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COVID-19-associated ARDS treated with DEXamethasone (CoDEX): study design and rationale for a randomized trial
RESUMO Objetivo: A infec ção causada pelo coronavírus da síndrome respiratória aguda grave 2 (SARS-CoV-2) disseminou-se por todo o mundo e foi categorizada como pandemia. As manifestações mais comuns da infecção pelo SARS-CoV-2 (doença pelo coronavírus 2019 - COVID-19) se referem a uma pneumonia viral com graus v ariáveis de comprometimento respiratório e até 40% dos pacientes hospitalizados, que podem desenvolver uma síndrome do desconforto respiratório agudo. Diferentes ensaios clínicos avaliaram o papel dos corticosteroides na síndrome do desconforto respiratório agudo não relacionada com COVID-1 9,...
Source: Revista Brasileira de Terapia Intensiva - October 12, 2020 Category: Intensive Care Source Type: research

Characteristics and outcomes of patients infected with nCoV19 requiring invasive mechanical ventilation in Argentina
Conclusion: Patients with COVID-19 and on mechanical ventilation in this series presented clinical variables similar to those described to date in other international reports. Our findings provide data that may predict outcomes. (Source: Revista Brasileira de Terapia Intensiva)
Source: Revista Brasileira de Terapia Intensiva - October 12, 2020 Category: Intensive Care Source Type: research

Rationale and design of the “Tocilizumab in patients with moderate to severe COVID-19: an open-label multicentre randomized controlled” trial (TOCIBRAS)
RESUMO Introdu ção: Os marcadores pró-inflamatórios desempenham papel importante na severidade de pacientes com COVID-19. Assim, terapêuticas anti-inflamatórias são agentes interessantes para potencialmente combater a cascata inflamatória descontrolada em tais pacientes. Delineamos um ensaio para testar t ocilizumabe em comparação com o tratamento padrão, tendo como objetivo melhorar os desfechos por meio da inibição da interleucina 6, um importante mediador inflamatório na COVID-19. Métodos e análises: Este será um estudo aberto multicêntrico, randomizado e controlado, que comparará os d esfechos de ...
Source: Revista Brasileira de Terapia Intensiva - October 12, 2020 Category: Intensive Care Source Type: research

Pediatric ventilation weaning
(Source: Revista Brasileira de Terapia Intensiva)
Source: Revista Brasileira de Terapia Intensiva - October 12, 2020 Category: Intensive Care Source Type: research

Erratum
We describe the performance of the apnea test without disconnection from the mechanical ventilator in two patients. The first case involved an 8-year-old boy admitted with severe hypoxemia due to pneumonia. He presented with cardiorespiratory arrest, followed by unresponsive coma due to hypoxic-ischemic encephalopathy. Two clinical exams revealed the absence of brainstem reflexes, and transcranial Doppler ultrasound revealed brain circulatory arrest. Three attempts were made to perform the apnea test, which were interrupted by hypoxemia; therefore, the apnea test was performed without disconnection from the mechanical vent...
Source: Revista Brasileira de Terapia Intensiva - July 13, 2020 Category: Intensive Care Source Type: research

Reply to: Efficacy and safety of high-flow nasal cannula oxygen therapy in moderate acute hypercapnic respiratory failure
We describe the performance of the apnea test without disconnection from the mechanical ventilator in two patients. The first case involved an 8-year-old boy admitted with severe hypoxemia due to pneumonia. He presented with cardiorespiratory arrest, followed by unresponsive coma due to hypoxic-ischemic encephalopathy. Two clinical exams revealed the absence of brainstem reflexes, and transcranial Doppler ultrasound revealed brain circulatory arrest. Three attempts were made to perform the apnea test, which were interrupted by hypoxemia; therefore, the apnea test was performed without disconnection from the mechanical vent...
Source: Revista Brasileira de Terapia Intensiva - July 13, 2020 Category: Intensive Care Source Type: research

Time to positivity: a useful parameter to evaluate intensive care unit blood stream infections?
We describe the performance of the apnea test without disconnection from the mechanical ventilator in two patients. The first case involved an 8-year-old boy admitted with severe hypoxemia due to pneumonia. He presented with cardiorespiratory arrest, followed by unresponsive coma due to hypoxic-ischemic encephalopathy. Two clinical exams revealed the absence of brainstem reflexes, and transcranial Doppler ultrasound revealed brain circulatory arrest. Three attempts were made to perform the apnea test, which were interrupted by hypoxemia; therefore, the apnea test was performed without disconnection from the mechanical vent...
Source: Revista Brasileira de Terapia Intensiva - July 13, 2020 Category: Intensive Care Source Type: research

