Cefepime is a widely used antibiotic. However, it can cause encephalopathy, which has been increasingly described in the literature, occurring mainly in patients with impaired renal function. The ...primary objective in this study was to measure the incidence of cefepime-induced encephalopathy and determine potential risk factors for its occurrence.
In the period from February 2005 to February 2006, a prospective cohort study was conducted, which followed 498 patients using cefepime. Other metabolic problems were ruled out for all patients with clinical suspicion of encephalopathy and, when cefepime was the probable cause, electroencephalographic (EEG) tests were performed to assist in the diagnosis, with the first performed during cefepime use and another performed at least 48 hours following drug discontinuation and/or clinical improvement.
Among patients selected for this study (n=498), 5 were diagnosed with cefepime-induced encephalopathy, thus indicating a cumulative incidence of approximately 1% (0.01), 387 had glomerular filtration rate (GFR) >or=60 ml/min and 111 had GFR <60 ml/min. Among the latter, 5 patients developed cefepime-induced encephalopathy. Mean GFR value in patients with encephalopathy (n=5) was 17.20 ml/min (SD +/-10.75 ml/min) and, in patients without encephalopathy (n=106) it was 32.59 ml/min (SD +/-14.89 ml/min) (p=0.025).
The development of cefepime-induced encephalopathy seems to be related to the severity of impairment in glomerular filtration.
Recentemente, o uso de fibrinolíticos tem sido proposto para trombólise da oclusão aguda do cateter de hemodiálise, tanto na forma de lock intraluminal quanto em infusão sistêmica. Nesse contexto, ...objetivamos relatar a experiência do uso de alteplase em cateter tunelizado de hemodiálise com oclusão trombótica. Unitermos: Trombose do cateter de hemodiálise, alteplase.
Aim: In this study we aimed to compare the efficacy and safety of enoxaparin with unfractioned heparin (UFH) as anticoagulant for continuous venovenous hemodialysis (CVVHD). Methods: An open-label ...randomized controlled trial was carried out in an intensive care unit (ICU) where 40 patients with acute renal failure (ARF) who needed continuous renal replacement therapy were randomized to receive UFH (n = 21) or enoxaparin (n = 19). Coagulation parameters were evaluated, and antithrombotic activity of UFH was measured by activated partial thromboplastin time (aPTT) and for enoxaparin by anti-factor Xa activity. Primary outcomes were thrombosis of the extracorporeal circuit and bleeding, classified as major or minor. Results: Minor bleeding episodes were observed only in patients anticoagulated with enoxaparin (26 vs. 0%, p = 0.018). Comparing patients with or without bleeding after 24 hours of therapy, the level of anticoagulation tended to be higher (anti-factor Xa: 1.62 vs. 1.13 IU mL, p = 0.09) and the platelet count to be lower 107 ± 53 vs. 229 ± 84 (×103 μL), p = 0.09 in patients who bled, but without statistical difference. Filter life span of enoxaparin and UFH groups was similar (43 ± 15 vs. 52 ± 18 hr, p = 0.10), as well as the proportion of circuit clotting. Conclusion: Weight-unadjusted enoxaparin in patients with ARF in CVVHD was associated with an increased rate of bleeding, a finding that addresses the need to adjust drug dose and to monitor anti-factor Xa activity during dialysis. No benefit to prolong dialysis circuit survival was found with enoxaparin. In patients who do not present contraindication for systemic anticoagulation, UFH remains an effective and low-cost option.
A cefepima é um antimicrobiano da classe das cefalosporinas de quarta geração, prescrita para muitas infecções consideradas graves. Os efeitos adversos que mais chamam a atenção são os que envolvem o ...sistema nervoso central, relatados como encefalopatia por cefepima. O diagnóstico dessa enfermidade deve ser rápido, e a interrupção da droga, imediata. Unitermos: Cefepima, estado epitélico.
O acesso vascular para pacientes que necessitam de tratamento com hemodiálise deve oferecer um fluxo sangüíneo efetivo, rápido, constante e capaz de ser utilizado repetidas vezes. A fístula ...arteriovenosa é o acesso vascular de escolha para a realização das sessões de hemodiálise, tanto pelo fluxo de sangue que oferece quanto pela baixa taxa de infecção e de trombose. O uso de cateter venoso central, nesses pacientes, tem sido utilizado como o primeiro acesso vascular. Esses cateteres podem ser divididos em tunelizados e não-tunelizados. Os tunelizados têm um trajeto subcutâneo antes de penetrar na veia e são utilizados nos pacientes que permanecerão com cateter por tempo mais prolongado. Os cateteres não-tunelizados são indicados nas situações que requerem uma menor permanência, como na insuficiência renal aguda. Unitermos: Cateter venoso central, fístula arteriovenosa, hemodiálise.
A insuficiência renal aguda no pós-operatório de cirurgia cardíaca, embora não seja freqüente, é considerada uma das mais importantes complicações, devido à alta mortalidade associada com essa ...condição, principalmente quando algum tipo de terapia de substituição renal se faz necessária. Vários fatores de risco têm sido identificados como significativos para o desenvolvimento da insuficiência renal aguda, entre eles a idade avançada, a insuficiência renal prévia, o tempo de circulação extracorpórea e o tipo de cirurgia realizada. A etiologia é multifatorial, identificando-se fatores genéticos e aspectos relacionados com o procedimento cirúrgico. Uma vez estabelecida a insuficiência renal aguda, medidas de suporte devem ser iniciadas, evitando perpetuar a lesão renal. A terapia de substituição renal não deve ser postergada, sendo, até o momento, a única ação terapêutica efetiva em termos de melhorar o prognóstico desses pacientes. Unitermos: Insuficiência renal aguda, pós-operatório de cirurgia cardíaca.
Continuous renal replacement therapies (CRRT) are commonly used in the majority of critically ill patients who need dialysis. Treatment success depends on an efficient anticoagulation protocol ...devised to maintain the dialysis circuit unclotted, with minimal complications such as bleeding due to excessive anticoagulation. Several features can contribute to dialysis circuit thrombosis, such as the speed of pump blood flow, dialysis catheter, type of dialyzer membrane and also, the type of technique prescribed. Unfractioned heparin (UFH) is the anticoagulant most used in CRRT. Recently, low-molecular weight heparins (LMWH) have been shown to be safe and effective drugs for this purpose. In critically ill patients, who frequently have contraindications to systemic anticoagulation, regional anticoagulation with trisodium citrate is an increasingly accepted method due to its safety and efficiency if applied under strict metabolic control. Regional anticoagulation with UFH/protamin now has limited use because of side effects related to protamin. If the patient has contraindication to systemic anticoagulation or if regional anticoagulation with citrate is not available, continuous flushing of circuit dialysis with saline is the only applicable alternative. In patients with contraindication to heparinization, new drugs not yet available in Brazil, such as prostaglandins, recombinant hirudin, argatroban and nafamostat can be used.
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