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[PMID]:28096296
[Au] Autor:Wong J; Agus MS; Graham DA; Melendez E
[Ad] Endereço:Divisions of Medicine Critical Care and.
[Ti] Título:A Critical Asthma Standardized Clinical and Management Plan Reduces Duration of Critical Asthma Therapy.
[So] Source:Hosp Pediatr;7(2):79-87, 2017 02.
[Is] ISSN:2154-1663
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND OBJECTIVE: Reduction of critical asthma management time can reduce intensive care utilization. The goal of this study was to determine whether a Critical Asthma Standardized Clinical Assessment and Management Plan (SCAMP) can decrease length of critical asthma management time. METHODS: This retrospective study compared critical asthma management times in children managed before and after implementation of a Critical Asthma SCAMP. The SCAMP used an asthma severity score management scheme to guide stepwise escalation and weaning of therapies. The SCAMP guided therapy until continuous albuterol nebulization (CAN) was weaned to intermittent albuterol every 2 hours (q2h). Because the SCAMP was part of a quality improvement initiative in which all patients received a standardized therapy, informed consent was waived. The study was conducted in Medicine ICU and Intermediate Care Units in a tertiary care freestanding children's hospital. Children ≥2 years of age who had CAN initiated in the emergency department and were admitted to the Division of Medicine Critical Care with status asthmaticus were included. The time to q2h dosing from initiation of CAN was compared between the baseline and SCAMP cohorts. Adverse events were compared. The Mann-Whitney test was used for analysis; P values <.05 were considered statistically significant. RESULTS: There were 150 baseline and 123 SCAMP patients eligible for analysis. There was a decrease in median time to q2h dosing after the SCAMP (baseline, 21.6 hours [interquartile range, 3.2-32.3 hours]; SCAMP, 14.2 hours [interquartile range, 9.0-23.1 hours]; P < .01). There were no differences in adverse events or readmissions. CONCLUSIONS: A Critical Asthma SCAMP was effective in decreasing time on continuous albuterol.
[Mh] Termos MeSH primário: Albuterol/uso terapêutico
Cuidados Críticos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos
Estado Asmático
[Mh] Termos MeSH secundário: Adolescente
Broncodilatadores/uso terapêutico
Criança
Pré-Escolar
Cuidados Críticos/métodos
Cuidados Críticos/normas
Gerenciamento Clínico
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia
Feminino
Seres Humanos
Masculino
Massachusetts/epidemiologia
Padrões de Prática Médica/normas
Melhoria de Qualidade
Estudos Retrospectivos
Índice de Gravidade de Doença
Estado Asmático/diagnóstico
Estado Asmático/terapia
Avaliação de Sintomas/métodos
Avaliação de Sintomas/normas
Fatores de Tempo
Adulto Jovem
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Bronchodilator Agents); QF8SVZ843E (Albuterol)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170614
[Lr] Data última revisão:
170614
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170119
[St] Status:MEDLINE
[do] DOI:10.1542/hpeds.2016-0087


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[PMID]:28055270
[Au] Autor:Kotsiou OS; Douras A; Makris D; Mpaka N; Gourgoulianis KI
[Ad] Endereço:a Department of Respiratory Medicine , Faculty of Medicine, University Hospital of Larissa, University of Thessaly, BIOPOLIS , Larissa , Greece.
[Ti] Título:Takotsubo cardiomyopathy: A known unknown foe of asthma.
[So] Source:J Asthma;54(8):880-886, 2017 Oct.
[Is] ISSN:1532-4303
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Patients with uncontrolled asthma are at a greater risk of asthma attacks requiring emergency room visits or hospital admissions. Takotsubo cardiomyopathy is potentially a significant complication in a course of status asthmaticus. CASE STUDY: We describe a 43-year-old female patient who presented with status asthmaticus that was further complicated with takotsubo cardiomyopathy. RESULTS: Recognizing apical ballooning syndrome is challenging in patients with a history of respiratory disease because the symptoms of the last entity may complicate the diagnostic approach. It is difficult to distinguish clinically apical ballooning syndrome from the acute airway exacerbation itself. Both asthma and takotsubo cardiomyopathy share the same clinical presentation with dyspnea and chest tightness. In our patient, the electrocardiographic abnormalities, the rapidly reversible distinctive characteristics of echocardiography, and the modest elevation of serum cardiac biomarkers levels, in combination with the presence of a stress trigger (severe asthma attack), strongly supported the diagnosis of broken heart syndrome. CONCLUSIONS: Clinicians should re-evaluate asthma management and be aware of the complications associated with asthma attacks such as stress-induced cardiomyopathy.
