Edna Estelita Costa Freitas

Desmame e interrupção da ventilação mecânica

A retirada da ventilacao mecânica e uma medida impor-tante na terapia intensiva. A utilizacao de diversos termos para definir este processo pode dificultar a avaliacao de sua duracao, dos diferentes modos e protocolos e do prognos-tico. Por esse motivo, e importante a definicao precisa dos termos, como se segue:

A moralidade da alocação de recursos no cuidado de idosos no centro de tratamento intensivo

The world is aging. In Brazil, and in several other countries in the world, changes in populations age composition have been accompanied by an increase in demand for types of health care whose cost is high. Actually, some moral conflicts are arising from allocation of public resources for health, because the magnitude of social inequalities in health and limited resources require that priorities for public management are based on knowledge of the health situation and the impact of policies, programs, projects and actions on health. In this context, the intensive medicine, managers and physicians in intensive care are subject to moral conflicts, especially at the fair micro allocation resources for the elderly in the intensive care unit level. This paper attempts to review the situation of conflicts in the light of the tools of bioethics.

Avaliação do sucesso do desmame da ventilação mecânica

BACKGROUND AND OBJECTIVES: The weaning of patients under mechanical ventilation (MV) is one of the critical stages of respiratory assistance in intensive care. There are several criteria for taking patients out of respiratory prothesis. The aim of this work was to assess if there is a group of parameter which can predict the patients who will succeed in weaning from mechanical ventilation. METHODS: Sixty patients were studied in a prospective way within 24 months. All of them had been in MV for, time > 48 hours. The specific mechanical parameters were monitored for the weaning, clinical data, gasometrical values and laboratory results. The patients were divided into both succeeding and unsucceeding groups for comparable analysis. By the ROC curve, it was observed the best cut point for the numerical variables evaluated for the success of the weaning. RESULTS: In analysis of logistic regression performed to evaluate the simultaneous influence of all the factors: MV (-) 20 cmH2O were statistically significant to predict the success to weaning, in this order of explainable capacity. CONCLUSIONS: We could conclude that the indexes evaluated were suitable for the determination of the success in the weaning of those patients in mechanical ventilation. APACHE II because of admition constitutes severity indicator and allows awareness from the patient. MV timing, optimizing the treatment in order to accelerate the process of weaning is conducts that aim not only for the weaning success but also interfere both in the evolution and period of hospital admition.

Argumentos morais sobre inclusão/exclusão de idosos na atenção à saúde

Moral arguments about inclusion/exclusion of elderly people in health care The fast population aging is the most significant demographic change observed in developing countries. Most patients admitted in hospital centers are the elderly, who are willing to submit themselves to treatments in or- der to return, after discharge, to a functional health status that is similar to the previous one. In this context, attention to the needs of population requires a proper bioethics training of human resources in health care to- ward geriatrics, including the Intensive Care Unit (ICU). However in the decision of elderly ICU admission, the moral aspects end up being subsumed to the purely technical aspects, with no cogent justification, what may influence the decision in a discriminatory manner, affecting the elderly population. In the present work, six moral arguments against the proposed hospital admission of geriatric patient into the ICU will be addressed and criticized in light of the tools of principlist bioethics and bioethics of protection.Moral arguments about inclusion/exclusion of elderly people in health care The fast population aging is the most significant demographic change observed in developing countries. Most patients admitted in hospital centers are the elderly, who are willing to submit themselves to treatments in order to return, after discharge, to a functional health status that is similar to the previous one. In this context, attention to the needs of population requires a proper bioethics training of human resources in health care toward geriatrics, including the Intensive Care Unit (ICU). However in the decision of elderly ICU admission, the moral aspects end up being subsumed to the purely technical aspects, with no cogent justification, what may influence the decision in a discriminatory manner, affecting the elderly population. In the present work, six moral arguments against the proposed hospital admission of geriatric patient into the ICU will be addressed and criticized in light of the tools of principlist bioethics and bioethics of protection.

Moral arguments about inclusion/exclusion of elderly people in health care

Moral arguments about inclusion/exclusion of elderly people in health care The fast population aging is the most significant demographic change observed in developing countries. Most patients admitted in hospital centers are the elderly, who are willing to submit themselves to treatments in or- der to return, after discharge, to a functional health status that is similar to the previous one. In this context, attention to the needs of population requires a proper bioethics training of human resources in health care to- ward geriatrics, including the Intensive Care Unit (ICU). However in the decision of elderly ICU admission, the moral aspects end up being subsumed to the purely technical aspects, with no cogent justification, what may influence the decision in a discriminatory manner, affecting the elderly population. In the present work, six moral arguments against the proposed hospital admission of geriatric patient into the ICU will be addressed and criticized in light of the tools of principlist bioethics and bioethics of protection.Moral arguments about inclusion/exclusion of elderly people in health care The fast population aging is the most significant demographic change observed in developing countries. Most patients admitted in hospital centers are the elderly, who are willing to submit themselves to treatments in order to return, after discharge, to a functional health status that is similar to the previous one. In this context, attention to the needs of population requires a proper bioethics training of human resources in health care toward geriatrics, including the Intensive Care Unit (ICU). However in the decision of elderly ICU admission, the moral aspects end up being subsumed to the purely technical aspects, with no cogent justification, what may influence the decision in a discriminatory manner, affecting the elderly population. In the present work, six moral arguments against the proposed hospital admission of geriatric patient into the ICU will be addressed and criticized in light of the tools of principlist bioethics and bioethics of protection.

Los argumentos morales sobre la inclusión/exclusión de personas mayores en el cuidado de la salud

Moral arguments about inclusion/exclusion of elderly people in health care The fast population aging is the most significant demographic change observed in developing countries. Most patients admitted in hospital centers are the elderly, who are willing to submit themselves to treatments in or- der to return, after discharge, to a functional health status that is similar to the previous one. In this context, attention to the needs of population requires a proper bioethics training of human resources in health care to- ward geriatrics, including the Intensive Care Unit (ICU). However in the decision of elderly ICU admission, the moral aspects end up being subsumed to the purely technical aspects, with no cogent justification, what may influence the decision in a discriminatory manner, affecting the elderly population. In the present work, six moral arguments against the proposed hospital admission of geriatric patient into the ICU will be addressed and criticized in light of the tools of principlist bioethics and bioethics of protection.Moral arguments about inclusion/exclusion of elderly people in health care The fast population aging is the most significant demographic change observed in developing countries. Most patients admitted in hospital centers are the elderly, who are willing to submit themselves to treatments in order to return, after discharge, to a functional health status that is similar to the previous one. In this context, attention to the needs of population requires a proper bioethics training of human resources in health care toward geriatrics, including the Intensive Care Unit (ICU). However in the decision of elderly ICU admission, the moral aspects end up being subsumed to the purely technical aspects, with no cogent justification, what may influence the decision in a discriminatory manner, affecting the elderly population. In the present work, six moral arguments against the proposed hospital admission of geriatric patient into the ICU will be addressed and criticized in light of the tools of principlist bioethics and bioethics of protection.