 80% da linha de base, 5 mg de efedrina iv eram administrados como vasopressor de resgate. A incidência de hipotensão, o número total de episódios de hipotensão, o número de pacientes que necessitaram de efedrina, o consumo médio de efedrina e os efeitos colaterais foram registrados. Resultados: Não houve diferença estatisticamente significante na incidência de hipotensão materna entre os grupos. O número de pacientes que necessitaram de efedrina foi significantemente maior no grupo solução fisiológica do que no grupo fenilefrina (p< 0,001). No entanto, foi semelhante entre os grupos fenilefrina, norepinefrina e epinefrina. O consumo médio de efedrina foi significantemente maior no grupo solução fisiológica do que nos grupos norepinefrina, epinefrina e fenilefrina (p = 0,001). Conclusão: Não houve diferença estatisticamente significante na incidência de hipotensão e consumo de efedrina durante raquianestesia para parto cesáreo com uso de epinefrina quando comparada à norepinefrina ou fenilefrina. A epinefrina pode ser considerada como agente alternativo para o tratamento da hipotensão após raquianestesia.

Humans , Female , Adult , Phenylephrine/administration & dosage , Norepinephrine/administration & dosage , Ephedrine/administration & dosage , Hypotension/prevention & control , Vasoconstrictor Agents/administration & dosage , Cesarean Section/adverse effects , Cesarean Section/methods , Double-Blind Method , Prospective Studies , Hypotension/etiology , Hypotension/epidemiology , Anesthesia, Spinal/adverse effects , Anesthesia, Spinal/methods
Arq. bras. cardiol ; 114(2): 295-303, Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1088850


Abstract Background: Cigarette smoking is usually associated with hypertension and may modify vasoconstrictor response. Objective: The present study aimed to analyze and compare the interaction of passive cigarette smoking and hypertension on epinephrine and felypressin blood pressure effects after intravascular injection. Method: 45-day male Wistar rats had the main left renal artery partially constricted and the right kidney removed (1K1C model). Rats were placed in the chamber for exposition to passive cigarette smoking (10 cigarettes) during 10 min (6 days a week). Hypertensive rats received atenolol (90 mg/kg/day) by gavage for two weeks. Hypotensive and hypertensive response, response duration and heart rate were recorded from direct blood pressure values. The significance level was 5%. Results: Passive cigarette smoking increased maximal hypertensive response to epinephrine in normotensive and 1K1C-atenolol treated rats and to felypressin only in 1K1C-atenolol treated rats; it also reduced epinephrine hypotensive response. Epinephrine increased heart rate in normotensive and hypertensive passive smokers or non-smoker rats. Comparing the two vasoconstrictors, epinephrine showed greater hypertensive response in normotensive smokers, 1K1C-atenolol treated smokers and non-smokers. However, in normotensive-nonsmoker rats, felypressin showed a greater and longer hypertensive effect. Conclusions: Our results suggest that passive cigarette smoking may reduce epinephrine vasodilation and increase hypertensive response when compared to felypressin. Therefore, felypressin may be safe for hypertensive patients to avoid tachycardia and atenolol interaction, but for normotensive and non-smoker patients, epinephrine may be safer than felypressin.

Resumo Fundamento: O tabagismo geralmente está associado à hipertensão e pode modificar a resposta vasoconstritora. Objetivo: O presente estudo teve como objetivo analisar e comparar a interação do tabagismo passivo e hipertensão sobre os efeitos da epinefrina e felipressina na pressão arterial após injeção intravascular. Métodos: Ratos Wistar machos de 45 dias tiveram a artéria renal principal esquerda parcialmente obstruída e o rim direito removido (modelo 1K1C). Os ratos foram colocados na câmara para exposição ao tabagismo passivo (10 cigarros) durante 10 minutos (6 dias por semana). Ratos hipertensos receberam atenolol (90 mg/kg/dia) por gavagem durante duas semanas. A resposta hipotensora e hipertensiva, a duração da resposta e a frequência cardíaca foram registradas a partir da medida dos valores diretos da pressão arterial. O nível de significância foi de 5%. Resultados: O tabagismo passivo aumentou a resposta hipertensiva máxima à epinefrina em ratos normotensos e ratos 1K1C tratados com atenolol e à felipressina apenas em ratos 1K1C tratados com atenolol; também reduziu a resposta hipotensiva à epinefrina. A epinefrina aumentou a frequência cardíaca em ratos fumantes passivos ou não-fumantes, normotensos e hipertensos. Comparando os dois vasoconstritores, a epinefrina apresentou maior resposta hipertensiva em fumantes normotensos, ratos 1K1C fumantes e não fumantes tratados com atenolol. No entanto, em ratos normotensos e não fumantes, a felipressina apresentou um efeito hipertensivo maior e mais prolongado. Conclusões: Nossos resultados sugerem que o tabagismo passivo pode reduzir a vasodilatação da epinefrina e aumentar a resposta hipertensiva quando comparado à felipressina. Portanto, a felipressina pode ser segura para pacientes hipertensos, com o objetivo de evitar a interação entre taquicardia e atenolol, mas para pacientes normotensos e não-fumantes, a epinefrina pode ser mais segura que a felipressina.

