Material Usado em Capnografia Um dos obstáculos à utilização de CO 2 expirado monitoramento reside na disparidade do material utilizado por médicos de emergência. Para esclarecer esta situação, é importante distinguir se o paciente está ventilados artificialmente ou respirar espontaneamente. Quanto ao resto, as diferentes técnicas utilizadas para a análise já não têm uma implicação nos resultados clínicos e eficiência. Esta declaração está no caso de a tradicional distinção entre sidestream e capnografia mainstream. Estas duas técnicas de medida de CO 2, utilizando ondas de infravermelho, o sistema sidestream utiliza uma bomba de aspiração para o transporte de CO 2 desde a boca até o detector localizado no monitor, enquanto as medidas do sistema convencional CO 2 diretamente em uma pequena câmara situada na foz do paciente e ligado ao monitor por um cabo. Tradicionalmente, o sistema sidestream é usado para pacientes com respiração espontânea como o sistema é mais leve, eo sistema mainstream, um pouco mais volumoso, é conectado diretamente ao tubo endotraqueal em pacientes entubados. Avanços tecnológicos nos últimos anos, têm reduzido fundamentalmente a diferença entre mainstream e sistemas de fluxo lateral. A nova tecnologia está a apontar para o sistema Microstream, que é uma espécie de &quot;sistema sidestream reforçadas&quot; no qual o CO2 viaja ao longo de um tubo fino antes de chegar à câmara onde o detector está localizado, permitindo um período menor de transição entre a boca ea câmara de detecção e portanto, uma curva de capnografia que é quase sincronizado com a passagem de ar pela boca. Então, vamos ter um olhar para o que distingue a escolha de material, como explicado na segunda metade da sequência de vídeo: <ul><li> Se o médico deseja monitorar um paciente em ventilação espontânea, de modo a detectar precocely apnéia (durante a sedação, ou após intoxicação médicos), então apenas a forma da curva é essencial, o valor real do ETCO 2 sendo de menor importância. Neste caso, ele médico pode escolher entre tubos nasais ou uma combinação de capnomask administração de oxigênio e aspiração CO 2, ou um fino tubo de aspiração CO 2 que pode ser colocado sob uma máscara clássica. </li><li> Se o médico quer analisar com precisão ETCO 2, a fim de adaptar os parâmetros em um respirador, para verificar o posicionamento correto de um tubo endotraqueal, ou para avaliar o prognóstico durante a parada cardíaca, ele deve usar o material que pode ser adaptado para uso com um tubo endotraqueal (sempre colocado atrás do filtro de modo secreções do paciente não bloqueiam o tubo). </li></ul> A curva de capnografia A curva de capnografia típicas durante três expirações é dada na Figura 1. A curva retoma o eixo x (valor 0) em cada inspiração, como não há praticamente nenhum CO 2 no ar inspirado. <img src="/files/ftp_upload/2508/2508fig1.jpg" alt="Figura 1" /> Figura 1: alternância inspiração-expiração Diferenças entre o PaCO 2 e ETCO 2 Seria eutopic a acreditar que o monitoramento não-invasivo de CO 2 expirado pode substituir em todas as circunstâncias a necessidade de gás no sangue arterial (ABG) As medidas, consideradas o padrão-ouro para a medição da PaCO 2. Tudo depende das indicações para a medição de CO 2 e terminou a condição do paciente cardio-respiratória. Se a indicação é o monitoramento da atividade respiratória para evitar hipoventilação e apnéia durante a sedação, uma simples análise da curva é suficiente, seja qual for o valor de ETCO 2. Por outro lado, se a indicação é para monitorar a ventilação adequada de um paciente de trauma na cabeça, sem histórico de distúrbios cardio-respiratória, podemos esperar que o ETCO 2 valor a ser próximo de 2 PaO valor, embora a necessidade de uma precisa PaCO valor 2 impõe pelo menos uma amostra ABG, que também nos permite confirmar que realmente ETCO 2 está perto de PaCO 2 no presente caso. Finalmente, se somos confrontados com o caso de um paciente que está entubado e ventilado devido ao desconforto respiratório, ETCO 2 valores não ser, evidentemente, uma boa aproximação da PaCO 2. A razão é simples: assim como há um distúrbio na ventilação-perfusão relações, independentemente do que o presente distúrbio cardio-pulmonar é, um obstáculo para a eliminação correta de CO 2 pelos pulmões é criado. Como resultado, o CO 2 se acumula no sangue, e naso-bucal eliminação é reduzida, criando uma PaCO 2 - ETCO gradiente 2. Nesta circunstância, é fundamental saber o valor de PaCO 2 antesqualquer interpretação do ETCO 2 valor. A primeira parte da sequência de vídeo descreve o procedimento a seguir para interpretar a diferença entre o PaCO 2 e ETCO 2. Vemos que a medida de ETCO 2 é obtido imediatamente e de forma não-invasiva, mas nesta fase não pode permitir a adaptação dos parâmetros do respirador. Isto implica ter que medir a PaCO 2, que pode então ser comparada com a ETCO 2. A PaCO 2 valor permanece o valor de referência para a apreciação da ventilação do paciente. <ul><li> Se PaCO 2 medido é superior ao valor desejado, por exemplo, em vez de 60mmHg 40mmHg, isso significa que o paciente é hipoventilada. Os parâmetros do respirador poderão ser adaptadas; tanto a taxa respiratória ou o volume corrente pode ser aumentada, a fim de aumentar a ventilação e, assim, diminuir a PaCO 2. O objectivo consiste em reduzir o ETCO 2 por 20 mmHg, independentemente da inicial ETCO 2 valor. Por exemplo, pode ser possível que o ETCO 2 valor é 50 mmHg, quando a PaCO 2 é medido a 60mmHg, devido a uma PaCO 2-ETCO gradiente 2 criado pela presença de uma doença cardio-respiratória. Quando a adaptação dos parâmetros do respirador permite que o ETCO 2 a queda de 50mmHg a 30mmHg, podemos seguramente supor que o paciente esteja adequadamente ventilado com um 2 PaCO ter valor caiu de 60mmHg para 40mmHg. </li><li> Inversamente, se a PaCO 2 é inferior ao valor-alvo, o paciente é hiperventilado e, consequentemente, taxa respiratória ou volume corrente deve ser reduzida para atingir o valor alvo. Se PaCO 2 é de 20 mmHg inferior ao valor-alvo, é preciso aumentar o ETCO 2 por 20 mmHg através da modificação dos parâmetros do respirador. </li></ul> Artefatos e Armadilhas na capnografia. Se a tecnologia de medição de CO 2 tornou-se confiável em termos de tempo de precisão, reprodutibilidade de resposta e qualidade curva, ele ainda apresenta, como para qualquer parâmetro monitorado, de certos limites: <ul><li> A primeira limitação é devido à falta de conhecimento correto sobre a fisiopatologia de CO 2 pelo médico, que então está relutante em usar a técnica. Esperamos que esta explicação e as seqüências de vídeo que acompanha vai ajudar a resolver esta limitação. </li><li> No caso de o paciente respirando espontaneamente, a adição de oxigenoterapia via máscara vai diluir o CO expirado 2, que irá modificar significativamente a capnografia e da ETCO 2 vai cair. A seqüência de vídeo demonstra esse fenômeno. </li><li> Se se deseja monitorar hipoventilação, apnéia ou um evento, durante a sedação, esperamos ETCO 2, em correlação com a PaCO 2, para aumentar em paralelo à hipoventilação do paciente. Paradoxalmente, um evento de hipoventilação em um paciente respirando espontaneamente, é traduzida por uma queda no ETCO 2, pois o paciente é, então, apenas a respiração com um volume muito pequeno de maré, que essencialmente corresponde ao volume morto do espaço tráqueo-bronchal, e como nós sabe, este espaço não participa na troca gasosa e, portanto, contém muito pouco CO 2. </li><li> Durante a ventilação mecânica, a armadilha é que se esquece que ETCO 2 não refletem, necessariamente, PaCO 2 (ver capítulo anterior). </li></ul>

