4 dias), doença crônica, trauma e internação prolongada na UTI (> 30 dias). Os fatores de risco associados à morte foram idade, APACHE II, falência orgânica e prótese em via aérea com ou sem ventilação mecânica. CONCLUSÕES: A infecção adquirida na UTI é comum e freqüentemente associada a isolados de microorganismos resistentes. Este estudo, apesar de sua abrangência regional, serve de referência epidemiológica para ajudar a programar políticas de controle de infecção.]]>
BackgroundPersistent hyperlactatemia during septic shock is multifactorial. Hypoperfusion-related anaerobic production and adrenergic-driven aerobic generation together with impaired lactate clearance have been implicated. An excessive adrenergic response could contribute to persistent hyperlactatemia and adrenergic modulation might be beneficial. We assessed the effects of dexmedetomidine and esmolol on hemodynamics, lactate generation, and exogenous lactate clearance during endotoxin-induced septic shock.MethodsEighteen anesthetized and mechanically ventilated sheep were subjected to a multimodal hemodynamic/perfusion assessment including hepatic and portal vein catheterizations, total hepatic blood flow, and muscle microdialysis. After monitoring, all received a bolus and continuous infusion of endotoxin. After 1 h they were volume resuscitated, and then randomized to endotoxin-control, endotoxin-dexmedetomidine (sequential doses of 0.5 and 1.0 μg/k/h) or endotoxin-esmolol (titrated to decrease basal heart rate by 20 %) groups. Samples were taken at four time points, and exogenous lactate clearance using an intravenous administration of sodium L-lactate (1 mmol/kg) was performed at the end of the experiments.ResultsDexmedetomidine and esmolol were hemodynamically well tolerated. The dexmedetomidine group exhibited lower epinephrine levels, but no difference in muscle lactate. Despite progressive hypotension in all groups, both dexmedetomidine and esmolol were associated with lower arterial and portal vein lactate levels. Exogenous lactate clearance was significantly higher in the dexmedetomidine and esmolol groups.ConclusionsDexmedetomidine and esmolol were associated with lower arterial and portal lactate levels, and less impairment of exogenous lactate clearance in a model of septic shock. The use of dexmedetomidine and esmolol appears to be associated with beneficial effects on gut lactate generation and lactate clearance and exhibits no negative impact on systemic hemodynamics.
Comparison of apaCHE ii and tHrEE abbrEviatEd apaCHE ii sCorEs for prEdiCting outComE among EmErgEnCy trauma patiEnts rEv assoC mEd bras 2014; 60(4):381-386 381Original articleComparison of APACHE II and three abbreviated APACHE II scores for predicting outcome among emergency trauma patients
The present study reveals that the smaller European nations have a greater participation than the larger European nations in the major intensive care journals. This phenomenon could be due to different submission practices in these countries compared with the larger European countries, where a considerable number of papers are submitted to local renowned journals. There was no absolute correlation between a nation's gross national product and the total number of publications.
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