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o que pode ter importantes implica&#231;&#245;es no tratamento e nos resultados&#46; A inicia&#231;&#227;o inadequada ou tardia dos cuidados de apoio pode piorar os resultados&#46; A ecocardiografia &#224; beira do leito supera esse problema ao possibilitar visualiza&#231;&#227;o direta do cora&#231;&#227;o e de veias boas para aprimorar a terapia&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">8&#44;9</span></a> Contudo&#44; os relatos do uso da ecocardiografia s&#227;o limitados no choque s&#233;ptico pedi&#225;trico&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">As &#250;ltimas diretrizes internacionais de manejo inclu&#237;ram ressuscita&#231;&#227;o com fluidos em b&#243;lus por mais de 5&#8208;10 minutos titulados para reverter a hipotens&#227;o&#44; aumentar a diurese e atingir o enchimento capilar normal&#44; os pulsos perif&#233;ricos e o n&#237;vel de consci&#234;ncia sem induzir hepatomegalia ou estertores&#46; Quando a hepatomegalia ou os estertores se desenvolverem&#44; deve&#8208;se implantar o suporte inotr&#243;pico&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">6&#44;10</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Alguns investigadores acreditam que as diretrizes pedi&#225;tricas atuais ainda s&#227;o preliminares e exigem an&#225;lise por amplos estudos prospectivos multi&#8208;institucionais&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> O presente estudo visou a avaliar o uso da ecocardiografia na redu&#231;&#227;o do tempo de revers&#227;o do choque no choque s&#233;ptico pedi&#225;trico&#44; aprimorar a terapia com fluidos e vasoativa&#47;inotr&#243;pica com base em seus achados&#46; Assim&#44; fornecer dados &#250;teis a serem incorporados nas futuras diretrizes de sepse pedi&#225;trica&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><p id="par0030" class="elsevierStylePara elsevierViewall">Este estudo cl&#237;nico prospectivo randomizado foi conduzido em uma UTIP da Alexandria University Teaching Hospital&#44; de setembro de 2013 a maio de 2016&#46; Foi obtida uma aprova&#231;&#227;o do estudo pelo comit&#234; de &#233;tica da Alexandria University e o consentimento informado dos pais dos pacientes&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Crit&#233;rios de elegibilidade</span><p id="par0035" class="elsevierStylePara elsevierViewall">Os pacientes consecutivos entre um m&#234;s e 11 anos foram eleg&#237;veis caso apresentassem um novo epis&#243;dio de choque s&#233;ptico na interna&#231;&#227;o na UTIP&#46; O choque s&#233;ptico pedi&#225;trico foi definido com base no American College of Critical Care Medicine e no Consenso Internacional Sobre Sepse Pedi&#225;trica&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#44;6</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Crit&#233;rios de exclus&#227;o</span><p id="par0040" class="elsevierStylePara elsevierViewall">Foram exclu&#237;dos os pacientes com miocardite&#44; cardiomiopatia&#44; cirurgia cardiotor&#225;cica e cardiopatia cong&#234;nita&#44; bem como aqueles com vasopressores&#47;inotr&#243;picos antes das interna&#231;&#245;es na UTIP&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Protocolo do estudo</span><p id="par0045" class="elsevierStylePara elsevierViewall">A redu&#231;&#227;o do tempo de revers&#227;o do choque foi nosso objetivo principal&#46; Foi calculado um tamanho da amostra de 70 para estimar uma diferen&#231;a clinicamente significativa no tempo de revers&#227;o do choque entre os dois grupos de 51&#44;7 &#177; 15&#44;6 minutos com um erro alfa de 0&#44;05 e 10&#37; de taxa de precis&#227;o para fornecer um poder de estudo de 80&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a> A diferen&#231;a calculada foi obtida de um estudo piloto anterior devido &#224; falta de modelo de estudo semelhante&#46; A randomiza&#231;&#227;o em blocos foi feita com um <span class="elsevierStyleItalic">software</span> de internet para atribuir 90 pacientes em uma propor&#231;&#227;o 1&#58;1 para o grupo de controle&#44; no qual o manejo do choque s&#233;ptico foi feito por ades&#227;o &#224;s diretrizes atuais de sepse pedi&#225;trica conforme detalhado na se&#231;&#227;o pedi&#225;trica da Campanha Sobrevivendo &#224; Sepse &#40;CSS&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> ou para o grupo de estudo&#44; no qual o manejo do choque s&#233;ptico foi feito de acordo com as diretrizes da CSS e foi modificado com base nos achados da ecocardiografia transtor&#225;cica&#46; Foram usados envelopes opacos fechados e sequencialmente numerados por m&#233;dicos para alocar os pacientes eleg&#237;veis aos grupos&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Para o grupo de estudo&#44; foi feita ecocardiografia transtor&#225;cica pelo autor para correspond&#234;ncia e todos os dados foram revisados instantaneamente pelo segundo coautor&#44; com o Doppler de Ecocardiografia Philips HD 11XE &#40;modelo&#58; Philips 989605325131&#44; CA&#44; EUA&#41; no momento da interna&#231;&#227;o&#44; cinco&#44; 10&#44; 15&#44; 20&#44; 30 minutos&#44; uma&#44; seis&#44; 24 horas da interna&#231;&#227;o e diariamente depois disso at&#233; que o paciente recebesse alta hospitalar ou falecesse&#44; para responder duas perguntas espec&#237;ficas&#58; a&#41; status do volume e b&#41; fun&#231;&#227;o mioc&#225;rdica&#46; O status do volume foi avaliado pela dimens&#227;o da veia cava inferior &#40;VCI&#41; e pela varia&#231;&#227;o respirof&#225;sica ao comparar os di&#226;metros m&#225;ximos da VCI nas duas fases da respira&#231;&#227;o no plano anterior&#8208;posterior apenas caudal em rela&#231;&#227;o &#224; conflu&#234;ncia da veia hep&#225;tica no corte subxifoide com dias dimens&#245;es &#40;2D&#41; e o modo de movimento &#40;modo M&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">8&#44;12</span></a> O di&#226;metro m&#225;ximo da VCI dependeu do modo de ventila&#231;&#227;o&#44; durante a expira&#231;&#227;o em um paciente com respira&#231;&#227;o espont&#226;nea &#40;RE&#41; &#40;antes da intuba&#231;&#227;o ou ap&#243;s o desmame da ventila&#231;&#227;o mec&#226;nica&#41; e durante a inspira&#231;&#227;o na ventila&#231;&#227;o mec&#226;nica controlada &#40;volumes correntes&#44; 6&#8208;8<span class="elsevierStyleHsp" style=""></span>mL&#47;kg&#41;&#59; a RE n&#227;o foi permitida durante o exame da ecocardiografia em pacientes sob ventila&#231;&#227;o&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Usamos a combina&#231;&#227;o de duas t&#233;cnicas para avaliar a fun&#231;&#227;o sist&#243;lica do ventr&#237;culo esquerdo &#40;VE&#41;&#59; qualitativamente por avalia&#231;&#227;o visual global da contratilidade do VE&#44; inclusive avalia&#231;&#227;o da movimenta&#231;&#227;o e espessamento do septo interventricular e da parede posterior do VE no corte apical de quatro c&#226;maras com a fra&#231;&#227;o de eje&#231;&#227;o &#40;FE&#41; do VE com o modo M no corte do eixo longo paraesternal&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a> A fun&#231;&#227;o sist&#243;lica do VE foi classificada em tr&#234;s categorias pela combina&#231;&#227;o da avalia&#231;&#227;o visual e pela mensura&#231;&#227;o da FEVE&#44; em que &#8220;fun&#231;&#227;o normal&#8221; foi a contratilidade boa com FEVE de 56&#8208;78&#37;&#44; &#8220;disfun&#231;&#227;o&#8221; foi a redu&#231;&#227;o da contratilidade com FEVE de menos de 55&#37; e &#8220;hiperdin&#226;mica&#8221; foi diagnosticada caso a atividade do VE parecesse vigorosa com FEVE de mais de 78&#37;&#46; A fun&#231;&#227;o diast&#243;lica do VE avaliada por Doppler de onda pulsada focou no enchimento diast&#243;lico precoce &#40;onda E&#41; e tardio &#40;onda A&#41; no corte apical de quatro c&#226;maras e na propor&#231;&#227;o entre elas&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a> A disfun&#231;&#227;o diast&#243;lica foi considerada quando a propor&#231;&#227;o E&#47;A foi inferior a 1&#46; Durante a primeira hora&#44; dependemos das avalia&#231;&#245;es qualitativas da fun&#231;&#227;o card&#237;aca e&#44; sempre que anomalias card&#237;acas foram detectadas&#44; foram medidos os valores quantitativos&#46; Todos os pacientes do grupo de estudo apresentaram avalia&#231;&#245;es qualitativas e quantitativas uma hora e depois disso&#46; A disfun&#231;&#227;o mioc&#225;rdica s&#233;ptica &#40;DMS&#41; foi considerada presente se o paciente apresentasse disfun&#231;&#227;o sist&#243;lica do VE&#44; disfun&#231;&#227;o diast&#243;lica ou ambas&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">A terapia foi ajustada no grupo de estudo de acordo com os achados ecocardiogr&#225;ficos&#46; Primeiramente&#44; para orienta&#231;&#227;o da terapia com fluidos&#44; quando a VCI entrou em colapso ou estava com varia&#231;&#227;o respirof&#225;sica &#62; 50&#37;&#44; os b&#243;lus de fluidos foram descontinuados ou reduzidos&#46; Segundo&#44; quando a DMS estava presente&#44; foram iniciados os inotr&#243;picos&#46; Usamos dobutamina &#40;at&#233; 20<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;kg&#47;min&#41; e milrinona &#40;0&#44;25&#8208;0&#44;75<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;kg&#47;min&#41;&#46; Quando a fun&#231;&#227;o card&#237;aca foi normalizada&#44; continuamos com o initr&#243;pico na mesma dosagem at&#233; que o paciente ficasse hemodinamicamente est&#225;vel&#46; Os inotr&#243;picos foram retirados na fun&#231;&#227;o card&#237;aca hiperdin&#226;mica&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Dados coletados</span><p id="par0065" class="elsevierStylePara elsevierViewall">Foram registrados os dados relacionados &#224;s caracter&#237;sticas demogr&#225;ficas&#44; caracter&#237;sticas cl&#237;nicas&#44; ao curso cl&#237;nico e &#224;s investiga&#231;&#245;es&#46; Foram registradas as avalia&#231;&#245;es cl&#237;nicas na interna&#231;&#227;o com o escore do &#205;ndice Pedi&#225;trico de Mortalidade 2 &#40;IPM2&#41;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a> e o acompanhamento cl&#237;nico com o escore da Disfun&#231;&#227;o Org&#226;nica Log&#237;stica Pedi&#225;trica &#40;PELOD&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a> Os dados a seguir foram usados para compara&#231;&#227;o entre ambos os grupos inicialmente e ap&#243;s uma&#44; seis e 24 horas&#58; frequ&#234;ncia card&#237;aca &#40;FC&#41;&#44; press&#227;o arterial sist&#243;lica &#40;PAS&#41;&#44; press&#227;o arterial diast&#243;lica &#40;PAD&#41;&#44; press&#227;o arterial m&#233;dia &#40;PAM&#41;&#44; press&#227;o venosa central &#40;PVC&#41;&#44; press&#227;o de perfus&#227;o &#40;PAM&#8208;PVC&#41;&#44; satura&#231;&#227;o venosa central de oxig&#234;nio &#40;ScvO<span class="elsevierStyleInf">2</span>&#41;&#44; diurese e n&#237;vel de lactato arterial&#46; Os cateteres venosos centrais foram inseridos pela mesma equipe nos dois grupos na primeira hora de interna&#231;&#227;o&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Os pontos finais terap&#234;uticos da ressuscita&#231;&#227;o do choque s&#233;ptico foram enchimento capilar de &#8804; 2 segundos&#44; pulsos normais sem diferen&#231;a entre a qualidade dos pulsos perif&#233;ricos e centrais&#44; extremidades quentes&#44; diurese &#62; 1<span class="elsevierStyleHsp" style=""></span>mL&#47;kg&#47;hora&#44; estado mental normal&#44; FC normal&#44; PA e press&#227;o de perfus&#227;o para a idade e ScvO2 &#8805; 70&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">6&#44;10</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">O tratamento recebido foi registro tempestivamente&#46; O Escore Vasoativo&#47;Inotr&#243;pico &#40;EVI&#41; foi calculado diariamente&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a> Assim que os pontos finais terap&#234;uticos foram atingidos&#44; os vasopressores&#47;inotr&#243;picos foram gradualmente retirados conforme a toler&#226;ncia dos pacientes&#46; Em casos de falha na manuten&#231;&#227;o da estabilidade hemodin&#226;mica na redu&#231;&#227;o das dosagens&#44; os pacientes voltaram para a &#250;ltima dosagem que mant&#233;m a estabilidade&#46; Foi registrado o &#8220;tempo de retirada&#8221; em que os vasopressores&#47;inotr&#243;picos foram retirados com sucesso&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Resultados</span><p id="par0080" class="elsevierStylePara elsevierViewall">Foi registrado o &#8220;tempo de revers&#227;o do choque&#8221;&#44; definido como manuten&#231;&#227;o da PAS &#60; 5&#176; percentil para idade ou &#62; 70<span class="elsevierStyleHsp" style=""></span>mmHg de um m&#234;s a um ano &#40;idade &#215; 2 &#43; 70&#41; de 1&#8208;10 anos e PAS de no m&#237;nimo 90<span class="elsevierStyleHsp" style=""></span>mmHg em crian&#231;as &#62; 10 anos&#59; sem suporte de vasopressores por pelo menos 24 horas&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Registramos &#8220;tempo de ressuscita&#231;&#227;o&#8221; quando o paciente atingiu os pontos finais terap&#234;uticos de ressuscita&#231;&#227;o do choque s&#233;ptico enquanto em vasopressores&#47;inotr&#243;picos&#46; Tamb&#233;m foram registradas a dura&#231;&#227;o na UTIP entre os sobreviventes e a taxa de mortalidade na UTIP&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">An&#225;lise estat&#237;stica</span><p id="par0090" class="elsevierStylePara elsevierViewall">Os dados foram coletados&#44; revisados&#44; codificados e inseridos no <span class="elsevierStyleItalic">software</span> estat&#237;stico SPSS &#40;IBM SPSS Estat&#237;stica para Windows&#44; Vers&#227;o 20&#46;0&#46; NY&#44; EUA&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a> Toda a an&#225;lise estat&#237;stica foi feita com os testes bicaudais&#46; Foi adotado um valor estat&#237;stico significativo de &#8804; 0&#44;05&#46; As estat&#237;sticas descritivas na forma de frequ&#234;ncias e percentual foram usadas para descrever os dados categ&#243;ricos vari&#225;veis&#44; enquanto