[Mh] Termos MeSH primário: Estado Asmático/complicações
Cardiomiopatia de Takotsubo/complicações
[Mh] Termos MeSH secundário: Adulto
Asma/complicações
Biomarcadores
Ecocardiografia
Eletrocardiografia
Feminino
Seres Humanos
Cardiomiopatia de Takotsubo/diagnóstico por imagem
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biomarkers)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171025
[Lr] Data última revisão:
171025
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170106
[St] Status:MEDLINE
[do] DOI:10.1080/02770903.2016.1276586


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[PMID]:27818334
[Au] Autor:deBacker J; Hart N; Fan E
[Ad] Endereço:Cleveland Clinic Lerner College of Medicine, Cleveland, OH; Interdepartmental Division of Critical Care Medicine, Toronto, ON, Canada.
[Ti] Título:Neuromuscular Blockade in the 21st Century Management of the Critically Ill Patient.
[So] Source:Chest;151(3):697-706, 2017 Mar.
[Is] ISSN:1931-3543
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Neuromuscular blockings agents (NMBAs) have a controversial role in the ventilatory and medical management of critical illness. The clinical concern surrounding NMBA-induced complications stems from evidence presented in the 2002 clinical practice guidelines, but new evidence from subsequent randomized trials and studies provides a more optimistic outlook about the application of NMBAs in the ICU. Furthermore, changes in the delivery of critical care, such as protocolized care pathways, minimizing or interrupting sedation, increased monitoring techniques, and overall improvements in reducing immobility, have created a modern, 21st century ICU environment whereby NMBAs may be administered safely. In this article we start with a review of the mechanism of action, side effects, and pharmacology of commonly used NMBAs. We then address the rationale for NMBA use for an expanding number of indications (endotracheal intubation, acute respiratory distress syndrome, status asthmaticus, increased intracranial and intra-abdominal pressure, and therapeutic hypothermia after cardiac arrest), with an emphasis on NMBA use in facilitating lung-protective ventilation for respiratory failure. We end with an appraisal over the importance of monitoring depth of paralysis and the concerns of complications, such as prolonged skeletal muscle weakness. In the context of adequate sedation and analgesia, monitored NMBA use (continuous or bolus administration) can be considered for the small number of clinical indications in critically ill patients for which evidence currently exists.
[Mh] Termos MeSH primário: Cuidados Críticos
Parada Cardíaca/terapia
Hipertensão Intracraniana/terapia
Bloqueio Neuromuscular/métodos
Bloqueadores Neuromusculares/uso terapêutico
Síndrome do Desconforto Respiratório do Adulto/terapia
Estado Asmático/terapia
[Mh] Termos MeSH secundário: Estado Terminal
Gerenciamento Clínico
Seres Humanos
Hipotermia Induzida/métodos
Unidades de Terapia Intensiva
Intubação Intratraqueal/métodos
Respiração Artificial/métodos
Insuficiência Respiratória/terapia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Neuromuscular Blocking Agents)
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170529
[Lr] Data última revisão:
170529
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:161108
[St] Status:MEDLINE


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[PMID]:27789310
[Au] Autor:Hehir MP; Ananth CV; Wright JD; Siddiq Z; D'Alton ME; Friedman AM
[Ad] Endereço:Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY. Electronic address: mh3616@cumc.columbia.edu.
[Ti] Título:Severe maternal morbidity and comorbid risk in hospitals performing <1000 deliveries per year.
[So] Source:Am J Obstet Gynecol;216(2):179.e1-179.e12, 2017 Feb.