<ol>
	<li>Gravenstein, J. S., Jaffe, M. B., Paulus, D. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Capnography, Clinical aspects. , (2004).</li><li>Kupnik, D., Skok, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Capnometry+in+the+prehospital+setting:+are+we+using+its+potential.">Capnometry in the prehospital setting: are we using its potential.</a> Emerg Med J. 24, 614-617 (2007).</li><li>Delorio, N. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Continuous+end-tidal+carbon+dioxide+monitoring+for+confirmation+of+endotracheal+tube+placement+is+neither+widely+available+nor+consistently+applied+by+emergency+physicians.">Continuous end-tidal carbon dioxide monitoring for confirmation of endotracheal tube placement is neither widely available nor consistently applied by emergency physicians.</a> Emerg Med J. 22, 490-493 (2005).</li><li>Burton, J. H., Harrah, J. D., Germann, C. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Does+end-tidal+carbon+dioxide+monitoring+detect+respiratory+events+prior+to+current+sedation+monitoring+practices?.">Does end-tidal carbon dioxide monitoring detect respiratory events prior to current sedation monitoring practices?.</a> Acad Emerg Med. 13, 500-504 (2006).</li><li>Fletcher, R., Jonson, B., Cumming, G., Brew, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+concept+of+deadspace+with+special+reference+to+the+single+breath+test+for+carbon+dioxide.">The concept of deadspace with special reference to the single breath test for carbon dioxide.</a> Br J Anaesth. 53, 77-78 (1981).</li></ol>

