Délio José Kipper

Perfil epidemiológico de dezesseis anos de uma unidade de terapia intensiva pediátrica

OBJETIVO: Revisar e descrever os dados epidemiologicos dos pacientes admitidos em uma unidade de terapia pediatrica brasileira (UTIP) e compara-los aos aspectos clinicos associados aos indices de gravidade e mortalidade. Descrever as caracteristicas desses pacientes, incluindo os dados demograficos, prevalencia de doencas, indices de mortalidade e fatores associados. METODOS: Os dados foram coletados retrospectivamente de todos os pacientes admitidos na UTIP de um hospital universitario entre 1978 e 1994. Os dados foram expressos em percentagens e comparados pelo teste qui-quadrado, calculando-se o risco relativo (RR) com um intervalo de confianca de 95%, considerando-se um p<0,05. RESULTADOS: Foram selecionados 13.101 pacientes - em sua maioria meninos (58,4%) - com doenca clinica (73,1%), menores de 12 meses de idade (40,4%) e eutroficos (69,5%). O indice geral de mortalidade foi de 7,4%. Os pacientes menores de 12 meses de idade mostraram um RR de 1,86 (CI 1,65-2,10; p<0,0001), enquanto que a desnutricao mostrou um RR de 2,98 (IC 2,64-3,36; p<0,0001). CONCLUSOES: O levantamento epidemiologico mostrou que a mortalidade e maior entre desnutridos e menores de 12 meses de idade. A sepse foi a principal causa de morte.

Recomendações para a proteção da privacidade do paciente

Concerns regarding the bioethical aspects of the privacy of the individual and the confidentiality of their medical treatment data is increasing in the medical community. The current preliminary clinical and therapeutic processes require the multidisciplinary involvement of a number of individuals, especially in the case of hospitalization. The transmission and storage of clinical and laboratory patient information involves different media, with inherent problems of accessibility and protection of information. The authors describe hypothetical situations that exemplify issues commonly addressed in the work of a clinical bioethics committee, contextualizing these problems in Brazil and globally, and suggest steps to minimize potential problems of the breaching of privacy and confidentiality.

Limites do poder familiar nas decisões sobre a saúde de seus filhos – diretrizes

The limits of parental power in health decisions relating children ‒ guidelines Respect for human beings is one of the fundamental principles of bioethics, and is manifested through the exercise of autonomy. When a patient is not competent to make decisions regarding his or her health, as is the case with children under twelve years of age, there is a presumption that parents should make decisions on behalf of the child through the exercise of parental authority. The present study discusses the legitimacy and judicial right of parents to make decisions for their children when the choices involved go beyond the boundaries permitted by ethics, law and society. The study also considers common practice in Brazil, when there is a conflict of interest between the treatment proposed by the medical professiomal and the wishes of parents.Abstract Respect for human beings is one of the fundamental principles of bioethics, and is manifested through the exercise of autonomy. When a patient is not competent to make decisions regarding his or her health, as is the case with children under twelve years of age, there is a presumption that parents should make decisions on behalf of the child through the exercise of parental authority. The present study discusses the legitimacy and judicial right of parents to make decisions for their children when the choices involved go beyond the boun-daries permitted by ethics, law and society. The study also considers common practice in Brazil, when there is a conflict of interest between the treatment proposed by the medical professiomal and the wishes of parents. Keywords: Bioethics. Decision-making. Parenting. Ethical analysis. Legislation.Resumo Limites do poder familiar nas decisoes sobre a saude de seus filhos – diretrizesO respeito pelo ser humano e um dos principios fundamentais da bioetica, que se manifesta no exercicio da autonomia. Quando o paciente nao tem competencia para tomar suas proprias decisoes em relacao a saude, como no caso de criancas com menos de 12 anos, ha a presuncao de que seus pais decidem por elas, no exercicio do poder familiar. O que queremos discutir e a legitimidade e a justica dessa decisao, quando suas opcoes ultrapassam os limites tolerados pela etica, pela lei e pela sociedade em determinadas situacoes, e qual e a pratica usual no Brasil quando ha conflito de interesses entre a proposta terapeutica do medico e o desejo dos pais.