[Is] ISSN:1097-6868
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: While research has demonstrated increasing risk for severe maternal morbidity in the United States, risk at lower volume hospitals remains poorly characterized. More than half of all obstetric units in the United States perform <1000 deliveries per year and improving care at these hospitals may be critical to reducing risk nationwide. OBJECTIVE: We sought to characterize maternal risk profiles and severe maternal morbidity at low-volume hospitals in the United States. STUDY DESIGN: We used data from the Nationwide Inpatient Sample to evaluate trends in severe maternal morbidity and comorbid risk during delivery hospitalizations in the United States from 1998 through 2011. Comorbid maternal risk was estimated using a comorbidity index validated for obstetric patients. Severe maternal morbidity was defined as the presence of any 1 of 15 diagnoses representative of acute organ injury and critical illness. RESULTS: A total of 2,300,279 deliveries occurred at hospitals with annual delivery volume <1000, representing 20% of delivery hospitalizations overall. There were 7849 cases (0.34%) of severe morbidity in low-volume hospitals and this risk increased over the course of the study from 0.25% in 1998 through 1999 to 0.49% in 2010 through 2011 (P < .01). The risk in hospitals with ≥1000 deliveries increased from 0.35-0.62% during the same time periods. The proportion of patients with the lowest comorbidity decreased, while the proportion of patients with highest comorbidity increased the most. The risk of severe morbidity increased across all women including those with low comorbidity scores. Risk for severe morbidity associated with obstetric hemorrhage, infection, hypertensive diseases of pregnancy, and medical conditions all increased during the study period. CONCLUSION: Our findings demonstrate increasing maternal risk at hospitals performing <1000 deliveries per year broadly distributed over the patient population. Rates of morbidity in centers with ≥1000 deliveries have also increased. These findings suggest that maternal safety improvements are necessary at all centers regardless of volume.
[Mh] Termos MeSH primário: Estado Terminal/epidemiologia
Hospitais com Baixo Volume de Atendimentos/estatística & dados numéricos
Mortalidade Materna
[Mh] Termos MeSH secundário: Lesão Renal Aguda/epidemiologia
Adulto
Transtornos Cerebrovasculares/epidemiologia
Coma/epidemiologia
Delírio/epidemiologia
Coagulação Intravascular Disseminada/epidemiologia
Feminino
Insuficiência Cardíaca/epidemiologia
Seres Humanos
Hipertensão Induzida pela Gravidez/epidemiologia
Falência Hepática Aguda/epidemiologia
Modelos Logísticos
Infarto do Miocárdio/epidemiologia
Gravidez
Transtornos Puerperais/epidemiologia
Edema Pulmonar/epidemiologia
Embolia Pulmonar/epidemiologia
Risco
Sepse/epidemiologia
Índice de Gravidade de Doença
Choque/epidemiologia
Estado Asmático/epidemiologia
Estado Epiléptico/epidemiologia
Estados Unidos/epidemiologia
Hemorragia Uterina/epidemiologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170531
[Lr] Data última revisão:
170531
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:161030
[St] Status:MEDLINE


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[PMID]:27340744
[Au] Autor:Steinack C; Lenherr R; Hendra H; Franzen D
[Ad] Endereço:a Division of Pulmonology , University Hospital Zurich , Zurich , Switzerland.
[Ti] Título:The use of life-saving extracorporeal membrane oxygenation (ECMO) for pregnant woman with status asthmaticus.
[So] Source:J Asthma;54(1):84-88, 2017 Jan 02.
[Is] ISSN:1532-4303
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Status asthmaticus can develop into a life-threatening disorder that requires mechanical ventilation. Severe respiratory failure during pregnancy can worsen maternal and fetal outcomes. Previous case studies have demonstrated extracorporeal membrane oxygenation (ECMO) as a life-saving measure for pregnant women with acute respiratory distress syndrome (ARDS) as well as non-pregnant patients with status asthmaticus. CASE STUDY: A 25-year-old woman, who was 5 weeks pregnant, was admitted with status asthmaticus and severe hypercapnic respiratory failure. Despite rescue therapies such as pressure control ventilation with high inspiratory pressures, inhaled beta2 agonists and antimuscarinic drugs, intravenous salbutamol, methylprednisolone and magnesium sulfate, her condition gradually deteriorated. Veno-venous ECMO was initiated for respiratory support and the patient's clinical condition as well as the gas exchange improved within the next few days. ECMO was removed and the patient was extubated after 2 days. Sonography, however, revealed a retrochorial hematoma; the patient was diagnosed with abortus imminens and successfully treated with magnesium substitution and bed rest. Finally, she gave birth to a healthy boy at 38 weeks of gestation. CONCLUSIONS: This is the first case report on the successful use of ECMO in a pregnant woman with severe respiratory insufficiency due to status asthmaticus, who failed to respond to invasive mechanical ventilation and maximum pharmacological treatment. Despite this life-threatening condition, the use of ECMO in our patient has greatly improved the chance of survival for the mother and the baby, who was born without any complications.
