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Prevention of acute kidney injury and protection of renal function in the intensive
care unit. Expert opinion of the working group for nephrology, ESICM. Intensive
Care Med 2009 Nov 17 [Epub ahead of print]
Expansão volêmica
Diuréticos
Pelo menos dois estudos (11;12) sugerem que uma PAM 60-65mmHg é
adequada para manter a perfusão orgânica. No entanto, o mantra de
“individualizar” a PAM alvo de acordo com os níveis de PA prévios
sempre é repetido, embora nenhum estudo tenha mostrado isso.
Pelo menos um estudo clínico (13) sugere não haver diferenças entre os
dois vasopressores. De qualquer modo, o alvo de PAM é atingido mais
rapidamente com a noradrenalina.
Controle glicêmico
1. Não se deve realizar controle estrito, mas sim usar protocolos que
mantenham a glicemia “na faixa normal para a idade” e que minimizem o
risco de hipoglicemia.
Referências
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Arterial blood pressure during early sepsis and outcome. Intensive Care
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(13) Patel GP, Grahe JS, Sperry M, Singla S, Elpern E, Lateef O et al.
Efficacy and Safety of Dopamine versus Norepinephrine in the
Management of Septic Shock. Shock 2009.
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Chest 2003; 123(4):1266-1275.
(19) Griesdale DE, de Souza RJ, van Dam RM, Heyland DK, Cook DJ,
Malhotra A et al. Intensive insulin therapy and mortality among critically ill
patients: a meta-analysis including NICE-SUGAR study data. CMAJ
2009; 180(8):821-827.
(21) Merten GJ, Burgess WP, Gray LV, Holleman JH, Roush TS, Kowalchuk
GJ et al. Prevention of contrast-induced nephropathy with sodium
bicarbonate: a randomized controlled trial. JAMA 2004; 291(19):2328-
2334.
(22) Brar SS, Shen AY, Jorgensen MB, Kotlewski A, Aharonian VJ, Desai N
et al. Sodium bicarbonate vs sodium chloride for the prevention of
contrast medium-induced nephropathy in patients undergoing coronary
angiography: a randomized trial. JAMA 2008; 300(9):1038-1046.
(23) Birck R, Krzossok S, Markowetz F, Schnulle P, van der Woude FJ, Braun
C. Acetylcysteine for prevention of contrast nephropathy: meta-analysis.
Lancet 2003; 362(9384):598-603.