RESUMO
Near-infrared spectroscopy (NIRS) could be a useful continuous, non-invasive technique for monitoring the effect of partial pressure of carbon dioxide (PaCO2) fluctuations in the cerebral circulation during ventilation. The aim of this study was to examine the efficacy of NIRS to detect acute changes in cerebral blood flow following PaCO2 fluctuations after confirming the autoregulation physiology in piglets. Fourteen piglets (<72 h of life) were studied. Mean arterial blood pressure, oxygen saturation, pH, glycemia, hemoglobin, electrolytes, and temperature were monitored. Eight animals were used to evaluate brain autoregulation, assessing superior cava vein Doppler as a proxy of cerebral blood flow changing mean arterial blood pressure. Another 6 animals were used to assess hypercapnia generated by decreasing ventilatory settings and complementary CO2 through the ventilator circuit and hypocapnia due to increasing ventilatory settings. Cerebral blood flow was determined by jugular vein blood flow by Doppler and continuously monitored with NIRS. A decrease in PaCO2 was observed after hyperventilation (47.6±2.4 to 29.0±4.9 mmHg). An increase in PaCO2 was observed after hypoventilation (48.5±5.5 to 90.4±25.1 mmHg). A decrease in cerebral blood flow after hyperventilation (21.8±10.4 to 15.1±11.0 mL/min) and an increase after hypoventilation (23.4±8.4 to 38.3±10.5 mL/min) were detected by Doppler ultrasound. A significant correlation was found between cerebral oxygenation and Doppler-derived parameters of blood flow and PaCO2. Although cerebral NIRS monitoring is mainly used to detect changes in regional brain oxygenation, modifications in cerebral blood flow following experimental PaCO2 changes were detected in newborn piglets when no other important variables were modified.
RESUMO
Objetivo. Analizar el perfil, la incidencia de limitaciónde tratamiento de soporte vital (LTSV) y la potencialidad de donación de órganos enpacientes neurocríticos. Diseño Multicéntrico prospectivo. Ámbito Nueve centros autorizados para extracción de órganos para trasplante...
Assuntos
Doação Dirigida de Tecido , Morte Encefálica/diagnósticoRESUMO
A household survey was conduced in Skeikh Omer Primary Health Care Center in Baghdad City to assess the continuation of oral contraceptive method used in respect to some variables among clients who attended family planning clinic for the first time during January / 1997 and they were followed up one year after using the method. Sample of the study consisted of [109] clients using oral contraceptive. Data were collected through an interview questionnaire form after one year using the method through home visit. Results of the study revealed that [65.1%] of the study sample had continued to use the oral contraceptive method after one year, in addition more than one third of study sample had discontinued to use the method either dropped out or switched to other method after one year. There were five variables which emerged from multiple Logistic regression analysis as the prime determinants of the continuation of oral contraceptive method and which came in order of importance which include: Duration between last two pregnancy, regular attendance of client to family planning clinic, acceptance of oral contraceptive method, husband desire and desire for having the last child. Also the result stated that the highest percentage [84.4%] of intrauterine contraceptive device users mentioned that the occurrence of side effects were the reason for discontinuation of the method. The study recommended that the necessity of improving the educational aspect of family planning services and establishing a follow up system in each clinic to detect continuation of the method and necessity the integration system of family planning services with primary health care and obstetrical and gynecology health services