To what extent do parents have the right to decide for their children

OBJECTIVE To review the hierarchy of bioethical principles when there are conflicting interests between the medical team and the childs parents in decision making in pediatrics. Our hypothesis is that when the parentś decisions can be questioned, they loose the right to decide for their children. METHODS The case of a 9-year-old girl from a Jehovas Witness family is presented. She was a candidate for renal transplantation but her parents were against blood transfusion in case it was required. A member of the medical team presented a denounce to the hospital Medical Ethic Committee and asked for advice. Several materials were reviewed for the ethic aspects involved: the Bioethic Live Plus 1973-4/96, literature provided by people from Jehovas Witnesses, the chapters about ethics in the main pediatric text-books, a journal on Bioethics published by the Brazilian Federal Medical Board, and the Child and Adolescent Act (Brazilian Law 8,069 from January 13th, 1990). RESULTS The Committees finding, based on ethic and legal aspects reviewed in the literature about similar cases, favors the beneficence principle under the justification of preserving life as an ultimate goal, and recommends the interference of the Children and Youth Court so that the patients interest and greater benefits prevail. Nevertheless, it also recommends that the medical team should make every possible effort to avoid blood transfusion in order to respect this conception of life and protect the people who believe in it, in accordance with the fundamental principle of bioethics which postulates the respect for human dignity and autonomy of belief.

Ética em pesquisa com crianças e adolescentes: à procura de normas e diretrizes virtuosas

Ninos y jovenes fueron victimas de la ciencia en investigaciones clinicas durante un largo periodo de la historia de la humanidad. Cuando la sociedad, ante los horrores de las investigaciones o estudios durante la Segunda Guerra Mundial, adoto el Codigo de Nuremberg, los ninos y adolescentes fueron excluidos de las investigaciones por no tener competencia para dar un consentimiento autonomo. Esta rigida exigencia de dicho Codigo, resulto en una orfandad terapeutica para muchas complicaciones en la salud de estos ninos. Los que cuidan de los ninos y adolescentes se vieron colocados ante un dilema: por un lado, defienden la proteccion especial para este grupo y, por el otro, trabajan para no excluirlos de los beneficios que la ciencia y la tecnologia pueden ofrecer. Se inicio, entonces, un ejercicio para equilibrar los principios en conflicto, con la elaboracion de normas y directrices de proteccion especial. Discutir en torno a ellas es el objetivo principal de este articulo.During the course of human history, children and adolescents have often been the victims of science in clinical studies. When society was confronted with the horrors of the experiments conducted during World War II, it issued the Nuremberg Code, excluding minors from any such studies as they lack the competence to give autonomous consent. This permanent requirement of the code has resulted in therapeutic orphanhood for many aggravations of the health status of this population. Those who care for children and adolescents now face a dilemma: on one hand, they defend special protection for the group, but on the other, they work to not exclude them from the benefits that science and technology has to offer. Therefore an effort to balance these conflicting principles has emerged through the development of standards and guidelines for such special protection. The purpose of this article is to discuss those guidelines.

Ética en la investigación con niños y adolescentes: en busca de normas y directrices virtuosas