[Mh] Termos MeSH primário: Oxigenação por Membrana Extracorpórea/métodos
Estado Asmático/terapia
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Gravidez
Respiração Artificial
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170717
[Lr] Data última revisão:
170717
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160625
[St] Status:MEDLINE
[do] DOI:10.1080/02770903.2016.1193871


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[PMID]:27755068
[Au] Autor:Murray MJ; DeBlock H; Erstad B; Gray A; Jacobi J; Jordan C; McGee W; McManus C; Meade M; Nix S; Patterson A; Sands MK; Pino R; Tescher A; Arbour R; Rochwerg B; Murray CF; Mehta S
[Ad] Endereço:1Geisinger Medical Center, Danville, PA. 2Albany Medical Center, Albany, NY. 3University of Arizona College of Pharmacy, Tucson, AZ. 4Clinic Medical Center, Burlington, MA. 5Indiana University, Indiana, IN. 6Grand Strand Medical Center, Myrtle Beach, SC. 7Baystate Medical Center, Springfield, MA. 8Saint Elizabeth's Medical Center, Boston, MA. 9University of Toronto, Toronto, Canada. 10Riverside Medical Group, Yorktown, VA. 11University of Nebraska Medical Center, Omaha, NE. 12Novant Health, Clemmons, NC. 13Massachusetts General Hospital, Boston, MA. 14Mayo Clinic, Rochester, MN. 15Lancaster General Hospital, Lancaster, PA. 16McMaster University, Hamilton, Ontario, Canada. 17Medscape, New York, NY. 18University of Toronto, Toronto, Canada.
[Ti] Título:Clinical Practice Guidelines for Sustained Neuromuscular Blockade in the Adult Critically Ill Patient.
[So] Source:Crit Care Med;44(11):2079-2103, 2016 Nov.
[Is] ISSN:1530-0293
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To update the 2002 version of "Clinical practice guidelines for sustained neuromuscular blockade in the adult critically ill patient." DESIGN: A Task Force comprising 17 members of the Society of Critical Medicine with particular expertise in the use of neuromuscular-blocking agents; a Grading of Recommendations Assessment, Development, and Evaluation expert; and a medical writer met via teleconference and three face-to-face meetings and communicated via e-mail to examine the evidence and develop these practice guidelines. Annually, all members completed conflict of interest statements; no conflicts were identified. This activity was funded by the Society for Critical Care Medicine, and no industry support was provided. METHODS: Using the Grading of Recommendations Assessment, Development, and Evaluation system, the Grading of Recommendations Assessment, Development, and Evaluation expert on the Task Force created profiles for the evidence related to six of the 21 questions and assigned quality-of-evidence scores to these and the additional 15 questions for which insufficient evidence was available to create a profile. Task Force members reviewed this material and all available evidence and provided recommendations, suggestions, or good practice statements for these 21 questions. RESULTS: The Task Force developed a single strong recommendation: we recommend scheduled eye care that includes lubricating drops or gel and eyelid closure for patients receiving continuous infusions of neuromuscular-blocking agents. The Task Force developed 10 weak recommendations. 1) We suggest that a neuromuscular-blocking agent be administered by continuous intravenous infusion early in the course of acute respiratory distress syndrome for patients with a PaO2/FIO2 less than 150. 2) We suggest against the routine administration of an neuromuscular-blocking agents to mechanically ventilated patients with status asthmaticus. 3) We suggest a trial of a neuromuscular-blocking agents in life-threatening situations associated with profound hypoxemia, respiratory acidosis, or hemodynamic compromise. 4) We suggest that neuromuscular-blocking agents may be used to manage overt shivering in therapeutic hypothermia. 5) We suggest that peripheral nerve stimulation with train-of-four monitoring may be a useful tool for monitoring the depth of neuromuscular blockade but only if it is incorporated into a more inclusive assessment of the patient that includes clinical assessment. 6) We suggest against the use of peripheral nerve stimulation with train of four alone for monitoring the depth of neuromuscular blockade in patients receiving continuous infusion of neuromuscular-blocking agents. 7) We suggest that patients receiving a continuous infusion of neuromuscular-blocking agent receive a structured physiotherapy regimen. 8) We suggest that clinicians target a blood glucose level of less than 180 mg/dL in patients receiving neuromuscular-blocking agents. 9) We suggest that clinicians not use actual body weight and instead use a consistent weight (ideal body weight or adjusted body weight) when calculating neuromuscular-blocking agents doses for obese patients. 10) We suggest that neuromuscular-blocking agents be discontinued at the end of life or when life support is withdrawn. In situations in which evidence was lacking or insufficient and the study results were equivocal or optimal clinical practice varies, the Task Force made no recommendations for nine of the topics. 