Navegando por Palavras-chave "fluid therapy"

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    Hidratação com bicarbonato de sódio não previne a nefropatia de contraste: ensaio clínico multicêntrico
    (Sociedade Brasileira de Cardiologia - SBC, 2012-12-01) Gomes, Vitor O.; Lasevitch, Ricardo; Lima, Valter C. [UNIFESP]; Brito Jr., Fábio S.; Perez-alva, Juan Carlos; Moulin, Bruno; Arruda, Airton; Oliveira, Denise; Caramori, Paulo; PUCRS Hospital São Lucas; Universidade Federal de São Paulo (UNIFESP); Hospital São Camilo; Hospital General de Puebla; Hospital da Unimed; Hospital Intercath Meridional; UFRGS
    BACKGROUND: Radiographic contrast media exposition can cause acute renal function impairment. There is limited and conflicting evidence that hydration with sodium bicarbonate prevents contrast-induced nephropathy (CIN) in patients undergoing cardiac catheterization. OBJECTIVE: The present study was aimed at determining whether sodium bicarbonate is superior to hydration with saline to prevent nephropathy in patients at risk undergoing cardiac catheterization. METHODS: Three hundred and one patients undergoing coronary angiography or percutaneous coronary intervention with serum creatinine > 1.2mg/dL or glomerular filtration rate (GFR) < 50ml/min were randomized to receive hydration with sodium bicarbonate starting 1 hour before the procedure and 6 hours after the procedure, or hydration with 0.9% saline. CIN was defined as an increase of 0.5mg/dL in creatinine in 48h RESULTS: Eighteen patients (5.9%) developed contrast induced nephropathy: 9 patients in the bicarbonate group (6.1%) and 9 patients in the saline group (6.0%), p = 0.97. The change in serum creatinine was similar in both groups, 0.01 ± 0.26 mg/dL in the bicarbonate group and 0.01 ± 0.35 mg/dL in the saline group, p = 0.9. No statistical difference was observed between the change in glomerular filtration rate (0.89 ± 9 ml/min vs. 2.29 ± 10 ml/min, p = 0.2 bicarbonate group and saline group, respectively). CONCLUSION: Hydration with sodium bicarbonate was not superior to saline to prevent contrast media induced nephropathy in patients at risk undergoing cardiac catheterization.
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    Oral hydration in children with cerebral palsy
    (Faculdade de Odontologia de Piracicaba - UNICAMP, 2014-04-01) Santos, Maria Teresa Botti Rodrigues; Ferreira, Maria Cristina Duarte; Guaré, Renata Oliveira; Nascimento, Oliver Augusto [UNIFESP]; Jardim, José Roberto [UNIFESP]; Universidade Cruzeiro do Sul School of Dentistry; Serviço Nacional de Aprendizagem Comercial; Universidade Federal de São Paulo (UNIFESP)
    AIM:To investigate whether oral motor performance is determinant for the hydration status and the effect of a supplemental oral fluid supply on salivary osmolality.METHODS:The sample consisted of 99 children with cerebral palsy aged 6 to 13 years old. In this study, children participated in 2-day evaluations: 1st day - baseline: saliva collection, caries experience and oral motor performance evaluations; and 2nd day: saliva collection after supplemental fluid supply. Prior to each evaluation, the participants were trained for saliva collection. Unstimulated whole saliva was collected using cotton roll at baseline, with the amount of fluid usually offered by caregivers, and 48 h after baseline, with as much as twice the normal daily fluid intake previously offered. Salivary osmolality was measured using a freezing point depression osmometer. Caries experience index for decayed, missed and filled teeth (DMFT) was evaluated. According to the Oral Motor Assessment Scale, the children were classified into subfunctional or functional groups. Chi-square, Student's t test and Pearson's correlation coefficient were used.RESULTS:The subfunctional group presented a higher percentage of quadriplegic children (p<0.001), with significantly higher values for caries experience (p<0.001) and salivary osmolality (p<0.001), which did not diminish when supplemental fluid supply was offered, compared with the functional group (p=0.001).CONCLUSIONS:The effectiveness of oral motor performance plays an important role in the hydration status of children with cerebral palsy and those with worse oral motor performance may be at higher risk of oral diseases.
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    Predictive value of pulse pressure variation for fluid responsiveness in septic patients using lung-protective ventilation strategies
    (Oxford Univ Press, 2013-03-01) Freitas, Flavio Geraldo Rezende [UNIFESP]; Bafi, Antonio Tonete [UNIFESP]; Nascente, A. P. M. [UNIFESP]; Assuncao, M. [UNIFESP]; Mazza, B. [UNIFESP]; Azevedo, L. C. P. [UNIFESP]; Machado, F. R. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    The applicability of pulse pressure variation (PP) to predict fluid responsiveness using lung-protective ventilation strategies is uncertain in clinical practice. We designed this study to evaluate the accuracy of this parameter in predicting the fluid responsiveness of septic patients ventilated with low tidal volumes (TV) (6 ml kg(1)).Forty patients after the resuscitation phase of severe sepsis and septic shock who were mechanically ventilated with 6 ml kg(1) were included. the PP was obtained automatically at baseline and after a standardized fluid challenge (7 ml kg(1)). Patients whose cardiac output increased by more than 15 were considered fluid responders. the predictive values of PP and static variables [right atrial pressure (RAP) and pulmonary artery occlusion pressure (PAOP)] were evaluated through a receiver operating characteristic (ROC) curve analysis.Thirty-four patients had characteristics consistent with acute lung injury or acute respiratory distress syndrome and were ventilated with high levels of PEEP [median (inter-quartile range) 10.0 (10.013.5)]. Nineteen patients were considered fluid responders. the RAP and PAOP significantly increased, and PP significantly decreased after volume expansion. the PP performance [ROC curve area: 0.91 (0.821.0)] was better than that of the RAP [ROC curve area: 0.73 (0.590.90)] and pulmonary artery occlusion pressure [ROC curve area: 0.58 (0.400.76)]. the ROC curve analysis revealed that the best cut-off for PP was 6.5, with a sensitivity of 0.89, specificity of 0.90, positive predictive value of 0.89, and negative predictive value of 0.90.Automatized PP accurately predicted fluid responsiveness in septic patients ventilated with low TV.