os dados em escala foram expressos por m&#233;dia e desvio&#8208;padr&#227;o para as vari&#225;veis normalmente distribu&#237;das e mediana com intervalo para vari&#225;veis distorcidas&#46; Foram usados os testes exatos para testar as diferen&#231;as nos percentuais&#44; ao passo que o teste de Mann&#8208;Whitney e o teste <span class="elsevierStyleItalic">t</span> com amostras independentes foram usados para comparar a mediana e as m&#233;dias&#44; respectivamente&#46; O valor da an&#225;lise de vari&#226;ncia &#40;Anova&#41; foi usado para comparar as m&#233;dias com o passar dos per&#237;odos&#46;</p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Resultados</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Caracter&#237;sticas de base e avalia&#231;&#227;o inicial</span><p id="par0095" class="elsevierStylePara elsevierViewall">Como pode ser observado na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#44; n&#227;o houve diferen&#231;as significativas entre os dois grupos em quaisquer das caracter&#237;sticas de base&#46; Choque s&#233;ptico frio predominou entre os dois grupos&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Vari&#225;veis hemodin&#226;micas</span><p id="par0100" class="elsevierStylePara elsevierViewall">Como pode ser observado na <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#44; n&#227;o houve diferen&#231;a significativa nas vari&#225;veis fisiol&#243;gicas iniciais&#44; exceto a FC inicial&#44; que foi maior no grupo de estudo&#46; Houve uma melhoria significativa em todas as vari&#225;veis medidas nos tr&#234;s pontos de tempo &#40;uma&#44; seis&#44; 24 horas&#41; em compara&#231;&#227;o com os valores iniciais nos dois grupos&#46; A PAM e PAM&#8208;PVC foram significativamente maiores no grupo de estudo em uma e 24 horas&#46; &#192;s 24 horas&#44; os valores de lactato melhoraram acentuadamente no grupo de estudo para menos de 2 mmol&#47;L&#44; ao passo que n&#227;o normalizaram no grupo de controle&#46; Os pacientes no grupo de estudo receberam significativamente mais fluido na primeira hora &#91;70 em compara&#231;&#227;o com 61<span class="elsevierStyleHsp" style=""></span>mL&#47;kg&#59; p &#61; 0&#44;003&#93;&#44; por&#233;m&#44; no fim das 24 horas&#44; o total de fluido recebido foi significativamente menos &#91;86 em compara&#231;&#227;o com 98<span class="elsevierStyleHsp" style=""></span>mL&#47;kg&#59; p &#61; 0&#44;027&#93;&#46; A incid&#234;ncia de sobrecarga cl&#237;nica de fluidos entre o grupo de estudo foi acentuadamente inferior &#91;11&#37; em compara&#231;&#227;o com 44&#37;&#59; p &#61; 0&#44;001&#93;&#44; com PVC &#224;s 24 horas &#91;14&#44;6 &#177; 3 em compara&#231;&#227;o com 16&#44;3 &#177; 3 cmH<span class="elsevierStyleInf">2</span>O&#59; p &#61; 0&#44;02&#93;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Tratamento administrado</span><p id="par0105" class="elsevierStylePara elsevierViewall">Como pode ser observado na <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#44; os inotr&#243;picos foram usados com mais frequ&#234;ncia entre o grupo de estudo &#91;89&#37; em compara&#231;&#227;o com 67&#37;&#59; p &#61; 0&#44;011&#93;&#46; O uso de dobutamina predominou entre o grupo de controle&#44; ao passo que o uso de milrinona predominou entre o grupo de estudo&#46; Os tempos m&#233;dios de in&#237;cio da dobutamina e milrinona foram significativamente antecipados no grupo de estudo &#91;12&#44;5 &#177; 10&#44;3 em compara&#231;&#227;o com 24&#44;1 &#177; 14&#44;8 horas&#59; p &#61; 0&#44;005 para dobutamina e 11&#44;9 &#177; 7&#44;8 em compara&#231;&#227;o com 44&#44;4 &#177; 17&#44;9 horas&#59; p &#61; 0&#44;047 para milrinona&#93;&#46; Sete pacientes no grupo de estudo e oito no grupo de controle receberam dobutamina e milrinona simultaneamente&#46; No grupo de estudo&#44; o EVI m&#225;ximo foi significativamente menor &#91;120 &#40;30&#8208;325&#41; em compara&#231;&#227;o com 170 &#40;80&#8208;395&#41;&#59; p &#61; 0&#44;047&#93; com tempo de retirada acentuadamente antecipado &#91;24 &#40;8&#8208;96&#41; em compara&#231;&#227;o com 48 &#40;8&#8208;144&#41; horas&#59; p &#8804; 0&#44;001&#93;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Resultados</span><p id="par0110" class="elsevierStylePara elsevierViewall">Como pode ser observado na <a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a>&#44; a propor&#231;&#227;o de crian&#231;as que apresentaram sucesso na revers&#227;o do choque foi significativamente maior &#91;89&#37; em compara&#231;&#227;o com 67&#37;&#59; p &#61; 0&#44;011&#93; com tempo de revers&#227;o do choque acentuadamente menor &#91;3&#44;3 &#40;1&#8208;8&#41; em compara&#231;&#227;o com 4&#44;5 &#40;1&#44;3&#8208;10&#41; dias&#59; p &#61; 0&#44;01&#93;&#46; O tempo de ressuscita&#231;&#227;o foi significativamente antecipado no grupo de estudo &#91;24 &#40;6&#8211;&#8208;72&#41; em compara&#231;&#227;o com 6 &#40;6&#8208;32&#41;&#59; p &#8804; 0&#44;001&#93;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">O escore PELOD melhorou significativamente com o passar do tempo no grupo de estudo&#44; acentuadamente inferior no terceiro dia em compara&#231;&#227;o com o grupo de controle&#46; A perman&#234;ncia na UTIP entre os sobreviventes do grupo de estudo foi significativamente mais curta &#91;8 &#177; 3 em compara&#231;&#227;o com 14 &#177; 10 dias&#59; p &#61; 0&#44;005&#93;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Apesar de a propor&#231;&#227;o de crian&#231;as falecidas ter sido menor&#44; por&#233;m n&#227;o estatisticamente significativa no grupo de estudo &#91;29&#37; &#40;n &#61; 13&#41; em compara&#231;&#227;o coma 38&#37; &#40;n &#61; 17&#41;&#59; p &#61; 0&#44;371&#93;&#44; a taxa de mortalidade devido a choque n&#227;o resolvido foi significativamente menor &#91;38&#37; &#40;5&#47;13&#41; em compara&#231;&#227;o com 88&#37; &#40;15&#47;17&#41;&#59; p &#61; 0&#44;006&#93;&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Discuss&#227;o</span><p id="par0125" class="elsevierStylePara elsevierViewall">A &#8220;revers&#227;o do choque&#8221; &#233; a primeira tarefa que deve ser cumprida ao ver pacientes pedi&#225;tricos com choque s&#233;ptico&#46; Han et al&#46; constataram que cada hora adicional de choque persistente foi associada a &#62; 2 vezes de aumento das chances de mortalidade&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a> O objetivo principal do estudo foi avaliar o papel da ecocardiografia na redu&#231;&#227;o do &#8220;tempo de revers&#227;o do choque&#8221; entre pacientes pedi&#225;tricos com choque s&#233;ptico&#46; O manejo dos pacientes foi feito com ecocardiografia para avaliar seu estado hemodin&#226;mico e orientar mudan&#231;as na terapia em compara&#231;&#227;o com somente avalia&#231;&#227;o cl&#237;nica comum&#46; Os usos cl&#237;nicos dos achados ecocardiogr&#225;ficos em crian&#231;as com choque s&#233;ptico e suas poss&#237;veis implica&#231;&#245;es na escolha e no aprimoramento de medicamentos vasoativos&#47;inotr&#243;picos ainda n&#227;o foram avaliados adequadamente&#46; V&#225;rios estudos avaliaram o uso da ecocardiografia em pacientes adultos na UTI&#44; mas poucos abordam a popula&#231;&#227;o pedi&#225;trica&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a> Ademais&#44; estudos anteriores de avalia&#231;&#227;o ecocardiogr&#225;fica da DMS geralmente forneciam apenas uma avalia&#231;&#227;o &#8220;resumida&#8221; no momento do estudo&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">7&#44;8</span></a> Contudo&#44; o monitoramento ecocardiogr&#225;fico em s&#233;rie &#8220;com o passar do tempo&#8221; feito neste estudo ultrapassou essa limita&#231;&#227;o&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">O percentual de crian&#231;as que apresentaram sucesso na revers&#227;o do choque foi significativamente maior no grupo de estudo &#91;86&#37; &#40;n &#61; 40&#47;45&#41; em compara&#231;&#227;o com 67&#37; &#40;n &#61; 30&#47;45&#41;&#93;&#44; com mediana de 1&#44;2 dia antes do grupo de controle &#91;3&#44;3 em compara&#231;&#227;o com 4&#44;5 dias&#93;&#46; Os dois estudos de Ranjit et al&#46; relataram revers&#227;o do choque s&#233;ptico em 96&#37; &#40;n &#61; 46&#47;48&#41; em um estudo prospectivo e 77&#37; &#40;n &#61; 17&#47;22&#41; em um estudo retrospectivo anterior&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">8&#44;9</span></a> O &#8220;tempo de ressuscita&#231;&#227;o&#8221; foi significativamente antecipado no grupo de estudo &#40;seis em compara&#231;&#227;o com 24 horas&#41;&#44; indicou que a ecocardiografia n&#227;o apenas levou ao desmame mais r&#225;pido do vasopressor&#47;inotr&#243;picos&#44; mas tamb&#233;m &#224; estabiliza&#231;&#227;o hemodin&#226;mica inicial antecipada&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Apesar de a propor&#231;&#227;o de crian&#231;as falecidas ter sido menor&#44; por&#233;m n&#227;o estatisticamente significativa no grupo de estudo &#91;29&#37; em compara&#231;&#227;o com 38&#37;&#93;&#44; os &#243;bitos devido a choque n&#227;o resolvido foram significativamente menores no grupo de estudo&#44; atingiu&#8208;se o objetivo do estudo&#46; Como era uma UTIP de um hospital de cuidados terci&#225;rios&#44; os pacientes foram internados de forma tardia&#44; refletido pelo alto escore IPM2 na interna&#231;&#227;o&#46; Ranjit &#38; Kissoon relataram uma taxa de mortalidade de 27&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a> ao passo que Raj et al&#46; e Ranjit et al&#46; relataram 6&#44;7&#37; e 8&#37;&#44; respectivamente&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">7&#44;8</span></a> A revers&#227;o do choque precoce no grupo de estudo foi associada a uma redu&#231;&#227;o significativa na perman&#234;ncia na UTIP &#91;8 &#177; 3 em compara&#231;&#227;o com 14 &#177; 10 dias&#93;&#46; Raj et al&#46; relataram perman&#234;ncia na UTIP de 14 &#177; 10 dias&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Todas as vari&#225;veis hemodin&#226;micas tempestivamente registradas aumentaram significativamente com o passar do tempo em ambos os grupos&#44; devido &#224; ades&#227;o &#224;s diretrizes atuais de sepse pedi&#225;trica&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> Contudo&#44; o aprimoramento da terapia com fluidos e vasopressores entre o grupo de estudo por meio da ecocardiografia resultou em uma PAM e PAM&#8208;PVC significativamente maiores &#224;s uma e 24 horas devido &#224; melhor press&#227;o diast&#243;lica&#46; No fim das 24 horas&#44; a PVC foi significativamente maior no grupo de controle&#44; coincidiu com as caracter&#237;sticas cl&#237;nicas de sobrecarga de fluidos nesse grupo&#44; que s&#227;o quatro vezes mais do que no grupo de estudo &#91;44&#37; em compara&#231;&#227;o com 11&#37;&#93;&#46; Esses resultados decorrem do papel efetivo da ecocardiografia no aprimoramento da terapia com fluidos&#46; Kelm et al&#46; declararam que a comprova&#231;&#227;o cl&#237;nica da sobrecarga de fluidos comumente atinge at&#233; 67&#37; dos pacientes com choque s&#233;ptico tratados com terapia precoce&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a> Os estudos recentes na UTIP demonstraram a associa&#231;&#227;o de fraco resultado com sobrecarga de fluidos&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> Apesar de Ranjit et al&#46; terem usado a ecocardiografia at&#233; seis horas do reconhecimento do choque s&#233;ptico para orientar a terapia&#44; houve desenvolvimento de sobrecarga de fluidos em 44&#37; de seus pacientes&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a> A grande diferen&#231;a entre o estudo de Ranjit e o nosso ocorreu em virtude do monitoramento ecocardiogr&#225;fico precoce e em s&#233;rie no nosso&#44; que levou &#224; interven&#231;&#227;o terap&#234;utica proativa em vez de reativa&#46; Apesar do recebimento significativamente maior de fluidos na primeira hora no grupo de estudo&#44; para tratar hipovolemia existente n&#227;o visualizada na ecocardiografia&#44; o fluido acumulado nas 24 horas foi significativamente menor devido ao manejo precoce e bem&#8208;sucedido de fluidos&#44; evitaram&#8208;se hipovolemia persistente e a necessidade de mais fluido posteriormente&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">No presente estudo&#44; os valores de lactato melhoraram acentuadamente no grupo de estudo para menos de 2 mmol&#47;L&#44; ao passo que n&#227;o normalizaram no grupo de controle &#224;s 24 horas&#46; A falha de normaliza&#231;&#227;o do lactato durante a doen&#231;a cr&#237;tica tem sido associada ao aumento do risco de importantes eventos adversos&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Os inotr&#243;picos foram usados com mais frequ&#234;ncia no grupo de estudo &#91;89&#37; em compara&#231;&#227;o com 67&#37;&#93; com hora de in&#237;cio antecipada &#91;12 em compara&#231;&#227;o com 24 horas&#93;&#44; pois a ecocardiografia possibilitou detec&#231;&#227;o precoce de DMS que n&#227;o pode ser diagnosticada com certeza somente no exame cl&#237;nico&#46; Beck et al&#46; declararam que o atraso acentuado no in&#237;cio da terapia com vasopressores&#47;inotr&#243;picos foi associado ao aumento no risco de mortalidade em pacientes com choque s&#233;ptico&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a> O uso de dobutamina predominou no grupo de controle&#44; pois ele &#233; recomendado nas diretrizes da CSS com rela&#231;&#227;o a PVC e Scvo<span class="elsevierStyleInf">2</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> Por outro lado&#44; o uso de milrinona predominou no grupo de estudo&#44; devido&#58; primeiro&#44; o grupo de estudo apresentou maior frequ&#234;ncia card&#237;aca do que o grupo de controle&#44; cujo uso de dobutamina foi proibido como primeira escolha&#44; ao passo que milrinona&#44; conforme relatado por Tomicic et al&#46;&#44; aprimora o desempenho cardiovascular no choque s&#233;ptico sem afetar as vari&#225;veis