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Importância de CO 2 para o organismo Antes de explorar CO 2 expirado monitoramento, é essencial para colocar em perspectiva o papel desempenhado pelo CO2 geral no corpo humano. Produzidos a uma taxa de aproximadamente 200 ml por minuto, CO 2 não é apenas um desperdício de subproduto do metabolismo celular. Se o nosso quimiorreceptores medulares têm o papel de manter a pressão arterial parcial de CO2 (PaCO 2) em 40mmHg, é porque o CO 2</s...

expired co2 measurement in intubated or spontaneously breathing patients from the emergency department

Dióxido de carbono (CO 2), juntamente com o oxigênio (O 2) dividem o papel de ser a gases mais importantes do corpo humano. A medição de CO 2 expirado na boca tem solicitado um interesse crescente entre os médicos clínicos no departamento de emergência para várias indicações: (1) vigilância et monitoramento do paciente entubado, (2) a verificação do posicionamento correto de um tubo endotraqueal; (3 ) monitoramento de um paciente em parada cardíaca, (4) atingir normocapnia em pacientes entubados trauma cabeça; (5) ventilação monitoramento durante sedação. O vídeo permite que os médicos se familiarizarem com o uso de capnografia e o texto oferece uma revisão da teoria e diretores envolvidos. Em particular, a importância de CO 2 para o organismo, a relevância de medir CO 2 expirado, as diferenças entre CO 2 arterial e expirado, o material utilizado na capnografia com seus artefatos e armadilhas, será revista. Uma vez que a relutância principal no uso de CO 2 expirado medida é devido à falta de conhecimento correto sobre a fisiopatologia de CO 2 pelo médico, esperamos que esta explicação e as seqüências de vídeo que acompanha vai ajudar a resolver esta limitação.