Animals , Male , Atenolol/pharmacology , Tobacco Smoke Pollution/adverse effects , Blood Pressure/drug effects , Epinephrine/pharmacology , Felypressin/pharmacology , Antihypertensive Agents/pharmacology , Time Factors , Vasoconstrictor Agents/pharmacology , Vasodilation/drug effects , Rats, Wistar , Dose-Response Relationship, Drug , Drug Interactions , Heart Rate/drug effects , Hypertension/drug therapy , Hypotension
Article in English | WPRIM | ID: wpr-886630


@#BACKGROUND: Septic shock causes life threatening organ dysfunction needing vasopressor despite adequate fluid resuscitation. Numerous studies and meta-analysis have proven norepinephrine as the initial vasopressor of choice in septic shock with vasopressin as add-on. Although guidelines have established the goal monitoring response in septic shock, optimal approach in discontinuation of the vasopressors in the recovery phase of septic shock remains limited. METHODS: A systematic review and meta-analysis was performed on randomized controlled trials (RCTs) and nonrandomized studies comparing incidence of hypotension within 24 hours of discontinuing norepinephrine first versus vasopressin. Three reviewers independently selected studies, assessed their quality, and extracted the following data: the number and characteristics of patients enrolled, inclusion and exclusion criteria for each study, the description of interventions (discontinuing norepinephrine first versus discontinuing vasopressin first) and outcomes (incidence of hypotension within 24 hours). RESULTS: Seven retrospective cohort studies and one prospective randomized control trial were included. Compared with norepinephrine, risk of hypotension is higher when vasopressin is discontinued first among patients in the recovery phase of septic shock (RR 2.06; 95% CI [1.11,3.82]; I 2 91%). Results were consistent in the subgroup analysis after excluding abstract-only and poor-quality studies (RR 1.73; 95% CI [0.74, 4.03]; I 2 93%). There is no difference in ICU (RR 0.97; 95% CI [0.71, 1.32]; I 2 38%) and in-hospital mortality (RR 0.88; 95% CI [0.66, 1.16]; I 2 41%) between the two vasopressor weaning strategies. Finally ICU length of stay was reported on 5 studies with no significant difference between the two strategies. CONCLUSION: Based on the results, there is increased risk of hypotension when vasopressin is discontinued first versus norepinephrine.

Norepinephrine , Shock, Septic , Vasopressins , Vasoconstrictor Agents , Neurophysins
Rev. latinoam. enferm. (Online) ; 28: e3334, 2020. tab, graf
Article in English | LILACS, BDENF | ID: biblio-1126991


Objective: to clinically validate the nursing diagnosis of Dysfunctional Ventilatory Weaning Response in adult patients admitted to Intensive Care Units. Method: a concurrent cohort performed with 93 patients admitted to Intensive Care Units. The incidence and incidence density of the diagnosis were estimated, its related factors were identified based on bivariate analysis and clinical indicators for determining its occurrence, according to the global and temporal presentation. Results: the overall incidence of the diagnosis was 44.09% and the incidence density was 14.49 occurrences for every 100 extubations/day. The factors related to the diagnosis were the following: age, clinical severity, fluid balance, oliguria, hemodialysis, edema in upper/lower limbs, anasarca, number of antibiotics, hypothermia, hyperthermia, amount of secretion, muscle retraction, anxiety score, heart rate, use of vasopressors and non-invasive ventilation after extubation. The clinical indicators most frequently identified for determining the diagnosis were the following: tachypnea, drop of saturation and tachycardia. Temporal progression in the severity of these manifestations was found. Conclusion: the Dysfunctional Ventilatory Weaning Response is a common finding in critically ill patients. Some components of the diagnosis of the NANDA-International (2018) version could be clinically validated. It is noteworthy that there are variables not yet described in the taxonomy, demonstrating the need to review this nursing diagnosis.

