Echocardiography for prognostication during the resuscitation of intensive care unit patients with non-shockable rhythm cardiac arrest.

AIM: Transthoracic echocardiography (TTE) during cardiopulmonary arrest (CPA) has been studied in victims of cardiac arrests. Our objective was to evaluate the feasibility and usefulness of TTE in victims of cardiac arrest with non-shockable rhythms hospitalized in intensive care units (ICUs). METHODS: This prospective and observational cohort study evaluated ICU patients with CPA in asystole or pulseless electrical activity (PEA). Intensivists performed TTE during intervals of up to 10s as established in the treatment protocol. Myocardial contractility was defined as intrinsic movement of the myocardium coordinated with cardiac valve movement. PEA without contractility was classified as electromechanical dissociation (EMD), and with contractility as pseudo-EMD. The images, the rates of return of spontaneous circulation (ROSC) and the survival upon hospital discharge and after 180 days were evaluated. RESULTS: A total of 49 patients were included. Image quality was considered adequate in all cases and contributed to the diagnosis of CPA in 51.0% of the patients. Of the 49 patients included, 17 (34.7%) were in asystole and 32 (65.3%) in PEA, among which 5 (10.2%) were in EMD and 27 (55.1%) in pseudo-EMD. The rates of ROSC were 70.4% for those in pseudo-EMD, 20.0% for those in EMD, and 23.5% for those in asystole. Survival upon hospital discharge and after 180 days occurred only in patients in pseudo-EMD (22.2% and 14.8%, respectively). CONCLUSIONS: TTE conducted during cardiopulmonary resuscitation in ICU patients can be performed without interfering with care protocols and can contribute to the differential diagnosis of CPA and to the identification of a subgroup of patients with better prognosis.

Como avaliar criticamente um ensaio clínico de alocação aleatória em terapia intensiva / How to assess intensive care randomized trials

Ensaios clínicos aleatorizados são investigações científicas consideradas padrão-ouro para avaliar intervenções terapêuticas. Ensaios clínicos aleatorizados podem examinar e avaliar a segurança e eficácia de novas drogas ou procedimentos terapêuticos ou comparar os efeitos entre duas ou mais drogas ou qualquer outra intervenção. Nesse artigo apresentamos as características essenciais e fatores que podem introduzir viés nesses estudos. Em seguida, apresentamos critérios para avaliação crítica de artigos reportando os resultados de ensaios clínicos aleatorizados e mostramos como interpretar e aplicá-los à prática clínica.

Randomized controlled trials are scientific investigations considered as the gold-standard to evaluate therapeutic interventions. Randomized controlled trials may examine the safety and efficacy of new drugs and therapeutic procedures or compare the effects of two or more drugs or any other intervention. In this article, we present the essential features of these studies, as well as, factors which may bias randomized controlled trials. We also present criteria to critically appraise articles reporting randomized controlled trials, explain how to interpret the results and how to apply them to clinical practice.

How to assess intensive care randomized trials. / Como avaliar criticamente um ensaio clínico de alocação aleatória em terapia intensiva.

Randomized controlled trials are scientific investigations considered as the gold-standard to evaluate therapeutic interventions. Randomized controlled trials may examine the safety and efficacy of new drugs and therapeutic procedures or compare the effects of two or more drugs or any other intervention. In this article, we present the essential features of these studies, as well as, factors which may bias randomized controlled trials. We also present criteria to critically appraise articles reporting randomized controlled trials, explain how to interpret the results and how to apply them to clinical practice.

Proposta de uma escala para avaliação de estresse em pacientes atendidos em programa de check-up clínico / Proposal of an evaluation scale for stress in patients attending a clinical check-up program

A prevenção primária em psicologia hospitalar possibilita o estudo dos fatores de risco e proteção para desordens psicológicas e assume um modelo que privilegia a dimensão biopsicossocial. Constata-se que diferentes modelos teóricos relacionam o estresse com o desencadeamento de doenças, possibilitando que esse seja...

Aerobic exercise and submaximal functional capacity in overweight pregnant women: a randomized trial.

OBJECTIVE: To evaluate the effects of aerobic training on submaximal cardiorespiratory capacity in overweight pregnant women. METHODS: We conducted a randomized clinical trial in a referral center prenatal clinic during the period 2000-2002. Of 132 overweight (body mass index 26-31 kg/m2) but otherwise healthy volunteers, at 20 years of age or older, with gestational age of 20 weeks or less, and without diabetes or hypertension, 92 consented to participate and were randomized. Intervention consisted of 3 one-hour aerobic exercise sessions per week; the control group received weekly relaxation and focus group discussions. The main outcome measure was submaximal exercise capacity evaluated by oxygen uptake at the anaerobic (first ventilatory) threshold during cardiopulmonary treadmill testing 12 weeks after randomization. RESULTS: Oxygen uptake at the anaerobic threshold increased 18% (15.9 +/- 2.6 to 18.1 +/- 3.1 mL . min(-1) . kg(-1)) in the exercise group but decreased 16% (16.9 +/- 3.0 to 15.8 +/- 2.6 mL . min(-1) . kg(-1)) among the control group. Oxygen consumption at the anaerobic threshold, adjusted through analysis of covariance for baseline oxygen uptake, was 2.68 (95% confidence interval 1.23 to 4.12) mL . min(-1) . kg(-1) greater in the exercise group. Women in the exercise group were approximately 5 times more likely than those in the control group to have regular or good cardiorespiratory capacity (12/38 versus 2/38; relative risk 5.2, 95% confidence interval 1.2 to 22.0, number needed to treat 5). CONCLUSION: Aerobic training in overweight pregnant women substantially increases submaximal exercise capacity, overcoming the otherwise negative effects of pregnancy in this regard. Additional studies are required to evaluate its effect on major clinical outcomes.