Watch this Scientific Journal Video about Expired CO2 Measurement in Intubated or Spontaneously Breathing Patients from the Emergency Department at JoVE.com

Expired CO2 Measurement in Intubated or Spontaneously Breathing Patients from the Emergency Department

Este vídeo descreve como executar CO<sub&gt; 2</sub&gt; Medição em pacientes entubados, bem como com respiração espontânea. As principais indicações clínicas se referem a situações de emergência: (1) verificar o posicionamento adequado de um tubo endotraqueal; (2) alcançar normocapnia em pacientes com trauma; (3) de ventilação de monitorização no caso de sedação.

CO expirado 2 Medição em pacientes entubados com respiração espontânea ou do Departamento de Emergência

Carbon dioxide (CO2) along with oxygen (O2) share the role of being the most important gases in the human body. The measuring of expired CO2 at the mouth ...

expired-co2-measurement-intubated-or-spontaneously-breathing-patients

Research

JoVE Journal

Medicine

Expired CO2 Measurement in Intubated or Spontaneously Breathing Patients from the Emergency Department

16.1K visualizações.  Universit Catholique de Louvain Cliniques Universitaires Saint-Luc. Este vídeo descreve como executar CO 2 Medição em pacientes entubados, bem como com respiração espontânea. As principais indicações clínicas se referem a situações de emergência: (1) verificar o posicionamento adequado de um tubo endotraqueal; (2) alcançar normocapnia em pacientes com trauma; (3) de ventilação de monitorização no caso de sedação.

Vídeo: Expired CO2 Measurement in Intubated or Spontaneously Breathing Patients from the Emergency Department

Scleral Cross-linking Using Riboflavin and Ultraviolet-A Radiation for Prevention of Axial Myopia in a Rabbit Model

Myopic individuals, especially those with severe myopia, are at higher-than-normal risk of cataract, glaucoma, retinal detachment and chorioretinal abnormalities. In addition, pathological myopia is a common irreversible cause of visual impairment and blindness1-3. Our study demonstrates the effect of scleral crosslinking using riboflavin and ultraviolet-A radiation on the development of axial myopia in a rabbit model. The axial length of the eyeball was measured by A-scan ultrasound in New Zealand white rabbits aged 13 days (male and female). The eye then underwent 360&#176; conjunctival peritomy with scleral crosslinking, followed by tarsorrhaphy. Axial elongation was induced in 13 day-old New Zealand rabbits by suturing their right eye eyelids (tarsorrhaphy). The eyes were divided into quadrants, and every quadrant had two scleral irradiation zones, each with an area of 0.2 cm&#178; and a radius of 4 mm. Crosslinking was performed by dropping 0.1% dextran-free riboflavin-5-phosphate onto the irradiation zones 20 sec before ultraviolet-A irradiation and every 20 sec during the 200 sec irradiation time. UVA radiation (370 nm) was applied perpendicular to the sclera at 57 mW/cm&#178; (total UVA light dose, 57 J/cm&#178;). Tarsorrhaphies were removed on day 55, followed by repeated axial length measurements. This study demonstrates that scleral crosslinking with riboflavin and ultraviolet-A radiation effectively prevents occlusion-induced axial elongation in a rabbit model.

We demonstrate the effect of scleral crosslinking with riboflavin and UVA on an axial elongation rabbit eye. Axial elongation was induced in 13 day-old New Zealand rabbits (male and female) by suturing their right eye eyelids (tarsorrhaphy).

Escleral reticulação Usando ultravioleta e riboflavina-A radiação de Prevenção de Axial Miopia em um modelo de coelho

Myopic individuals, especially those with severe myopia, are at higher-than-normal risk of cataract, glaucoma, retinal detachment and chorioretinal ...