Objetivo: validar clinicamente o diagnóstico de enfermagem Resposta Disfuncional ao Desmame Ventilatório em pacientes adultos internados em Unidades de Terapia Intensiva. Método: coorte concorrente realizada com 93 pacientes internados em Unidades de Terapia Intensiva. Foram estimadas a incidência e a densidade de incidência do diagnóstico, identificados seus fatores relacionados a partir de análise bivariada e indicadores clínicos de determinação da sua ocorrência, segundo apresentação global e temporal. Resultados: a incidência global do diagnóstico foi de 44,09% e a densidade de incidência de 14,49 ocorrências a cada 100 extubações/dia. Os fatores relacionados ao diagnóstico foram: idade, gravidade clínica, balanço hídrico, oligúria, hemodiálise, edema em membros superiores/inferiores, anasarca, número de antibióticos, hipotermia, hipertermia, quantidade de secreção, retração muscular, escore de ansiedade, frequência cardíaca, uso de vasopressores e ventilação não invasiva após a extubação. Os indicadores clínicos identificados mais frequentemente para a determinação do diagnóstico foram: taquipneia, queda de saturação e taquicardia. Verificou-se progressão temporal da gravidade dessas manifestações. Conclusão: a Resposta Disfuncional ao Desmame Ventilatório é um achado comum em pacientes críticos. Alguns componentes do diagnóstico da versão NANDA-International (2018) puderam ser validados clinicamente. Destaca-se que existem variáveis ainda não descritas na taxonomia, demonstrando a necessidade de revisão desse diagnóstico de enfermagem.

Objetivo: validar clínicamente el diagnóstico de enfermería Respuesta Ventilatoria Disfuncional al Destete en pacientes adultos internados en Unidades de Cuidados Intensivos. Método: cohorte concurrente realizada con 93 pacientes internados en Unidades de Cuidados Intensivos. Se estimó la incidencia y densidad de incidencia del diagnóstico y se identificaron los factores vinculados a partir de análisis bivariados e indicadores clínicos para determinar su ocurrencia, de acuerdo con la presentación global y temporal. Resultados: la incidencia global del diagnóstico fue de 44,09% y la densidad de incidencia de 14,49 casos por cada 100 extubaciones/día. Los factores relacionados con el diagnóstico fueron: edad, gravedad clínica, balance hídrico, oliguria, hemodiálisis, edema en miembros superiores/inferiores, anasarca, número de antibióticos, hipotermia, hipertermia, cantidad de secreción, retracción muscular, grado de ansiedad, frecuencia cardíaca, uso de vasopresores y ventilación no invasiva después de la extubación. Los indicadores clínicos identificados con mayor frecuencia para determinar el diagnóstico fueron: taquipnea, disminución de la saturación de oxígeno y taquicardia. Se verificó una progresión temporal en la gravedad de estas afecciones. Conclusión: La Respuesta Ventilatoria Disfuncional al Destete es un hallazgo común en pacientes críticos. Algunos componentes del diagnóstico de la versión NANDA-International (2018) podrían validarse clínicamente. Es de destacar que hay variables aún no descriptas en la taxonomía, lo que demuestra la necesidad de revisar este diagnóstico de enfermería.

Humans , Male , Female , Adult , Vasoconstrictor Agents , Nursing Diagnosis , Ventilator Weaning , Nursing , Treatment Failure , Validation Study , Airway Extubation , Noninvasive Ventilation , Intensive Care Units
Int. braz. j. urol ; 45(5): 1033-1042, Sept.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1040068


ABSTRACT Cinnamomum cassia (Cinnamon) is a well-known traditional medicine with therapeutic benefits for centuries. We evaluated the effects of cinnamon essential oil (CEO) and its main component cinnamaldehyde (CA) on human corpus cavernosum (HCC) and rat CC. The essential oil of cinnamon was analyzed for the confirmation of the oil profile. HCC specimens from patients undergoing penile prosthesis surgery (age 48-69 years) were utilized for functional studies. In addition, erectile responses in anesthetized control and diabetic rats were evaluated in vivo after intracavernosal injection of CEO and CA, and rat CC strips were placed in organ baths. After precontraction with phenylephrine (10µM), relaxant responses to CEO and CA were investigated. CA (96.9%) was found as the major component. The maximum relaxation responses to CEO and CA were 96.4±3.5% and 96.0±5.0% in HCC and 97.5±5.5% and 96.8±4.8% in rat CC, respectively. There was no difference between control and diabetic rats in relaxation responses to CEO and CA. The relaxant responses obtained with essential oil and CA were not attenuated in the presence of nitric oxide synthase (NOS) inhibitor, and soluble guanylate cyclase inhibitor (sGS) in CC. In vivo, erectile responses in diabetic rats were lower than in control rats, which was restored after intracavernosal injection of CEO and CA. CEO and CA improved erectile function and relaxation of isolated strips of rat CC and HCC by a NO/cGMP-independent mechanism. Further investigations are warranted to fully elucidate the restorative effects of CEO and CA on diabetic erectile dysfunction.

