PubMed Health⌕ Search

Biomedical subjects

Werther Brunow de Carvalho

Publications and source records attributed to Werther Brunow de Carvalho.

13 recordsLinked to original sources
PubMed2005

Serum albumin and clinical outcome in pediatric cardiac surgery.

OBJECTIVE: We evaluated the behavior of serum albumin concentrations in response to metabolic stress that is associated with cardiac surgery and the role of this protein as a predictor of clinical outcome in children at high surgical risk who undergo operative correction of congenital heart defects. METHODS: Serum albumin concentrations were measured in 30 children who had heart disease and were at high surgical risk. Analyses were performed before surgery, on the second postoperative day, and on discharge from the intensive care unit. Preoperative serum concentrations of albumin were compared with those of a control group that consisted of 20 healthy and well-nourished children. RESULTS: Preoperative albumin concentrations of patients were lower than those of the control group (3.4+/-0.25 g/dL versus 4.0+/-0.18 g/dL, P<0.05). Serum levels decreased on the second postoperative day and at discharge from the intensive care unit (3.1+/-0.65 g/dL and 3.2+/-0.44 g/dL, P<0.05) compared with preoperative concentrations. Preoperative concentrations lower than 3.0 g/dL were associated with increased postsurgical infection (P=0.0026) and with increased mortality (P=0.0138). Patients whose postoperative levels were lower than 3.0 g/dL had longer hospital stays compared with those whose concentrations were higher than 3.0 g/dL (14.5+/-1.3 d versus 10+/-2.2 d, P<0.05). CONCLUSION: The results suggest that hypoalbuminemia is common among children who have heart disease and are at high surgical risk, and serum albumin concentrations lower than 3 g/dL may be related to outcome in the period after cardiac surgery.

Cardiac Surgical Procedures↗
PubMed2004

Hypophosphatemia in critically ill children.

The purpose of this paper is to review clinical studies on hypophosphatemia in pediatric intensive care unit patients with a view to verifying prevalence and risk factors associated with this disorder. We searched the computerized bibliographic databases Medline, Embase, Cochrane Library, and LILACS to identify eligible studies. Search terms included critically ill, pediatric intensive care, trauma, sepsis, infectious diseases, malnutrition, inflammatory response, surgery, starvation, respiratory failure, diuretic, steroid, antiacid therapy, mechanical ventilation. The search period covered those clinical trials published from January 1990 to January 2004. Studies concerning endocrinological disorders, genetic syndromes, rickets, renal diseases, anorexia nervosa, alcohol abuse, and prematurity were not included in this review. Out of 27 studies retrieved, only 8 involved pediatric patients, and most of these were case reports. One clinical trial and one retrospective study were identified. The prevalence of hypophosphatemia exceeded 50%. The commonly associated factors in most patients with hypophosphatemia were refeeding syndrome, malnutrition, sepsis, trauma, and diuretic and steroid therapy. Given the high prevalence, clinical manifestations, and multiple risk factors, the early identification of this disorder in critically ill children is crucial for adequate replacement therapy and also to avoid complications.

Child↗
PubMed2003

[Evaluation of oxygenation, ventilation and respiratory mechanics before and after endotracheal suction in mechanically ventilated children].

OBJECTIVES: The aim of this study was to know the effects of endotracheal suction in respiratory mechanics and oxigenation of patients with mechanical ventilation. METHODS: 13 children were studied in the pediatric intensive care unit of Hospital São Paulo, age between 47 days and 5 years old, male and female, surgical and clinic pathology, intubated by cuffed endotracheal tube, sedated and paralyzed few minutes before measurements, under previous established suction routine without preventive maneuvers, followed by a continuous monitoring of oxygenation, ventilation and respiratory mechanics under identical ventilatory sets. The parameters analyzed was Heart rate; SpO2; ph arterial; PaO2; PaCO2; SaO2; inspiratory and expiratory tidal volume; minute volume; dynamic compliance, respiratory resistance; mean airway pressure; PEEP and PEEPi., and the measurements were made immediately before suction, immediately after, ten and twenty minutes after suction RESULTS: The results showed that the technique increase the CO2 arterial pressures (PaCO2) even after 20 minutes; decrease the oxygen saturation (SpO2) immediately after the procedure with regular recuperation after 10 minutes and decrease the lung compliance (Cdin.) immediately after with lower recuperation after 10 minutes. CONCLUSION: We concluded that intratracheal suction in front of compromise of oxygenation, ventilation or respiratory mechanic, applied as minimal as possible under preventive maneuvers. We need more studies to establish the real need of intratracheal suction and a practice guideline of intervention to avoid deleterious effects of that in pediatric patients.

