Organ transplantation is the only alternative for many patients with terminal
diseases. The increasing disproportion between the high demand for organ
transplants and the low rate of transplants actually performed is worrisome.
Some of the causes of this disproportion are errors in the identification of
potential organ donors and in the determination of contraindications by the
attending staff. Therefore, the aim of the present document is to provide
guidelines for intensive care multi-professional staffs for the recognition,
assessment and acceptance of potential organ donors.
The CAIP is safer than and as effective as the standard strict protocol for controlling glucose in MICU patients. Hypoglycemia was rare under conventional treatment. However, BG levels were higher than with IV insulin protocols.
IntroductionPatients undergoing mechanical ventilation (MV) are frequently administered prolonged and/or high doses of opioids which when removed can cause a withdrawal syndrome and difficulty in weaning from MV. We tested the hypothesis that the introduction of enteral methadone during weaning from sedation and analgesia in critically ill adult patients on MV would decrease the weaning time from MV.MethodsA double-blind randomized controlled trial was conducted in the adult intensive care units (ICUs) of four general hospitals in Brazil. The 75 patients, who met the criteria for weaning from MV and had been using fentanyl for more than five consecutive days, were randomized to the methadone (MG) or control group (CG). Within the first 24 hours after study enrollment, both groups received 80% of the original dose of fentanyl, the MG received enteral methadone and the CG received an enteral placebo. After the first 24 hours, the MG received an intravenous (IV) saline solution (placebo), while the CG received IV fentanyl. For both groups, the IV solution was reduced by 20% every 24 hours. The groups were compared by evaluating the MV weaning time and the duration of MV, as well as the ICU stay and the hospital stay.ResultsOf the 75 patients randomized, seven were excluded and 68 were analyzed: 37 from the MG and 31 from the CG. There was a higher probability of early extubation in the MG, but the difference was not significant (hazard ratio: 1.52 (95% confidence interval (CI) 0.87 to 2.64; P = 0.11). The probability of successful weaning by the fifth day was significantly higher in the MG (hazard ratio: 2.64 (95% CI: 1.22 to 5.69; P < 0.02). Among the 54 patients who were successfully weaned (29 from the MG and 25 from the CG), the MV weaning time was significantly lower in the MG (hazard ratio: 2.06; 95% CI 1.17 to 3.63; P < 0.004).ConclusionsThe introduction of enteral methadone during weaning from sedation and analgesia in mechanically ventilated patients resulted in a decrease in the weaning time from MV.
Potential drug interactions prevalence in intensive care units Prevalência de potenciais interações medicamentosas droga-droga em unidades de terapia intensiva ORIGINAL ARTICLE INTRODUCTION A drug interaction takes place when the effects and/or toxicity of a drug are affected by another drug. (1,2) Although results may be positive (increased efficacy) or negative (decrease of efficacy, toxicity or idiosyncrasy), in pharmacotherapy they are usually unforeseen and undesirable. (3) With the continued development of new drugs and subsequent prescriptions with increasingly more complex combinations it has become difficult for physicians and pharmaceutics to be familiar with all potential interactions. (4) Risk of occurrence and severity rest upon several factors, among them
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