Humans , Animals , Male , Aged , Penis/drug effects , Acrolein/analogs & derivatives , Oils, Volatile/pharmacology , Cinnamomum zeylanicum/chemistry , Muscle Relaxation/drug effects , Penis/physiopathology , Phenylephrine/pharmacology , Vasoconstrictor Agents/pharmacology , Acrolein/pharmacology , Penile Erection/drug effects , Penile Erection/physiology , Reproducibility of Results , Analysis of Variance , Rats, Sprague-Dawley , Phosphodiesterase 5 Inhibitors/pharmacology , Sildenafil Citrate/pharmacology , Erectile Dysfunction/physiopathology , Erectile Dysfunction/drug therapy , Middle Aged , Muscle Relaxation/physiology
Rev. ADM ; 76(4): 229-233, jul.-ago 2019. tab
Article in Spanish | LILACS | ID: biblio-1023911


La medición de los signos vitales es de gran importancia en el consultorio dental, de esta forma podemos obtener una visión objetiva y anticipada del estado funcional del paciente. Según la información obtenida, se tomarán decisiones terapéuticas. El odontólogo debe saber que el seguimiento clínico y el uso de la técnica adecuada para sus mediciones representan un aspecto muy relevante para prevenir emergencias en el consultorio dental. El odontólogo debe medir los signos vitales antes, durante y después del procedimiento dental y, del mismo modo, debe estar involucrado en la situación individual de cada paciente y proporcionar medidas higiénicodietéticas para mejorar su calidad de vida. La evaluación continua de los signos vitales durante el procedimiento quirúrgico dental, en el que se usan anestésicos locales, es particularmente relevante en este caso, ya que puede ayudarnos a prevenir complicaciones como arritmias cardiacas, crisis hipertensivas o angina de pecho. El objetivo de este artículo es promover en toda la profesión odontológica, el monitoreo de los signos vitales, su técnica de medición correcta y su correlación con otros datos de un historial completo médico y dental (AU)

The measurement of vital signs is of great importance in the dental office, this way we can obtain an objective and anticipated vision of the functional state of the patient. According to the information obtained, therapeutic decisions will be made. The dentist must know that monitoring and using the appropriate technique for its measurements, represents a very relevant aspect for the emergency in the dental office. The dentist must measure the vital signs before, during and after the dental procedure, likewise, they must be involved in the individual situation of each patient and provide hygienic-dietetic measures to improve their quality of life. The continuous assessment of vital signs during the dental surgical procedure, in which local anesthetics are used, is particularly relevant in this case since it can help us prevent complications such as cardiac arrhythmias, hypertensive crisis or angor pectoris. The objective of this article is to promote throughout the dental profession, the monitoring of vital signs, their correct measurement technique and their correlation with other data from a complete medical and dental history (AU)

Humans , Emergencies , Vital Signs , Arrhythmias, Cardiac , Pulse , Vasoconstrictor Agents , Comprehensive Dental Care , Oral Surgical Procedures , Arterial Pressure , Hypertension , Angina Pectoris
Article in English | WPRIM | ID: wpr-740000


Periodontal procedures require adequate anesthesia not only to ensure the patient's comfort but also to enhance the operator's performance and minimize chair time. In the maxilla, anesthesia is often achieved using highly traumatic nerve blocks, apart from multiple local infiltrations through the buccal vestibule. In recent years, anterior middle superior alveolar (AMSA) field block has been claimed to be a less traumatic alternative to several of these conventional injections, and it has many other advantages. This critical review of the existing literature aimed to discuss the rationale, mechanism, effectiveness, extent, and duration of AMSA injections for periodontal surgical and non-surgical procedures in the maxilla. It also focused on future prospects, particularly in relation to computer-controlled local anesthetic delivery systems, which aim to achieve the goal of pain-free anesthesia. A literature search of different databases was performed to retrieve relevant articles related to AMSA injections. After analyzing the existing data, it can be concluded that this anesthetic technique may be used as a predictable method of effective palatal anesthesia with adequate duration for different periodontal procedures. It has additional advantages of being less traumatic, requiring lesser amounts of local anesthetics and vasoconstrictors, as well as achieving good hemostasis. However, its effect on the buccal periodontium appears highly unpredictable.

Amsacrine , Anesthesia , Anesthetics, Local , Hemostasis , Maxilla , Methods , Nerve Block , Palate , Periodontal Debridement , Periodontium , Vasoconstrictor Agents
Esc. Anna Nery Rev. Enferm ; 23(4): e20190013, 2019. tab, graf
Article in English | LILACS, BDENF | ID: biblio-1019852


Abstract Objective: To evaluate nurses' knowledge about the definitions of Sepsis-3 and updates to the Surviving Sepsis Campaign. Methods: This descriptive study was carried out from July to August 2018, with 30 nurses from four wards of a large university hospital. For data collection, we created, structured, and validated a questionnaire composed of socio-demographic/occupational data and knowledge test. Results: Only 16.6% of the professionals received in-service training on the subject. There was no implementation of sepsis protocols in the institution, although 96.6% of the participants considered their implementation necessary. Professionals aged ≥35 years old had a higher level of knowledge about the new definition of sepsis (p=0.042). The knowledge about volume resuscitation (p=0.001) and use of vasopressors (p=0.025) was greater in those with ≥10.5 years of experience in the profession. Nurses from the clinical units presented a higher level of knowledge about the organic dysfunctions caused by sepsis (p=0.025). Conclusion and implications for the practice: Nurses do not have satisfactory knowledge for the proper identification, treatment, and clinical management of sepsis. There is a need for greater professional, institutional, and political incentives to implement a permanent education and the sepsis protocol.