hemodin&#226;micas&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> Segundo&#44; a milrinona acelera o relaxamento do mioc&#225;rdio&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a> Assim&#44; foi poss&#237;vel tratar a disfun&#231;&#227;o diast&#243;lica n&#227;o visualizada na ecocardiografia em nosso estudo&#44; no qual 70&#37; dos pacientes com DMS desenvolveram disfun&#231;&#227;o diast&#243;lica&#46; Yano et al&#46; comprovaram que a milrinona acelera o relaxamento do VE muito mais do que a dobutamina&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a> Sankar et al&#46; relataram que o aumento na press&#227;o venosa central ap&#243;s a ressuscita&#231;&#227;o inicial com fluidos pode ser um indicador precoce de disfun&#231;&#227;o diast&#243;lica e exigir ecocardiografia &#224; beira do leito para orientar manejo adicional&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a> Por fim&#44; a ecocardiografia n&#227;o visualizou a falta de resposta &#224; dobutamina&#44; n&#227;o melhoria do d&#233;bito card&#237;aco e em muitos pacientes com a DMS resultou da dessensibiliza&#231;&#227;o induzida por sepse dos receptores beta&#8208;adren&#233;rgicos&#59; assim&#44; foi recomendada milrinona&#44; pois ela n&#227;o age por meio de receptores adren&#233;rgicos&#44; por&#233;m&#44; em vez disso&#44; por meio de inibi&#231;&#227;o seletiva de fosfodiesterase III&#44; torna&#8208;a imune ao efeito da dessensibiliza&#231;&#227;o do receptor adren&#233;rgico&#46;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">29&#44;30</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">O EVI m&#225;ximo foi acentuadamente menor no grupo de estudo&#46; Dosagens desnecess&#225;rias de vasopressores&#47;inotr&#243;picos seriam evitadas&#44; pois a ecocardiografia possibilitou ajustar a terapia de acordo com a condi&#231;&#227;o de cada paciente&#46; Gaies et al&#46; conclu&#237;ram que o alto EVI m&#225;ximo foi fortemente associado a um fraco resultado comparado com pacientes com baixo EVI m&#225;ximo&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a> O tempo de in&#237;cio da retirada dos vasopressores&#47;inotr&#243;picos foi significativamente antecipado no grupo de estudo&#46; O ponto&#8208;chave foi o reconhecimento imediato&#44; por ecocardiografia&#44; da estabiliza&#231;&#227;o cardiovascular&#44; que possibilita a retirada tranquila dos medicamentos de apoio cardiovascular&#44; possibilita&#44; assim&#44; revers&#227;o precoce do choque&#46; N&#227;o houve estudos publicados anteriormente que relataram o tempo inicial da retirada dos vasopressores&#47;inotr&#243;picos e seu impacto sobre o resultado do paciente&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">O principal ponto forte do estudo atual foi fazer ecocardiografia em s&#233;rie em vez de ap&#243;s a interna&#231;&#227;o&#46; Tratou&#8208;se de um estudo prospectivo randomizado com tamanho da amostra suficiente&#46; As principais limita&#231;&#245;es do estudo foram o fato de tratar&#8208;se de um estudo de &#250;nico centro e que mais de 50&#37; dos pacientes inclu&#237;dos eram neonatos&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">A ecocardiografia fornece dados essenciais que n&#227;o podem ser obtidos somente por exame cl&#237;nico&#46; A ecocardiografia em s&#233;rie possibilitou o ajuste ideal da terapia&#44; melhorou significativamente todos os par&#226;metros hemodin&#226;micos e reduziu o &#8220;tempo de revers&#227;o do choque&#8221;&#46; Recomendamos que o curr&#237;culo de resid&#234;ncia da UTIP inclua foco no treinamento de ecocardiograma para possibilitar incorporar a ecocardiografia no manejo do choque s&#233;ptico&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflitos de interesse</span><p id="par0170" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflitos de interesse&#46;</p></span></span>"
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            2 => "Shock reversal time"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To evaluate the role of echocardiography in reducing shock reversal time in pediatric septic shock&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A prospective study conducted in the pediatric intensive care unit &#40;PICU&#41; of a tertiary care teaching hospital from September 2013 to May 2016&#46; Ninety septic shock patients were randomized in a 1&#58;1 ratio for comparing the serial echocardiography&#8208;guided therapy in the study group with the standard therapy in the control group regarding clinical course&#44; timely treatment&#44; and outcomes&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Shock reversal was significantly higher in the study group &#40;89&#37; <span class="elsevierStyleItalic">vs</span>&#46; 67&#37;&#41;&#44; with significantly reduced shock reversal time &#40;3&#46;3 <span class="elsevierStyleItalic">vs</span>&#46; 4&#46;5 days&#41;&#46; PICU stay in the study group was significantly shorter &#40;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3 <span class="elsevierStyleItalic">vs</span>&#46; 14<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10 days&#41;&#46; Mortality due to unresolved shock was significantly lower in the study group&#46; Fluid overload was significantly lower in the study group &#40;11&#37; <span class="elsevierStyleItalic">vs</span>&#46; 44&#37;&#41;&#46; In the study group&#44; inotropes were used more frequently &#40;89&#37; <span class="elsevierStyleItalic">vs</span>&#46; 67&#37;&#41; and initiated earlier &#40;12&#91;0&#46;5&#8211;24&#93; <span class="elsevierStyleItalic">vs</span>&#46; 24&#91;6&#8211;72&#93;<span class="elsevierStyleHsp" style=""></span>h&#41; with lower maximum vasopressor inotrope score &#40;120&#91;30&#8211;325&#93; <span class="elsevierStyleItalic">vs</span>&#46; 170&#91;80&#8211;395&#93;&#41;&#44; revealing predominant use of milrinone &#40;62&#37; <span class="elsevierStyleItalic">vs</span>&#46; 22&#37;&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Serial echocardiography provided crucial data for early recognition of septic myocardial dysfunction and hypovolemia that was not apparent on clinical assessment&#44; allowing a timely management and resulting in shock reversal time reduction among children with septic shock&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Avaliar o papel da ecocardiografia na redu&#231;&#227;o do tempo de revers&#227;o do choque no choque s&#233;ptico pedi&#225;trico&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudo prospectivo conduzido em uma UTIP de um hospital universit&#225;rio de cuidados terci&#225;rios de setembro de 2013 a maio de 2016&#46; Foram randomizados 90 pacientes com choque s&#233;ptico na propor&#231;&#227;o 1&#58;1 para comparar a terapia guiada por ecocardiografia em s&#233;rie com a terapia padr&#227;o no grupo de controle com rela&#231;&#227;o ao curso cl&#237;nico&#44; tratamento oportuno e resultados&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A revers&#227;o do choque foi significativamente maior no grupo de estudo &#40;89&#37; em compara&#231;&#227;o com 67&#37;&#41; com redu&#231;&#227;o significativa do tempo de revers&#227;o do choque &#40;3&#44;3 em compara&#231;&#227;o com 4&#44;5 dias&#41;&#46; A perman&#234;ncia na UTIP no grupo de estudo foi significativamente mais curta &#40;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3 em compara&#231;&#227;o com 14<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10 dias&#41;&#46; A mortalidade devido ao choque n&#227;o resolvido foi significativamente menor no grupo de estudo&#46; A sobrecarga de fluidos foi significativamente menor no grupo de estudo &#40;11&#37; em compara&#231;&#227;o com 44&#37;&#41;&#46; No grupo de estudo&#44; os inotr&#243;picos foram usados com mais frequ&#234;ncia &#40;89&#37; em compara&#231;&#227;o com 67&#37;&#41; e foram administrados antecipadamente &#40;12 &#91;0&#44;5&#8208;24&#93; em compara&#231;&#227;o com 24 &#91;6&#8208;72&#93; horas&#41; e o menor escore inotr&#243;pico m&#225;ximo dos vasopressores &#40;120 &#91;30&#8208;325&#93; em compara&#231;&#227;o com 170 &#91;80&#8208;395&#93;&#41; revela o uso predominante de milrinona &#40;62&#37; em compara&#231;&#227;o com 22&#37;&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A ecocardiografia em s&#233;rie forneceu dados fundamentais para o reconhecimento precoce da disfun&#231;&#227;o mioc&#225;rdica s&#233;ptica e hipovolemia n&#227;o evidente na avalia&#231;&#227;o cl&#237;nica&#44; possibilitou o manejo tempestivamente adequado e resultou na redu&#231;&#227;o do tempo de revers&#227;o do choque entre crian&#231;as com choque s&#233;ptico&#46;</p></span>"
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Imunocompetente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39 &#40;86&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 &#40;88&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Fonte da infec&#231;&#227;o n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pneumonia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;44&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;28&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">FE</span>p &#61; 0&#44;126&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Infec&#231;&#227;o abdominal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;48&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;44&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">FE</span>p &#61; 0&#44;673&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Urossepse&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;8&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;4&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">FE</span>p &#61; 0&#44;677&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Infec&#231;&#227;o de pele ou do tecido mole&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;2&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;2&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">FE</span>p &#61; 1&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Meningite&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;42&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;51&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">FE</span>p &#61; 0&#44;398&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Infec&#231;&#227;o na corrente sangu&#237;nea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;53&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;66&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">FE</span>p &#61; 0&#44;197&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Achados laboratoriais de base</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hemoglobina<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> &#40;gm&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;24 &#177; 2&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;94 &#177; 2&#44;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">t</span>p &#61; 0&#44;514&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Contagem de c&#233;lulas brancas<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> &#40;por mm<span class="elsevierStyleSup">3</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11400 &#40;200&#8208;82400&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10000 &#40;1900&#8208;91600&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">U</span>p &#61; 0&#44;744&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Prote&#237;na C reativa<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72 &#40;2&#44;5&#8208;317&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43 &#40;1&#44;9&#8208;262&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">U</span>p &#61; 0&#44;093&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Troponinas I<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> &#40;ng&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;63 &#40;0&#44;01&#8208;6&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;8 &#40;0&#44;01&#8208;2&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">U</span>p &#61; 0&#44;671&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Escore de CID<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;0&#8208;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;0&#8208;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">U</span>p &#61; 1&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tipo de choque n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Choque quente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;42&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;42&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">MC</span>p &#61; 0&#44;895&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Choque frio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;51&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;53&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Frio com ampla press&#227;o de pulso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;6&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;4&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Controle&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">54&#44;33 &#177; 13&#44;52&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Frequ&#234;ncia card&#237;aca &#40;pulso&#47;min&#46;&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Controle&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">169&#44;87 &#177; 22&#44;42&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">167&#44;78 &#177; 24&#44;43&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">163&#44;42 &#177; 23&#44;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">155&#44;51 &#177; 24&#44;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;01<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">184&#44;09 &#177; 14&#44;95&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">168&#44;0 &#177; 