Cardiopulmonary resuscitation in an average brazilian intensive care unit: should we perform less or better?

Abstract Introduction: Few data can be found about cardiac arrest in the intensive care unit outside reference centers in third world countries. Objective: To study epidemiology and prognostic factors associated with cardiac arrest in the intensive care unit (ICU) in an average Brazilian center. Methods: Between June 2011 and July 2014, 302 cases of cardiac arrest in the intensive care unit were prospectively evaluated in 273 patients (age: 68.9 ± 15 years) admitted in three mixed units. Data regarding cardiac arrest and cardiopulmonary resuscitation were collected in an "Utstein style" form and epidemiologic data was prospectively obtained. Factors associated with do not resuscitate orders, return of spontaneous circulation and survival were studied using binary logistic regression. Statistical package software used was SPSS 19.0 (IBM Inc., USA). Results: Among 302 cardiac arrests, 230 (76.3%) had their initial rhythm recorded and 141 (61.3%) was in asystole, 62 (27%) in pulseless electric activity (PEA) and 27 had a shockable rhythm (11.7%). In 109 (36.1%) cases, cardiac arrest had a suspected reversible cause. Most frequent suspected cardiac arrest causes were hypotension (n=98; 32.5%), multiple (19.2%) and hypoxemia (17.5%). Sixty (19.9%) cardiac arrests had do not resuscitate orders. Prior left ventricle dysfunction was the only predictor of do not resuscitate order (OR: 3.1 [CI=1.03-9.4]; P=0.04). Among patients that received cardiopulmonary resuscitation, 59 (24.4%) achieved return of spontaneous circulation and 12 survived to discharge (5.6%). Initial shockable rhythm was the only return of spontaneous circulation predictor (OR: 24.9 (2.4-257); P=0.007) and survival (OR: 4.6 (1.4-15); P=0.01). Conclusion: Cardiopulmonary resuscitation rate was high considering ICU patients, so was mortality. Prior left ventricular dysfunction was a predictor of do not resuscitate order. Initial shockable rhythm was a predictor of return of spontaneous circulation and survival.

Effects of anti-glaucoma drugs on resistive index of the medial long posterior ciliary artery using color Doppler imaging in Beagle dogs

Color Doppler imaging (CDI) was carried out to evaluate the effects of anti-glaucoma drugs on ophthalmic circulation using CDI-derived resistive index (RI) values. CDI was performed on nine Beagle dogs, and RI values were calculated for the medial long posterior ciliary artery before and after the administration of anti-glaucoma drugs. A significant increase in RI values was found after topical administration of levobunolol (p < 0.05) or dipivefrin (p < 0.05). Pilocarpine showed no effects on RI values after topical administration. The results suggest that some anti-glaucoma drugs could affect ophthalmic blood flow.

Alpha1 and alpha2 adrenoceptor mediated melanosome aggregatory responses in vitro in Oreochromis mossambica (Peters) melanophores.

Effects of specific and non-specific adrenoceptor agonists and antagonists were examined on the isolated scale melanophores of O. mossambica in physiological Ringer solution. The responses were recorded as melanophore size index. It was observed that adrenaline, nor-adrenaline, phenylpropanolamine, clonidine and phenylepherine induced melanosome aggregation in a dose-dependent manner. Denervation of the fish melanophores increased the sensitivity of the melanophores to adrenaline but not to nor-adrenaline. Phentolamine (3.55 x 10(-5) M), prazosin (2.38 x 10(-5) M) and yohimbine (2.821 x 10(-5) M) significantly inhibited the aggregatory responses of the fish melanophores to adrenaline, nor-adrenaline, clonidine and phenylepherine. The blocking effect of yohimbine was significantly higher than that of prazosin. It is concluded that the effect of adrenaline is directly mediated through the receptors and alpha2 adrenoceptors are predominantly involved in the aggregatory responses of this fish melanophores, while alpha1 adrenoceptors presence has been indicated.

Time sequence of changes in the responsiveness of glycogen breakdown to adrenergic agonists in perfused liver of rats with insulin-induced hypoglycemia

The time-course changes of the responsiveness of glycogen breakdown to a- and Beta-adrenergic agonists during insulin-induced hypoglycemia (IIH) were investigated. Blood glucose levels were decreased prior to the alteration in the hepatic responsiveness to adrenergic agonists. The activation of hepatic glucose production and glycogenolysis by phenylephrine (2 µM) and isoproterenol (20 µM) was decreased in IIH. The changes in the responsiveness of glycogen catabolism were first observed for isoproterenol and later for phenylephrine. Hepatic ß-adrenergic receptors showed a higher degree of adrenergic desensitization than did a-receptors. Liver glycogen synthase activity, glycogen content and the catabolic effect of dibutyryl cyclic AMP (the Beta-receptor second messenger) were not affected by IIH.

Effects of trypan blue on the action of adrenergic agonists in the guinea-pig isolated atrium.