Resumen Objetivo: Evaluar el conocimiento de los enfermeros que actúan en enfermerías sobre las definiciones de Sepsis-3 y las actualizaciones de Surviving Sepsis Campaign. Métodos: Estudio descriptivo realizado de julio a agosto de 2018 con 30 enfermeros de cuatro enfermerías de un hospital universitario de gran porte. Para la recolección de datos, creamos, estructuramos y validamos una encuesta compuesta de datos sociodemográficos/ocupacionales y tests de conocimiento. Resultados: Solo el 16,6% de los profesionales recibieron capacitación en servicio sobre la temática. En la institución no había protocolo de sepsis implantado, aunque el 96,6% de los participantes consideraron su implantación necesaria. Los profesionales con edad ≥35 años presentaron mayor nivel de conocimiento acerca de la nueva definición de sepsis (p=0,042). El conocimiento sobre la resucitación volémica (p=0,001) y el uso de vasopresores (p=0,025) fue mayor en aquellos con tiempo ≥10,5 años de ejercicio en la profesión. Los enfermeros de las unidades clínicas presentaron un mayor nivel de conocimiento de las disfunciones orgánicas causadas por la sepsis (p=0,025). Conclusión e implicaciones para la práctica: Los enfermeros no presentan un conocimiento satisfactorio para identificar, tratar y administrar clinicamente la sepsis de forma adecuada. Existe la necesidad de mayores incentivos profesionales, institucionales y políticos, con miras a implementar una educación permanente y un protocolo de sepsis.

Resumo Objetivo: Avaliar o conhecimento dos enfermeiros que atuam em enfermarias sobre as definições do Sepsis-3 e atualizações da Surviving Sepsis Campaign. Métodos: Estudo descritivo realizado de julho a agosto de 2018 com 30 enfermeiros de quatro enfermarias de um hospital universitário de grande porte. Para coleta de dados, criamos, estruturamos e validamos um questionário composto por dados sociodemográficos/ocupacionais e teste de conhecimento. Resultados: Apenas 16,6% dos profissionais receberam treinamento em serviço sobre o tema. Na instituição não havia protocolo de sepse implantado, embora 96,6% dos participantes tenham considerado sua implantação necessária. Profissionais com idade ≥35 anos apresentaram maior nível de conhecimento acerca da nova definição de sepse (p=0,042). O conhecimento sobre ressuscitação volêmica (p=0,001) e uso de vasopressores (p=0,025) foi maior naqueles com tempo ≥10,5 anos de exercício na profissão. Enfermeiros das unidades clínicas apresentaram maior nível de conhecimento das disfunções orgânicas causada pela sepse (p=0,025). Conclusão e implicações para a prática: Os enfermeiros não apresentam conhecimento satisfatório para identificação, tratamento e gerenciamento clínico da sepse de forma adequada. Existe a necessidade de maiores incentivos profissionais, institucionais e políticos, com vistas às implementações da educação permanente e do protocolo de sepse.

Humans , Male , Female , Adult , Sepsis/nursing , Employee Performance Appraisal/statistics & numerical data , Nurses , Resuscitation , Vasoconstrictor Agents/therapeutic use , Clinical Protocols/standards , Cross-Sectional Studies , Surveys and Questionnaires/statistics & numerical data , Sepsis/diagnosis , Early Diagnosis , Education, Nursing, Continuing , Organ Dysfunction Scores , Blood Culture
Rev. Col. Bras. Cir ; 46(6): e20192269, 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-1057180


RESUMO Convencionalmente, a associação de anestésicos locais com vasoconstritores é evitada em extremidades pelo risco de isquemia. Entretanto, estudos recentes sugerem haver segurança no uso de vasoconstritor em extremidades. Procuramos, assim, avaliar a efetividade e segurança do uso de vasoconstritores combinados com anestésicos locais no bloqueio de nervos digitais em comparação ao uso de anestésicos plenos, através de uma revisão sistemática com metanálise de ensaios clínicos randomizados. Pesquisamos, até maio de 2019, nas bases de dados MEDLINE, LILACS, SciELO, ScienceDirect, Scopus, e literatura cinzenta, sem restrições de data ou idioma, os descritores: bloqueio digital, vasoconstritor e isquemia. Foram incluídos ensaios clínicos randomizados nos quais houve a utilização de anestésicos locais associados ou não a vasoconstritores em bloqueios digitais. Nas variáveis primárias foram analisadas a ocorrência de complicações isquêmicas e a duração da anestesia, e nas variáveis secundárias foram observadas necessidade de reaplicação anestésica, de controle de sangramento e latência. Dez estudos foram incluídos nesta revisão. Não foi observada a ocorrência de isquemia, independente do uso ou não de vasoconstritores. O uso de vasoconstritores na concentração de 1:100.000 ou menor esteve associado a maior duração da anestesia (P<0,00001), menor necessidade de reaplicação anestésica (P=0,02), menor necessidade de controle de sangramento (P=0,00006) e menor latência (P<0,00001). Pudemos concluir que uso de vasoconstritores associados a anestésicos locais no bloqueio digital mostrou-se uma técnica segura e efetiva.

