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Made available in DSpace on 2014-06-11T19:22:21Z (GMT). No. of bitstreams: 0 Previous issue date: 2001Bitstream added on 2014-06-13T19:27:33Z : No. of bitstreams: 1 paivafilho_o_me_botfm.pdf: 504699 bytes, checksum: 1172b273f934761c359be9d53a5db958 (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / A detecção da hipovolemia insidiosa no intra-operatório é difícil devido a pouca especificidade dos sinais clínicos e hemodinâmicos. Estudos introduziram um novo método para avaliação da pré-carga, baseados na análise da variação da pressão sistólica (VPS) durante a ventilação mecânica. O presente estudo tem por objetivo avaliar se a VPS e sua derivada delta down (ddown) são indicadoras precoces de hipovolemia e guias de reposição volêmica com solução hiperosmótica e hiperoncótica no cão anestesiado submetido a hipovolemia. Doze cães sem raça definida, anestesiados com propofol, fentanil, rocurônio e isoflurano, e esplenectomizados, foram submetidos a sangramentos parciais de 5% da volemia até se atingir a retirada total de 20% da volemia (14 ml.kg-1). Após cada momento foram realizadas análises hemodinâmicas, respiratórias e sangüíneas. Em seguida, os cães foram submetidos à reposição volêmica com solução de NaCl a 7,5% em dextran 70 a 3,75% (4 ml.kg-1) em 10 minutos e novas análises foram realizadas aos 5 e 30 minutos após a reposição volêmica. A freqüência cardíaca não apresentou alteração... / The insidious hypovolemia detection in the intraoperative is difficult due to little specificity of clinical and hemodynamic signs. Studies introduced a new method for preload evaluation, based on systolic pressure variation analysis (SPV) during mechanical ventilation. The present study aims to evaluate if SPV and its derived delta down (ddown) are early indicator of hypovolemia, and guides of volemic replacement with hyperosmotic and hyperoncotic solution in anesthetized dogs submitted to hypovolemia. Twelve mogrel dogs, anesthetized with propofol, fentanyl, rocuronium and isoflurane, were submitted to graded haemorrhage of 5% of its volemia to reach the total of 20% of volemia (14 ml.kg-1). After every haemorrhage period, hemodynamic, ventilatory and blood atributes were studied. Imediately after, the dogs were submitted to volemic replacement with 7.5% NaCl solution in 3,75% dextran 70 (4 ml.kg-1) in 10 minutes, and the atributes were studied after 5 and 30 minutes following the volemic replacement. Heart rate was not changed significantly. Mean arterial pressure decreased significantly during haemorrhage, and increased... (Complete abstract, click electronic access below)

Objective: To determine if inhaled Hypertonic Saline (7%) improves the Lung Clearance Index in paediatric Cystic Fibrosis patients with FEV1 ≥80% predicted. Methods: In a blinded crossover trial, twenty CF patients received 4 weeks of hypertonic saline (7%) (HS) and 4 weeks of isotonic saline (0.9%) (IS) separated by a 4 week washout period. The primary endpoint was the change in LCI in the HS versus the IS treatment periods. Results: Four weeks of twice daily inhalation of HS significantly improved the LCI as compared to IS by 1.16, 95% CI [0.26, 2.05]; p=0.016. Baseline LCI before IS, 8.71+/-2.10, was not significantly different from baseline LCI before HS inhalation, 8.84+/-1.95 (p=0.73). Randomization order had no significant impact on the treatment effect (p=0.61). Conclusions: Four weeks of twice daily Hypertonic Saline (7%) inhalations improved the LCI and may be a suitable early intervention therapy for CF patients with mild disease.

Objective: To determine if inhaled Hypertonic Saline (7%) improves the Lung Clearance Index in paediatric Cystic Fibrosis patients with FEV1 ≥80% predicted. Methods: In a blinded crossover trial, twenty CF patients received 4 weeks of hypertonic saline (7%) (HS) and 4 weeks of isotonic saline (0.9%) (IS) separated by a 4 week washout period. The primary endpoint was the change in LCI in the HS versus the IS treatment periods. Results: Four weeks of twice daily inhalation of HS significantly improved the LCI as compared to IS by 1.16, 95% CI [0.26, 2.05]; p=0.016. Baseline LCI before IS, 8.71+/-2.10, was not significantly different from baseline LCI before HS inhalation, 8.84+/-1.95 (p=0.73). Randomization order had no significant impact on the treatment effect (p=0.61). Conclusions: Four weeks of twice daily Hypertonic Saline (7%) inhalations improved the LCI and may be a suitable early intervention therapy for CF patients with mild disease.

