Browsing by Author "Marques, Nuno"
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- Application of mechanical chest compressions in the prehospital : favorable neurological outcome at hospital dischargePublication . Marques, Nuno; Almeida, Vitor; Cunha, Madalena; Santos, EduardoIntroduction: The quality of Cardiopulmonary Resuscitation (CPR), especially the chest compression, is vital to the success of the Return of Spontaneous Circulation (ROSC) and for good neurological outcomes at hospital discharge, in victims who have suffered Out-Of-Hospital Cardiac Arrest (OHAC). Objectives: The aim of this study is to determine the effectiveness of mechanical chest compressions on the neurological outcomes of victims with OHCA. Methods: A Systematic Review of Literature (SRL) on studies evaluated the assessing of effectiveness in the using of mechanical devices on chest compressions on cardiac arrest patients with OHCA. After a research (in PUBMED, EBSCO and Google Scholar) in studies published between January 2009 and 31 October 2014, were found studies and subjected to analysis, taking into account the previously established inclusion criteria. The quality of the studies included was assessed by two reviewers using the critical evaluation scale of a study describing a prospective, Randomized Controlled Clinical Trial (RCT) by Carneiro (2008). The meta-analysis was performed by using the Mantel-Haenszel method, using the effect of random models. Results: From three RCTs that involving 7208 participants, were selected 3027 of the group of the mechanical devices and 4181 of the control group. The analysis of the combined trials, shows no significant differences on the good neurological outcome at hospital discharged. The mechanical compressions in PH provide advantage with clinical relevance in comparison to manual compressions (RR=0.90; CI 95%=0.68-1.19; p=0.47). Conclusions: The mechanical CPR in Prehospital shows benefit, with clinical relevance, in a favorable way the neurological outcome at hospital discharge.
- Hipotermia terapêutica no pré-hospitalar em vítimas de paragem cardíaca recuperadaPublication . Marques, Nuno; Cunha, Madalena; Alves, MónicaINTRODUÇÃO A Hipotermia terapêutica consiste no arrefecimento corporal induzido com o objetivo de manter uma temperatura central de 33ºC, com a finalidade de reverter e ou prevenir os mecanismos responsáveis pela lesão neurológica de reperfusão após recuperação de circulação espontânea. Existe alguma evidência de que a hipotermia terapêutica melhora a sobrevivência e o resultado neurológico após paragem cardíaca ocorrida no préhospitalar, contudo a sua utilização não é ainda consensual em vítimas com recuperação de circulação espontânea. OBJETIVO Determinar a eficácia da Hipotermia Terapêutica induzida no Pré-Hospitalar na melhoria da sobrevivência e dos resultados neurológicos das vítimas que sofreram paragem cardíaca extrahospitalar. MÉTODOS Foi realizada uma revisão sistemática da literatura sobre estudos que avaliavam a eficácia da aplicação de hipotermia terapêutica nas vítimas de paragem cardíaca no contexto de pré-hospitalar. Cinco RCT’s, envolvendo 759 participantes, sendo 378 do grupo de hipotermia pré-hospitalar e 381 do grupo controlo. RESULTADOS A análise dos estudos revelou que existem diferenças significativas na diminuição da temperatura na admissão hospitalar quando utilizada a HTPH comparativamente à normotermia ou hipotermia terapêutica hospitalar (HTH) (IV=-1,16; IC 95%= -1,40-0,92; p<0,00001). Contudo não são observadas diferenças significativas no que se refere à sobrevivência (RR=0,97; IC 95%=0,79-1,19; p=0,76) e outcomes neurológicos favoráveis (RR=0,98; IC 95%=0,79-1,20; p=0,83). CONCLUSÕES A hipotermia terapêutica no pré-hospitalar não tem influência na sobrevivência e nos outcomes neurológicos favoráveis no momento da alta, mas apresenta benefício com relevância clinica nos valores da temperatura no momento da admissão hospitalar, pelo que se infere serem necessários mais estudos para aferir da eficácia desta medida terapêutica.
- Intervenções de enfermagem pré-hospitalar : revisão narrativaPublication . Mota, Mauro; Cunha, Madalena; Reis-Santos, Margarida; Cunha, Isabel Cristina Kowal Olm; Alves, Mónica; Marques, NunoObjetivo: Construir algoritmos de intervenção de enfermagem pré-hospitalar para vítimas de trauma. Metodologia: Revisão Narrativa da Literatura, entre 2008 e 2019, nas principais bases de dados. Dois revisores independentes realizaram a avaliação crítica, extração e síntese dos dados. A construção dos algoritmos resultou do processo interpretativo da revisão narrativa por três peritos na área. Utilizou-se o modelo teórico de Virgínia Henderson. Resultados: Obtiveram-se 17 documentos, seis foram incluídos no desenvolvimento dos metaparadigmas Saúde, Pessoa e Ambiente e 16 na elaboração e construção de Algoritmos de avaliação, diagnóstico e intervenções de enfermagem às vítimas de trauma. Conclusões: A revisão possibilitou a operacionalização do modelo teórico de Henderson para a assistência pré-hospitalar permitindo a criação de algoritmos orientadores da prática de enfermagem.
