Cuidados paliativos na emergência: revisão integrativa / Palliative care in emergency services: an integrative review / Cuidados paliativos en servicios de emergencia: revisión integradora

Resumo O objetivo do artigo é conhecer a abordagem de equipes de emergência à assistência de pacientes com doença crônica avançada, na perspectiva dos cuidados paliativos. O texto traz resultados de revisão integrativa que buscou artigos em cinco bases de dados, utilizando os descritores "serviços médicos de emergência", "equipe de assistência ao paciente", "atitude do pessoal de saúde" e "cuidados paliativos". Inicialmente, foram identificadas 12.290 publicações, reduzidas, após análise, a uma amostra final de 26 artigos. Entre as principais medidas mencionadas na literatura para levar os cuidados paliativos à emergência, estão: plano de cuidados individualizado e flexível; gestão de redes; acesso à equipe de cuidados paliativos; comunicação empática; identificação dos pacientes elegíveis; e controle de sintomas. Conclui-se que as equipes de emergência precisam reconhecer a importância dos cuidados paliativos nesse serviço, redirecionando o cuidado concentrado em "salvar vidas" para um cuidado que preserve a dignidade humana.

Abstract This article seeks to understand the approach of emergency teams to patients with an advanced chronic condition from a palliative care perspective. This integrative review searched for articles in five databases using the descriptors "emergency medical services," "patient assistance team," "attitudes of health personnel" and "palliative care". At first, 12,290 publications were identified, which were then reduced to 26 articles for the final sample. Among the main measures found in the literature to use palliative care in emergency services, the following stand out: individualized and flexible care plan; network management; access to the palliative care team; empathic communication; identification eligible patients; and control of symptoms. We thus conclude that emergency teams must recognize the importance of palliative care and redirect the care focused in "saving lives" towards a care that preserves human dignity.

Resumen Este artículo tuvo como objetivo comprender el enfoque del equipo de emergencia a los pacientes con enfermedad crónica avanzada desde una perspectiva paliativa. Se realizó una revisión integradora, buscando artículos en portugués, inglés y español en las bases de datos MEDLINE, LILACS, SciELO, IBECS y CINAHL, utilizando los descriptores "servicios médicos de emergencia", "equipo de asistencia al paciente", "actitud del personal de salud" y "cuidados paliativos", con 12.290 publicaciones identificadas inicialmente, que tras su análisis dieron como resultado una muestra final de 26 artículos. Entre los principales aspectos destacan: plan de cuidados individualizado y flexible; gestión de redes; acceso al equipo de cuidados paliativos; comunicación empática; identificación de pacientes elegibles; y control de síntomas. Se concluye que el equipo de emergencias necesita reconocer la importancia de los cuidados paliativos en este servicio y reorientar los cuidados enfocados a "salvar vidas" hacia cuidados que "preserven la dignidad humana".

Exposure of Toxocara canis eggs to Purpureocillium lilacinum as a biocontrol strategy: an experimental model evaluation.

Purpureocillium lilacinum is a nematophagous fungus used in biological control against some parasites, including Toxocara canis. This study researched the infectivity of embryonated T. canis eggs after exposure to the fungus P. lilacinum. T. canis eggs were exposed to P. lilacinum for 15 or 30 days and subsequently administered to Swiss mice (n=20). Control group consisted of mice who received T. canis embryonated eggs without fungal exposure. Forty-eight hours after infection, heart, lung, and liver from animals of each group were collected to assess larval recovery. The organs of mice that received embryonated eggs exposed to the fungus showed a lower average larval recovery (P<0.05) suggesting that exposure of T. canis eggs to P. lilacinum was able to reduce experimental infection. Under the evaluated conditions, the interaction time between the fungus and the parasite eggs was not a significant factor in larvae recovery. P. lilacinum may be considered a promising T. canis biological control agent. However, further studies are needed to determine a protocol for the use of this fungus as a biological control agent.

