Avaliação do uso da clonidina para sedoanalgesia de pacientes sob ventilação mecânica prolongada, internados em unidade de terapia intensiva

Moritz, Rachel Duarte; Machado, Fernando Osni; Pinto, Erick Przybysz; Cardoso, Gil Schmidt; Nassar, Sílvia Modesto

doi:10.1590/s0103-507x2008000100004

Cited by 5 publications

(4 citation statements)

References 18 publications

(27 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In sepsis, beta-blockers or alpha-2 agonists minimize the inflammation [183,262], the systemic vasodilation [9][10][11]183,196,198], the emergence delirium [301], the delayed emergence from conventional sedation, the duration of controlled mechanical ventilation [302], the CCU stay [172,298,303], and the mortality [111,[162][163][164][165][166][167][168][169][170][171].…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, a metanalysis [172] concluded an absence of effect of alpha-2 agonists on outcome. However, this study [172] did not reference the positive trials [111,[162][163][164][165][166][167][168][169] or the meta-analysis [170] and needs reassessment.…”

Section: Sympatholytics In the Setting Of Septic Shockmentioning

confidence: 99%

“…The beneficial effects of vasodilators in the setting of cardiogenic shock and beta-blockers in the setting of congestive cardiomyopathy [153] renewed the interest in sympathetic deactivation in septic patients. The use of antihypertensive drugs in hypotensive sepsis is counterintuitive but beneficial ("inverted therapy" [154]: ergotoxine [115], chlorpromazine [6,16,106], phenoxybenzamine [5,151,152], beta-blockers [155][156][157][158][159][160][161], and alpha-2 agonists [111,[162][163][164][165][166][167][168][169][170][171]). On the other hand, a metanalysis [172] concluded an absence of effect of alpha-2 agonists on outcome.…”

Section: Sympatholytics In the Setting Of Septic Shockmentioning

confidence: 99%

See 2 more Smart Citations

Is the Sympathetic System Detrimental in the Setting of Septic Shock, with Antihypertensive Agents as a Counterintuitive Approach? A Clinical Proposition

Petitjeans

Géloën

Pichot

et al. 2021

JCM

View full text Add to dashboard Cite

Mortality in the setting of septic shock varies between 20% and 100%. Refractory septic shock leads to early circulatory failure and carries the worst prognosis. The pathophysiology is poorly understood despite studies of the microcirculatory defects and the immuno-paralysis. The acute circulatory distress is treated with volume expansion, administration of vasopressors (usually noradrenaline: NA), and inotropes. Ventilation and anti-infectious strategy shall not be discussed here. When circulation is considered, the literature is segregated between interventions directed to the systemic circulation vs. interventions directed to the micro-circulation. Our thesis is that, after stabilization of the acute cardioventilatory distress, the prolonged sympathetic hyperactivity is detrimental in the setting of septic shock. Our hypothesis is that the sympathetic hyperactivity observed in septic shock being normalized towards baseline activity will improve the microcirculation by recoupling the capillaries and the systemic circulation. Therefore, counterintuitively, antihypertensive agents such as beta-blockers or alpha-2 adrenergic agonists (clonidine, dexmedetomidine) are useful. They would reduce the noradrenaline requirements. Adjuncts (vitamins, steroids, NO donors/inhibitors, etc.) proposed to normalize the sepsis-evoked vasodilation are not reviewed. This itemized approach (systemic vs. microcirculation) requires physiological and epidemiological studies to look for reduced mortality.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Sympatholytics In the Setting Of Septic Shockmentioning

confidence: 99%

Section: Sympatholytics In the Setting Of Septic Shockmentioning

confidence: 99%

See 1 more Smart Citation

Is the Sympathetic System Detrimental in the Setting of Septic Shock, with Antihypertensive Agents as a Counterintuitive Approach? A Clinical Proposition

Petitjeans

Géloën

Pichot

et al. 2021

JCM

View full text Add to dashboard Cite

show abstract

“…Ainda sobre a PAVM, Souza et al (2019) ressalva que a má higienização oral em pacientes da UTI contribui para a colonização de bactérias patogênicas na cavidade oral, aumentando o risco de Pneumonia Associada à Ventilação Mecânica (PAVM). A aspiração dessas bactérias pode resultar em infecções respiratórias graves e complicações pulmonares.…”