1) We make no recommendation as to whether neuromuscular blockade is beneficial or harmful when used in patients with acute brain injury and raised intracranial pressure. 2) We make no recommendation on the routine use of neuromuscular-blocking agents for patients undergoing therapeutic hypothermia following cardiac arrest. 3) We make no recommendation on the use of peripheral nerve stimulation to monitor degree of block in patients undergoing therapeutic hypothermia. 4) We make no recommendation on the use of neuromuscular blockade to improve the accuracy of intravascular-volume assessment in mechanically ventilated patients. 5) We make no recommendation concerning the use of electroencephalogram-derived parameters as a measure of sedation during continuous administration of neuromuscular-blocking agents. 6) We make no recommendation regarding nutritional requirements specific to patients receiving infusions of neuromuscular-blocking agents. 7) We make no recommendation concerning the use of one measure of consistent weight over another when calculating neuromuscular-blocking agent doses in obese patients. 8) We make no recommendation on the use of neuromuscular-blocking agents in pregnant patients. 9) We make no recommendation on which muscle group should be monitored in patients with myasthenia gravis receiving neuromuscular-blocking agents. Finally, in situations in which evidence was lacking or insufficient but expert consensus was unanimous, the Task Force developed six good practice statements. 1) If peripheral nerve stimulation is used, optimal clinical practice suggests that it should be done in conjunction with assessment of other clinical findings (e.g., triggering of the ventilator and degree of shivering) to assess the degree of neuromuscular blockade in patients undergoing therapeutic hypothermia. 2) Optimal clinical practice suggests that a protocol should include guidance on neuromuscular-blocking agent administration in patients undergoing therapeutic hypothermia. 3) Optimal clinical practice suggests that analgesic and sedative drugs should be used prior to and during neuromuscular blockade, with the goal of achieving deep sedation. 4) Optimal clinical practice suggests that clinicians at the bedside implement measure to attenuate the risk of unintended extubation in patients receiving neuromuscular-blocking agents. 5) Optimal clinical practice suggests that a reduced dose of an neuromuscular-blocking agent be used for patients with myasthenia gravis and that the dose should be based on peripheral nerve stimulation with train-of-four monitoring. 6) Optimal clinical practice suggests that neuromuscular-blocking agents be discontinued prior to the clinical determination of brain death.
[Mh] Termos MeSH primário: Estado Terminal
Bloqueio Neuromuscular
Bloqueadores Neuromusculares/uso terapêutico
[Mh] Termos MeSH secundário: Adulto
Analgésicos/uso terapêutico
Morte Encefálica
Feminino
Hemodinâmica
Seres Humanos
Hipnóticos e Sedativos/uso terapêutico
Hipotermia Induzida
Miastenia Gravis/complicações
Bloqueadores Neuromusculares/farmacologia
Junção Neuromuscular/fisiologia
Monitoração Neuromuscular
Obesidade/complicações
Gravidez
Síndrome do Desconforto Respiratório do Adulto/tratamento farmacológico
Estado Asmático/tratamento farmacológico
Assistência Terminal
Suspensão de Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; PRACTICE GUIDELINE; REVIEW
[Nm] Nome de substância:
0 (Analgesics); 0 (Hypnotics and Sedatives); 0 (Neuromuscular Blocking Agents)
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170525
[Lr] Data última revisão:
170525
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:161019
[St] Status:MEDLINE


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[PMID]:27737430
[Au] Autor:Chantar CD; Cravo JP; Esquinas AM
[Ad] Endereço:Servicio de Neumología, Hospital Universitario Morales Meseguer, Murcia, España.
[Ti] Título:To: Heliox in the treatment of status asthmaticus: case reports.
[Ti] Título:Para: Heliox no tratamento do mal asmático: relato de caso..
[So] Source:Rev Bras Ter Intensiva;28(3):348-349, 2016 09.
[Is] ISSN:1982-4335
[Cp] País de publicação:Brazil
[La] Idioma:eng; spa
[Mh] Termos MeSH primário: Estado Asmático
[Mh] Termos MeSH secundário: Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; COMMENT
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170802
[Lr] Data última revisão:
170802
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161014
[St] Status:MEDLINE


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[PMID]:27737414
[Au] Autor:Carvalho I; Querido S; Silvestre J; Póvoa P
[Ad] Endereço:Unidade de Cuidados Intensivos Polivalente, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal.
[Ti] Título:Reply to: Heliox in the treatment of status asthmaticus: case reports.
[Ti] Título:Resposta para: Heliox no tratamento do mal asmático: relato de casos..