15&#44;44&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">175&#44;18 &#177; 15&#44;26&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">158&#44;96 &#177; 21&#44;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;959&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;006<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;478&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Satura&#231;&#227;o venosa central de oxig&#234;nio</span><a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">b</span></a><span class="elsevierStyleItalic">&#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Controle&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">43&#44;43 &#177; 18&#44;14&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">53&#44;14 &#177; 19&#44;35&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">59&#44;13 &#177; 20&#44;79&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">61&#44;69 &#177; 15&#44;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">45&#44;23 &#177; 13&#44;34&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">56&#44;43 &#177; 15&#44;03&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">65&#44;42 &#177; 15&#44;44&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">63&#44;98 &#177; 10&#44;97&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;601&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;371&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;107&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;422&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Press&#227;o venosa central</span><a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">b</span></a><span class="elsevierStyleItalic">&#40;cmH2O&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Controle&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7&#44;09 &#177; 2&#44;45&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10&#44;49 &#177; 3&#44;61&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">13&#44;40 &#177; 3&#44;04&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16&#44;33 &#177; 3&#44;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;078&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;818&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;020<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">PAM&#8208;PVC &#40;mmHg&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Controle&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">60&#44;50 &#177; 11&#44;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">50&#44;99 &#177; 6&#44;73&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">56&#44;63 &#177; 8&#44;65&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">57&#44;29 &#177; 10&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">65&#44;95 &#177; 10&#44;51&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>P&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;728&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60; 0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;718&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;023<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Lactato &#40;mmol&#47;L&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Controle&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#44;1 &#177; 3&#44;07&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#44;70 &#177; 2&#44;06&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;96 &#177; 0&#44;75&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>P&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;050<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Diurese &#40;mL&#47;kg&#47;hora&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Controle&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;75 &#177; 0&#44;64&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;68 &#177; 1&#44;12&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;4 &#177; 1&#44;76&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;82 &#177; 1&#44;39&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;594&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;738&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Fluido acumulado &#40;mL&#47;kg&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Controle&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">61&#44;33 &#177; 10&#44;79&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">75&#44;11 &#177; 15&#44;47&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">98&#44;2 &#177; 26&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">70&#44;2 &#177; 16&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">77&#44;2 &#177; 19&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">86&#44;0 &#177; 24&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;125&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#227;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">23 &#40;51&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;57&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleSup">MC</span>p &#61; 0&#44;735&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Adrenalina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4 &#40;8&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;11&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;31&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Inotr&#243;picos<a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">a</span></a> n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;66&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 &#40;88&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">FE</span>p &#61; 0&#44;011<a class="elsevierStyleCrossRef" href="#tblfn0060"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In&#237;cio dos inotr&#243;picos<a class="elsevierStyleCrossRef" href="#tblfn0045"><span class="elsevierStyleSup">b</span></a>&#40;horas de interna&#231;&#227;o&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">24 &#40;6&#8211;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">12 &#40;0&#44;5&#8211;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">U</span>p &#61; 0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0060"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dobutamina n&#176; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 &#40;62&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;42&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">FE</span>p &#61;0&#44;050<a class="elsevierStyleCrossRef" href="#tblfn0060"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In&#237;cio da dobutamina<a class="elsevierStyleCrossRef" href="#tblfn0050"><span class="elsevierStyleSup">c</span></a>&#40;horas de interna&#231;&#227;o&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#44;1 &#177; 14&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;5 &#177; 10&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">t</span>p &#61; 0&#44;005<a class="elsevierStyleCrossRef" href="#tblfn0060"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Milrinona n&#176; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;22&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 &#40;62&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">FE</span>p &#8804; 0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0060"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In&#237;cio da milrinona<a class="elsevierStyleCrossRef" href="#tblfn0050"><span class="elsevierStyleSup">c</span></a>&#40;horas de interna&#231;&#227;o&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#44;4 &#177; 17&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;9 &#177; 7&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">t</span>p &#8804; 0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0060"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EVI m&#225;ximo<a class="elsevierStyleCrossRef" href="#tblfn0045"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">170 &#40;80&#8211;395&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">120 &#40;30&#8211;325&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">U</span>p &#61; 0&#44;047<a class="elsevierStyleCrossRef" href="#tblfn0060"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tempo de retirada<a class="elsevierStyleCrossRef" href="#tblfn0045"><span class="elsevierStyleSup">b</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0055"><span class="elsevierStyleSup">d</span></a>&#40;horas de interna&#231;&#227;o&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#40;8&#8208;144&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#40;8&#8208;96&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">U</span>p &#8804; 0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0060"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Controle &#40;n &#61; 45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Estudo &#40;n &#61; 45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Revers&#227;o do choque n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;66&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 &#40;88&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">FE</span>p &#61;0&#44;011<a class="elsevierStyleCrossRef" href="#tblfn0085"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tempo de revers&#227;o do choque<a class="elsevierStyleCrossRef" href="#tblfn0065"><span class="elsevierStyleSup">a</span></a>&#40;horas de interna&#231;&#227;o&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">108 &#40;30&#8211;240&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78 &#40;24&#8211;192&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">U</span>p &#61; 0&#44;010<a class="elsevierStyleCrossRef" href="#tblfn0085"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tempo de ressuscita&#231;&#227;o<a class="elsevierStyleCrossRef" href="#tblfn0065"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0070"><span class="elsevierStyleSup">b</span></a> &#40;horas de interna&#231;&#227;o&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;6&#8211;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;6&#8211;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">U</span>p &#8804; 0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0085"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PELOD dia 1<a class="elsevierStyleCrossRef" href="#tblfn0075"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#44;8 &#177; 12&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#44;0 &#177; 16&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">t</span>p &#61; 0&#44;488&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PELOD dia 2<a class="elsevierStyleCrossRef" href="#tblfn0075"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#44;5 &#177; 15&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#44;2 &#177; 15&#44;4<a class="elsevierStyleCrossRef" href="#tblfn0080"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">t</span>p &#61; 0&#44;497&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PELOD dia 3<a class="elsevierStyleCrossRef" href="#tblfn0075"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#44;9 &#177; 17&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;8 &#177; 17&#44;9<a class="elsevierStyleCrossRef" href="#tblfn0080"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">t</span>p &#61; 0&#44;050<a class="elsevierStyleCrossRef" href="#tblfn0085"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Durante na UTIP entre os sobreviventes &#40;dias&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;2 &#177; 10&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;1 &#177; 2&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">t</span>p &#61; 0&#44;005<a class="elsevierStyleCrossRef" href="#tblfn0085"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Destino n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sobreviveram&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#40;62&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#40;71&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">FE</span>p &#61; 0&#44;371&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Faleceram&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#40;37&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#40;28&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Devido a choque n&#227;o resolvido&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#40;88&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#40;38&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleSup">FE</span>p &#61; 0&#44;006<a class="elsevierStyleCrossRef" href="#tblfn0085"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Outras causas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#40;11&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#40;61&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                      "titulo" => "Pediatric sepsis"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "B&#46; Mathias"
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                          "etal" => true
                          "autores" => array:6 [
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                      "titulo" => "Surviving sepsis campaign&#58; international guidelines for management of severe sepsis and septic shock&#58; 2012"
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                            4 => "H&#46; Gerlach"
                            5 => "S&#46;M&#46; Opal"
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                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46; Klugman"
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Artigo Original
Role of echocardiography in reducing shock reversal time in pediatric septic shock: a randomized controlled trial
Papel da ecocardiografia na redução do tempo de reversão do choque no choque séptico pediátrico: ensaio controlado randomizado
Ahmed A. EL‐Nawawya, Aly M. Abdelmohsenb, Hadir M. Hassounaa,
Autor para correspondência
hadirelrouby@yahoo.com

Autor para correspondência.