ABSTRACT Conventionally, the association of local anesthetics with vasoconstrictors is avoided at extremities due to the risk of ischemia. However, recent studies suggest that there is safety in the use of vasoconstrictors at extremities. Thus, we sought to evaluate the effectiveness and safety of vasoconstrictor use combined with local anesthetics in digital nerve block compared to the use of anesthetics without vasoconstrictors, through a systematic review with meta-analysis of randomized clinical trials. Until May 2019 we searched MEDLINE, LILACS, SciELO, ScienceDirect, Scopus,, and gray literature databases, without date or language restrictions. The keywords were the following: digital block, vasoconstrictor, and ischemia. We included randomized clinical trials in which there was the use of local anesthetics with associated or not with vasoconstrictors in digital blocks. In the primary variables, the occurrence of ischemic complications and the duration of anesthesia were analysed; in the secondary variables, the need for anesthetic reapplication, bleeding control, and latency were observed. Ten studies were included in this review. The occurrence of ischemia was not observed, regardless of the use of vasoconstrictors or not. The use of vasoconstrictors at a concentration of 1:100,000 or less was associated with longer anesthesia duration (P<0.00001), lower need for anesthetic reapplication (P=0.02), lower need for bleeding control (P=0.00006), and lower latency (P<0.00001). We could conclude that the use of vasoconstrictors associated with local anesthetics in digital block proved to be a safe and effective technique.

Humans , Vasoconstrictor Agents/administration & dosage , Anesthetics, Local/administration & dosage , Nerve Block/methods , Vasoconstrictor Agents/adverse effects , Anesthetics, Local/adverse effects , Nerve Block/adverse effects
Rev. bras. ter. intensiva ; 30(4): 423-428, out.-dez. 2018. tab
Article in Portuguese | LILACS | ID: biblio-977991


RESUMO Objetivo: Avaliar a evolução em curto prazo de pacientes com choque séptico refratário à norepinefrina tratados com vasopressina em uma unidade de terapia intensiva de um hospital universitário. Métodos: Foi realizado estudo retrospectivo não comparado (série de casos). Foram coletados dados clínicos, laboratoriais e antropométricos de pacientes que receberam infusão de vasopressina para tratamento de choque refratário a catecolaminas no período de dezembro de 2014 a junho de 2016. Para a avaliação de gravidade, foram utilizados o APACHE II e o SOFA. O desfecho principal foi mortalidade em 3 e em 30 dias. Resultados: Foram incluídos 80 pacientes, sendo 60% do sexo masculino. Em 86,3% dos casos, verificou-se APACHE II nas faixas mais altas (> 20). A mortalidade em 30 dias foi de 86,2%, sendo que 75% dos pacientes foram a óbito dentro de 72 horas após início do uso da vasopressina. Conclusão: A série avaliada apresentou alta mortalidade nas primeiras 72 horas de tratamento com vasopressina. O uso de vasopressina em pacientes refratários à norepinefrina teve pouco ou nenhum impacto na mortalidade. Não é possível excluir que a alta mortalidade no presente estudo esteja vinculada ao início relativamente tardio (após estabelecida refratariedade à norepinefrina) da vasopressina, devendo essa hipótese ser melhor avaliada por estudo randomizado.

ABSTRACT Objective: To evaluate the short-term evolution of patients with septic shock refractory to norepinephrine treated with vasopressin in an intensive care unit of a university hospital. Methods: An unmatched retrospective study (case series) was performed. Clinical, laboratory, and anthropometric data were collected from patients who received vasopressin infusion for treatment of catecholamine-refractory shock from December 2014 to June 2016. For the assessment of severity, APACHE II and SOFA scores were used. The main outcome was mortality at 3 and 30 days. Results: A total of 80 patients were included, of which 60% were male. In 86.3% of the cases, APACHE II was observed in the highest ranges (> 20). The 30-day mortality was 86.2%, and 75% of the patients died within 72 hours after starting vasopressin. Conclusion: The series evaluated had high mortality in the first 72 hours of treatment with vasopressin. The use of vasopressin in patients who are refractory to norepinephrine had little or no impact on mortality. It was not possible to exclude the possibility that the high mortality in the present study was linked to the relatively late onset (after established refractoriness of norepinephrine) of vasopressin; this hypothesis should be further evaluated in a randomized study.