Exposure of Toxocara canis eggs to Purpureocillium lilacinum as a biocontrol strategy: an experimental model evaluation / Exposição de ovos de Toxocara canis a Purpureocillium lilacinum como estratégia de biocontrole: uma avaliação em modelo experimental

Abstract Purpureocillium lilacinum is a nematophagous fungus used in biological control against some parasites, including Toxocara canis. This study researched the infectivity of embryonated T. canis eggs after exposure to the fungus P. lilacinum. T. canis eggs were exposed to P. lilacinum for 15 or 30 days and subsequently administered to Swiss mice (n=20). Control group consisted of mice who received T. canis embryonated eggs without fungal exposure. Forty-eight hours after infection, heart, lung, and liver from animals of each group were collected to assess larval recovery. The organs of mice that received embryonated eggs exposed to the fungus showed a lower average larval recovery (P<0.05) suggesting that exposure of T. canis eggs to P. lilacinum was able to reduce experimental infection. Under the evaluated conditions, the interaction time between the fungus and the parasite eggs was not a significant factor in larvae recovery. P. lilacinum may be considered a promising T. canis biological control agent. However, further studies are needed to determine a protocol for the use of this fungus as a biological control agent.

Resumo Purpureocillium lilacinum é um fungo nematófago com potencial para uso no controle biológico de parasitos, incluindo Toxocara canis. Este estudo pesquisou a infectividade de ovos de T. canis embrionados após exposição ao fungo P. lilacinum . Ovos de T. canis foram expostos ao fungo por 15 ou 30 dias e subsequentemente administrados a camundongos Swiss (n=20). O grupo controle consistiu de camundongos que receberam ovos embrionados do parasita sem exposição ao fungo. Quarenta e oito horas após a infecção, coração, pulmão e fígado dos camundongos foram coletados para avaliar a recuperação larval. Os órgãos dos animais que receberam ovos embrionados expostos ao fungo apresentaram menor média de recuperação larval (P<0,05) do que os infectados com ovos sem exposição ao fungo, sugerindo que a exposição dos ovos de T. canis a P. lilacinum foi capaz de reduzir a infecção experimental. Nas condições avaliadas, o tempo de interação entre o fungo e os ovos do parasito não foi um fator significativo na recuperação das larvas. P. lilacinum pode ser considerado um promissor agente de controle biológico de T. canis, no entanto, mais estudos são necessários para avaliar o emprego deste fungo como um agente de controle biológico.

Exposure of Toxocara canis eggs to Purpureocillium lilacinum as a biocontrol strategy: an experimental model evaluation / Exposição de ovos de Toxocara canis a Purpureocillium lilacinum como estratégia de biocontrole: uma avaliação em modelo experimental

Purpureocillium lilacinum is a nematophagous fungus used in biological control against some parasites, including Toxocara canis. This study researched the infectivity of embryonated T. canis eggs after exposure to the fungus P. lilacinum. T. canis eggs were exposed to P. lilacinum for 15 or 30 days and subsequently administered to Swiss mice (n=20). Control group consisted of mice who received T. canis embryonated eggs without fungal exposure. Forty-eight hours after infection, heart, lung, and liver from animals of each group were collected to assess larval recovery. The organs of mice that received embryonated eggs exposed to the fungus showed a lower average larval recovery (P 0.05) suggesting that exposure of T. canis eggs to P. lilacinum was able to reduce experimental infection. Under the evaluated conditions, the interaction time between the fungus and the parasite eggs was not a significant factor in larvae recovery. P. lilacinum may be considered a promising T. canis biological control agent. However, further studies are needed to determine a protocol for the use of this fungus as a biological control agent.(AU)

