Tez (Tıpta Uzmanlık) - Süleyman Demirel Üniversitesi, Tıp Fakültesi, Genel Cerrahi Anabilim Dalı, 2003. / Kaynakça var.

Thesis (Ph.D.)--Virginia Commonwealth University, 2008. / Prepared for: Dept. of Computer Science. Title from thesis description page. Includes bibliographical references.

Thesis (Ph. D.)--University of Wisconsin, 1954. / Typescript (carbon copy). eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 78-85).

Orientador: José Reinaldo Cerqueira Braz / Resumo: Os anestésicos inalatórios halogenados podem apresentar papel importante na patogênese das alterações cardiocirculatórias e renais durante o choque hemorrágico por alterarem, de maneira dose dependente, os mecanismos de defesa compensatórios. O presente estudo teve como objetivo comparar os efeitos de uma concentração alveolar mínima (CAM) de halotano, sevoflurano e isoflurano sobre o sistema cardiovascular e renal em cães submetidos a choque hemorrágico e reposição volêmica com o sangue retirado do animal. O estudo aleatório foi realizado em trinta cães, sem raça definida, distribuídos em três grupos de acordo com o anestésico inalatório halogenado utilizado durante a anestesia, em concentrações eqüipotentes de uma CAM: GH (n=10) - halotano a 0,89%; GS (n=10) - sevoflurano a 2,4%; e GI (n=10) - isoflurano a 1,4%. Todos os cães foram ventilados mecânicamente, esplenectomizados e submetidos a sangramento, com retirada em torno de 40% do volume sangüíneo, visando manter a pressão arterial média de 40 a 50 mm Hg durante 45 minutos. A seguir, os cães foram submetidos à expansão volêmica com o sangue removido. Os atributos hemodinâmicos foram determinados no momento controle, após 45 minutos de hemorragia, e 15 e 60 minutos após a reposição sangüínea. Os atributos renais foram medidos nos mesmos momentos, exceto no período hemorrágico, pela ausência de diurese. No momento controle, a maioria das variáveis hemodinâmicas e renais foram semelhantes entre os grupos, com exceção da fração de filtração, cujos valores foram menores no grupo GI, em relação aos grupos GH e GS (p < 0,05), e da osmolalidade urinária, cujos valores foram maiores no grupo GS, em comparação com o grupo GH (p < 0,05). Após a hemorragia ...(Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Halogenated anesthetics may play an important role in the pathogenesis of cardiovascular and renal changes during hemorrhagic shock because they modify, in a dose-dependent manner, compensatory defense mechanisms. The aim of the present study was to compare the effects of a minimum alveolar concentration (MAC) of halothane, sevoflurane and isoflurane on the cardiovascular and renal systems of dogs subjected to hemorrhagic shock followed by restoration of blood volume with shed blood. Thirty mongrel dogs were randomly distributed into three groups according to the halogenated anesthetic used for anesthesia. They were anesthetized with halothane (H group; n=10), sevoflurane (S group; n=10) or isoflurane (I group; n=10) and anesthesia was maintained at 1.0 MAC: 0.89%, 2.4%, and 1.4%, respectively. All the dogs were mechanically ventilated, splenectomized and subjected to bleeding with 40% blood reduction to keep mean arterial pressure between 40 and 50 mm Hg for 45 min. Thereafter, the dogs were resuscitated with shed blood. The hemodynamic attributes were determined at the control moment, after 45 min of hemorrhage, 15 and 60 min after restoration of blood volume. The renal attributes were determined at the described moments, except during the hemorrhage period, for lack of diuresis. At the control moment, most of the hemodynamic and renal variables were similar among the groups, except for the filtered fraction, Introdução e Literatura 11 which was lower in GI than in groups GH and GS (p < 0.05), and for urinary osmolarity, which was higher in GS compared to GH (p < 0.05). After hemorrhage, the hemodynamic attributes decreased, without significant differences among the groups (p > 0.05). Fifteen minutes after resuscitation, most of the hemodynamic and renal attributes were... (Complete abstract click electronic access below) / Doutor