Section: Introductionunclassified

Cuidados Essenciais: Enfermagem E a Higiene Bucal Em Unidade De Terapia Intensiva

Duffeck,

Oliveira,

Oliveira

2023

REASE

View full text Add to dashboard Cite

A higiene bucal adequada é vital para a saúde, incluindo a remoção de placa bacteriana, limpeza da língua e uso de antissépticos. A equipe de enfermagem desempenha um papel crucial na prevenção de complicações e na promoção da saúde bucal OBJETIVO: O estudo visou compreender a equipe multidisciplinar da Unidade de Terapia Intensiva em relação à implementação da higiene bucal em pacientes críticos. MÉTODOS: O estudo, de natureza exploratória e descritiva com abordagem quantitativa, empregou questionários para avaliar 36 profissionais de saúde em uma equipe multidisciplinar de uma Unidade de Terapia Intensiva em um Hospital Filantrópico no Oeste do Paraná. RESULTADOS: Em relação ao conhecimento da equipe de Enfermagem a respeito da importância da Higiene Oral (72,97%) acredita que os profissionais de Enfermagem possuem conhecimento adequado para realizar a higiene bucal, com apenas 10,81% discordando. Quanto à frequência recomendada da higiene oral, 77,78% dos profissionais de Terapia Intensiva percebem uma falta de ênfase e regularidade, indicando um desafio na atenção adequada dentro da UTI. CONCLUSÃO: A Higiene Oral na UTI é essencial, sendo subestimada em relação a outras práticas. Destaca-se a necessidade de maior ênfase para aumentar a conscientização sobre sua importância na rotina de cuidados intensivos.

show abstract

Hypothesis: Fever control, a niche for alpha-2 agonists in the setting of septic shock and severe acute respiratory distress syndrome?

et al. 2018

View full text Add to dashboard Cite

During severe septic shock and/or severe acute respiratory distress syndrome (ARDS) patients present with a limited cardio-ventilatory reserve (low cardiac output and blood pressure, low mixed venous saturation, increased lactate, low PaO2/FiO2 ratio, etc.), especially when elderly patients or co-morbidities are considered. Rescue therapies (low dose steroids, adding vasopressin to noradrenaline, proning, almitrine, NO, extracorporeal membrane oxygenation, etc.) are complex. Fever, above 38.5-39.5 C, increases both the ventilatory (high respiratory drive: large tidal volume, high respiratory rate) and the metabolic (increased O2 consumption) demands, further limiting the cardio-ventilatory reserve. Some data (case reports, uncontrolled trial, small randomized prospective trials) suggest that control of elevated body temperature ("fever control") leading to normothermia (35.5-37 C) will lower both the ventilatory and metabolic demands: fever control should simplify critical care management when limited cardio-ventilatory reserve is at stake. Usually fever control is generated by a combination of general anesthesia ("analgo-sedation", light total intravenous anesthesia), antipyretics and cooling. However general anesthesia suppresses spontaneous ventilation, making the management more complex. At variance, alpha-2 agonists (clonidine, dexmedetomidine) administered immediately following tracheal intubation and controlled mandatory ventilation, with prior optimization of volemia and atrio-ventricular conduction, will reduce metabolic demand and facilitate normothermia. Furthermore, after a rigorous control of systemic acidosis, alpha-2 agonists will allow for accelerated emergence without delirium, early spontaneous ventilation, improved cardiac output and micro-circulation, lowered vasopressor requirements and inflammation. Rigorous prospective randomized trials are needed in subsets of patients with a high fever and spiraling toward refractory septic shock and/or presenting with severe ARDS.

show abstract

Avaliação do uso da clonidina para sedoanalgesia de pacientes sob ventilação mecânica prolongada, internados em unidade de terapia intensiva

Cited by 5 publications

References 18 publications

Is the Sympathetic System Detrimental in the Setting of Septic Shock, with Antihypertensive Agents as a Counterintuitive Approach? A Clinical Proposition

Is the Sympathetic System Detrimental in the Setting of Septic Shock, with Antihypertensive Agents as a Counterintuitive Approach? A Clinical Proposition

Cuidados Essenciais: Enfermagem E a Higiene Bucal Em Unidade De Terapia Intensiva

Hypothesis: Fever control, a niche for alpha-2 agonists in the setting of septic shock and severe acute respiratory distress syndrome?

Contact Info

Product

Resources

About