Purpureocillium lilacinum é um fungo nematófago com potencial para uso no controle biológico de parasitos, incluindo Toxocara canis. Este estudo pesquisou a infectividade de ovos de T. canis embrionados após exposição ao fungo P. lilacinum . Ovos de T. canis foram expostos ao fungo por 15 ou 30 dias e subsequentemente administrados a camundongos Swiss (n=20). O grupo controle consistiu de camundongos que receberam ovos embrionados do parasita sem exposição ao fungo. Quarenta e oito horas após a infecção, coração, pulmão e fígado dos camundongos foram coletados para avaliar a recuperação larval. Os órgãos dos animais que receberam ovos embrionados expostos ao fungo apresentaram menor média de recuperação larval (P 0,05) do que os infectados com ovos sem exposição ao fungo, sugerindo que a exposição dos ovos de T. canis a P. lilacinum foi capaz de reduzir a infecção experimental. Nas condições avaliadas, o tempo de interação entre o fungo e os ovos do parasito não foi um fator significativo na recuperação das larvas. P. lilacinum pode ser considerado um promissor agente de controle biológico de T. canis, no entanto, mais estudos são necessários para avaliar o emprego deste fungo como um agente de controle biológico.(AU)

Isolamento e caracterização de espécies de Pythium de ambientes aquáticos no Estado do Rio Grande do Sul e avaliação da patogenicidade em modelo experimental / Isolation and characterization of Pythium species from swampy areas in the Rio Grande do Sul, Brazil, and evaluation of pathogenicity in an experimental model

Foram coletadas 186 amostras de água de ambientes pantanosos em 13 municípios das regiões Sul, Central e Oeste do Rio Grande do Sul, Brasil, com o objetivo de isolar e caracterizar espécies de Pythium e avaliar a sua patogenicidade empregando coelhos como modelo experimental. Em 11,8% (n=22) das águas coletadas foram isoladas diferentes espécies de Pythium incluindo: P. insidiosum (n=1), P. catenulatum (n=3), P. pachycaule voucher (n=1), P. rhizo-oryzae (n=3), P. torulosum (n=4) e Pythium spp. (n=10). Zoósporos desses micro-organismos foram produzidos in vitro e inoculados por via subcutânea em coelhos, os quais foram avaliados durante 45 dias. Dentre os oomicetos testados, apenas P. insidiosum evidenciou patogenicidade, causando pitiose no modelo experimental, evidenciando que, em nossas condições, apenas esta espécie de Pythium é patógena para mamíferos.(AU)

One hundred and eighty-six water samples from swampy areas were collected in 13 municipalities of South, Central and West regions of Rio Grande do Sul, Brazil, in order to isolate and characterize Pythium species and assess their pathogenicity using rabbits as experimental model. Different Pythium species were isolated from 22 (11.8%) water samples, including P. insidiosum (n=1), P. catenulatum (n=3), P. pachycaule voucher (n=1), P. rhizo-oryzae (n=3), P. torulosum (n=4) e Pythium spp. (n=10). Zoospores of these microorganisms were produced in vitro and inoculated subcutaneously into rabbits, which were assessed over 45 days. Only P. insidiosum showed pathogenicity, causing pythiosis in the experimental model.(AU)

Isolamento e caracterização de espécies de Pythium de ambientes aquáticos no Estado do Rio Grande do Sul e avaliação da patogenicidade em modelo experimental / Isolation and characterization of Pythium species from swampy areas in the Rio Grande do Sul, Brazil, and evaluation of pathogenicity in an experimental model

Foram coletadas 186 amostras de água de ambientes pantanosos em 13 municípios das regiões Sul, Central e Oeste do Rio Grande do Sul, Brasil, com o objetivo de isolar e caracterizar espécies de Pythium e avaliar a sua patogenicidade empregando coelhos como modelo experimental. Em 11,8% (n=22) das águas coletadas foram isoladas diferentes espécies de Pythium incluindo: P. insidiosum (n=1), P. catenulatum (n=3), P. pachycaule voucher (n=1), P. rhizo-oryzae (n=3), P. torulosum (n=4) e Pythium spp. (n=10). Zoósporos desses micro-organismos foram produzidos in vitro e inoculados por via subcutânea em coelhos, os quais foram avaliados durante 45 dias. Dentre os oomicetos testados, apenas P. insidiosum evidenciou patogenicidade, causando pitiose no modelo experimental, evidenciando que, em nossas condições, apenas esta espécie de Pythium é patógena para mamíferos.(AU)