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Over the last 20 years, much work has focused on computer-aided clinical decision support systems due to a rapid increase in the need for management and processing of medical knowledge. Among all fields of medicine, trauma care has the highest need for proper information management due to the high prevalence of complex, life-threatening injuries. In particular, hemorrhage, which is encountered in most traumatic injuries, is a dominant factor in determining survival in both civilian and military settings. This complication can be better managed using a more in-depth analysis of patient information. Trauma physicians must make precise and rapid decisions, while considering a large number of patient variables and dealing with stressful environments. The ability of a computer-aided decision making system to rapidly analyze a patient’s condition can enable physicians to make more accurate decisions and thereby significantly improve the quality of care provided to patients. The first part of this study is focused on classification of highly complex databases using a hierarchical method which combines two complementary techniques: logistic regression and machine learning. This method, hereafter referred to as Classification Using Significant Features (CUSF), includes a statistical process to select the most significant variables from the correlated database. Then a machine learning algorithm is used to identify the data into classes using only the significant variables. As the main application addressed by CUSF, a set of computer-assisted rule-based trauma decision making system are designed. Computer aided decision-making system not only provides vital assistance for physicians in making fast and accurate decisions, proposed decisions are supported by transparent reasoning, but also can confirm a physicians’ current knowledge, enabling them to detect complex patterns and information which may reveal new knowledge not easily visible to the human eyes. The second part of this study proposes an algorithm based on a set of novel wavelet features to analyze physiological signals, such as Electrocardiograms (ECGs) that can provide invaluable information typically invisible to human eyes. These wavelet-based method, hereafter referred to as Signal Analysis Based on Wavelet-Extracted Features (SABWEF), extracts information that can be used to detect and analyze complex patterns that other methods such as Fourier cannot deal with. For instance, SABWEF can evaluate the severity of hemorrhagic shock (HS) from ECG, while the traditional technique of applying power spectrum density (PSD) and fractal dimension (FD) cannot distinguish between the ECG patterns of patients with HS (i.e. blood loss), and those of subjects undergoing physical activity. In this study, as the main application of SABWEF, ECG is analyzed to distinguish between HS and physical activity, and show that SABWEF can be used in both civilian and military settings to detect HS and its extent. This is the first reported use of an ECG analysis method to classify blood volume loss. SABWEF has the capability to rapidly determine the degree of volume loss from hemorrhage, providing the chance for more rapid remote triage and decision making.

The thesis is focused on the specifics of care for women with postpartum bleeding in intensive care. Part of this work are two segments, theoretical and empirical. The first segment focuses on the theoretical part, which lists the existing knowledge from literature approaching the issue of bleeding complications accompanying childbirth, especially postpartum period, when the lack of timely solution can endanger the woman's life. This section defines the terms postpartum bleeding, hemorrhagic shock, DIC, intensive care and severe postpartum bleeding complications. The work also focuses on nursing care for women with postpartum bleeding. The theoretical part is concluded postoperative nursing care. The second segment of the work is of empirical character. The main objective of this thesis was to investigate how the care provided to the ARO / ICU for women with problems postpartum bleeding. This part of the non-standardized using an anonymous questionnaire identifies issues of bleeding complications in postpartum period. The work deals with the level of care provided in intensive care for women with severe postpartum bleeding complications, knowledge of the healthcare paramedical personnel in the care of patients with postpartum bleeding and acquiring new information on nursing care in case postpartum...