Medicina

A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings

The available routes of administration commonly used for medications and fluids in the acute care setting are generally limited to oral, intravenous, or intraosseous routes, but in many patients, particularly in the emergency or critical care settings, these routes are often unavailable or time-consuming to access. A novel device is now available that offers an easy route for administration of medications or fluids via rectal mucosal absorption (also referred to as proctoclysis in the case of fluid administration and subsequent absorption). Although originally intended for the palliative care market, the utility of this device in the emergency setting has recently been described. Specifically, reports of patients being treated for dehydration, alcohol withdrawal, vomiting, fever, myocardial infarction, hyperthyroidism, and cardiac arrest have shown success with administration of a wide variety of medications or fluids (including water, aspirin, lorazepam, ondansetron, acetaminophen, methimazole, and buspirone). Device placement is straightforward, and based on the observation of expected effects from the medication administrations, absorption is rapid. The rapidity of absorption kinetics are further demonstrated in a recent report of the measurement of phenobarbital pharmacokinetics. We describe here the placement and use of this device, and demonstrate methods of pharmacokinetic measurements of medications administered by this method.

This study presents a novel device that offers an easy route to quickly provide medications and fluids in patients with limited or difficult IV access. This small-diameter device is placed in the distal third of the rectum, allowing for ongoing medication and fluids administration.

Uma nova abordagem para a administração de medicamentos e fluídos em cenários de emergência e Configurações

The available routes of administration commonly used for medications and fluids in the acute care setting are generally limited to oral, intravenous, or ...

Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide

Time is of the essence when caring for an acute stroke patient. The ultimate goal is to restore blood flow to the ischemic brain. This can be&#160;achieved by either&#160;thrombolysis with recombinant tissue-plasminogen activator (rt-PA), the standard therapy for stroke patients who present within the first hours of symptom onset without contraindications, or by an endovascular approach, if a proximal brain vessel occlusion is detected. As the efficacy of both therapies declines over time, every minute saved along the way will improve the patient&#39;s outcome.
This critical situation requires thorough work and precise communication with the patient, the family and colleagues from different professions to acquire all relevant information and reach the right decision while carefully monitoring the patient. This is a high fidelity situation. In nonmedical high-fidelity environments such as aviation, Crew Resource Management (CRM) is used to enhance safety and team efficiency.
This guide shows how a Stroke Team algorithm, which is transferable to other hospital settings, was established and how regular simulation-based trainings were performed. It requires determination and endurance to maintain these time-consuming simulation trainings on a regular basis over the course of time. However, the resulting improvement of team spirit and excellent door-to-needle times will benefit both the patients and the work environment in any hospital.
A dedicated Stroke Team of 7 persons who are notified 24/7 by a collective call via speed dial and run a binding algorithm that takes approximately 20 min, was established. To train everybody involved in this algorithm, a simulation-based team training for all new Stroke Team members was conceived and conducted at monthly intervals. This led to a relevant and sustained reduction of the mean door-to-needle time to 25 min, and enhanced the feeling of stroke readiness especially in junior doctors and nurses.

Every min counts in acute stroke care. This guide shows how to establish a Stroke Team algorithm and enhance its performance with regular simulation training. The principles of Crew Resource Management (CRM) facilitate a straight workflow, reduce door-to-needle times and increase staff satisfaction.

Configurando um curso equipe Algoritmo e conduzir treinamento baseado em simulação no Departamento de Emergência - Um Guia Prático

Time is of the essence when caring for an acute stroke patient. The ultimate goal is to restore blood flow to the ischemic brain. This can ...

