Rosmari A.R.A. Oliveira

Continuous positive airway pressure increases inspiratory capacity of COPD patients

Background and objective:  Hyperinflation with a decrease in inspiratory capacity (IC) is a common presentation for both unstable and stable COPD patients. As CPAP can reduce inspiratory load, possibly secondary to a reduction in hyperinflation, this study examined whether CPAP would increase IC in stable COPD patients.

Syndromes related to sodium and arginine vasopressin alterations in post-operative neurosurgery

BACKGROUND Cerebral salt wasting syndrome (CSWS), syndrome of inappropriate antidiuretic hormone secretion (SIADH) and diabetes insipidus (DI) are frequently found in postoperative neurosurgery. PURPOSE To identify these syndromes following neurosurgery. METHOD The study included 30 patients who had been submitted to tumor resection and cerebral aneurysm clipping. Sodium levels in serum and urine and urine volume were measured daily up to the 5th day following surgery. Plasma arginine vasopressin (AVP) was measured on the first, third and fifth days post-surgery. RESULTS CSWS was found in 27/30 patients (90%), in 14 (46.7%) of whom it was associated with a reduction in the levels of plasma AVP (mix syndrome). SIADH was found in 3/30 patients (10%). There was no difference between the two groups of patients. CONCLUSION CSWS was the most common syndrome found, and in half the cases it was associated with DI. SIADH was the least frequent syndrome found.

Influência da fisioterapia respiratória na pressão intracraniana em pacientes com traumatismo craniencefálico grave

OBJETIVO: Estudar a influencia das manobras de fisioterapia respiratoria na pressao intracraniana (PIC) dos pacientes com trauma craniencefalico grave. METODO: Trinta e cinco pacientes com trauma craniencefalico grave foram incluidos no estudo, sendo divididos em tres grupos: com PIC < 10, 11-20 e 21-30 mmHg. As variaveis monitorizadas foram: PIC e pressao arterial media. A pressao de perfusao cerebral foi calculada pela diferenca de pressao arterial media e PIC. RESULTADOS: A manobra de aspiracao traqueal causou aumento de PIC em todos os grupos. A pressao arterial media nao teve alteracoes e a pressao de perfusao cerebral diminuiu pouco, porem mantendo valores normais. CONCLUSAO: As manobras de fisioterapia respiratoria podem ser usadas com seguranca em pacientes com traumatismo craniencefalico grave, com PIC abaixo de 30 mmHg.Certo cuidado deve ser tomado durante a aspiracao traqueal.

Vasopressin serum levels in patients with severe brain lesions and in brain-dead patients

INTRODUCTION Patients with severe brain lesions (SBL) and brain-dead patients (BD) frequently present with vasopressin (AVP) secretion disorders. OBJECTIVE To evaluate AVP serum levels in SBL and BD patients. DESIGN Prospective, open label, observational trial. SETTING A general teaching hospital. METHOD Three groups of adult subjects (age> 18y) of both sexes were included in this study: control group: 29 healthy volunteers; SBL group: 17 patients with Glasgow Coma Scale (GCS)< 8; and BD group: 11 brain-dead patients. Samples of venous blood were collected in the morning at rest from healthy volunteers and at 8 hourly intervals over a period of 24h from SBL and BD patients for AVP determinations. Concomitantly, some clinical and laboratorial variables were also recorded. RESULTS AVP serum levels (pg/ml) were [mean (SD); median]: control [2.2(1.1); 2.0]; SBL [5.7(6.3); 2.9]; and BD [2.6(1.0); 2.8]. AVP serum levels varied greatly in SBL patients, but without statistically significant difference in relation to the other groups (p=0.06). Hypotension (p=0.02), hypernatremia (p=0.0001), serum hyperosmolarity (p=0.0001) and urinary hypoosmolarity (p=0.003) were outstanding in BD patients when compared with SBL. CONCLUSIONS The AVP serum levels did not demonstrate significant statistical difference between the groups, only showing a greater variability in SBL patients (manifested as serum spike levels). Hypernatremia and hyperosmolarity were present in BD patients, indicating a failure of the hypothalamic-pituitary system in AVP production and release.

Glasgow outcome scale at hospital discharge as a prognostic index in patients with severe traumatic brain injury

OBJECTIVE Evaluate the Glasgow outcome scale (GOS) at discharge (GOS-HD) as a prognostic indicator in patients with traumatic brain injury (TBI). METHOD Retrospective data were collected of 45 patients, with Glasgow coma scale <8, age 25±10 years, 36 men, from medical records. Later, at home visit, two measures were scored: GOS-HD (according to information from family members) and GOS LATE (12 months after TBI). RESULTS At discharge, the ERG showed: vegetative state (VS) in 2 (4%), severe disability (SD) in 27 (60%), moderate disability (MD) in 15 (33%) and good recovery (GR) in 1 (2%). After 12 months: death in 5 (11%), VS in 1 (2%), SD in 7 (16%), MD in 9 (20%) and GR in 23 (51%). Variables associated with poor outcome were: worse GOS-HD (p=0.03), neurosurgical procedures (p=0.008) and the kind of brain injury (p=0.009). CONCLUSION The GOS-HD was indicator of prognosis in patients with severe TBI.