One hundred and eighty-six water samples from swampy areas were collected in 13 municipalities of South, Central and West regions of Rio Grande do Sul, Brazil, in order to isolate and characterize Pythium species and assess their pathogenicity using rabbits as experimental model. Different Pythium species were isolated from 22 (11.8%) water samples, including P. insidiosum (n=1), P. catenulatum (n=3), P. pachycaule voucher (n=1), P. rhizo-oryzae (n=3), P. torulosum (n=4) e Pythium spp. (n=10). Zoospores of these microorganisms were produced in vitro and inoculated subcutaneously into rabbits, which were assessed over 45 days. Only P. insidiosum showed pathogenicity, causing pythiosis in the experimental model.(AU)

Trichoderma virens as a biocontrol of Toxocara canis: In vivo evaluation.

BACKGROUND: Microorganisms have been widely studied as biological control agents of parasites of medical and veterinary importance. Coprophagous arthropods, bacteria and fungi are among the different organisms evaluated as potential biological control agents. Nematophagous fungi capture and digest the free forms of nematodes in the soil. Due to its zoonotic potential, Toxocara canis have been brought to the attention of researchers. AIMS: The aim of the present study was to determine whether the administration of embryonated T. canis eggs exposed to the nematophagous fungus Trichoderma virens reduces parasite infection in experimental animals. METHODS: Embryonated T. canis eggs were exposed to T. virens mycelium for 15 days at 25°C. Subsequently, 100 fungus-exposed eggs were orally administered to 20 Swiss mice. As a positive control, another 20 mice received 100 embryonated eggs that were not exposed to the fungus. After 48h, the animals were killed, and heart, lungs and liver were harvested for the recovery of larvae. RESULTS: The organs of the animals that received embryonated T. canis eggs exposed to the fungus showed a lower mean larval recovery when compared with the animals that received embryonated eggs without fungus exposure (p<0.05). CONCLUSIONS: The exposure of T. canis eggs to T. virens reduces the experimental infection, demonstrating the potential of this nematophagous fungus as a biocontrol agent.

Effect of Paecilomyces lilacinus, Trichoderma harzianum and Trichoderma virens fungal extracts on the hatchability of Ancylostoma eggs.

BACKGROUND: Ancylostoma species have demanded attention due to their zoonotic potential. The use of anthelmintics is the usual method to prevent environmental contamination by Ancylostoma eggs and larvae. Nematophagous fungi have been widely used in their biological control due to the fungus ability to capture and digest free nematode forms. AIMS: The aim of this study was to evaluate the effect of four different fungal extracts of Paecilomyces lilacinus (n=2), Trichoderma harzianum (n=1) and Trichoderma virens (n=1) isolates on the hatchability of Ancylostoma eggs. METHODS: Fungal extracts consisted of fungal broth culture supernatant without filtration (crude extract) and filtered broth (filtered extract), macerated mycelium (crude macerate), and macerated mycelium submitted to filtration (filtered macerate). The Ancylostoma eggs were obtained from the feces of naturally infected dogs. In vitro assays were performed in five replicates and consisted of four treatments and one control group. RESULTS: The activity of the fungal extracts of each evaluated fungus differed (p<0.05) from those of the control group, showing significant ovicidal activity. The hatching of the eggs suffered reduction percentages of 68.43% and 47.05% with P. lilacinus, and 56.43% with T. harzianum, when crude macerate extract was used. The reduction with the macerate extract of T. virens was slightly lower (52.25%) than that for the filtered macerate (53.64%). CONCLUSIONS: The results showed that all extracts were effective in reducing the hatchability of Ancylostoma eggs. The ovicidal effect observed is likely to have been caused by the action of hydrolytic enzymes secreted by the fungi.