Emergency Undocking in Robotic Surgery: A Simulation Curriculum

The following is a training platform to allow robotic surgeons to develop the skills necessary to lead an interprofessional team in emergency undocking of a robotic system. In traditional robotic training for surgeons, a brief web based overview of performing an emergency undocking is provided during initial introductory training to the robotics system. During such a process, there is no training in delineation of interdisciplinary roles for operating room (OR) personnel. The training presented here uses formative simulation and debriefing followed by a lecture. For the simulation, a modified gynecologic simulator is draped in a steep trendelenburg position consistent with most gynecologic laparoscopic surgery. The training torso is modified using tubing hooked to pressure bags of red food colored IV fluid used to simulate a catastrophic vessel injury on demand. Positioned throughout the operating room setting is an interprofessional team consisting of embedded standardized persons (ESPs) to fulfill the roles of a circulating nurse, scrub nurse, anesthesiologist, and bedside assist surgeon. Robotic surgeons are presented a case scenario necessitating emergency undocking, and given control of the robotic instruments. The scenario is terminated following either successful completion of an emergency undock, or at five minutes due to the emergent nature of the case. A debriefing session with hands on training of the steps to emergency undocking, necessary equipment, troubleshooting techniques, and operating room personnel roles follows the simulation. The learners are presented with a short lecture reemphasizing the material presented in the debriefing for their own self-study. This training results in improved time accessing the patient, improved knowledge, confidence, and completion of critical actions, and can be replicated in most institutions. All robotic surgeons should be able to demonstrate competence in this crucial intervention. A limitation of the curriculum is ability to access the in-situ environment for training purposes.

This training platform is designed to allow robotic surgeons to develop the skills necessary to lead an interprofessional team in emergency undocking of the robotic system. Training includes the utilization of the technology and equipment to perform an emergency undocking, as well as delineation of roles for such a scenario.

Desacoplamento de emergência em cirurgia robótica: um currículo de simulação

The following is a training platform to allow robotic surgeons to develop the skills necessary to lead an interprofessional team in emergency undocking of ...

Setup and Execution Of the Blindfolded Code Training Exercise

Miscommunication is the most common cause of preventable patient harm in medicine. Currently, there is limited knowledge of innovative techniques to improve resident physician communication and leadership strategies in high-acuity situations. The blindfolded code training exercise removes visual stimuli from the team leader, forcing the team leader to effectively utilize closed-loop communication. The simple act of blindfolding the team leader creates a learning environment where the leader must utilize a conceptual framework and critical thinking strategies to organize the team and manage the resuscitation. An advantage to this teaching technique is that it does not require any special simulation equipment, making it a low-cost approach. The blindfolded code training exercise can be applied to the management of any critically ill patient where the primary objective is to focus on developing communication skills in acute resuscitations. The purpose of the description of the blindfolded code training exercise is to provide guidance on how to perform this innovative teaching technique to force effective closed-loop communication.

The blindfolded code training exercise, which blindfolds the team leader in a code resuscitation simulation, is an advanced teaching technique to improve closed-loop communication, organizational skills, and critical thinking.&#160;

Instalação e execução do exercício de treino código com os olhos vendados

Miscommunication is the most common cause of preventable patient harm in medicine. Currently, there is limited knowledge of innovative techniques to ...

CO2-Lasertonsillotomy Under Local Anesthesia in Adults

Tonsil-related complaints are very common among the adult population. Tonsillectomy under general anesthesia is currently the most performed surgical treatment in adults for such complaints. Unfortunately, tonsillectomy is an invasive treatment associated with a high complication rate and a long recovery time. Complications and a long recovery time are mostly related to removing the vascular and densely innervated capsule of the tonsils. Recently, CO2-lasertonsillotomy under local anesthesia has been demonstrated to be a viable alternative treatment for tonsil-related disease with a significantly shorter and less painful recovery period. The milder side-effect profile of CO2-lasertonsillotomy is likely related to leaving the tonsil capsule intact. The aim of the current report is to present a concise protocol detailing the execution of CO2-lasertonsillotomy under local anesthesia. This intervention has been performed successfully in our hospital in more than 1,000 patients and has been found to be safe and to be associated with a steep learning curve.

CO2-Lasertonsillotomy Under Local Anesthesia in Adults

CO2-lasertonsillotomy under local anesthesia is an interesting alternative treatment method for tonsillectomy under general anesthesia for tonsil-related complaints in adults. This report presents a step-by-step protocol detailing the execution of CO2-lasertonsillotomy under local anesthesia.

CO2-Lasertonsillotomy Anestesia Local em Adultos

Tonsil-related complaints are very common among the adult population. Tonsillectomy under general anesthesia is currently the most performed surgical ...