a Alexandria University, Faculty of Medicine, Department of Pediatrics, Alexandria, Egito
b Alexandria University, Faculty of Medicine, Pediatric Cardiology Unit, Alexandria, Egito
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a mortalidade devido a choque s&#233;ptico em crian&#231;as ainda &#233; alta&#44; atinge 10&#8208;13&#37; nos pa&#237;ses desenvolvidos&#44; 18&#8208;24&#37; em pa&#237;ses com renda restrita e ainda mais em alguns outros pa&#237;ses&#44; chega a 34&#8208;58&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Com base no Consenso Internacional Sobre Sepse Pedi&#225;trica&#44; o choque s&#233;ptico &#233; definido como sepse com disfun&#231;&#227;o cardiovascular&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#44;6</span></a> A instabilidade circulat&#243;ria e a disfun&#231;&#227;o mioc&#225;rdica s&#227;o as principais causas de morte&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> Durante o tratamento&#44; o exame f&#237;sico pode ser n&#227;o sens&#237;vel o suficiente para detectar mudan&#231;as precoces e sutis na fisiopatologia&#44; o que pode ter importantes implica&#231;&#245;es no tratamento e nos resultados&#46; A inicia&#231;&#227;o inadequada ou tardia dos cuidados de apoio pode piorar os resultados&#46; A ecocardiografia &#224; beira do leito supera esse problema ao possibilitar visualiza&#231;&#227;o direta do cora&#231;&#227;o e de veias boas para aprimorar a terapia&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">8&#44;9</span></a> Contudo&#44; os relatos do uso da ecocardiografia s&#227;o limitados no choque s&#233;ptico pedi&#225;trico&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">As &#250;ltimas diretrizes internacionais de manejo inclu&#237;ram ressuscita&#231;&#227;o com fluidos em b&#243;lus por mais de 5&#8208;10 minutos titulados para reverter a hipotens&#227;o&#44; aumentar a diurese e atingir o enchimento capilar normal&#44; os pulsos perif&#233;ricos e o n&#237;vel de consci&#234;ncia sem induzir hepatomegalia ou estertores&#46; Quando a hepatomegalia ou os estertores se desenvolverem&#44; deve&#8208;se implantar o suporte inotr&#243;pico&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">6&#44;10</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Alguns investigadores acreditam que as diretrizes pedi&#225;tricas atuais ainda s&#227;o preliminares e exigem an&#225;lise por amplos estudos prospectivos multi&#8208;institucionais&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> O presente estudo visou a avaliar o uso da ecocardiografia na redu&#231;&#227;o do tempo de revers&#227;o do choque no choque s&#233;ptico pedi&#225;trico&#44; aprimorar a terapia com fluidos e vasoativa&#47;inotr&#243;pica com base em seus achados&#46; Assim&#44; fornecer dados &#250;teis a serem incorporados nas futuras diretrizes de sepse pedi&#225;trica&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><p id="par0030" class="elsevierStylePara elsevierViewall">Este estudo cl&#237;nico prospectivo randomizado foi conduzido em uma UTIP da Alexandria University Teaching Hospital&#44; de setembro de 2013 a maio de 2016&#46; Foi obtida uma aprova&#231;&#227;o do estudo pelo comit&#234; de &#233;tica da Alexandria University e o consentimento informado dos pais dos pacientes&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Crit&#233;rios de elegibilidade</span><p id="par0035" class="elsevierStylePara elsevierViewall">Os pacientes consecutivos entre um m&#234;s e 11 anos foram eleg&#237;veis caso apresentassem um novo epis&#243;dio de choque s&#233;ptico na interna&#231;&#227;o na UTIP&#46; O choque s&#233;ptico pedi&#225;trico foi definido com base no American College of Critical Care Medicine e no Consenso Internacional Sobre Sepse Pedi&#225;trica&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#44;6</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Crit&#233;rios de exclus&#227;o</span><p id="par0040" class="elsevierStylePara elsevierViewall">Foram exclu&#237;dos os pacientes com miocardite&#44; cardiomiopatia&#44; cirurgia cardiotor&#225;cica e cardiopatia cong&#234;nita&#44; bem como aqueles com vasopressores&#47;inotr&#243;picos antes das interna&#231;&#245;es na UTIP&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Protocolo do estudo</span><p id="par0045" class="elsevierStylePara elsevierViewall">A redu&#231;&#227;o do tempo de revers&#227;o do choque foi nosso objetivo principal&#46; Foi calculado um tamanho da amostra de 70 para estimar uma diferen&#231;a clinicamente significativa no tempo de revers&#227;o do choque entre os dois grupos de 51&#44;7 &#177; 15&#44;6 minutos com um erro alfa de 0&#44;05 e 10&#37; de taxa de precis&#227;o para fornecer um poder de estudo de 80&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a> A diferen&#231;a calculada foi obtida de um estudo piloto anterior devido &#224; falta de modelo de estudo semelhante&#46; A randomiza&#231;&#227;o em blocos foi feita com um <span class="elsevierStyleItalic">software</span> de internet para atribuir 90 pacientes em uma propor&#231;&#227;o 1&#58;1 para o grupo de controle&#44; no qual o manejo do choque s&#233;ptico foi feito por ades&#227;o &#224;s diretrizes atuais de sepse pedi&#225;trica conforme detalhado na se&#231;&#227;o pedi&#225;trica da Campanha Sobrevivendo &#224; Sepse &#40;CSS&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> ou para o grupo de estudo&#44; no qual o manejo do choque s&#233;ptico foi feito de acordo com as diretrizes da CSS e foi modificado com base nos achados da ecocardiografia transtor&#225;cica&#46; Foram usados envelopes opacos fechados e sequencialmente numerados por m&#233;dicos para alocar os pacientes eleg&#237;veis aos grupos&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Para o grupo de estudo&#44; foi feita ecocardiografia transtor&#225;cica pelo autor para correspond&#234;ncia e todos os dados foram revisados instantaneamente pelo segundo coautor&#44; com o Doppler de Ecocardiografia Philips HD 11XE &#40;modelo&#58; Philips 989605325131&#44; CA&#44; EUA&#41; no momento da interna&#231;&#227;o&#44; cinco&#44; 10&#44; 15&#44; 20&#44; 30 minutos&#44; uma&#44; seis&#44; 24 horas da interna&#231;&#227;o e diariamente depois disso at&#233; que o paciente recebesse alta hospitalar ou falecesse&#44; para responder duas perguntas espec&#237;ficas&#58; a&#41; status do volume e b&#41; fun&#231;&#227;o mioc&#225;rdica&#46; O status do volume foi avaliado pela dimens&#227;o da veia cava inferior &#40;VCI&#41; e pela varia&#231;&#227;o respirof&#225;sica ao comparar os di&#226;metros m&#225;ximos da VCI nas duas fases da respira&#231;&#227;o no plano anterior&#8208;posterior apenas caudal em rela&#231;&#227;o &#224; conflu&#234;ncia da veia hep&#225;tica no corte subxifoide com dias dimens&#245;es &#40;2D&#41; e o modo de movimento &#40;modo M&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">8&#44;12</span></a> O di&#226;metro m&#225;ximo da VCI dependeu do modo de ventila&#231;&#227;o&#44; durante a expira&#231;&#227;o em um paciente com respira&#231;&#227;o espont&#226;nea &#40;RE&#41; &#40;antes da intuba&#231;&#227;o ou ap&#243;s o desmame da ventila&#231;&#227;o mec&#226;nica&#41; e durante a inspira&#231;&#227;o na ventila&#231;&#227;o mec&#226;nica controlada &#40;volumes correntes&#44; 6&#8208;8<span class="elsevierStyleHsp" style=""></span>mL&#47;kg&#41;&#59; a RE n&#227;o foi permitida durante o exame da ecocardiografia em pacientes sob ventila&#231;&#227;o&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Usamos a combina&#231;&#227;o de duas t&#233;cnicas para avaliar a fun&#231;&#227;o sist&#243;lica do ventr&#237;culo esquerdo &#40;VE&#41;&#59; qualitativamente por avalia&#231;&#227;o visual global da contratilidade do VE&#44; inclusive avalia&#231;&#227;o da movimenta&#231;&#227;o e espessamento do septo interventricular e da parede posterior do VE no corte apical de quatro c&#226;maras com a fra&#231;&#227;o de eje&#231;&#227;o &#40;FE&#41; do VE com o modo M no corte do eixo longo paraesternal&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a> A fun&#231;&#227;o sist&#243;lica do VE foi classificada em tr&#234;s categorias pela combina&#231;&#227;o da avalia&#231;&#227;o visual e pela mensura&#231;&#227;o da FEVE&#44; em que &#8220;fun&#231;&#227;o normal&#8221; foi a contratilidade boa com FEVE de 56&#8208;78&#37;&#44; &#8220;disfun&#231;&#227;o&#8221; foi a redu&#231;&#227;o da contratilidade com FEVE de menos de 55&#37; e &#8220;hiperdin&#226;mica&#8221; foi diagnosticada caso a atividade do VE parecesse vigorosa com FEVE de mais de 78&#37;&#46; A fun&#231;&#227;o diast&#243;lica do VE avaliada por Doppler de onda pulsada focou no enchimento diast&#243;lico precoce &#40;onda E&#41; e tardio &#40;onda A&#41; no corte apical de quatro c&#226;maras e na propor&#231;&#227;o entre elas&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a> A disfun&#231;&#227;o diast&#243;lica foi considerada quando a propor&#231;&#227;o E&#47;A foi inferior a 1&#46; Durante a primeira hora&#44; dependemos das avalia&#231;&#245;es qualitativas da fun&#231;&#227;o card&#237;aca e&#44; sempre que anomalias card&#237;acas foram detectadas&#44; foram medidos os valores quantitativos&#46; Todos os pacientes do grupo de estudo apresentaram avalia&#231;&#245;es qualitativas e quantitativas uma hora e depois disso&#46; A disfun&#231;&#227;o mioc&#225;rdica s&#233;ptica &#40;DMS&#41; foi considerada presente se o paciente apresentasse disfun&#231;&#227;o sist&#243;lica do VE&#44; disfun&#231;&#227;o diast&#243;lica ou ambas&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">A terapia foi ajustada no grupo de estudo de acordo com os achados ecocardiogr&#225;ficos&#46; Primeiramente&#44; para orienta&#231;&#227;o da terapia com fluidos&#44; quando a VCI entrou em colapso ou estava com varia&#231;&#227;o respirof&#225;sica &#62; 50&#37;&#44; os b&#243;lus de fluidos foram descontinuados ou reduzidos&#46; Segundo&#44; quando a DMS estava presente&#44; foram iniciados os inotr&#243;picos&#46; Usamos dobutamina &#40;at&#233; 20<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;kg&#47;min&#41; e milrinona &#40;0&#44;25&#8208;0&#44;75<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;kg&#47;min&#41;&#46; Quando a fun&#231;&#227;o card&#237;aca foi normalizada&#44; continuamos com o initr&#243;pico na mesma dosagem at&#233; que o paciente ficasse hemodinamicamente est&#225;vel&#46; Os inotr&#243;picos foram retirados na fun&#231;&#227;o card&#237;aca hiperdin&#226;mica&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Dados coletados</span><p id="par0065" class="elsevierStylePara elsevierViewall">Foram registrados os dados relacionados &#224;s caracter&#237;sticas demogr&#225;ficas&#44; caracter&#237;sticas cl&#237;nicas&#44; ao curso cl&#237;nico e &#224;s investiga&#231;&#245;es&#46; Foram registradas as avalia&#231;&#245;es cl&#237;nicas na interna&#231;&#227;o com o escore do &#205;ndice Pedi&#225;trico de Mortalidade 2 &#40;IPM2&#41;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a> e o acompanhamento cl&#237;nico com o escore da Disfun&#231;&#227;o Org&#226;nica Log&#237;stica Pedi&#225;trica &#40;PELOD&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a> Os dados a seguir foram usados para compara&#231;&#227;o entre ambos os grupos inicialmente e ap&#243;s uma&#44; seis e 24 horas&#58; frequ&#234;ncia card&#237;aca &#40;FC&#41;&#44; press&#227;o arterial sist&#243;lica &#40;PAS&#41;&#44; press&#227;o arterial diast&#243;lica &#40;PAD&#41;&#44; press&#227;o arterial m&#233;dia &#40;PAM&#41;&#44; press&#227;o venosa central &#40;PVC&#41;&#44; press&#227;o de perfus&#227;o &#40;PAM&#8208;PVC&#41;&#44; satura&#231;&#227;o venosa central de oxig&#234;nio &#40;ScvO<span class="elsevierStyleInf">2</span>&#41;&#44; diurese e n&#237;vel de lactato arterial&#46; Os cateteres venosos centrais foram inseridos pela mesma equipe nos dois grupos na primeira hora de interna&#231;&#227;o&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Os pontos finais terap&#234;uticos da ressuscita&#231;&#227;o do choque s&#233;ptico foram enchimento capilar de &#8804; 2 segundos&#44; pulsos normais sem diferen&#231;a entre a qualidade dos pulsos perif&#233;ricos e centrais&#44; extremidades quentes&#44; diurese &#62; 1<span class="elsevierStyleHsp" style=""></span>mL&#47;kg&#47;hora&#44; estado mental normal&#44; FC normal&#44; PA e press&#227;o de perfus&#227;o para a idade e ScvO2 &#8805; 70&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">6&#44;10</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">O tratamento recebido foi registro tempestivamente&#46; O Escore Vasoativo&#47;Inotr&#243;pico &#40;EVI&#41; foi calculado diariamente&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a> Assim que os pontos finais terap&#234;uticos foram atingidos&#44; os vasopressores&#47;inotr&#243;picos foram gradualmente retirados conforme a toler&#226;ncia dos pacientes&#46; Em casos de falha na manuten&#231;&#227;o da estabilidade hemodin&#226;mica na redu&#231;&#227;o das dosagens&#44; os pacientes voltaram para a &#250;ltima dosagem que mant&#233;m a estabilidade&#46; Foi registrado o &#8220;tempo de retirada&#8221; em que os vasopressores&#47;inotr&#243;picos foram retirados com sucesso&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Resultados</span><p id="par0080" class="elsevierStylePara elsevierViewall">Foi registrado o &#8220;tempo de revers&#227;o do choque&#8221;&#44; definido como manuten&#231;&#227;o da PAS &#60; 5&#176; percentil para idade ou &#62; 70<span class="elsevierStyleHsp" style=""></span>mmHg de um m&#234;s a um ano &#40;idade &#215; 2 &#43; 70&#41; de 1&#8208;10 anos e PAS de no m&#237;nimo 90<span class="elsevierStyleHsp" style=""></span>mmHg em crian&#231;as &#62; 10 anos&#59; sem suporte de vasopressores por pelo menos 24 horas&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Registramos &#8220;tempo de ressuscita&#231;&#227;o&#8221; quando o paciente atingiu os pontos finais terap&#234;uticos de ressuscita&#231;&#227;o do choque s&#233;ptico enquanto em vasopressores&#47;inotr&#243;picos&#46; Tamb&#233;m foram registradas a dura&#231;&#227;o