Justification: Endotoxemia and sepsis are major causes of mortality in horses, resulting in significant economic losses for the equine industry. Objective: To determine the effects of the combination of Hypertonic Saline Solution and Hetastarch in endotoxemic horses. Animals: Eighteen horses divided into three groups of six. Procedure: All horses received a total dose of intravenous E. coli endotoxin infused at 50 ug/kg; divided into a bolus infusion of 20 ug/kg followed by 30 ug/kg given over 30 minutes. After induction of endotoxic shock; group I (control) received a bolus (15 ml/kg) of isotonic solution, group II (isotonic solution) received a bolus (60 ml/kg) of balanced polyionic crystalloid solution and group III (Hypertonic saline plus Hetastarch) received a bolus of 5 ml/kg of hypertonic saline, followed by a bolus of 10 ml/kg of Hetastarch. Hemodynamic and hematological parameters were measure at different time points. Results: Hemodynamic, biochemical and hematological differences were observed among the three groups. Conclusions and Relevance: the use of large volume crystalloid fluid resuscitation causes volume overload, exerting deleterious effects on the cardiovascular and pulmonary systems. The use of small volume resuscitation (HSS-HES) showed a trend towards better cardiovascular and pulmonary function, without the deleterious effects of volume overload. Abnormalities with regard to coagulation were not seen for the time period of the experimental protocol and the dose regimen used for HSS-HES. Small volume resuscitation in critically ill horses shows promise for its beneficial effects in cardiovascular and pulmonary functions. / Master of Science

More than 70,000 people worldwide suffer from cystic fibrosis, a genetic disease characterized by chronic accumulation of mucus in patients’ lungs provoking bacterial infections, and leading to respiratory failure. An employed age-old treatment to prevent the symptoms of the disease is inhalation of hypertonic saline solution, NaCl at concentrations higher than in the human body (~150 mM). This procedure clears the mucus in the lungs, bringing relief to the patient. However, the biophysical mechanisms underlying this process are not entirely clear. We undertook a new experimental approach to understand the effects of sprayed saline solutions on model lung surfactants towards understanding the mechanisms of the treatment. The surface of lungs contains mainly 1,2-Dipalmitol-sn-glycero-3-phosphocoline (DPPC). As previously assumed by others, we considered that monolayer of DPPC at the air-water interface serves as model system for the lungs surface; we employed a Langmuir-Blodgett (LB) trough and PM-IRRAS to measure surface-specific infrared spectra of the surfactant monolayers and effects on the interfacial tensions. We investigated spraying hyper-saline solutions onto surfactant monolayers at the airwater interface in two parts: (i) validation of our methodology and techniques with stearic acid and (ii) experiments with DPPC monolayers at the air-water interface. Remarkably, when micro-droplets of NaCl were sprayed to the monolayer of stearic acid, we observed enhanced organization of the surfactant, interpreted from the intensities of the CH2 peaks in the surface-specific IR spectra. However, our results with DPPC monolayers didn’t show an effect with the salt added as aerosol, possibly indicating that the experimental methodology proposed is not adequate for the phenomena studied. In parallel, we mimicked respiratory mucous by preparing salt solutions containing 1% (wt%) agar and measured effects on their viscosities. Interestingly, we found that NaCl was much more effective than NaI and NaClO4. This thesis reports structural dynamics of monolayers of stearic acid and DPPC at the airwater interfaces and those of aqueous solutions towards understanding mechanisms underlying the most commonly employed treatment for cystic fibrosis. Our methodology has never been reported before; but requires further modifications to gain deeper insights into the effects of salt sprays on model lung systems.

Orientador: José Reinaldo Cerqueira Braz / Resumo: A detecção da hipovolemia insidiosa no intra-operatório é difícil devido a pouca especificidade dos sinais clínicos e hemodinâmicos. Estudos introduziram um novo método para avaliação da pré-carga, baseados na análise da variação da pressão sistólica (VPS) durante a ventilação mecânica. O presente estudo tem por objetivo avaliar se a VPS e sua derivada delta down (ddown) são indicadoras precoces de hipovolemia e guias de reposição volêmica com solução hiperosmótica e hiperoncótica no cão anestesiado submetido a hipovolemia. Doze cães sem raça definida, anestesiados com propofol, fentanil, rocurônio e isoflurano, e esplenectomizados, foram submetidos a sangramentos parciais de 5% da volemia até se atingir a retirada total de 20% da volemia (14 ml.kg-1). Após cada momento foram realizadas análises hemodinâmicas, respiratórias e sangüíneas. Em seguida, os cães foram submetidos à reposição volêmica com solução de NaCl a 7,5% em dextran 70 a 3,75% (4 ml.kg-1) em 10 minutos e novas análises foram realizadas aos 5 e 30 minutos após a reposição volêmica. A freqüência cardíaca não apresentou alteração... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The insidious hypovolemia detection in the intraoperative is difficult due to little specificity of clinical and hemodynamic signs. Studies introduced a new method for preload evaluation, based on systolic pressure variation analysis (SPV) during mechanical ventilation. The present study aims to evaluate if SPV and its derived delta down (ddown) are early indicator of hypovolemia, and guides of volemic replacement with hyperosmotic and hyperoncotic solution in anesthetized dogs submitted to hypovolemia. Twelve mogrel dogs, anesthetized with propofol, fentanyl, rocuronium and isoflurane, were submitted to graded haemorrhage of 5% of its volemia to reach the total of 20% of volemia (14 ml.kg-1). After every haemorrhage period, hemodynamic, ventilatory and blood atributes were studied. Imediately after, the dogs were submitted to volemic replacement with 7.5% NaCl solution in 3,75% dextran 70 (4 ml.kg-1) in 10 minutes, and the atributes were studied after 5 and 30 minutes following the volemic replacement. Heart rate was not changed significantly. Mean arterial pressure decreased significantly during haemorrhage, and increased... (Complete abstract, click electronic access below) / Mestre