- Prehospital therapeutic hypothermia : influence in good neurological outcome at hospital dischargePublication . Marques, Nuno; Cunha, Madalena; Alves, Mónica; Santos, EduardoIntroduction: Therapeutic hypothermia improves neurological outcomes after Out-of-Hospital Cardiac Arrest (OHCA). Its use has been recommended in the victims with Return of Spontaneous Circulation (ROSC). Objectives: The aim of this study was to know the effect of Prehospital Therapeutic Hypothermia (PHTH) on the neurological outcomes in victims with OHCA. Methods: We conducted a Systematic Review of Literature (SRL) on studies that evaluated the effect of HTPH in victims with OHCA and also performed a research (in PUBMED, EBSCO and Google Scholar) in studies published between January 2007 and 31 May 2013. The studies found were then assessed taking into account the previously established inclusion criteria. The quality of the studies included was assessed by two reviewers using the critical evaluation scale of a study describing a prospective, randomized, controlled clinical trial (RCT) by Carneiro (2008). The meta-analysis was performed using the Mantel-Haenszel method, using the effect of random models. Results: Five RCT's that respect the inclusion criteria were used, involving 759 participants from which 378 were selected from the prehospital hypothermia group and 381 from the control group. The studies show that there are not significant differences observed with respect to the neurological outcomes favorable at discharge (RR = 0.98; 95% CI = 0.79 to 1.20; p = 0.83). Conclusions: Despite SRL show that PHTH has no influence on the neurological outcome at hospital discharge, the scientific evidence points to an improvement in neurologic outcomes when kept at normothermia, so suggests a prompt reference to health units where can be made a control of temperature in the victims with ROSC in prehospital.
- The effect of coffee on blood pressure in hypertensive persons : a systematic reviewPublication . Gomes, Rosa; Marques, Nuno; Santos, Eduardo; Cunha, MadalenaIntroduction: Hypertension is one of the major risk factors for cardiovascular disease. Coffee consumption has been associated with hypertension leading health professionals advise against him, it being one of the most consumed beverages in the world. Objectives: To evaluate the effect of coffee consumption in systolic and diastolic blood pressure in people over 18 years with hypertension. Methods: A systematic review following the principles proposed by the Cochrane Handbook was performed by a systematic search in CINAHL, MedicLatina, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Nursing & Allied Health Collection; Scielo; Elsevier; Pubmed; Google Scholar from January 2008 to May 2016. The inclusion criteria were: adults with 18 or more years with hypertension. Exclusion criteria: childs, pregnant women, diabetes, endocrine or metabolic disorders, cardiovascular disease, liver dysfunction, nephopathy, other serious disease, or caffeine/coffee hypersensitivity. Results: 5865 studies were identified, after applying the selection criteria and duplicates removal we stayed with 5 studies. For the critical appraisal we used the scale from the Centre for Evidence Based Medicine of FML and JBI Critical Appraisal Checklist for Cohort and Case-control studies. Preliminary results shows contradictory aspects because studies suggests that coffee consumption increases the risk of cardiovascular diseases in hypertension and by other hand hydroxyhydroquinonereduced coffee decreased blood pressure in subjects with mild hypertension. Conclusions: We found a shortness of quality studies available on this subject and the methodological limitations and differences in interventions make it difficult to compare study results.
- The noninvasive ventilation in prehospital : influence in mortalityPublication . Marques, Nuno; Cunha, Madalena; Alves, Mónica; Santos, EduardoIntroduction: The Noninvasive Ventilation (NIV) is considered one of the pillars in the treatment of victims with Acute Pulmonary Edema (APE). Objectives: The aim of this study consisted in determine the effectiveness of the application of NIV in victims with APE, in the Prehospital (PH) context in what concerns the outcomes of the mortality. Methods: We conducted a Systematic Review of Literature (SRL) on studies that assessed the effectiveness of NIV application in APE in the PH context. After research (in PUBMED, EBSCO, Google Scholar and SciELO) in studies published between January 2007 and 31 December 2013. The studies found were subjected to analysis, taking into account the previously established inclusion criteria. The quality of the studies included was assessed by two reviewers using the critical evaluation scale of a study describing a prospective, randomized, controlled clinical trial (RCT) by Carneiro (2008). In the meta-analysis was performed using the Mantel-Haenszel method, using the effect of random models. Results: From two RCT's that involved 329 participants were selected 167 of the NIV and 162 of the control group. The studies show in what concerns the mortality, the use of NIV associated with the standard medical treatment in PH provides clinically relevant advantage compared to the application in exclusive of standard medical treatment, but without statistical power (RR = 0.85; 95% CI = 0.43-1.69, p = 0.65). Conclusions: The use of NIV in the treatment of patients with APE in PH compared to the exclusive application of standard medical treatment presents benefits in the mortality rate, so we suggest that NIV should be implemented in victims with APE in PH.