Ninos y jovenes fueron victimas de la ciencia en investigaciones clinicas durante un largo periodo de la historia de la humanidad. Cuando la sociedad, ante los horrores de las investigaciones o estudios durante la Segunda Guerra Mundial, adoto el Codigo de Nuremberg, los ninos y adolescentes fueron excluidos de las investigaciones por no tener competencia para dar un consentimiento autonomo. Esta rigida exigencia de dicho Codigo, resulto en una orfandad terapeutica para muchas complicaciones en la salud de estos ninos. Los que cuidan de los ninos y adolescentes se vieron colocados ante un dilema: por un lado, defienden la proteccion especial para este grupo y, por el otro, trabajan para no excluirlos de los beneficios que la ciencia y la tecnologia pueden ofrecer. Se inicio, entonces, un ejercicio para equilibrar los principios en conflicto, con la elaboracion de normas y directrices de proteccion especial. Discutir en torno a ellas es el objetivo principal de este articulo.During the course of human history, children and adolescents have often been the victims of science in clinical studies. When society was confronted with the horrors of the experiments conducted during World War II, it issued the Nuremberg Code, excluding minors from any such studies as they lack the competence to give autonomous consent. This permanent requirement of the code has resulted in therapeutic orphanhood for many aggravations of the health status of this population. Those who care for children and adolescents now face a dilemma: on one hand, they defend special protection for the group, but on the other, they work to not exclude them from the benefits that science and technology has to offer. Therefore an effort to balance these conflicting principles has emerged through the development of standards and guidelines for such special protection. The purpose of this article is to discuss those guidelines.

Ethics in research with children and teens: in search of virtuous standards and guidelines

Ninos y jovenes fueron victimas de la ciencia en investigaciones clinicas durante un largo periodo de la historia de la humanidad. Cuando la sociedad, ante los horrores de las investigaciones o estudios durante la Segunda Guerra Mundial, adoto el Codigo de Nuremberg, los ninos y adolescentes fueron excluidos de las investigaciones por no tener competencia para dar un consentimiento autonomo. Esta rigida exigencia de dicho Codigo, resulto en una orfandad terapeutica para muchas complicaciones en la salud de estos ninos. Los que cuidan de los ninos y adolescentes se vieron colocados ante un dilema: por un lado, defienden la proteccion especial para este grupo y, por el otro, trabajan para no excluirlos de los beneficios que la ciencia y la tecnologia pueden ofrecer. Se inicio, entonces, un ejercicio para equilibrar los principios en conflicto, con la elaboracion de normas y directrices de proteccion especial. Discutir en torno a ellas es el objetivo principal de este articulo.During the course of human history, children and adolescents have often been the victims of science in clinical studies. When society was confronted with the horrors of the experiments conducted during World War II, it issued the Nuremberg Code, excluding minors from any such studies as they lack the competence to give autonomous consent. This permanent requirement of the code has resulted in therapeutic orphanhood for many aggravations of the health status of this population. Those who care for children and adolescents now face a dilemma: on one hand, they defend special protection for the group, but on the other, they work to not exclude them from the benefits that science and technology has to offer. Therefore an effort to balance these conflicting principles has emerged through the development of standards and guidelines for such special protection. The purpose of this article is to discuss those guidelines.

The limits of parental power in health decisions relating children - guidelines

The limits of parental power in health decisions relating children ‒ guidelines Respect for human beings is one of the fundamental principles of bioethics, and is manifested through the exercise of autonomy. When a patient is not competent to make decisions regarding his or her health, as is the case with children under twelve years of age, there is a presumption that parents should make decisions on behalf of the child through the exercise of parental authority. The present study discusses the legitimacy and judicial right of parents to make decisions for their children when the choices involved go beyond the boundaries permitted by ethics, law and society. The study also considers common practice in Brazil, when there is a conflict of interest between the treatment proposed by the medical professiomal and the wishes of parents.Abstract Respect for human beings is one of the fundamental principles of bioethics, and is manifested through the exercise of autonomy. When a patient is not competent to make decisions regarding his or her health, as is the case with children under twelve years of age, there is a presumption that parents should make decisions on behalf of the child through the exercise of parental authority. The present study discusses the legitimacy and judicial right of parents to make decisions for their children when the choices involved go beyond the boun-daries permitted by ethics, law and society. The study also considers common practice in Brazil, when there is a conflict of interest between the treatment proposed by the medical professiomal and the wishes of parents. Keywords: Bioethics. Decision-making. Parenting. Ethical analysis. Legislation.Resumo Limites do poder familiar nas decisoes sobre a saude de seus filhos – diretrizesO respeito pelo ser humano e um dos principios fundamentais da bioetica, que se manifesta no exercicio da autonomia. Quando o paciente nao tem competencia para tomar suas proprias decisoes em relacao a saude, como no caso de criancas com menos de 12 anos, ha a presuncao de que seus pais decidem por elas, no exercicio do poder familiar. O que queremos discutir e a legitimidade e a justica dessa decisao, quando suas opcoes ultrapassam os limites tolerados pela etica, pela lei e pela sociedade em determinadas situacoes, e qual e a pratica usual no Brasil quando ha conflito de interesses entre a proposta terapeutica do medico e o desejo dos pais.