INTRODUÇÃO: Diferentes parâmetros hemodinâmicos, incluindo os indicadores estáticos de pré-carga cardíaca como o índice de volume diastólico final ventrículo direito (IVDFVD) e parâmetros dinâmicos como a variação de pressão de pulso (VPP) têm sido usados na tomada de decisão para considerar o processo da expansão volêmica em pacientes em estado grave. O objetivo deste estudo foi comparar a reanimação por fluidos guiados tanto por VPP ou IVDFVD após choque hemorrágico induzido experimentalmente. MÉTODO: vinte e seis suínos anestesiados e ventilados mecanicamente foram alocados em três grupos: controle (Grupo I), VPP (Grupo II) e IVDFVD (Grupo III). Foi induzido choque hemorrágico por retirada de sangue até atingir a pressão arterial média de 40mmhg, que foi mantida por 60 minutos. Parâmetros foram medidos no tempo basal (B), no tempo do choque (Choque 0), sessenta minutos depois do choque (Choque 60), imediatamente depois da ressuscitação com hidroxietilamido 6% (130/0. 4) (R0), uma hora (R60) e duas horas (R120) depois ressuscitação. Os pontos de avaliação da reanimação por fluidos foram determinados pelo retorno aos valores basais iniciais de VPP e IVDFVD. A análise estatística dos dados foi baseada em ANOVA para medidas repetidas seguidos pelo teste de Bonferroni (P<0.05%). RESULTADOS: O volume e tempo para ressuscitação foram maiores no grupo III do que no grupo II (Grupo III = 1305±331ml e Grupo II = 965±245ml; p<0.05 e Grupo III = 24.8± 4.7min e Grupo II = 8.8 ± 1.3 min, p<0.01, respectivamente). Todos os parâmetros estáticos e dinâmicos, bem como os biomarcadores de oxigenação tecidual foram afetados pelo choque hemorrágico e quase todos os parâmetros foram totalmente restaurados após a reanimação em ambos os grupos. CONCLUSÃO: Neste estudo em modelo de choque hemorrágico, a reanimação guiada pelo VPP utilizou menor quantidade de fluido e menor quantidade de tempo do que quando guiado por IVDFVD derivado de cateter de artéria pulmonar. / INTRODUCTION: Different hemodynamic parameters, including static indicators of cardiac preload as right ventricular end-diastolic volume index (RVEDVI) and dynamic parameters as pulse pressure variation (PPV) have been used in the decision-making process regarding volume expansion in critically ill patients. The objective of this study was to compare fluid resuscitation guided by either PPV or RVEDVI after experimentally-induced hemorrhagic shock. METHODS: 26 anesthetized and mechanically ventilated pigs were allocated into control (Group-I), PPV (Group-II) and RVEDVI (Group- III). Hemorrhagic shock was induced by blood withdrawal to target mean arterial pressure of 40mmHg, maintained for 60 minutes. Parameters were measured at baseline, time of shock, sixty minutes after shock, immediately after resuscitation with hydroxyethyl starch 6% (130/0.4), one hour and two hours thereafter. The endpoint of fluid resuscitation was determined as the baseline values of PPV and RVEDVI. Statistical analysis of data was based on ANOVA for repeated measures followed by the Bonferroni test (P<0.05). RESULTS: Volume and time to resuscitation were higher in Group-III than in Group-II (Group-III = 1305±331ml and Group-II = 965±245ml; p<0.05 and Group-IIII = 24.8±4.7min and Group-II = 8.8±1.3 min, p<0.05, respectively). All static and dynamic parameters and biomarkers of tissue oxygenation were affected by hemorrhagic shock and nearly all parameters were restored after resuscitation in both groups. CONCLUSION: In the proposed model of hemorrhagic shock, resuscitation to the established endpoints was achieved within a smaller amount of time and with less volume when guided by PPV than when guided by pulmonary artery catheter-derived RVEDVI.