Cooling or Warming the Esophagus to Reduce Esophageal Injury During Left Atrial Ablation in the Treatment of Atrial Fibrillation

Ablation of the left atrium using either radiofrequency (RF) or cryothermal energy is an effective treatment for atrial fibrillation (AF) and is the most frequent type of cardiac ablation procedure performed. Although generally safe, collateral injury to surrounding structures, particularly the esophagus, remains a concern. Cooling or warming the esophagus to counteract the heat from RF ablation, or the cold from cryoablation, is a method that is used to reduce thermal esophageal injury, and there are increasing data to support this approach. This protocol describes the use of a commercially available esophageal temperature management device to cool or warm the esophagus to reduce esophageal injury during left atrial ablation. The temperature management device is powered by standard water-blanket heat exchangers, and is shaped like a standard orogastric tube placed for gastric suctioning and decompression. Water circulates through the device in a closed-loop circuit, transferring heat across the silicone walls of the device, through the esophageal wall. Placement of the device is analogous to the placement of a typical orogastric tube, and temperature is adjusted via the external heat-exchanger console.

The goal of this protocol is to describe the use of esophageal temperature modulation to counteract esophageal thermal injury from left atrial ablation for the treatment of atrial fibrillation.

Resfriamento ou Aquecimento do Esôfago para reduzir a lesão esofágica durante a ablação atrial esquerda no tratamento da fibrilação atrial

Ablation of the left atrium using either radiofrequency (RF) or cryothermal energy is an effective treatment for atrial fibrillation (AF) and is the most ...

Measurement of Tissue Oxygenation Using Near-Infrared Spectroscopy in Patients Undergoing Hemodialysis

Near-infrared spectroscopy (NIRS) has recently been applied as a tool to measure regional oxygen saturation (rSO2), a marker of tissue oxygenation, in clinical settings including cardiovascular and brain surgery, neonatal monitoring and prehospital medicine. The NIRS monitoring devices are real-time and noninvasive, and have mainly been used for evaluating cerebral oxygenation in critically ill patients during an operation or intensive care. Thus far, the use of NIRS monitoring in patients with chronic kidney disease (CKD) including hemodialysis (HD) has been limited; therefore, we investigated rSO2 values in some organs during HD. We monitored rSO2 values using a NIRS device transmitting near-infrared light at 2 wavelengths of attachment. The HD patients were placed in a supine position, with rSO2 measurement sensors attached to the foreheads, the right hypochondrium and the lower legs to evaluate rSO2 in the brain, liver and lower leg muscles, respectively. NIRS monitoring could be a new approach to clarify changes in organ oxygenation during HD or factors affecting tissue oxygenation in CKD patients. This article describes a protocol to measure tissue oxygenation represented by rSO2 as applied in HD patients.

We present a protocol to measure regional oxygen saturation (rSO2) in hemodialysis (HD) patients by using a near-infrared spectroscopy monitor. The rSO2 value is an index of tissue oxygenation. This noninvasive and real-time monitoring could be useful for confirming changes in organ oxygenation during HD.

Mensuração da Oxigenação Tecidual por Espectroscopia no Infravermelho Próximo em Pacientes em Hemodiálise

Near-infrared spectroscopy (NIRS) has recently been applied as a tool to measure regional oxygen saturation (rSO2), a marker of tissue oxygenation, in ...