Use of CPAP as an alternative to the apnea test during the determination of brain death in hypoxemic patients. Report of two cases
We describe the performance of the apnea test without disconnection from the mechanical ventilator in two patients. The first case involved an 8-year-old boy admitted with severe hypoxemia due to pneumonia. He presented with cardiorespiratory arrest, followed by unresponsive coma due to hypoxic-ischemic encephalopathy. Two clinical exams revealed the absence of brainstem reflexes, and transcranial Doppler ultrasound revealed brain circulatory arrest. Three attempts were made to perform the apnea test, which were interrupted by hypoxemia; therefore, the apnea test was performed without disconnection from the mechanical vent...
Source: Revista Brasileira de Terapia Intensiva - July 13, 2020 Category: Intensive Care Source Type: research

Apnea test for brain death diagnosis in adults on extracorporeal membrane oxygenation: a review
RESUMO Entre as potenciais complica ções da oxigenação por membrana extracorpórea, as disfunções neurológicas, incluindo morte encefálica, não são desprezíveis. No Brasil, o processo diagnóstico é regulamentado pela resolução 2.173 de 2017 do Conselho Federal de Medicina. Entre os testes diagnósticos, está o de apnei a, que objetiva verificar se existe resposta ventilatória ao estímulo hipercápnico. Contudo, trocas gasosas, incluindo a remoção de dióxido de carbono, são mantidas sob oxigenação por membrana extracorpórea, tornando o teste desafiador. Somado ao fato de que a citada resolução nã...
Source: Revista Brasileira de Terapia Intensiva - July 13, 2020 Category: Intensive Care Source Type: research

The medical decision-making process in the time of the coronavirus pandemic
RESUMO A pandemia causada pelo novo coronav írus tem provocado mudanças significativas no processo de tomada de decisão médica diante do paciente grave. Repentinamente, aumentaram as admissões em unidades de tratamento intensivo, porém, muitos desses casos não apresentam quadros relacionados à infecção viral, mas à exacerbação de doenças preexistentes. Nesse contexto, precisamos evitar que o processo decisório intuitivo e a insegurança nos levem a exaurir a disponibilidade de leitos críticos, antes do momento em que eles sejam realmente necessários, mesmo reconhecendo a importância do método decisório...
Source: Revista Brasileira de Terapia Intensiva - July 13, 2020 Category: Intensive Care Source Type: research

Modified Early Warning Score as a predictor of intensive care unit readmission within 48 hours: a retrospective observational study
Conclusion: The MEWS is associated with intensive care unit readmission, and a score> 6 has excellent accuracy as a prognostic predictor. (Source: Revista Brasileira de Terapia Intensiva)
Source: Revista Brasileira de Terapia Intensiva - July 13, 2020 Category: Intensive Care Source Type: research

Does the endotracheal tube insertion depth predicted by formulas in children have a good concordance with the ideal position observed by X-ray?
Conclusion: The formulas that estimate the insertion depth of the endotracheal tube in children were not accurate and were discordant with the gold-standard method of X-ray evaluation. There is a need for a new method based on anthropometric variables (weight and height) and age that is effective in guiding health professionals of pediatric intensive care units at the time of intubation. (Source: Revista Brasileira de Terapia Intensiva)
Source: Revista Brasileira de Terapia Intensiva - July 13, 2020 Category: Intensive Care Source Type: research

Outcomes of ventilatory asynchrony in patients with inspiratory effort
Conclusion: Patient-ventilator asynchrony is a frequent disorder in critically ill patients with inspiratory effort. The patient ’ s interaction with the ventilator should be optimized to improve hemogasometric parameters and clinical results. Further studies are required to confirm these results. (Source: Revista Brasileira de Terapia Intensiva)
Source: Revista Brasileira de Terapia Intensiva - July 13, 2020 Category: Intensive Care Source Type: research

Pharmacokinetics of micafungin in patients treated with extracorporeal membrane oxygenation: an observational prospective study
Conclusion: The pharmacokinetic parameters of micafungin were not significantly altered. (Source: Revista Brasileira de Terapia Intensiva)
Source: Revista Brasileira de Terapia Intensiva - July 13, 2020 Category: Intensive Care Source Type: research

Practices for promoting sleep in intensive care units in Brazil: a national survey
Conclusion: The responses to this Brazilian survey revealed that few intensive care units had a program for promoting sleep, although almost all participants recognized the importance of sleep in patient recovery. (Source: Revista Brasileira de Terapia Intensiva)
Source: Revista Brasileira de Terapia Intensiva - July 13, 2020 Category: Intensive Care Source Type: research