In Vitro Activity of Melaleuca alternifolia (Tea Tree) in Its Free Oil and Nanoemulsion Formulations Against Pythium insidiosum.

Pythium insidiosum is an important aquatic oomycete which can cause pythiosis in both animals and humans. This microorganism shows low susceptibility to antifungal drugs available. This study analyzed the in vitro antimicrobial activity of Melaleuca alternifolia in its free oil (FO) and nanoemulsion (NE) formulations against Brazilian P. insidiosum isolates. The antimicrobial activity evaluation was performed by the broth microdilution method according to CSLI M38-A2 document adapted to phytopharmaceuticals. Twenty-six P. insidiosum isolates were evaluated, and the minimum inhibitory concentration was determined at 100 % growth inhibition. Melaleuca alternifolia essential oil or FO was obtained commercially. The NE containing 1 % M. alternifolia essential oil was prepared by the spontaneous emulsification method. All P. insidiosum isolates evaluated showed minimum inhibitory concentrations (MIC) ranging from 531.5 to 2125 µg/mL for the FO formulation; MIC50 and MIC90 showed values between 1062.5 and 2125 µg/mL, respectively. When the NE formulation was evaluated, MIC values ranged from 132.7 to 2125 µg/mL and both MIC50 and MIC90 corresponded to 1062.5 µg/mL. FO and NE formulations of M. alternifolia showed antimicrobial activity against P. insidiosum. This study demonstrated that M. alternifolia oil can be an additional therapy in pythiosis treatment; however, further studies are needed to evaluate the applicability of the plant essential oils in the treatment of clinical pythiosis.

In Vitro Susceptibility of Pythium insidiosum to Melaleuca alternifolia, Mentha piperita and Origanum vulgare Essential Oils Combinations.

Pythium insidiosum is the etiologic agent of pythiosis, a severe and emerging disease that affects mammals. Failure of conventional antifungal therapies is partially justified by the absence of ergosterol in the plasma membrane of this oomycete. Despite research advancement, the treatment of pythiosis has not been not fully established. The present study investigated the in vitro susceptibility profile of Brazilian isolates of P. insidiosum (n = 20) against Melaleuca alternifolia, Mentha piperita and Origanum vulgare essential oils, and their combinations. Susceptibility tests were performed according to CLSI M38-A2 protocol, and combinations were evaluated by the microdilution cherkerboard method. All tested essential oils showed antimicrobial activity against P. insidiosum, and the greatest activity of O. vulgare was highlighted. Synergistic and/or indifferent effect was observed for all combinations evaluated, especially the M. piperita and O. vulgare combination, which showed 65 % synergism. This is the first study to report in vitro combinations of essential oils against P. insidiosum indicating the susceptibility of this oomycete to M. alternifolia, M. piperita and O. vulgare essential oils, as well as their combinations.

Treatment of experimental pythiosis with essential oils of Origanum vulgare and Mentha piperita singly, in association and in combination with immunotherapy.

This study investigated the in vivo antimicrobial activity of the essential oils of Origanum vulgare and Mentha piperita both singly, associated and in combination with immunotherapy to treat experimental pythiosis. The disease was reproduced in 18 rabbits divided into six groups (n=3): group 1, control; group 2, treated with essential oil of Mentha piperita; group 3, treated with essential oil of Origanum vulgare; group 4, treated with commercial immunotherapic; group 5, treated with a association of oils of M. piperita and O. vulgare and group 6, treated with a combination of both oils plus immunotherapy. Essential oils were added in a topical cream base formula, and lesions were treated daily for 45 days. The animals in groups 4 and 6 received a dose of immunotherapeutic agent every 14 days. The results revealed that the evolution of lesions in groups 5 and 6 did not differ from one another but differed from the other groups. The lesions of group 5 increased 3.16 times every measurement, while those of group 6 increased 1.83 times, indicating that the smallest growth of the lesions occurred when the combination of therapies were used. A rabbit from group 5 showed clinical cure at day 20 of treatment. This research is the pioneer in the treatment of experimental pythiosis using essential oils from medicinal plants and a combination of therapies. This study demonstrated that the use of essential oils can be a viable alternative treatment to cutaneous pythiosis, particularly when used in association or combination with immunotherapy.