Child, Preschool↗
PubMed2003

[Hypertonic solutions for pediatric patients].

OBJECTIVE: To describe the current knowledge and indications for use of hypertonic saline solutions in pediatrics patients. SOURCE OF DATA: Medline recent review articles and personal files. SUMMARY OF THE FINDINGS: Basic physiologic principles were reviewed concerning the distribution of fluid inside the intravascular, interstitial and intracellular compartments. We also reviewed the findings concerning the mechanisms responsible for the rapid onset of cardiocirculatory effects and the additional effect of the colloid component. Finally, we present the medical terms used in the context of small-volume resuscitation, the indications for clinical use, the evidence from clinical research (hemorrhagic shock, preclinical trauma care, septic shock, and head trauma), and the disadvantages and potential adverse effects of small-volume resuscitation. CONCLUSIONS: Resuscitation by means of hypertonic saline solutions associated or not with colloid solutions is one of the most innovative concepts for primary resuscitation from trauma and shock established in the past decade. Currently, the spectrum of potential indications involves not only prehospital trauma care, but also perioperative and intensive care therapy. However, additional randomized double-blind studies are required with both children and adult patients to confirm the advantages of the method in terms of survival.

Child↗
PubMed2002

Bedside transpyloric tube placement in the pediatric intensive care unit: a modified insufflation air technique.

OBJECTIVE: To test air insufflation as an adjunct to placement of enteral feeding tubes and the effectiveness of using a smaller insufflation volume in pediatric patients. DESIGN AND SETTING: A randomized, controlled study in a pediatric intensive care unit in two tertiary hospitals. PATIENTS: A total of 78 children with indication for transpyloric tube feeding were studied. INTERVENTIONS: An unweighted feeding tube was placed into the stomach through the nares; a 20-ml syringe was used to insufflate 10 ml/kg air into the stomach. The tube was advanced an estimated distance into the pylorus or beyond. The control group received the same procedure except for air insufflation. Resident physicians performed all procedures. Abdominal radiography was performed 3 h later. RESULTS: Of 38 tubes in the study group 33 (86.8%) were successfully placed in a single attempt, compared to 18 of 40 tubes (45%) in the control group. Compared with the technique of using 20 ml/kg air for insufflation, no statistically significant difference was observed. No significant complication was observed. CONCLUSIONS: The gastric insufflation technique required no expensive equipment, minimal training, and consistently allowed transpyloric passage of feeding tubes. The use of 10 ml/kg air may significantly improve the rate of success without increasing risks.

Brazil↗
PubMedDate not supplied

Outcomes in a pediatric intensive care unit before and after the implementation of a nutrition support team.

BACKGROUND: We evaluated the effect of parenteral nutrition (PN) and enteral nutrition (EN) on in-pediatric intensive care unit (PICU) mortality before and after a continuous education program in nutrition support that leads to implementation of a nutrition support team (NST). METHODS: We used a historical cohort study of infants hospitalized for >72 hours at the PICU from 1992 to 2003. Five periods were selected (P1 to P5), considering the modifications incorporated into the program: P1, without intervention; P2, basic themes and original articles discussion; P3, clinical and nursing staff participation; P4, clinical visits; P5, NST. The samples were compared in terms of sex, age, admitting service (ie, medical vs surgical), prognostic index of mortality, length of stay (LOS), duration of mechanical ventilation, in-PICU mortality rate, and percentage of time receiving EN and PN for each patient. Bi- and multivariate analyses were performed. Statistical significance was set at 0.05 level. RESULTS: Progressive increase was observed in EN use (p = .0001), median values for which were 25% in P1 and rose to 67% by P5 in medical patients; there was no significant difference in surgical patients. A reduction was observed in PN use; in P1 medians were 73% and 69% for medical and surgical patients respectively, and decreased to 0% in P5 for both groups (p = .0001). There was significant reduction in-PICU mortality rate during P4 and P5 among medical patients (p < .001). The risk of death was 83% lower in patients that received EN for >50% of LOS (odds ratio, 0.17; confidence interval, 0.066-0.412; p = .000). CONCLUSIONS: The program motivated an increase in EN and a decrease in PN use, mainly after implementation of NST and reduced in-PICU mortality rate.

Cohort Studies↗
PubMedDate not supplied

Hypophosphatemia in children hospitalized within an intensive care unit.