The purpose of this study was to determine if a relationship existed between the change in serum osmolality in the chronic renal failure patient on hemodialysis and the number of clinical symptoms of the dialysis disequilibrium syndrome experienced during hemodialysis. The study was conducted at the Renal Dialysis Unit of an urban medical center located in a southeastern city. Data were collected from May 25, 1978 to June 30, 1978. Data were obtained during 28 hemodialysis procedures performed on 11 subjects. Serum osmolality measurements were collected prior to initiation of the dialysis procedure, at half-hour intervals during dialysis, and prior to termination of dialysis. Clinical symptoms which occurred during dialysis were recorded by the patients and nursing personnel. The hypothesis was that the number of clinical symptoms of the dialysis disequilibrium syndrome experienced by the chronic renal failure patient during hemodialysis will increase as the serum osmolality decreases.

A hemodiluição normovolêmica aguda (HNA) é terapia mundialmente reconhecida como vantajosa em cirurgias que possuem grande potencial para sangramento, mas o edema provocado pela maior infusão de fluidos pode ser danoso em alguns pacientes. No intuito de avaliar as repercussões hemodinâmicas e laboratoriais da utilização da solução salina hipertônica a 7,5% como líquido parcial de reposição na HNA foram estudados 20 pacientes submetidos à artrodese para correção de escoliose de coluna. No grupo 1 (SS 0,9%, n=10) o sangue retirado na HNA, realizada momentos antes da cirurgia, foi reposto por solução salina 0,9% em um volume três vezes maior que o retirado. No grupo 2 (SS 7,5%, n=10) a metade do que foi retirado foi reposto com solução a 0,9% (três vezes o volume retirado) e a outra metade por 4 ml.kg-1 de solução salina hipertônica 7,5%. Nenhum dos pacientes apresentou distúrbios do equilíbrio ácido-básico e as alterações metabólicas (aumento da osmolaridade, sódio e cloro plasmáticos) foram passageiras. Os pacientes mantiveram-se hemodinamicamente estáveis e não foi observado sangramento anormal intra-operatório. A incidência de transfusão sangüínea foi semelhante embora os pacientes do grupo solução hipertônica tenham ficado clinicamente menos edemaciados. Mesmo não sendo objeto do estudo, observou-se menor incidência de infecções pós-operatórias nos pacientes submetidos à infusão de solução hipertônica, o que pode significar potencial efeito protetor da solução. Embora mais estudos com números maiores de pacientes sejam necessários para se comprovar esses efeitos, a solução hipertônica mostrou-se barata, simples e segura como maneira de redução do volume infundido na HNA. / The acute normovolemic hemodilution (ANH) is a therapy recognized as benefic in surgeries that have a great potential for bleeding but the swelling caused by solutions infused intra-operative can be harmful in some kind of patients. Twenty patients submitted to arthrodesis for scoliosis correction were studied in order to evaluate the hemodynamic and laboratory effects of 7.5% hypertonic saline solution as a partial fluid replacement in ANH. In group 1 (SS 0.9%, n = 10) the collected blood in ANH was replaced by saline solution 0.9% in a volume three times greater than the withdrawal. In group 2 (SS 7.5%, n = 10), half of the blood removed was restored by 0.9% solution (three times the amount withdrawn) and the other half by 4 ml.kg-1 of 7.5% solution. None of the patients presented acid-base disorders. Metabolic changes - enhanced of plasmatic levels of sodium, chlorine and osmolarity - were all transitory. Patients remain hemodynamic stable and no abnormal bleeding was observed. They had similar incidence of blood transfusion but the ones in hypertonic solution group were clinically less swollen. Lower incidences of post-operative infections were found in this group, which could mean a possible protector potential of hypertonic solution. SS 7.5% was a cheap, simple and safe alternative to reduce volume infused in ANH.