Humans , Male , Female , Adult , Young Adult , Shock, Septic/drug therapy , Vasoconstrictor Agents/therapeutic use , Vasopressins/therapeutic use , Intensive Care Units , Shock, Septic/mortality , Severity of Illness Index , Norepinephrine/therapeutic use , Retrospective Studies , Treatment Outcome , APACHE , Organ Dysfunction Scores , Hospitals, University , Middle Aged
Rev. bras. ter. intensiva ; 30(4): 460-470, out.-dez. 2018. tab, graf
Article in Portuguese | LILACS | ID: biblio-977995


RESUMO Objetivo: Acompanhar o índice cardíaco e o índice de resistência vascular sistêmica até a ressuscitação. Métodos: Por meio de ecocardiografia junto ao leito, obteve-se um conjunto de parâmetros hemodinâmicos, inclusive débito cardíaco, volume sistólico, índice cardíaco, índice de resistência vascular sistêmica, integral velocidade-tempo, índice de desempenho miocárdico, tempo de reenchimento capilar e frequência cardíaca no momento zero após infusão de fluidos em bolo, e início e utilização de fármacos inotrópicos, com seguimento até 6 horas e 24 horas. Resultados: Incluíram-se 45 pacientes com choque séptico adquirido na comunidade. Os focos de infecção foram gastrenterite (24%), perfuração intestinal com necessidade de cirurgia emergencial (24%), pneumonia (20%), infecção do sistema nervoso central (22%) e infecção de tecidos moles (8%). Os isolados mais frequentes foram de Klebsiella e Enterobacter. Estimamos os fatores que afetaram o índice cardíaco: pressão venosa central elevada no momento zero (r = 0,33; p = 0,024) e persistência de frequência cardíaca elevada após 6 horas (r = 0,33; p = 0,03). O índice de resistência vascular sistêmica foi alto na maioria dos pacientes no momento zero e após 24 horas, e por ocasião da ressuscitação, afetando inversamente o índice cardíaco, assim como a integral velocidade-tempo (r = -0,416; -0,61; 0,55 e -0,295). O tempo de reenchimento capilar aumentado foi preditor clínico de valores baixos de integral velocidade-tempo após 24 horas (r = -0,4). O índice de mortalidade foi de 27%. Nos pacientes que não sobreviveram, observaram-se índices de resistência vascular sistêmica mais baixos e débitos cardíacos mais altos. Conclusão: O índice de resistência vascular sistêmica esteve persistentemente elevado em pacientes com choque frio, o que influenciou no índice de volume sistólico, no índice cardíaco e na integral velocidade-tempo. O uso de ecocardiografia para obtenção de mensurações hemodinâmicas é importante em pacientes pediátricos com choque séptico, para que se possam ajustar as doses de vasodilatadores e vasopressores, e obter os objetivos da ressuscitação em tempo apropriado.

ABSTRACT Objective: Follow-up of cardiac index and systemic vascular resistance index by bedside echocardiography until resuscitation. Methods: A set of hemodynamic parameters was obtained, including cardiac output, stroke volume, cardiac index, systemic vascular resistance index, velocity time integral, myocardial performance index, capillary refill time, and heart rate at 0 hours after fluid boluses before the start of inotropes, and followed up after 6 hours and 24 hours. Results: Included were 45 patients with community-acquired septic shock. Septic foci were gastroenteritis (24%), intestinal perforation requiring emergency surgery (24%), pneumonia (20%), central nervous system infection (22%) and soft tissue infection (8%). Klebsiella and Enterobacter were the most frequent isolates. We estimated the factors affecting the cardiac index: high central venous pressure at zero time (r = 0.33, p = 0.024) and persistently high heart rate at hour 6 (r = 0.33, p = 0.03). The systemic vascular resistance index was high in most patients at 0 and 24 hours and at the time of resuscitation and inversely affected the cardiac index as well as affecting the velocity time integral (r = -0.416, -0.61, 0.55 and -0.295). Prolonged capillary refill time was a clinical predictor of the low velocity time integral at 24 hours (r = -0.4). The mortality was 27%. Lower systemic vascular resistance index and higher cardiac output were observed in nonsurviving patients. Conclusion: There was a persistently high systemic vascular resistance index in cold shock patients that influenced the stroke volume index, cardiac index, and velocity time integral. The use of echocardiograms for hemodynamic measurements is important in pediatric septic shock patients to adjust dilators, and vasopressor doses and achieve resuscitation targets in a timely manner.