na UTIP entre os sobreviventes e a taxa de mortalidade na UTIP&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">An&#225;lise estat&#237;stica</span><p id="par0090" class="elsevierStylePara elsevierViewall">Os dados foram coletados&#44; revisados&#44; codificados e inseridos no <span class="elsevierStyleItalic">software</span> estat&#237;stico SPSS &#40;IBM SPSS Estat&#237;stica para Windows&#44; Vers&#227;o 20&#46;0&#46; NY&#44; EUA&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a> Toda a an&#225;lise estat&#237;stica foi feita com os testes bicaudais&#46; Foi adotado um valor estat&#237;stico significativo de &#8804; 0&#44;05&#46; As estat&#237;sticas descritivas na forma de frequ&#234;ncias e percentual foram usadas para descrever os dados categ&#243;ricos vari&#225;veis&#44; enquanto os dados em escala foram expressos por m&#233;dia e desvio&#8208;padr&#227;o para as vari&#225;veis normalmente distribu&#237;das e mediana com intervalo para vari&#225;veis distorcidas&#46; Foram usados os testes exatos para testar as diferen&#231;as nos percentuais&#44; ao passo que o teste de Mann&#8208;Whitney e o teste <span class="elsevierStyleItalic">t</span> com amostras independentes foram usados para comparar a mediana e as m&#233;dias&#44; respectivamente&#46; O valor da an&#225;lise de vari&#226;ncia &#40;Anova&#41; foi usado para comparar as m&#233;dias com o passar dos per&#237;odos&#46;</p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Resultados</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Caracter&#237;sticas de base e avalia&#231;&#227;o inicial</span><p id="par0095" class="elsevierStylePara elsevierViewall">Como pode ser observado na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#44; n&#227;o houve diferen&#231;as significativas entre os dois grupos em quaisquer das caracter&#237;sticas de base&#46; Choque s&#233;ptico frio predominou entre os dois grupos&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Vari&#225;veis hemodin&#226;micas</span><p id="par0100" class="elsevierStylePara elsevierViewall">Como pode ser observado na <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#44; n&#227;o houve diferen&#231;a significativa nas vari&#225;veis fisiol&#243;gicas iniciais&#44; exceto a FC inicial&#44; que foi maior no grupo de estudo&#46; Houve uma melhoria significativa em todas as vari&#225;veis medidas nos tr&#234;s pontos de tempo &#40;uma&#44; seis&#44; 24 horas&#41; em compara&#231;&#227;o com os valores iniciais nos dois grupos&#46; A PAM e PAM&#8208;PVC foram significativamente maiores no grupo de estudo em uma e 24 horas&#46; &#192;s 24 horas&#44; os valores de lactato melhoraram acentuadamente no grupo de estudo para menos de 2 mmol&#47;L&#44; ao passo que n&#227;o normalizaram no grupo de controle&#46; Os pacientes no grupo de estudo receberam significativamente mais fluido na primeira hora &#91;70 em compara&#231;&#227;o com 61<span class="elsevierStyleHsp" style=""></span>mL&#47;kg&#59; p &#61; 0&#44;003&#93;&#44; por&#233;m&#44; no fim das 24 horas&#44; o total de fluido recebido foi significativamente menos &#91;86 em compara&#231;&#227;o com 98<span class="elsevierStyleHsp" style=""></span>mL&#47;kg&#59; p &#61; 0&#44;027&#93;&#46; A incid&#234;ncia de sobrecarga cl&#237;nica de fluidos entre o grupo de estudo foi acentuadamente inferior &#91;11&#37; em compara&#231;&#227;o com 44&#37;&#59; p &#61; 0&#44;001&#93;&#44; com PVC &#224;s 24 horas &#91;14&#44;6 &#177; 3 em compara&#231;&#227;o com 16&#44;3 &#177; 3 cmH<span class="elsevierStyleInf">2</span>O&#59; p &#61; 0&#44;02&#93;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Tratamento administrado</span><p id="par0105" class="elsevierStylePara elsevierViewall">Como pode ser observado na <a class="elsevierStyleCrossRef" href="#tbl0015">tabela 3</a>&#44; os inotr&#243;picos foram usados com mais frequ&#234;ncia entre o grupo de estudo &#91;89&#37; em compara&#231;&#227;o com 67&#37;&#59; p &#61; 0&#44;011&#93;&#46; O uso de dobutamina predominou entre o grupo de controle&#44; ao passo que o uso de milrinona predominou entre o grupo de estudo&#46; Os tempos m&#233;dios de in&#237;cio da dobutamina e milrinona foram significativamente antecipados no grupo de estudo &#91;12&#44;5 &#177; 10&#44;3 em compara&#231;&#227;o com 24&#44;1 &#177; 14&#44;8 horas&#59; p &#61; 0&#44;005 para dobutamina e 11&#44;9 &#177; 7&#44;8 em compara&#231;&#227;o com 44&#44;4 &#177; 17&#44;9 horas&#59; p &#61; 0&#44;047 para milrinona&#93;&#46; Sete pacientes no grupo de estudo e oito no grupo de controle receberam dobutamina e milrinona simultaneamente&#46; No grupo de estudo&#44; o EVI m&#225;ximo foi significativamente menor &#91;120 &#40;30&#8208;325&#41; em compara&#231;&#227;o com 170 &#40;80&#8208;395&#41;&#59; p &#61; 0&#44;047&#93; com tempo de retirada acentuadamente antecipado &#91;24 &#40;8&#8208;96&#41; em compara&#231;&#227;o com 48 &#40;8&#8208;144&#41; horas&#59; p &#8804; 0&#44;001&#93;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Resultados</span><p id="par0110" class="elsevierStylePara elsevierViewall">Como pode ser observado na <a class="elsevierStyleCrossRef" href="#tbl0020">tabela 4</a>&#44; a propor&#231;&#227;o de crian&#231;as que apresentaram sucesso na revers&#227;o do choque foi significativamente maior &#91;89&#37; em compara&#231;&#227;o com 67&#37;&#59; p &#61; 0&#44;011&#93; com tempo de revers&#227;o do choque acentuadamente menor &#91;3&#44;3 &#40;1&#8208;8&#41; em compara&#231;&#227;o com 4&#44;5 &#40;1&#44;3&#8208;10&#41; dias&#59; p &#61; 0&#44;01&#93;&#46; O tempo de ressuscita&#231;&#227;o foi significativamente antecipado no grupo de estudo &#91;24 &#40;6&#8211;&#8208;72&#41; em compara&#231;&#227;o com 6 &#40;6&#8208;32&#41;&#59; p &#8804; 0&#44;001&#93;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">O escore PELOD melhorou significativamente com o passar do tempo no grupo de estudo&#44; acentuadamente inferior no terceiro dia em compara&#231;&#227;o com o grupo de controle&#46; A perman&#234;ncia na UTIP entre os sobreviventes do grupo de estudo foi significativamente mais curta &#91;8 &#177; 3 em compara&#231;&#227;o com 14 &#177; 10 dias&#59; p &#61; 0&#44;005&#93;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Apesar de a propor&#231;&#227;o de crian&#231;as falecidas ter sido menor&#44; por&#233;m n&#227;o estatisticamente significativa no grupo de estudo &#91;29&#37; &#40;n &#61; 13&#41; em compara&#231;&#227;o coma 38&#37; &#40;n &#61; 17&#41;&#59; p &#61; 0&#44;371&#93;&#44; a taxa de mortalidade devido a choque n&#227;o resolvido foi significativamente menor &#91;38&#37; &#40;5&#47;13&#41; em compara&#231;&#227;o com 88&#37; &#40;15&#47;17&#41;&#59; p &#61; 0&#44;006&#93;&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Discuss&#227;o</span><p id="par0125" class="elsevierStylePara elsevierViewall">A &#8220;revers&#227;o do choque&#8221; &#233; a primeira tarefa que deve ser cumprida ao ver pacientes pedi&#225;tricos com choque s&#233;ptico&#46; Han et al&#46; constataram que cada hora adicional de choque persistente foi associada a &#62; 2 vezes de aumento das chances de mortalidade&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a> O objetivo principal do estudo foi avaliar o papel da ecocardiografia na redu&#231;&#227;o do &#8220;tempo de revers&#227;o do choque&#8221; entre pacientes pedi&#225;tricos com choque s&#233;ptico&#46; O manejo dos pacientes foi feito com ecocardiografia para avaliar seu estado hemodin&#226;mico e orientar mudan&#231;as na terapia em compara&#231;&#227;o com somente avalia&#231;&#227;o cl&#237;nica comum&#46; Os usos cl&#237;nicos dos achados ecocardiogr&#225;ficos em crian&#231;as com choque s&#233;ptico e suas poss&#237;veis implica&#231;&#245;es na escolha e no aprimoramento de medicamentos vasoativos&#47;inotr&#243;picos ainda n&#227;o foram avaliados adequadamente&#46; V&#225;rios estudos avaliaram o uso da ecocardiografia em pacientes adultos na UTI&#44; mas poucos abordam a popula&#231;&#227;o pedi&#225;trica&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a> Ademais&#44; estudos anteriores de avalia&#231;&#227;o ecocardiogr&#225;fica da DMS geralmente forneciam apenas uma avalia&#231;&#227;o &#8220;resumida&#8221; no momento do estudo&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">7&#44;8</span></a> Contudo&#44; o monitoramento ecocardiogr&#225;fico em s&#233;rie &#8220;com o passar do tempo&#8221; feito neste estudo ultrapassou essa limita&#231;&#227;o&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">O percentual de crian&#231;as que apresentaram sucesso na revers&#227;o do choque foi significativamente maior no grupo de estudo &#91;86&#37; &#40;n &#61; 40&#47;45&#41; em compara&#231;&#227;o com 67&#37; &#40;n &#61; 30&#47;45&#41;&#93;&#44; com mediana de 1&#44;2 dia antes do grupo de controle &#91;3&#44;3 em compara&#231;&#227;o com 4&#44;5 dias&#93;&#46; Os dois estudos de Ranjit et al&#46; relataram revers&#227;o do choque s&#233;ptico em 96&#37; &#40;n &#61; 46&#47;48&#41; em um estudo prospectivo e 77&#37; &#40;n &#61; 17&#47;22&#41; em um estudo retrospectivo anterior&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">8&#44;9</span></a> O &#8220;tempo de ressuscita&#231;&#227;o&#8221; foi significativamente antecipado no grupo de estudo &#40;seis em compara&#231;&#227;o com 24 horas&#41;&#44; indicou que a ecocardiografia n&#227;o apenas levou ao desmame mais r&#225;pido do vasopressor&#47;inotr&#243;picos&#44; mas tamb&#233;m &#224; estabiliza&#231;&#227;o hemodin&#226;mica inicial antecipada&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Apesar de a propor&#231;&#227;o de crian&#231;as falecidas ter sido menor&#44; por&#233;m n&#227;o estatisticamente significativa no grupo de estudo &#91;29&#37; em compara&#231;&#227;o com 38&#37;&#93;&#44; os &#243;bitos devido a choque n&#227;o resolvido foram significativamente menores no grupo de estudo&#44; atingiu&#8208;se o objetivo do estudo&#46; Como era uma UTIP de um hospital de cuidados terci&#225;rios&#44; os pacientes foram internados de forma tardia&#44; refletido pelo alto escore IPM2 na interna&#231;&#227;o&#46; Ranjit &#38; Kissoon relataram uma taxa de mortalidade de 27&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a> ao passo que Raj et al&#46; e Ranjit et al&#46; relataram 6&#44;7&#37; e 8&#37;&#44; respectivamente&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">7&#44;8</span></a> A revers&#227;o do choque precoce no grupo de estudo foi associada a uma redu&#231;&#227;o significativa na perman&#234;ncia na UTIP &#91;8 &#177; 3 em compara&#231;&#227;o com 14 &#177; 10 dias&#93;&#46; Raj et al&#46; relataram perman&#234;ncia na UTIP de 14 &#177; 10 dias&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Todas as vari&#225;veis hemodin&#226;micas tempestivamente registradas aumentaram significativamente com o passar do tempo em ambos os grupos&#44; devido &#224; ades&#227;o &#224;s diretrizes atuais de sepse pedi&#225;trica&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> Contudo&#44; o aprimoramento da terapia com fluidos e vasopressores entre o grupo de estudo por meio da ecocardiografia resultou em uma PAM e PAM&#8208;PVC significativamente maiores &#224;s uma e 24 horas devido &#224; melhor press&#227;o diast&#243;lica&#46; No fim das 24 horas&#44; a PVC foi significativamente maior no grupo de controle&#44; coincidiu com as caracter&#237;sticas cl&#237;nicas de sobrecarga de fluidos nesse grupo&#44; que s&#227;o quatro vezes mais do que no grupo de estudo &#91;44&#37; em compara&#231;&#227;o com 11&#37;&#93;&#46; Esses resultados decorrem do papel efetivo da ecocardiografia no aprimoramento da terapia com fluidos&#46; Kelm et al&#46; declararam que a comprova&#231;&#227;o cl&#237;nica da sobrecarga de fluidos comumente atinge at&#233; 67&#37; dos pacientes com choque s&#233;ptico tratados com terapia precoce&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a> Os estudos recentes na UTIP demonstraram a associa&#231;&#227;o de fraco resultado com sobrecarga de fluidos&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a> Apesar de Ranjit et al&#46; terem usado a ecocardiografia at&#233; seis horas do reconhecimento do choque s&#233;ptico para orientar a terapia&#44; houve desenvolvimento de sobrecarga de fluidos em 44&#37; de seus pacientes&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a> A grande diferen&#231;a entre o estudo de Ranjit e o nosso ocorreu em virtude do monitoramento ecocardiogr&#225;fico precoce e em s&#233;rie no nosso&#44; que levou &#224; interven&#231;&#227;o terap&#234;utica proativa em vez de reativa&#46; Apesar do recebimento significativamente maior de fluidos na primeira hora no grupo de estudo&#44; para tratar hipovolemia existente n&#227;o visualizada na ecocardiografia&#44; o fluido acumulado nas 24 horas foi significativamente menor devido ao manejo precoce e bem&#8208;sucedido de fluidos&#44; evitaram&#8208;se hipovolemia persistente e a necessidade de mais fluido posteriormente&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">No presente estudo&#44; os valores de lactato melhoraram acentuadamente no grupo de estudo para menos de 2 mmol&#47;L&#44; ao passo que n&#227;o normalizaram no grupo de controle &#224;s 24 horas&#46; A falha de normaliza&#231;&#227;o do lactato durante a doen&#231;a cr&#237;tica tem sido associada ao aumento do risco de importantes eventos adversos&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Os inotr&#243;picos foram usados com mais frequ&#234;ncia no grupo de estudo &#91;89&#37; em compara&#231;&#227;o com 67&#37;&#93; com hora de in&#237;cio antecipada &#91;12 em compara&#231;&#227;o com 24 horas&#93;&#44; pois a ecocardiografia possibilitou detec&#231;&#227;o precoce de DMS que n&#227;o pode ser diagnosticada com certeza somente no exame cl&#237;nico&#46; Beck et al&#46; declararam que o atraso acentuado no in&#237;cio da terapia com vasopressores&#47;inotr&#243;picos foi associado ao aumento no risco de mortalidade em pacientes com choque s&#233;ptico&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a> O uso de dobutamina predominou no grupo de controle&#44; pois ele &#233; recomendado nas diretrizes da CSS com rela&#231;&#227;o a PVC e Scvo<span class="elsevierStyleInf">2</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> Por outro lado&#44; o uso de milrinona predominou no grupo de estudo&#44; devido&#58; primeiro&#44; o grupo de estudo apresentou maior frequ&#234;ncia card&#237;aca do que o grupo de controle&#44; cujo uso de dobutamina foi proibido como primeira escolha&#44; ao passo que milrinona&#44; conforme relatado por Tomicic et al&#46;&#44; aprimora o desempenho cardiovascular no choque s&#233;ptico sem afetar as vari&#225;veis hemodin&#226;micas&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a> Segundo&#44; a milrinona acelera o relaxamento do mioc&#225;rdio&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a> Assim&#44; foi poss&#237;vel tratar a disfun&#231;&#227;o diast&#243;lica n&#227;o visualizada na ecocardiografia em nosso estudo&#44; no qual 70&#37; dos pacientes com DMS desenvolveram disfun&#231;&#227;o diast&#243;lica&#46; Yano et al&#46; comprovaram que a milrinona acelera o relaxamento do VE muito mais do que a dobutamina&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a> Sankar et al&#46; relataram que o aumento na press&#227;o venosa central ap&#243;s a ressuscita&#231;&#227;o inicial com fluidos pode ser um indicador precoce de disfun&#231;&#227;o diast&#243;lica e exigir ecocardiografia &#224; beira do leito para orientar manejo adicional&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a> Por fim&#44; a ecocardiografia n&#227;o visualizou a falta de resposta &#224; dobutamina&#44; n&#227;o melhoria do d&#233;bito card&#237;aco e em muitos pacientes com a DMS resultou da dessensibiliza&#231;&#227;o induzida por sepse dos receptores beta&#8208;adren&#233;rgicos&#59; assim&#44; foi recomendada milrinona&#44; pois ela n&#227;o age por meio de receptores adren&#233;rgicos&#44; por&#233;m&#44; em vez disso&#44; por meio de inibi&#231;&#227;o seletiva de fosfodiesterase III&#44; torna&#8208;a imune ao efeito da dessensibiliza&#231;&#227;o do receptor adren&#233;rgico&#46;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">29&#44;30</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">O EVI m&#225;ximo foi acentuadamente menor no grupo de estudo&#46; Dosagens desnecess&#225;rias de vasopressores&#47;inotr&#243;picos seriam evitadas&#44; pois a ecocardiografia possibilitou ajustar a terapia de acordo com a condi&#231;&#227;o de cada paciente&#46; Gaies et al&#46; conclu&#237;ram que o alto EVI m&#225;ximo foi fortemente associado a um fraco resultado comparado com pacientes com baixo EVI m&#225;ximo&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a> O tempo de in&#237;cio da retirada dos vasopressores&#47;inotr&#243;picos foi significativamente antecipado no grupo de estudo&#46; O ponto&#8208;chave foi o reconhecimento imediato&#44; por ecocardiografia&#44; da estabiliza&#231;&#227;o cardiovascular&#44; que possibilita a retirada tranquila dos medicamentos de apoio cardiovascular&#44; possibilita&#44; assim&#44; revers&#227;o precoce do choque&#46; N&#227;o houve estudos publicados anteriormente que relataram o tempo inicial da retirada dos vasopressores&#47;inotr&#243;picos e seu impacto sobre o resultado do paciente&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">O principal ponto forte do estudo atual foi fazer ecocardiografia em s&#233;rie em vez de ap&#243;s a interna&#231;&#227;o&#46; Tratou&#8208;se de um estudo prospectivo randomizado com tamanho da amostra suficiente&#46; As principais limita&#231;&#245;es do estudo foram o fato de tratar&#8208;se de um estudo de &#250;nico centro e que mais de 50&#37; dos pacientes inclu&#237;dos eram neonatos&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">A ecocardiografia fornece dados essenciais que n&#227;o podem ser obtidos somente por exame cl&#237;nico&#46; A ecocardiografia em s&#233;rie possibilitou o ajuste ideal da terapia&#44; melhorou significativamente todos os par&#226;metros hemodin&#226;micos e reduziu o &#8220;tempo de revers&#227;o do choque&#8221;&#46; Recomendamos que o curr&#237;culo de resid&#234;ncia da UTIP inclua foco no treinamento de ecocardiograma para possibilitar incorporar a ecocardiografia no manejo do choque s&#233;ptico&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflitos de interesse</span><p id="par0170" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver conflitos de interesse&#46;</p></span></span>"
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            2 => "Shock reversal time"
            3 => "Inotropes"
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            1 => "Choque s&#233;ptico pedi&#225;trico"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To evaluate the role of echocardiography in reducing shock reversal time in pediatric septic shock&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A prospective study conducted in the pediatric intensive care unit &#40;PICU&#41; of a tertiary care teaching hospital from September 2013 to May 2016&#46; Ninety septic shock patients were randomized in a 1&#58;1 ratio for comparing the serial echocardiography&#8208;guided therapy in the study group with the standard therapy in the control group regarding clinical course&#44; timely treatment&#44; and outcomes&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Shock reversal was significantly higher in the study group &#40;89&#37; <span class="elsevierStyleItalic">vs</span>&#46; 67&#37;&#41;&#44; with significantly reduced shock reversal time &#40;3&#46;3 <span class="elsevierStyleItalic">vs</span>&#46; 4&#46;5 days&#41;&#46; PICU stay in the study group was significantly shorter &#40;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3 <span class="elsevierStyleItalic">vs</span>&#46; 14<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10 days&#41;&#46; Mortality due to unresolved shock was significantly lower in the study group&#46; Fluid overload was significantly lower in the study group &#40;11&#37; <span class="elsevierStyleItalic">vs</span>&#46; 44&#37;&#41;&#46; In the study group&#44; inotropes were used more frequently &#40;89&#37; <span class="elsevierStyleItalic">vs</span>&#46; 67&#37;&#41; and initiated earlier &#40;12&#91;0&#46;5&#8211;24&#93; <span class="elsevierStyleItalic">vs</span>&#46; 24&#91;6&#8211;72&#93;<span class="elsevierStyleHsp" style=""></span>h&#41; with lower maximum vasopressor inotrope score &#40;120&#91;30&#8211;325&#93; <span class="elsevierStyleItalic">vs</span>&#46; 170&#91;80&#8211;395&#93;&#41;&#44; revealing predominant use of milrinone &#40;62&#37; <span class="elsevierStyleItalic">vs</span>&#46; 22&#37;&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Serial echocardiography provided crucial data for early recognition of septic myocardial dysfunction and hypovolemia that was not apparent on clinical assessment&#44; allowing a timely management and resulting in shock reversal time reduction among children with septic shock&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Avaliar o papel da ecocardiografia na redu&#231;&#227;o do tempo de revers&#227;o do choque no choque s&#233;ptico pedi&#225;trico&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudo prospectivo conduzido em uma UTIP de um hospital universit&#225;rio de cuidados terci&#225;rios de setembro de 2013 a maio de 2016&#46; Foram randomizados 90 pacientes com choque s&#233;ptico na propor&#231;&#227;o 1&#58;1 para comparar a terapia guiada por ecocardiografia em s&#233;rie com a terapia padr&#227;o no grupo de controle com rela&#231;&#227;o ao curso cl&#237;nico&#44; tratamento oportuno e resultados&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A revers&#227;o do choque foi significativamente maior no grupo de estudo &#40;89&#37; em compara&#231;&#227;o com 67&#37;&#41; com redu&#231;&#227;o significativa do tempo de revers&#227;o do choque &#40;3&#44;3 em compara&#231;&#227;o com 4&#44;5 dias&#41;&#46; A perman&#234;ncia na UTIP no grupo de estudo foi significativamente mais curta &#40;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3 em compara&#231;&#227;o com 14<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10 dias&#41;&#46; A mortalidade devido ao choque n&#227;o resolvido foi significativamente menor no grupo de estudo&#46; A sobrecarga de fluidos foi significativamente menor no grupo de estudo &#40;11&#37; em compara&#231;&#227;o com 44&#37;&#41;&#46; No grupo de estudo&#44; os inotr&#243;picos foram usados com mais frequ&#234;ncia &#40;89&#37; em compara&#231;&#227;o com 67&#37;&#41; e foram administrados antecipadamente &#40;12 &#91;0&#44;5&#8208;24&#93; em compara&#231;&#227;o com 24 &#91;6&#8208;72&#93; horas&#41; e o menor escore inotr&#243;pico m&#225;ximo dos vasopressores &#40;120 &#91;30&#8208;325&#93; em compara&#231;&#227;o com 170 &#91;80&#8208;395&#93;&#41; revela o uso predominante de milrinona &#40;62&#37; em compara&#231;&#227;o com 22&#37;&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A ecocardiografia em s&#233;rie forneceu dados fundamentais para o reconhecimento precoce da disfun&#231;&#227;o mioc&#225;rdica s&#233;ptica e hipovolemia n&#227;o evidente na avalia&#231;&#227;o cl&#237;nica&#44; possibilitou o manejo tempestivamente adequado e resultou na redu&#231;&#227;o do tempo de revers&#227;o do choque entre crian&#231;as com choque s&#233;ptico&#46;</p></span>"
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Imunocompetente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39 &#40;86&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 &#40;88&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Fonte da infec&#231;&#227;o n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pneumonia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;44&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;28&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">FE</span>p &#61; 0&#44;126&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Infec&#231;&#227;o abdominal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;48&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;44&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">FE</span>p &#61; 0&#44;673&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Urossepse&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;8&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;4&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">FE</span>p &#61; 0&#44;677&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Infec&#231;&#227;o de pele ou do tecido mole&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;2&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;2&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">FE</span>p &#61; 1&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Meningite&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;42&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;51&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">FE</span>p &#61; 0&#44;398&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Infec&#231;&#227;o na corrente sangu&#237;nea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;53&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;66&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">FE</span>p &#61; 0&#44;197&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Achados laboratoriais de base</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hemoglobina<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> &#40;gm&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;24 &#177; 2&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;94 &#177; 2&#44;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">t</span>p &#61; 0&#44;514&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Contagem de c&#233;lulas brancas<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> &#40;por mm<span class="elsevierStyleSup">3</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11400 &#40;200&#8208;82400&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10000 &#40;1900&#8208;91600&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">U</span>p &#61; 0&#44;744&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Prote&#237;na C reativa<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72 &#40;2&#44;5&#8208;317&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43 &#40;1&#44;9&#8208;262&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">U</span>p &#61; 0&#44;093&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Troponinas I<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> &#40;ng&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;63 &#40;0&#44;01&#8208;6&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;8 &#40;0&#44;01&#8208;2&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">U</span>p &#61; 0&#44;671&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Escore de CID<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;0&#8208;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;0&#8208;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">U</span>p &#61; 1&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tipo de choque n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Choque quente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;42&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;42&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">MC</span>p &#61; 0&#44;895&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Choque frio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;51&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;53&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Frio com ampla press&#227;o de pulso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;6&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;4&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Controle&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">54&#44;33 &#177; 13&#44;52&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Frequ&#234;ncia card&#237;aca &#40;pulso&#47;min&#46;&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Controle&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">169&#44;87 &#177; 