Orientador: Francisco José Teixeira Neto / Banca: Paulo do Nascimento Junior / Banca: Suzane Lilian Beier / Resumo: Klein, A. V. Comparação entre a variação da pressão de pulso e o índice de variabilidade pletismográfica como índices dinâmicos de pré-carga em cães anestesiados com isoflurano submetidos à hemorragia hipotensiva seguida por reposição volêmica. 72 p. Dissertação (Mestrado) - Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, 2015. A variação da pressão de pulso (VPP) e índice de variabilidade pletismográfica (IVP) são parâmetros úteis para identificar os indivíduos onde o aumento da pré-carga obtido pela expansão volêmica resultará em elevação do índice sistólico (IS) e do índice cardíaco (IC). Este estudo objetivou comparar a VPP e o IVP como índices dinâmicos de pré-carga em cães anestesiados com isoflurano submetidos à hemorragia hipotensiva, seguida pela reposição volêmica (RV) com sangue autólogo. Em um estudo prospectivo, sete cães adultos pesando 25,1 ± 3,4 kg (média ± desvio padrão) foram anestesiados com isoflurano e submetidos à ventilação com volume controlado (volume corrente: 12 mL/kg) com o emprego do bloqueador neuromuscular atracúrio. As concentrações expiradas de isoflurano, ajustadas para manter a pressão arterial média (PAM) em 65 mmHg (±5 mmHg de variação) antes da hemorragia, foram mantidas constantes durante o estudo. O débito cardíaco foi obtido através da técnica de termodiluição pulmonar, enquanto a VPP e o IVP foram obtidos através da pressão arterial invasiva e através de um sensor de oxímetro de pulso posicionado na língua, respectivamente. As variáveis estudadas foram coletadas antes da hemorragia (momento basal), após a retirada de sangue até a redução da PAM para 45 mmHg (± 5 mmHg de variação) e após a RV com sangue autólogo durante 30 minutos. A hemorragia diminuiu significativamente (P < 0,05) o IS e o IC em relação ao momento basal, enquanto a RV normalizou estas variáveis. A VPP e o IVP aumentaram... / Abstract: Klein, A. V. Comparison of changes in pulse pressure variation and in plethysmographic variability index induced by hypotensive hemorrhage followed by volume replacement in isoflurane-anesthetized dogs. 72 p. Dissertation (MSc) - School of Medicine, São Paulo State University, Botucatu, 2015. The pulse pressure variation (PPV) and the pletysmographic variability index (IVP) are parameters that may identify individuals in which an increase in preload achieved by volume expansion will result in an increase in stroke index (SI) and in cardiac index (CI). This study aimed to compare the PPV and the PVI as dynamic preload indexes in isoflurane-anesthetized dogs undergoing hypotensive hemorrhage followed by volume replacement (VR) with autologous blood. In a prospective study, seven adult dogs weighing 25,1 ± 3,4 kg (mean ± standard deviation) were anesthetized with isoflurane under volume controlled ventilation (tidal volume: 12 mL/kg) and atracurium neuromuscular blockade. End-tidal isoflurane concentrations, adjusted to maintain mean arterial pressure (MAP) at 65 mmHg (± 5 mmHg range) before hemorrhage, were maintained constant throughout the study. Cardiac output was measured by the pulmonary thermodilution technique, while PPV and PVI were derived from invasive blood pressure from a pulse oxymeter placed in the tongue, respectively. Variables were recorded before hemorrhage (baseline), after withdrawing blood until MAP was decreased to 45 mmHg (± 5 mmHg range), and after VR with autologous blood over 30 minutes. Hemorrhage significantly (P < 0.05) decreased SI and CI from baseline; while VR normalized these variables. The PPV and PVI significantly increased from baseline after hemorrhage. Changes from baseline induced by hemorrhage were significantly higher for PPV (11 ± 5%) than for PVI (5 ± 5%). After VR, PPV returned to baseline while PVI decreased significantly from baseline. Changes from hemorrhage induced by VR were ... / Mestre

Source: Masters Abstracts International, Volume: 47-06, page: 3510. Adviser: Irwin B. Horwitz. Includes bibliographical references.