The aims of this study were to estimate the occurrence of hypophosphatemia and to identify potential risk factors and outcome measures associated with this disturbance in children admitted to a pediatric intensive care unit. Data concerning 42 children admitted consecutively to 1 pediatric intensive care unit over a 1-year period were examined. Serum phosphorus levels were measured on the third day of admission, where levels below 3.8 mg/dL were considered indicative of hypophosphatemia. Hypophosphatemia was found in 32 children (76%), and there was a significant association between this disturbance and malnutrition (P = .04). Of the potential risk factors such as sepsis, diuretic/steroid therapy, starvation (over 3 days), and Pediatric Index of Mortality, none discriminated for hypophosphatemia. There were no associations between hypophosphatemia and mortality, length of stay in the pediatric intensive care unit, or time on mechanical lung ventilation. Hypophosphatemia was a common finding in critically ill children and was associated with malnutrition.

Female↗
PubMedDate not supplied

[Preliminary study about the utility of gastric tonometry during the weaning from mechanical ventilation].

OBJECTIVE: The intramucosal pHi measurement has been studied and evaluated as a minimally invasive method able to offer information about the tissue oxygenation. It's most important advantage is to be a regional not systemic measurement in a place with early changes of blood flow, even in the compensated states of shock, as the gastrointestinal tract. The weaning from mechanical ventilation may cause cardiac output changes as well as redistribution of blood flow to the respiratory muscles. Our aim was to test the hypothesis that the splanchnic blood flow decreases may occur after patients extubation, detected by pHi reduction, and to verify if pHi can be a good predictive index for weaning from mechanical ventilation. METHODS: Clinical prospective non-randomized, uncontrolled study, realized in a University Hospital PICU. Assessment of pHi (gastric) in 15 children in the post-operative of elective cardiac surgery with cardiopulmonary bypass. A tonometer with saline solution was used and measurements were made one hour before and after extubation. The patients were divided into two groups with pHi < or = or > 7.32. The Wilcoxon test was used for statistical analysis. RESULTS: The pHi decreased after extubation in 10 patients (66.7%). The overall mean before extubation was 7.32 +/- 0.10 and after extubation was 7.27 +/- 0.10 (p = 0.096). In the group with pHi < or = 7.32 and > 7.32 the means were 7.25 +/- 0.05 to 7.32 +/- 0.10 (p = 0.72) and 7.41 +/- 0.07 to 7.31 +/- 0.10 (p = 0.059), before and after extubation respectively. None of the patients presented complications due to the procedure; no deaths or development of multiple organ failure occurred. All of the patients were successfully weaned. CONCLUSIONS: Our results show pHi decreasing confirming splanchnic blood flow reduction after extubation, however in despite of this circulatory change the patients were weaned from mechanical ventilation and successfully extubated. In this trial the pHi was not a good predictive index. The pHi monitoring seems to be useful and reliable, but it requires further studies to evaluate its sensitivity.

Blood Flow Velocity↗
PubMedDate not supplied

[Availability of pediatric and neonatal intensive care units in the city of São Paulo].

OBJECTIVE: To describe the health care service provided in pediatric intensive care units in the city of São Paulo, by identifying and describing the units and analyzing their geographic distribution. METHODS: A descriptive cross-sectional study was carried out during a two-year period (August 2000 to July 2002). Data were collected through questionnaires answered by medical directors of each pediatric and neonatal intensive care unit. RESULTS: São Paulo is served by 107 pediatric and neonatal intensive care units, of which 85 (79.4%) completed and returned the questionnaire. We found a very unequal distribution of units as there were more units in places with the least pediatric population. Regarding to pediatric intensive care units specialization, 7% were pediatric, 41.2% were neonatal and 51.7% were mixed (pediatric and neonatal). Regarding hospital funds, 15.3% were associated with philanthropic institutions, 37.6% were private and 47% were public. A total of 1,067 beds were identified, of which 969 were active. The ratio bed/patient aged 0-14 was 1/2,728, varying from 1/604 at health districts-I to 1/6,812 at health districts-III. The units reported an average of 11.7 beds (2 to 60). The neonatal intensive care unit had a median of 16.9 beds per unit and pediatric intensive care units a median of 8.5 beds/unit. CONCLUSION: In São Paulo, we found an uneven distribution of pediatric and neonatal intensive care units among the health districts. There was also an uneven distribution between public and private units, and neonatal and pediatric ones. The current report is the first step in the effort to improve the quality of medical assistance in pediatric and neonatal intensive care units in São Paulo.

Adolescent↗