[So] Source:Rev Bras Ter Intensiva;28(3):350-351, 2016 09.
[Is] ISSN:1982-4335
[Cp] País de publicação:Brazil
[La] Idioma:eng; por
[Mh] Termos MeSH primário: Estado Asmático
[Mh] Termos MeSH secundário: Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; COMMENT
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170802
[Lr] Data última revisão:
170802
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161014
[St] Status:MEDLINE


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[PMID]:27583095
[Au] Autor:Naidoo P
[Ad] Endereço:Khan Regional Hospital, University of Kwazulu-natal, Nelson Mandela College of Medicine, Department of Internal Medicine, Durban, South Africa.
[Ti] Título:Status asthmaticus with pseudo-dextrocardia, complicated by iatrogenic tension pneumothorax.
[So] Source:Pan Afr Med J;24:31, 2016.
[Is] ISSN:1937-8688
[Cp] País de publicação:Uganda
[La] Idioma:eng
[Mh] Termos MeSH primário: Dextrocardia/diagnóstico
Pneumotórax/diagnóstico
Estado Asmático/fisiopatologia
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Doença Iatrogênica
Pneumotórax/terapia
Estado Asmático/terapia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170322
[Lr] Data última revisão:
170322
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160902
[St] Status:MEDLINE
[do] DOI:10.11604/pamj.2016.24.31.9552


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[PMID]:27457112
[Au] Autor:Friedman AM; Ananth CV; Huang Y; D'Alton ME; Wright JD
[Ad] Endereço:Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY. Electronic address: amf2104@columbia.edu.
[Ti] Título:Hospital delivery volume, severe obstetrical morbidity, and failure to rescue.
[So] Source:Am J Obstet Gynecol;215(6):795.e1-795.e14, 2016 Dec.
[Is] ISSN:1097-6868
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: In the setting of persistently high risk for maternal death and severe obstetric morbidity, little is known about the relationship between hospital delivery volume and maternal outcomes. OBJECTIVE: The objectives of this analysis were (1) to determine maternal risk for severe morbidity during delivery hospitalizations by hospital delivery volume in the United States and (2) to characterize, by hospital volume, the risk for death in the setting of severe obstetric morbidity, a concept known as failure to rescue. STUDY DESIGN: This cohort study evaluated 50,433,539 delivery hospitalizations across the United States from 1998-2010. The main outcome measures were (1) severe morbidity that was defined as a composite of any 1 of 15 diagnoses that are representative of acute organ injury and critical illness and (2) failure to rescue that was defined as death in the setting of severe morbidity. RESULTS: The prevalence of severe morbidity rose from 471.2-751.5 cases per 100,000 deliveries from 1998-2010, which was an increase of 59.5%. Failure to rescue was highest in 1998 (1.5%), decreased to 0.6% in 2007, and rose to 0.9% in 2010. In models that were adjusted for comorbid risk and hospital factors, both low and high annualized delivery volume were associated with increased risk for failure to rescue and severe morbidity. However, the relative importance of hospital volume for both outcomes compared with other factors was relatively small. CONCLUSION: Although low-and high-delivery volume are associated with increased risk for both failure to rescue and severe maternal morbidity, other factors, in particular characteristics of individual centers, may be more important in the determination of outcomes.
[Mh] Termos MeSH primário: Estado Terminal/epidemiologia
Parto Obstétrico
Falha da Terapia de Resgate/estatística & dados numéricos
Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos
Hospitais com Baixo Volume de Atendimentos/estatística & dados numéricos
[Mh] Termos MeSH secundário: Doença Aguda
Lesão Renal Aguda/epidemiologia
Adulto
Transtornos Cerebrovasculares/epidemiologia
Coma/epidemiologia
Bases de Dados Factuais
Delírio/epidemiologia
Coagulação Intravascular Disseminada/epidemiologia
Feminino
Insuficiência Cardíaca/epidemiologia
Seres Humanos
Falência Hepática Aguda/epidemiologia
Infarto do Miocárdio/epidemiologia
Gravidez
Prevalência
Transtornos Puerperais/epidemiologia
Edema Pulmonar/epidemiologia
Embolia Pulmonar/epidemiologia
Insuficiência Respiratória/epidemiologia
Sepse/epidemiologia
Índice de Gravidade de Doença
Choque/epidemiologia
Estado Asmático/epidemiologia
Estado Epiléptico/epidemiologia
Estados Unidos/epidemiologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170531
[Lr] Data última revisão:
170531
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:160727
[St] Status:MEDLINE



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