It has been reported that trypan blue, a diazo dye with polyamphipathic structure, can inhibit the coupling of receptors to G-proteins. The present study was carried out to investigate the effect of trypan blue on the actions of adrenoceptor agonists in the guinea-pig atrium. Trypan blue (10 and 100 microM) antagonized the positive inotropic effects of isoprenaline and dobutamine by shifting their concentration-response curves to the right. With the selective beta 2-adrenoceptor agonist, salbutamol, there was a reduction of response in the presence of trypan blue. Therefore, we concluded that trypan blue diminish the response to beta-adrenoceptor agonists possibly via decoupling receptors from Gs. Trypan blue and similar agents, due to their unique mode of action, can be used as tools for the investigation of the mechanism of receptor-G protein coupling in the whole tissue preparation.

Efecto del tratamiento con dexametasona sobre las respuestas cardiovasculares de agentes adrenérgicos / Effect of treatment with dexamethasone on adrenergic agents cardiovascular responses

Las respuestas cardiovasculares a algunos agentes podría ser modificado por la administración de glucocorticoides en ratas. Nosotros investigamos la respuesta a agentes adrenérgicos tales como fenilefrina, noradrenalina, clonidina e isoproterenol y un bloqueante ganglionar como el hexametonio en ratas conscientes tratadas durante 7 días con dexametasona. Se utilizaron ratas Wistar, las que fueron tratadas con dexametasona (150 mug/día por vía oral) y otro grupo al que se la administró agua. La presión arterial media fue calculada a partir del registro intraarterial de presión sanguínea. No se observaron diferencias significativas en presión arterial media basal entre los grupos estudiados. Tanto la noradrenalina como la fenilefrina muestran un efecto presor en el grupo control, que es disminuído cuando se tratan los animales con dexametasona. La clonidina muestra un efecto presor similar en ambos grupos de ratas, aunque a los 10 min. posteriores a la administración, el grupo con dexametasona muestra un ligero efecto hipotensor. Isoproterenol y hexametonio muestra un efecto hipotensor similar en ambos grupos de ratas. En conclusión la dexametasona reduciría el efecto presor de fenilefrina y noradrenalina. La clonidina muestra un efecto hipotensor en ratas tratadas con dexametasona, aunque no se observan cambios a la respuesta del isoproterenol y hexametonio.

Panorama atual do tratamento farmacológico do déficit cognitivo da doença de Alzheimer: um estudo de revisäo / Actual view of the pharmacological treatment of cognitive deficit of Alzheimer disease: a review

Neste artigo o autor faz uma revisäo das estratégias farmacoterápicas mais recentes, usadas no cenário internacional, para o tratamento do declínio cognitivo progressivo que caracteriza a Doença de Alzheimer. Para tanto, baseia-se no conhecimento atual acerca da etiopatogenia e neuropatologia desta demência. Apesar dos progressos obtidos pela investigaçäo científica, a etiologia desta doença é ainda obscura e os resultados dos tratamento ainda duvidosos, priorizando-se no momento medidas terapêuticas que impliquem na lentificaçäo do processo degenerativo.

Effects of hydralazine on cardiac responsiveness to adrenergic agonists in streptozotocin-induced diabetic rats.

The present investigation was undertaken to study the effects of hydralazine treatment (50 mg/kg/day, p.o.) on methoxamine and isoproterenol-induced responses in cardiac preparations of control and streptozotocin (STZ)-induced diabetic rats. Triiodothyronine (T3) and thyroxine (T4) levels were found to be significantly decreased in diabetic rats and this decrease was prevented by hydralazine treatment. Methoxamine and isoproterenol produced a dose-dependent positive chronotropic and positive inotropic effect in right and left atrium respectively. These responses to methoxamine were significantly increased, whereas, those to isoproterenol were significantly decreased in preparations obtained from diabetic rats. Hydralazine treatment did not alter the isoproterenol-induced chronotropic effect in right atrium. However, it prevented the diabetes-induced increase in responsiveness to methoxamine in this preparation. Hydralazine increased significantly the inotropic response to methoxamine and isoproterenol in left atrium of control and diabetic rats. Both the pD2 value and maximum response were increased. The studies indicates that hydralazine-induced alterations in the responsiveness to methoxamine could partly be due to its ability to prevent diabetes-induced hypothyroidism. The effects of hydralazine on isoproterenol-induced responses appear to be independent of hypothyroidism, and some post-receptor mechanisms and metabolic derangements might be responsible for this effect.

Uso de drogas vasoativas em pediatria: uma revisäo / Use of vasoactive drugs in pediatrics: a review

O autor faz uma revisäo das principais drogas vasoativas utilizadas em pediatria, sendo apresentados os seus mecanismos de açäo, as doses habitualmente utilizadas, assim como as precauçöes que se deve ter com o seu uso. Finaliza apresentando algumas das novas drogas utilizadas no paciente em choque.