A Novel Inhalation Mask System to Deliver High Concentrations of Nitric Oxide Gas in Spontaneously Breathing Subjects

Nitric Oxide (NO) is administered as gas for inhalation to induce selective pulmonary vasodilation. It is a safe therapy, with few potential risks even if administered at high concentration. Inhaled NO gas is routinely used to increase systemic oxygenation in different disease conditions. The administration of high concentrations of NO also exerts a virucidal effect in vitro. Owing to its favorable pharmacodynamic and safety profiles, the familiarity in its use by critical care providers, and the potential for a direct virucidal effect, NO is clinically used in patients with coronavirus disease-2019 (COVID-19). Nevertheless, no device is currently available to easily administer inhaled NO at concentrations higher than 80 parts per million (ppm) at various inspired oxygen fractions, without the need for dedicated, heavy, and costly equipment. The development of a reliable, safe, inexpensive, lightweight, and ventilator-free solution is crucial, particularly for the early treatment of non-intubated patients outside of the intensive care unit (ICU) and in a limited-resource scenario. To overcome such a barrier, a simple system for the non-invasive NO gas administration up to 250 ppm was developed using standard consumables and a scavenging chamber. The method has been proven safe and reliable in delivering a specified NO concentration while limiting nitrogen dioxide levels. This paper aims to provide clinicians and researchers with the necessary information on how to assemble or adapt such a system for research purposes or clinical use in COVID-19 or other diseases in which NO administration might be beneficial.

This simple and highly adaptable system device for the inhalation of high-concentration nitric oxide (NO) gas does not require mechanical ventilators, positive pressure, or high gas flows. Standard medical consumables and a snug-fitting mask are used to safely deliver NO gas to spontaneously breathing subjects.

Um novo sistema de máscara de inalação para fornecer altas concentrações de gás óxido nítrico em sujeitos de respiração espontânea

Nitric Oxide (NO) is administered as gas for inhalation to induce selective pulmonary vasodilation. It is a safe therapy, with few potential risks even if ...

Prevendo o prognóstico na insuficiência cardíaca aguda usando o ângulo de fase e os escores Z da BIVA

Clinical Application of Phase Angle and BIVA Z-Score Analyses in Patients Admitted to an Emergency Department with Acute Heart Failure

Acute heart failure is characterized by neurohormonal activation, which leads to sodium and water retention and causes alterations in body composition, such as increased body fluid congestion or systemic congestion. This condition is one of the most common reasons for hospital admission and has been associated with poor outcomes. The phase angle indirectly measures intracellular status, cellular integrity, vitality, and the distribution of spaces between intracellular and extracellular body water. This parameter has been found to be a predictor of health status and an indicator of survival and other clinical outcomes. In addition, phase angle values of &lt;4.8&#176; upon admission were associated with higher mortality in patients with acute heart failure. However, low phase angle values may be due to alterations-such as the shifting of fluids from an intracellular body water (ICW) compartment to an ECW (extracellular body water) compartment and a concurrent decrease in body-cell mass (which can reflect malnutrition)-that are present in heart failure. Thus, a low phase angle may be due to overhydration and/or malnutrition. BIVA provides additional information about the body-cell mass and congestion status with a graphical vector (R-Xc graph). In addition, a BIVA Z-score analysis (the number of standard deviations from the mean value of the reference group) that has the same pattern as that of the ellipses for the percentiles on the original R-Xc graph can be used to detect changes in soft-tissue mass or tissue hydration and can help researchers compare changes in different study populations. This protocol explains how to obtain and interpret phase angle values and BIVA Z-score analyses, their clinical applicability, and their usefulness as a predictive marker for the prognosis of a 90-day event in patients admitted to an emergency department with acute heart failure.

Autor em destaque: Revelando indicadores prognósticos na insuficiência cardíaca - o papel do ângulo de fase e da análise de impedância bioelétrica 

In this protocol, we explain how to obtain and interpret phase angle values and bioelectrical impedance vectorial analysis (BIVA) Z-score obtained by bioelectrical impedance in patients with acute heart failure admitted to the Emergency Department and their clinical applicability as a predictive marker for the prognosis of a 90-day event.

Aplicação Clínica da Análise do Ângulo de Fase e do Escore Z BIVA em Pacientes Admitidos em um Serviço de Emergência com Insuficiência Cardíaca Aguda

Acute heart failure is characterized by neurohormonal activation, which leads to sodium and water retention and causes alterations in body composition, ...