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- Potenciais evocados motores em cirurgia da aorta toracoabdominalPublication . Magro, C; Nora, D; Marques, M; Alves, AGA patologia aórtica toracoabdominal (aneurisma ou disseção) tem tido uma incidência crescente nas últimas décadas. A cirurgia é o tratamento curativo, associando-se, porém, a uma elevada morbimortalidade perioperatória. A paraplegia é uma das mais severas complicações, cuja incidência tem diminuído significativamente com a implementação de estratégias de proteção medular. A patologia aórtica toracoabdominal (aneurisma ou disseção) tem tido uma incidência crescente nas últimas décadas. A cirurgia é o tratamento curativo, associando-se, porém, a uma elevada morbimortalidade perioperatória. A paraplegia é uma das mais severas complicações, cuja incidência tem diminuído significativamente com a implementação de estratégias de proteção medular. Nenhum método isolado ou combinação de métodos provou ser inteiramente eficaz na prevenção da paraplegia. Constituem objectivos desta revisão, uma análise da evidência científica sobre o papel da neuromonitorização intraopera- tória com potenciais evocados motores no prognóstico neurológico de doentes submetidos a cirurgia aórtica toracoabdominal. Procedeu-se a uma pesquisa bibliográfica online (PubMed). As referências consideradas relevantes foram seleccionadas e revistas. A neuromonitorização intraoperatória com potenciais evocados motores (PEM) permite a detecção atempada de eventos isquémicos espinhais e uma intervenção dirigida que impeça o desenvolvimento da lesão medular, reduzindo significativamente a incidência de paraplegia pós-operatória. A monitorização com PEM pode sofrer várias interferências intraoperatórias, com eventual compromisso da sua inter- pretação. O bloqueio neuromuscular é o principal factor limitante de origem anestésica. É essencial atingir um equilíbrio entre as condições de monitorização e as necessidades anestésico-cirúrgicas, bem como avaliar o risco e o benefício da técnica para cada doente. A neuromonitorização com PEM melhora o prognóstico neurológico, desde que integrada numa estratégia de actuação multidisciplinar, que envolva múltiplos mecanismos protectores e que se adeque à realidade hospitalar.
- Antibiotics and extracorporeal circulation – one size does not fit allPublication . Gonçalves-Pereira, J; Oliveira, B
- Infeções associadas a cuidados de saúde e resistência aos antibióticos - estudo pilotoPublication . Soares, Z; Mateus, D; Macedo, F; Valente, L; Gonçalves-Pereira, J
- Via Verde da Sépsis: Vantagens e LimitesPublication . Santos, M; Oliveira, B; Gonçalves-Pereira, J
- Oral Anticoagulation in the Elderly: New Oral Anticoagulants-Innovative Solution for an Old Problem?Publication . Barbosa, M; Menezes Falcão, LDirect oral anticoagulants emerge as the most innovative and promising drug toward preventing and treating cardiovascular disease, raising great interest among the scientific community. Numerous studies and meta-analysis generated much data clarifying clinicians' doubts; however, uncertainties remain regarding their use in particular groups such as patients with prosthetic valves, in valvular atrial fibrillation (defined as atrial fibrillation related to mitral rheumatic heart disease or prosthetic heart valves), among the elderly, in paraneoplastic thromboembolism, in pulmonary embolism with hemodynamic compromise, and scarcity of specific antidotes. This review article intends to condense the vast scientific production addressing new oral anticoagulants by focusing on their advantages and disadvantages when used on the elderly.
- Outpatient management of community-acquired pneumoniaPublication . Froes, F; Gonçalves-Pereira, J; Póvoa, PThe first guidelines on community-acquired pneumonia (CAP) were published in 1993, but since then many of the challenges regarding the outpatient management of CAP persist. These include the difficulty in establishing the initial clinical diagnosis, its risk stratification, which will dictate the place of treatment, the empirical choice of antibiotics, the relative scarcity of novel antibiotics and the importance of knowing local microbiological susceptibility patterns.
- Impact of antibiotic therapy in severe community-acquired pneumonia: Data from the Infauci studyPublication . Pereira, JM; Gonçalves-Pereira, J; Ribeiro, O; Baptista, JP; Froes, F; Paiva, JAAntibiotic therapy (AT) is the cornerstone of the management of severe community-acquired pneumonia (CAP). However, the best treatment strategy is far from being established. To evaluate the impact of different aspects of AT on the outcome of critically ill patients with CAP, we performed a post hoc analysis of all CAP patients enrolled in a prospective, observational, multicentre study. Of the 502 patients included, 76% received combination therapy, mainly a β-lactam with a macrolide (80%). AT was inappropriate in 16% of all microbiologically documented CAP (n=177). Hospital and 6months mortality were 34% and 35%. In adjusted multivariate logistic regression analysis, combination AT with a macrolide was independently associated with a reduction in hospital (OR 0.17, 95%CI 0.06-0.51) and 6months (OR 0.21, 95%CI 0.07-0.57) mortality. Prolonged AT (>7days) was associated with a longer ICU (14 vs. 7days; p<0.001) and hospital length of stay (LOS) (25 vs. 17days; p<0.001). Combination AT with a macrolide may be the most suitable AT strategy to improve both short and long term outcome of severe CAP patients. AT >7days had no survival benefit and was associated with a longer LOS.
- Infeção em Fim de Vida: Há Benefício da Terapêutica Antibiótica?Publication . Graça, C; Gonçalves-Pereira, J
- Silent hypokalemia – a sometimes fatal conditionPublication . Cadório, C; Simões, A; Gonçalves-Pereira, J
- Hidden hospital mortality in patients with sepsis discharged from the intensive care unitPublication . Aguiar-Ricardo, I; Mateus, H; Gonçalves-Pereira, JObjective: To evaluate the impact of the presence of sepsis on in-hospital mortality after intensive care unit discharge. Methods: Retrospective, observational, single-center study. All consecutive patients discharged alive from the intensive care unit of Hospital Vila Franca de Xira (Portugal) from January 1 to December 31, 2015 (N = 473) were included and followed until death or hospital discharge. In-hospital mortality after intensive care unit discharge was calculated for septic and non-septic patients. Results: A total of 61 patients (12.9%) died in the hospital after being discharged alive from the intensive care unit. This rate was higher among the patients with sepsis on admission, 21.4%, whereas the in-hospital, postintensive care unit mortality rate for the remaining patients was nearly half that, 9.3% (p < 0.001). Other patient characteristics associated with mortality were advanced age (p = 0.02), male sex (p < 0.001), lower body mass index (p =0.02), end-stage renal disease (p = 0.04) and high Simplified Acute Physiology Score II (SAPS II) at intensive care unit admission (p < 0.001), the presence of shock (p < 0.001) and medical admission (p < 0.001). We developed a logistic regression model and identified the independent predictors of inhospital mortality after intensive care unit discharge. Conclusion: Admission to the intensive care unit with a sepsis diagnosis is associated with an increased risk of dying in the hospital, not only in the intensive care unit but also after resolution of the acute process and discharge from the intensive care unit