Ventilação não invasiva versus oxigenoterapia em fase final dos cuidados paliativos oncológicos: uma revisão sistemática / Non-invasive Ventilation versus Oxygenotherapy in the end stage of Oncology Palliative Care: a Systematic Review

Introdução: A Organização Mundial da Saúde define como Cuidados Paliativos abordagens que melhoram a qualidade de vida dos pacientes (adultos e crianças) e de suas famílias que enfrentam problemas associados a doenças de risco de vida. Um dos principais objetivos dos Cuidados Paliativos é o alívio da dispneia. Objetivo: Esta revisão sistemática buscou encontrar na literatura evidências que indicam a efetividade das intervenções não invasivas para alívio da dispneia em fase final dos cuidados paliativos. Metodologia: Utilizou-se o guia metodológico da Cochrane Handbook. Resultados: Após a pesquisa inicial,110 artigos foram encontrados, 11 foram removidos por duplicação, 86 excluídos por não preencherem os critérios de inclusão. Após filtragem, 13 estudos foram recuperados em texto completo, e após leitura dos textos completos, 11 não corresponderam aos critérios de elegibilidade. Dois estudos foram incluídos na síntese qualitativa para avaliação da qualidade metodológica, e passaram para a síntese quantitativa. Nesta revisão sistemática, 230 pacientes incluídos foram alocados de forma aleatória para VNI (n=113) e Oxigenoterapia (n=117) seguindo uma randomização simples. Conclusão: Esta revisão sistemática apontou que as duas intervenções são métodos capazes de melhorar a dispneia dos pacientes em fase final dos Cuidados Paliativos Oncológicos, contudo a VNI mostrou ser superior à oxigenoterapia convencional e ao HFCN, principalmente nos pacientes hipercápnicos. Embora o HFCN também tenha apresentado dados significativos, seu uso ainda é controverso.

Introduction: The World Health Organization defines Palliative Care as approaches that improve the quality of life of patients (adults and children) and their families who face problems associated with lifethreatening diseases. One of the main objectives of Palliative Care is the relief of dyspnea. Objective: This systematic review sought to find evidence in the literature that indicates the effectiveness of non-invasive interventions for the relief of dyspnea in the final stage of palliative care. Methodology: The Cochrane Handbook methodological guide was used. Results: After the initial search, 110 articles were found, 11 were removed by duplication, 86 were excluded for not meeting the inclusion criteria, after filtering 13 studies were retrieved in full text, and after reading the full texts, 11 did not meet the criteria eligibility criteria. Two studies were included in the qualitative synthesis to assess methodological quality, and moved on to the quantitative synthesis. In this systematic review, 230 included patients were randomly allocated to NIV (n = 113) and oxygen therapy (n = 117) following simple randomization. Conclusion: This systematic review pointed out that the two interventions are methods capable of improving the dyspnea of patients in the final stage of Oncology Palliative Care, however NIV has been shown to be superior to conventional oxygen therapy and HFCN, especially in hypercapnic patients. Although HFCN has also presented significant data, its use is still controversial. Although supplemental oxygen therapy is widely prescribed, there is little evidence of benefit

Electrocardiogram changes in patients with end stage renal disease on chronic haemodialysis

Background: End stage renal disease (ESRD) is irreversible loss of renal function which is physiologically defined by a GFR of less than 15 ml / minute. ESRD is associated with a higher incidence of coronary artery disease and serious arrhythmia especially ventricular arrhythmia. The goal of study is to determine whether ESRD and haemodialysis (HD)are associated with occurrence of significant electrocardiogram (ECG) changes or not.Methods: This is a cross-sectional study design which involved 22 patients with ESRD on regular HD in Al Sadre teaching hospital / Al Najaf. Both sexes was included in this study. All patients underwent full medical history and examination which included the following aspects: Age, Sex, Occupation, BP, HR, RBS, B.urea, S.creatinine , Serum electrolyte (Na+, K+, Cl-, Ca++), Lipid profile (Cholesterol , Triglyceride, HDL, LDL), Duration of CRF, Duration of dialysis, Social history including (smoking, alcohol) and Drug used by the patient. Resting EGC and Hotler ECG.Results: Eighteen patients exhibited emergence of simple ectopic activity premature atrial complex (PAC) and premature ventricular complex (PVC) events and four patients exhibited (ST,T changes). Potentially lethal arrhythmias and other serious ECG changes are not detected in our patient’s sample.Conclusion: In this study, neither ESRD nor haemodialysis were associated with development of serious ECG changes or emergence of significant arrhythmia.