Objective:To identify and integrate the available scientific evidence related to the use of the prone position in patients with acute respiratory distress syndrome for the reduction of the outcome variable of mortality compared to the dorsal decubitus position. Method: Overview of systematic reviews or meta-analyzes of randomized clinical trials. It included studies that evaluated the use of prone positioning in patients with acute respiratory distress syndrome published between 2014 and 2016. The AMSTAR tool was used to determine the methodological quality of studies. The GRADE system was used to establish the overall quality of evidence for the mortality outcome. Results: From the search strategy, were retrieved seven relevant manuscripts of high methodological quality. Conclusion: Scientific evidence supports that combined use of protective ventilatory strategy and prone positioning for periods between 16 and 20 hours in patients with acute respiratory distress syndrome and PaO2/FiO2 ratio lower than 150 mm/Hg results in significant reduction of mortality rate. DESCRIPTORSCritical Care; Prone Position; Respiratory Distress Syndrome, Adult; Evidence-Based Nursing; Evidence-Based Practice; Review.Efficacy of prone position in acute respiratory distress syndrome: overview of systematic reviews Efetividade da posição prona na síndrome do desconforto respiratório agudo: overview de revisões sistemáticas Efectividad de la posición prona en el síndrome de dificultad respiratoria aguda: overview de revisiones sistemáticas Efficacy of prone position in acute respiratory distress syndrome: overview of systematic reviewsRev Esc Enferm USP · 2017;51:e03251 INTRODUCTIONAcute Respiratory Distress Syndrome (ARDS) is a potentially devastating form of hypoxemic respiratory failure caused by acute inflammatory lung injury (1) . Its characteristics are the sudden onset, presence of a triggering factor (diffuse bilateral pulmonary infiltrate), and normally there is no left heart failure (non-cardiogenic pulmonary edema) or circulatory overload (2) . In 2012, was proposed a new model for the standardization of diagnostic concepts of acute respiratory distress syndrome that took into account the severity of the disease (ARDS Definition Task Force). The name of the recommendation is Berlin Definition, and patients with ARDS are stratified into three categories, namely: mild ( . ARDS is a high incidence phenomenon in the field of intensive care. In this regard, 29,144 patients admitted to intensive care units were evaluated in a multicenter, international and prospective cohort study. It was found that 3,022 patients (10.4%) met the clinical criteria for ARDS. Of these, 2,377 patients developed the disease within the first 48 hours and required invasive ventilatory support to suppress severe acute respiratory failure. The mortality rate was directly proportional to the severity of disease, as follows: 35% among patients with mild ARDS, 40% among patients with moderate ARDS, and 46% for patients with severe ARDS. Incidence r...
OBJECTIVE To evaluate the effectiveness of hyaluronic acid in the healing of partial thickness burns. METHOD Systematic review of randomized controlled trials on the use of hyaluronic acid for the topical treatment of skin burns, based on recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS Two randomized controlled trials that analyzed 143 patients with partial thickness burns and/or deep partial thickness burns were selected. They compared the application of hyaluronic acid 0.2% associated to silver sulfadiazine 1% 5g/cm2 versus silver sulfadiazine 1% 5g/cm2 alone for the outcome of complete healing. CONCLUSION This review emphasizes the need for new well-designed randomized controlled trials to establish the therapeutic relevance of hyaluronic acid with respect to the healing of burns of partial thickness or deep partial thickness.
RESUMO: Objetivou-se realizar teste piloto do ensaio clinico randomizado: avaliação da efetividade do curativo impregnado com clorexidina para cobertura de cateter venoso central. A pesquisa clinica foi desenvolvida nos centros de terapia intensiva e semi-intensiva adulto de um hospital universitário da cidade de Curitiba-PR. A coleta de dados ocorreu entre outubro e novembro de 2011. Os pacientes incluídos foram randomizados para dois grupos: curativo transparente de poliuretano (controle) e curativo antimicrobiano de clorexidina (intervenção). Foram pesquisados oito pacientes. Houve um caso de infecção da corrente sanguínea associada ao cateter e um caso de colonização do cateter, ambos no grupo controle. O curativo transparente necessita de troca antecipada em relação ao tempo estipulado devido à má fixação e ao acúmulo de exsudato sob a película, expondo o paciente a maior risco de colonização e de infecção da corrente sanguínea associada ao cateter. Palavras-Chave: Ensaio clínico; clorexidina; cateterismo venoso central; tecnologia. ABSTRACT: This randomized pilot clinical trial aimed to evaluate the effectiveness of chlorhexidine-impregnated dressings covering central venous catheters. Data was collected between October and November 2011 at the adult intensive and semiintensive care units of a university hospital in Curitiba, Paraná, Brazil. The eight patients included in the trial were randomized into two groups: transparent polyurethane film dressing (control) and chlorhexidine-impregnated dressing. There was one case of blood stream infection associated with the catheter and one of catheter colonization, both in the control group. The transparent polyurethane film needs to be changed earlier than specified, due to poor fixation and the accumulation of exudate under the film, which can expose patients to greater risk of colonization and infection of the blood stream associated with the catheter.
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