In vitro reproduction of the life cycle of Pythium insidiosum from kunkers' equine and their role in the epidemiology of pythiosis.

Pythium insidiosum is an important pathogen of mammals' species, including humans. Equine is the main species affected by this oomycete. P. insidiosum requires an aquatic environment to develop its life cycle, and the susceptible hosts are contaminated when they contact the microorganism in swampy areas. The equine pythiosis is characterized by the formation of irregular masses within the cutaneous lesions, called kunkers, which easily detach from the lesion. From these structures, it is possible to isolate P. insidiosum in pure cultures. The present study aimed to reproduce in vitro the life cycle of P. insidiosum from kunkers of equine clinical lesions. Fifteen kunkers from different horses were tested. It was observed that the discharge of zoospores occurred after 24-48 h of incubation at 37 °C in, respectively, 40 and 47 % of the kunkers evaluated. Only two samples showed no development of the asexual cycle of P. insidiosum under the conditions tested. It was possible to demonstrate that kunkers are able to restart the asexual cycle of P. insidiosum. Based on our in vitro results, we highlight the importance of these structures in the epidemiology of the pythiosis, since kunkers can be a potential source of contamination of this oomycete for aquatic environments.

Perfuração gástrica em um canino induzida por nimesulida / Gastric perforation in a canine induced by nimesulide

Os anti-inflamatórios não esteroides (AINEs) têm sido muito utilizados na clínica de pequenos animais (FOX e JOHNSTON, 1997). Esses medicamentos possuem excelentes efeitos terapêuticos no alívio da dor e no tratamento de processos inflamatórios, no entanto possuem efeitos adversos especialmente no trato gastrointestinal onde podem promover o aparecimento de úlceras focais. As úlceras são lesões caracterizadas pela destruição da mucosa do trato gastroentérico (WILLARD, 2003). O objetivo deste trabalho é relatar o tratamento cirúrgico de um canino diagnosticado com úlcera gástrica perfurante devido ao uso de nimesulida.(AU)

Perfuração gástrica em um canino induzida por nimesulida / Gastric perforation in a canine induced by nimesulide

Os anti-inflamatórios não esteroides (AINEs) têm sido muito utilizados na clínica de pequenos animais (FOX e JOHNSTON, 1997). Esses medicamentos possuem excelentes efeitos terapêuticos no alívio da dor e no tratamento de processos inflamatórios, no entanto possuem efeitos adversos especialmente no trato gastrointestinal onde podem promover o aparecimento de úlceras focais. As úlceras são lesões caracterizadas pela destruição da mucosa do trato gastroentérico (WILLARD, 2003). O objetivo deste trabalho é relatar o tratamento cirúrgico de um canino diagnosticado com úlcera gástrica perfurante devido ao uso de nimesulida.

Cuidados paliativos na formação do profissional da área de saúde / Palliative care in the formation of health care professionals

Os cuidados paliativos formam um conjunto de intervenções aplicadas em doenças quando não há perspectiva de cura e exigem um conhecimento do médico que ultrapassa o controle de sinais e sintomas. O desenvolvimento desta área do cuidado no Brasil tornou-se evidente nos últimos dez anos e culminou com o reconhecimento da especialidade médica em 2011. Falar sobre morte na graduação implica abordar o treinamento em habilidades como comunicação, trabalho em equipe e suporte à família, além do controle de sinais e sintomas, para que se possa oferecer cuidados ao final de vida com qualidade e minimizar o sofrimento de quem enfrenta a fase de terminalidade da doença. A inclusão dos cuidados paliativos na graduação do ensino médico é uma opção a ser discutida nos currículos atuais para que se possa estimular a capacidade técnica especializada nesta área do saber e difundir as técnicas de cuidado para qualquer especialidade médica.