Límites del poder familiar en las decisiones acerca de la salud de sus hijos ‒ directrices

The limits of parental power in health decisions relating children ‒ guidelines Respect for human beings is one of the fundamental principles of bioethics, and is manifested through the exercise of autonomy. When a patient is not competent to make decisions regarding his or her health, as is the case with children under twelve years of age, there is a presumption that parents should make decisions on behalf of the child through the exercise of parental authority. The present study discusses the legitimacy and judicial right of parents to make decisions for their children when the choices involved go beyond the boundaries permitted by ethics, law and society. The study also considers common practice in Brazil, when there is a conflict of interest between the treatment proposed by the medical professiomal and the wishes of parents.Abstract Respect for human beings is one of the fundamental principles of bioethics, and is manifested through the exercise of autonomy. When a patient is not competent to make decisions regarding his or her health, as is the case with children under twelve years of age, there is a presumption that parents should make decisions on behalf of the child through the exercise of parental authority. The present study discusses the legitimacy and judicial right of parents to make decisions for their children when the choices involved go beyond the boun-daries permitted by ethics, law and society. The study also considers common practice in Brazil, when there is a conflict of interest between the treatment proposed by the medical professiomal and the wishes of parents. Keywords: Bioethics. Decision-making. Parenting. Ethical analysis. Legislation.Resumo Limites do poder familiar nas decisoes sobre a saude de seus filhos – diretrizesO respeito pelo ser humano e um dos principios fundamentais da bioetica, que se manifesta no exercicio da autonomia. Quando o paciente nao tem competencia para tomar suas proprias decisoes em relacao a saude, como no caso de criancas com menos de 12 anos, ha a presuncao de que seus pais decidem por elas, no exercicio do poder familiar. O que queremos discutir e a legitimidade e a justica dessa decisao, quando suas opcoes ultrapassam os limites tolerados pela etica, pela lei e pela sociedade em determinadas situacoes, e qual e a pratica usual no Brasil quando ha conflito de interesses entre a proposta terapeutica do medico e o desejo dos pais.

[Autonomic dysfunction in Guillain-Barré Syndrome: a 13 year experience in pediatric intensive care unit].

The acute inflammatory demyelinating polyneuropathy (Guillain-Barré Syndrome) might have a severe presentation but a good prognosis in children. It is an immune-mediated and inflammatory disorder of the peripheral nervous system. This retrospective study observed that GBS is frequently complicated by hypertension and other autonomic disorders. Cardiovascular instability is due to the involvement of the autonomic nervous system and results in labile blood pressure, cardiac dysrhythmias and hypovolemia. During a 13-year period (1982-1995), 21 children were admitted to the Pediatric Intensive Care Unit of São Lucas Hospital, Porto Alegre, south of Brazil. Eight patients were mechanically ventilated. Symptoms of autonomic disturbance were frequently seen, especially in patients with severe clinical evolution. Previous investigations of the mechanism of hypertension associated with GBS did not evaluate the etiology of these phenomena. With modern pediatric intensive care support the deaths are rare. There is no death in this studied group.