22&#44;42&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">167&#44;78 &#177; 24&#44;43&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">163&#44;42 &#177; 23&#44;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">155&#44;51 &#177; 24&#44;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;01<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">184&#44;09 &#177; 14&#44;95&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">168&#44;0 &#177; 15&#44;44&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">175&#44;18 &#177; 15&#44;26&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">158&#44;96 &#177; 21&#44;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;959&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;006<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;478&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Satura&#231;&#227;o venosa central de oxig&#234;nio</span><a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">b</span></a><span class="elsevierStyleItalic">&#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Controle&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">43&#44;43 &#177; 18&#44;14&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">53&#44;14 &#177; 19&#44;35&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">59&#44;13 &#177; 20&#44;79&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">61&#44;69 &#177; 15&#44;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">45&#44;23 &#177; 13&#44;34&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">56&#44;43 &#177; 15&#44;03&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">65&#44;42 &#177; 15&#44;44&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">63&#44;98 &#177; 10&#44;97&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;601&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;371&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;107&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;422&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Press&#227;o venosa central</span><a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">b</span></a><span class="elsevierStyleItalic">&#40;cmH2O&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Controle&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7&#44;09 &#177; 2&#44;45&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10&#44;49 &#177; 3&#44;61&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">13&#44;40 &#177; 3&#44;04&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16&#44;33 &#177; 3&#44;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;078&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;818&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;020<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">PAM&#8208;PVC &#40;mmHg&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Controle&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">60&#44;50 &#177; 11&#44;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">50&#44;99 &#177; 6&#44;73&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">56&#44;63 &#177; 8&#44;65&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">57&#44;29 &#177; 10&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">65&#44;95 &#177; 10&#44;51&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>P&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;728&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60; 0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;718&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;023<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Lactato &#40;mmol&#47;L&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Controle&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#44;1 &#177; 3&#44;07&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#44;70 &#177; 2&#44;06&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;96 &#177; 0&#44;75&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>P&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;050<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Diurese &#40;mL&#47;kg&#47;hora&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Controle&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;75 &#177; 0&#44;64&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;68 &#177; 1&#44;12&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;4 &#177; 1&#44;76&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;82 &#177; 1&#44;39&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;594&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;738&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Fluido acumulado &#40;mL&#47;kg&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Controle&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">61&#44;33 &#177; 10&#44;79&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">75&#44;11 &#177; 15&#44;47&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">98&#44;2 &#177; 26&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8208;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">70&#44;2 &#177; 16&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">77&#44;2 &#177; 19&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">86&#44;0 &#177; 24&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;125&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>N&#227;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">23 &#40;51&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;57&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleSup">MC</span>p &#61; 0&#44;735&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Adrenalina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4 &#40;8&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;11&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;31&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Inotr&#243;picos<a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">a</span></a> n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;66&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 &#40;88&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">FE</span>p &#61; 0&#44;011<a class="elsevierStyleCrossRef" href="#tblfn0060"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In&#237;cio dos inotr&#243;picos<a class="elsevierStyleCrossRef" href="#tblfn0045"><span class="elsevierStyleSup">b</span></a>&#40;horas de interna&#231;&#227;o&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">24 &#40;6&#8211;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">12 &#40;0&#44;5&#8211;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">U</span>p &#61; 0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0060"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dobutamina n&#176; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 &#40;62&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;42&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">FE</span>p &#61;0&#44;050<a class="elsevierStyleCrossRef" href="#tblfn0060"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In&#237;cio da dobutamina<a class="elsevierStyleCrossRef" href="#tblfn0050"><span class="elsevierStyleSup">c</span></a>&#40;horas de interna&#231;&#227;o&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#44;1 &#177; 14&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;5 &#177; 10&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">t</span>p &#61; 0&#44;005<a class="elsevierStyleCrossRef" href="#tblfn0060"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Milrinona n&#176; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;22&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 &#40;62&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">FE</span>p &#8804; 0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0060"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In&#237;cio da milrinona<a class="elsevierStyleCrossRef" href="#tblfn0050"><span class="elsevierStyleSup">c</span></a>&#40;horas de interna&#231;&#227;o&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#44;4 &#177; 17&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;9 &#177; 7&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">t</span>p &#8804; 0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0060"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EVI m&#225;ximo<a class="elsevierStyleCrossRef" href="#tblfn0045"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">170 &#40;80&#8211;395&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">120 &#40;30&#8211;325&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">U</span>p &#61; 0&#44;047<a class="elsevierStyleCrossRef" href="#tblfn0060"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tempo de retirada<a class="elsevierStyleCrossRef" href="#tblfn0045"><span class="elsevierStyleSup">b</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0055"><span class="elsevierStyleSup">d</span></a>&#40;horas de interna&#231;&#227;o&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#40;8&#8208;144&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#40;8&#8208;96&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">U</span>p &#8804; 0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0060"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Controle &#40;n &#61; 45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Estudo &#40;n &#61; 45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Revers&#227;o do choque n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;66&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 &#40;88&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">FE</span>p &#61;0&#44;011<a class="elsevierStyleCrossRef" href="#tblfn0085"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tempo de revers&#227;o do choque<a class="elsevierStyleCrossRef" href="#tblfn0065"><span class="elsevierStyleSup">a</span></a>&#40;horas de interna&#231;&#227;o&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">108 &#40;30&#8211;240&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78 &#40;24&#8211;192&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">U</span>p &#61; 0&#44;010<a class="elsevierStyleCrossRef" href="#tblfn0085"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tempo de ressuscita&#231;&#227;o<a class="elsevierStyleCrossRef" href="#tblfn0065"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0070"><span class="elsevierStyleSup">b</span></a> &#40;horas de interna&#231;&#227;o&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;6&#8211;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;6&#8211;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">U</span>p &#8804; 0&#44;001<a class="elsevierStyleCrossRef" href="#tblfn0085"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PELOD dia 1<a class="elsevierStyleCrossRef" href="#tblfn0075"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#44;8 &#177; 12&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#44;0 &#177; 16&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">t</span>p &#61; 0&#44;488&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PELOD dia 2<a class="elsevierStyleCrossRef" href="#tblfn0075"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#44;5 &#177; 15&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#44;2 &#177; 15&#44;4<a class="elsevierStyleCrossRef" href="#tblfn0080"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">t</span>p &#61; 0&#44;497&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PELOD dia 3<a class="elsevierStyleCrossRef" href="#tblfn0075"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#44;9 &#177; 17&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;8 &#177; 17&#44;9<a class="elsevierStyleCrossRef" href="#tblfn0080"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">t</span>p &#61; 0&#44;050<a class="elsevierStyleCrossRef" href="#tblfn0085"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Durante na UTIP entre os sobreviventes &#40;dias&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;2 &#177; 10&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;1 &#177; 2&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">t</span>p &#61; 0&#44;005<a class="elsevierStyleCrossRef" href="#tblfn0085"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Destino n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sobreviveram&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#40;62&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#40;71&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleSup">FE</span>p &#61; 0&#44;371&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Faleceram&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#40;37&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#40;28&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Devido a choque n&#227;o resolvido&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#40;88&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#40;38&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleSup">FE</span>p &#61; 0&#44;006<a class="elsevierStyleCrossRef" href="#tblfn0085"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Outras causas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#40;11&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#40;61&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                      "titulo" => "Pediatric sepsis"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "B&#46; Mathias"
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                          "etal" => true
                          "autores" => array:6 [
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                      "titulo" => "Surviving sepsis campaign&#58; international guidelines for management of severe sepsis and septic shock&#58; 2012"
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                            4 => "H&#46; Gerlach"
                            5 => "S&#46;M&#46; Opal"
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                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46; Klugman"
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ISSN: 22555536
Idioma original: Português
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