Palliative care form a set of interventions applied to diseases when there is no prospect of cure, and requires a doctor's knowledge which goes beyond the control of signs and symptoms. The development of this area of care in Brazil became evident in the last 10 years and culminated in the recognition of the medical specialty in 2011. Talking about death in medical school should be linked to training in skills such as communication, team work and support for the family, beyond the control of signs and symptoms so that it may be offered quality care at the end of life and minimized the suffering of those facing a terminal phase of disease. The inclusion of palliative care in undergraduate medical education is an option to be discussed in current curricula so that we can stimulate not only the expertise in this specialized area of ​​knowledge, but also to spread the techniques of care for any medical specialty.

Cuidados paliativos para idosos na unidade de terapia intensiva: revisão sistemática / Palliative care of elderly patients in intensive care units: a systematic review

OBJETIVO: O uso de tecnologia médica intervencionista em pacientes idosos em estado terminal necessita ser associado aos cuidados paliativos como medidas de suporte clínico na terapia intensiva. Esse recurso auxilia nas decisões ao final da vida do paciente e direciona a atenção da equipe de saúde para garantir o conforto do paciente e a satisfação da família. O prolongamento da vida sem a implementação de ações que visem amenizar sintomas, como dor e dispneia, contribui para o estresse familiar e a morte com sofrimento. O objetivo deste trabalho foi conhecer os avanços no uso dos cuidados paliativos na unidade de terapia intensiva. MÉTODOS: Revisão sistemática sobre a relação entre cuidados paliativos aos idosos e a terapia intensiva nos portais Medline e Bireme. RESULTADOS: Foram analisados 29 artigos, que mostram experiências de cuidados paliativos em unidades de terapia intensiva utilizando as variáveis "satisfação da família quando participa das discussões sobre os cuidados paliativos" e "dificuldades na implementação desse tipo de cuidado por falta de capacitação técnica dos profissionais". CONCLUSÃO: O tema "cuidados paliativos" deve ser aprofundado visando melhorar a relação entre pacientes, seus familiares e a equipe de saúde. Considerando o aumento do número de idosos na terapia intensiva, é fundamental melhorar a capacitação do profissional de saúde para enfrentar os desafios que envolvem a terminalidade da vida.

OBJECTIVE: The use of interventionist medical technology in terminal elderly patients must be associated with palliative care as a measure of clinical support in intensive care units. Palliative care is an important component of end-of-life care, and the assistance provided by the healthcare team should be guided by decisions made by patients and their family members. Prolongation of life not accompanied by therapies aimed at relieving symptoms, such as pain and dyspnea, contributes to patient and family member stress suffering. The aim of the present study was to survey advances made in the application of palliative care in intensive care units. METHODS: Medline and Bireme were used to perform a systematic literature review of intensive care units-based palliative care for elderly patients. RESULTS: A total of 29 articles describing palliative care in intensive care units were analyzed according to the variables "satisfaction of relatives when they participate in the discussions on palliative care" and "difficulties to implement such type of care due to lack of technical skills of the health caregivers." CONCLUSION: Palliative care for elderly patients in intensive care units must be more thoroughly investigated to improve the relationships and communication among patients, their relatives, and the healthcare team. As greater numbers of elderly patients are admitted to intensive care units, the skills of health caregivers must improve to meet the challenges posed by the end-of-life care.

Palliative care of elderly patients in intensive care units: a systematic review. / Cuidados paliativos para idosos na unidade de terapia intensiva: revisão sistemática.