Humans , Male , Female , Infant , Child, Preschool , Child , Shock, Septic/diagnosis , Vascular Resistance/physiology , Echocardiography/methods , Point-of-Care Systems , Resuscitation/methods , Shock, Septic/physiopathology , Stroke Volume/physiology , Time Factors , Vasoconstrictor Agents/administration & dosage , Cardiac Output/physiology , Prospective Studies , Cohort Studies , Heart Rate/physiology , Hemodynamics/physiology
Rev. bras. ter. intensiva ; 30(2): 135-143, abr.-jun. 2018. tab, graf
Article in Portuguese | LILACS | ID: biblio-959315


RESUMO Objetivo: Os distúrbios microcirculatórios estão implicados no prognóstico do choque séptico. A hiporresponsividade microvascular pode ser avaliada por meio do índice de perfusão, derivado da oximetria de pulso e hiperemia reativa. Com utilização do índice de perfusão, investigamos a hiperemia reativa e sua relação com a perfusão periférica e os parâmetros clínico-hemodinâmicos no choque séptico. Métodos: Avaliaram-se 82 pacientes, 47 deles com choque séptico e 35 controles. Os exames foram realizados dentro de 24 horas após a admissão. O índice de perfusão foi avaliado antes e após uma oclusão do fluxo sanguíneo durante 3 minutos, utilizando-se análise de resposta temporal por 5 minutos. O índice de perfusão foi também avaliado nas fases hiperêmicas, principalmente com derivação de mecanismos mecanossensitivos (ΔIP0-60) e metabólicos (ΔIP60-120). Realizaram-se testes de correlação entre a hiperemia reativa e dados clínicos hemodinâmicos. Resultados: A hiperemia reativa, medida pelo índice de perfusão, foi significantemente mais baixa no choque séptico apenas até 45 segundos após a desinflação do manguito. No período restante, não houve diferenças estatisticamente significantes entre os grupos. Os picos de índice de perfusão foram similares entre os grupos, embora o pico tenha sido atingido de forma mais lenta no grupo séptico. Os valores de ΔIP0-60 foram mais baixos no choque [1% (-19% - -40%) versus 39% (6% - 75%); p = 0,001]. No entanto, o ΔIP60-120 foi similar entre os grupos [43% (18% - 93%) versus 48% (18% - 98%); p = 0,58]. O tempo até o pico do índice de perfusão se correlacionou de forma positiva com o SOFA e negativamente com os níveis de proteína C-reativa. O pico de índice de perfusão se correlacionou de forma positiva com as doses de vasopressores; os valores de ΔIP60-120 tiveram correlação positiva com o nível de proteína C-reativa e as doses de vasopressores. Não ocorreram outras correlações significantes. Conclusões: Este estudo com base no índice de perfusão sugere que o choque séptico promove hiporresponsividade vascular periférica, enquanto a reatividade vascular posterior é consideravelmente preservada. Estes resultados demonstram resposta hiperêmica periférica dependente do tempo e significante reserva isquêmica no choque séptico.

ABSTRACT Objective: Microcirculation disturbances are implicated in the prognosis of septic shock. Microvascular hyporesponsiveness can be assessed by an oximetry-derived perfusion index and reactive hyperemia. Using this perfusion index, we investigated reactive hyperemia and its relationship with peripheral perfusion and clinical-hemodynamic parameters in septic shock. Methods: Eighty-two patients were evaluated: 47 with septic shock and 35 controls. Tests were performed within 24 hours after admission. The perfusion index was evaluated before and after a 3-min blood flow occlusion using a time-response analysis for 5 min. The perfusion index was also evaluated in the hyperemic phases and was mainly derived by mechanosensitive (ΔPI0-60) and metabolic mechanisms (ΔPI60-120). Correlation tests were performed between reactive hyperemia and clinical-hemodynamic data. Results: Reactive hyperemia measured by the perfusion index was significantly lower in patients with septic shock, but this was only observed for the first 45 seconds after cuff-deflation. In the remaining period, there were no statistical differences between the groups. The peaks in the perfusion index were similar between groups, although the peak was reached more slowly in the septic group. Values of ΔPI0-60 were lower in shock [01% (-19% - -40%) versus 39% (6% - 75%); p = 0.001]. However, ΔPI60-120 was similar between the groups [43% (18% - 93%) versus 48% (18% - 98%); p = 0.58]. The time-to-peak of the perfusion index was correlated positively with the SOFA scores and negatively with C-reactive protein; the peak of the perfusion index was positively correlated with vasopressor doses; and the ΔPI60-120 values were positively correlated with C-reactive protein and vasopressor doses. No other significant correlations occurred. Conclusions: This perfusion index-based study suggests that septic shock promotes initial peripheral vascular hyporesponsiveness and preserves posterior vascular reactivity to a considerable degree. These results demonstrate a time-dependent peripheral hyperemic response and a significant ischemic reserve in septic shock.

Humans , Male , Female , Aged , Shock, Septic/therapy , Fluid Therapy/methods , Hyperemia/metabolism , Shock, Septic/physiopathology , Time Factors , Vasoconstrictor Agents/administration & dosage , C-Reactive Protein/metabolism , Oximetry/methods , Case-Control Studies , Organ Dysfunction Scores , Hemodynamics , Microcirculation , Middle Aged