OBJECTIVE: The use of interventionist medical technology in terminal elderly patients must be associated with palliative care as a measure of clinical support in intensive care units. Palliative care is an important component of end-of-life care, and the assistance provided by the healthcare team should be guided by decisions made by patients and their family members. Prolongation of life not accompanied by therapies aimed at relieving symptoms, such as pain and dyspnea, contributes to patient and family member stress suffering. The aim of the present study was to survey advances made in the application of palliative care in intensive care units. METHODS: Medline and Bireme were used to perform a systematic literature review of intensive care units-based palliative care for elderly patients. RESULTS: A total of 29 articles describing palliative care in intensive care units were analyzed according to the variables "satisfaction of relatives when they participate in the discussions on palliative care" and "difficulties to implement such type of care due to lack of technical skills of the health caregivers." CONCLUSION: Palliative care for elderly patients in intensive care units must be more thoroughly investigated to improve the relationships and communication among patients, their relatives, and the healthcare team. As greater numbers of elderly patients are admitted to intensive care units, the skills of health caregivers must improve to meet the challenges posed by the end-of-life care.

Cuidados paliativos para idosos na unidade de terapia intensiva: realidade factível / Palliative care to elderly in critical care unit: feasible reality

Objetivos: este artigo discute o papel da Unidade de Terapia Intensiva na perspectiva dos idosos portadores de doenças crônicas em fase avançada, considerando que o local pode ser uma das alternativas de alocação desses enfermos e, nesses casos, os cuidados paliativos representam valiosas ferramentas de trabalho.Fonte de dados: foram revisados artigos dos últimos 10 anos no portal PubMed, utilizando os descritores Unidade de Terapia Intensiva, Cuidados Paliativos, Critical Care Unit e Palliative Care.Síntese dos dados: a interseção entre cuidados paliativos e a Unidade de Terapia Intensiva deve ser entendida no contexto das mudanças no padrão das doenças e na longevidade dos portadores das doenças crônicas não-transmissíveis. Os cuidados paliativos são intervenções clínicas direcionadas aos pacientes portadores de enfermidades cuja progressão provoca sinais e sintomas desconfortantes, inclusive com elementos associados à instabilidade clínica. As práticas da Unidade de Terapia Intensiva têm como premissa o restabelecimento da fisiologia, e para atingir seu objetivo aplicam recursos farmacológicos, próteses e dispositivos artificiais. A necessidade de utilizar as medidas paliativas na Unidade de Terapia Intensiva foi vislumbrada a partir de informações sobre a elevada prevalência de dor e de outros sintomas de sofrimento e angústia, seja para o paciente, seja para sua família ou para a equipe que o assiste.Conclusões: é preciso reforçar aos profissionais da saúde que os cuidados paliativos não são incompatíveis com a Unidade de Terapia Intensiva. Ao contrário, sua relevância evidencia-se na maneira com que as suas ações auxiliam no direcionamento do conforto.

Aims: This article discusses the role of Intensive Care Unit from the perspective of elderly with chronic diseases in advanced stage, considering that this place can be one of the alternatives for allocation of these patients, and in these cases palliative care are useful tools to work.Source of data: Articles from PubMed within the past 10 years were reviewed, using the key words Unidade de Terapia Intensiva, Cuidados Paliativos, Critical Care Unit and Palliative Care.Summary of findings: The intersection between palliative care and the Intensive Care Unit should be understood in the context of changing patterns of disease and longevity of patients with chronic non-communicable diseases. Palliative care are clinical interventions directed at patients whose disease progression cause discomforting symptoms and signs, including elements associated with clinical instability. The practices of the Intensive Care Unit have as premises the restoration of physiology, and to achieve this goal they apply pharmacological resources, prostheses and artificial devices. The need to use palliative measures in the Intensive Care Unit was realized from information about the high prevalence of pain and other symptoms of suffering and distress, either to the patients, either for their families or for the team that attends them.Conclusions: We must strengthen healthcare professionals that palliative care are not incompatible with the Critical Care Unit. Rather, their relevance is in the way that their actions assist in the targeting of comfort.