array:24 [
  "pii" => "S2173511506704031"
  "issn" => "21735115"
  "doi" => "10.1016/S2173-5115(06)70403-1"
  "estado" => "S300"
  "fechaPublicacion" => "2006-05-01"
  "aid" => "70403"
  "copyright" => "Sociedade Portuguesa de Pneumologia"
  "copyrightAnyo" => "2006"
  "documento" => "article"
  "crossmark" => 0
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Rev Port Pneumol. 2006;12:281-91"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 4257
    "formatos" => array:3 [
      "EPUB" => 213
      "HTML" => 2584
      "PDF" => 1460
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2173511506704043"
    "issn" => "21735115"
    "doi" => "10.1016/S2173-5115(06)70404-3"
    "estado" => "S300"
    "fechaPublicacion" => "2006-05-01"
    "aid" => "70404"
    "copyright" => "Sociedade Portuguesa de Pneumologia"
    "documento" => "article"
    "crossmark" => 0
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Pneumol. 2006;12:293-301"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 6109
      "formatos" => array:3 [
        "EPUB" => 224
        "HTML" => 2086
        "PDF" => 3799
      ]
    ]
    "pt" => array:10 [
      "idiomaDefecto" => true
      "titulo" => "A propósito de um caso de imunodeficiência comum variável – Revisão das hipogamaglobulinemias"
      "tienePdf" => "pt"
      "tieneTextoCompleto" => 0
      "tieneResumen" => array:2 [
        0 => "pt"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "293"
          "paginaFinal" => "301"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "About a case of common variable immunodeficiency – Revision of hypogammaglobulinemias"
        ]
      ]
      "contieneResumen" => array:2 [
        "pt" => true
        "en" => true
      ]
      "contienePdf" => array:1 [
        "pt" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Alexandra Lopes, Fernando Barata, Ricardo Conceição, Rui Pato"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Alexandra"
              "apellidos" => "Lopes"
            ]
            1 => array:2 [
              "nombre" => "Fernando"
              "apellidos" => "Barata"
            ]
            2 => array:3 [
              "preGrado" => "Dr."
              "nombre" => "Ricardo"
              "apellidos" => "Conceição"
            ]
            3 => array:3 [
              "preGrado" => "Dr."
              "nombre" => "Rui"
              "apellidos" => "Pato"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "pt"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511506704043?idApp=UINPBA00004E"
    "url" => "/21735115/0000001200000003/v1_201305151422/S2173511506704043/v1_201305151422/pt/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S217351150670402X"
    "issn" => "21735115"
    "doi" => "10.1016/S2173-5115(06)70402-X"
    "estado" => "S300"
    "fechaPublicacion" => "2006-05-01"
    "aid" => "70402"
    "copyright" => "Sociedade Portuguesa de Pneumologia"
    "documento" => "article"
    "crossmark" => 0
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Pneumol. 2006;12:275-80"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 5659
      "formatos" => array:3 [
        "EPUB" => 205
        "HTML" => 4000
        "PDF" => 1454
      ]
    ]
    "pt" => array:10 [
      "idiomaDefecto" => true
      "titulo" => "Hiperplasia linfóide angiofolicular – Doença de Castleman – do mediastino: Apresentação de um caso clínico"
      "tienePdf" => "pt"
      "tieneTextoCompleto" => 0
      "tieneResumen" => array:2 [
        0 => "pt"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "275"
          "paginaFinal" => "280"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Mediastinal angiofolicular lymphoid hyperplasia – Castleman's disease – Case report"
        ]
      ]
      "contieneResumen" => array:2 [
        "pt" => true
        "en" => true
      ]
      "contienePdf" => array:1 [
        "pt" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Vítor Sousa, Lina Carvalho, Fernanda Xavier da Cunha"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Vítor"
              "apellidos" => "Sousa"
            ]
            1 => array:2 [
              "nombre" => "Lina"
              "apellidos" => "Carvalho"
            ]
            2 => array:3 [
              "preGrado" => "Dra."
              "nombre" => "Fernanda"
              "apellidos" => "Xavier da Cunha"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "pt"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217351150670402X?idApp=UINPBA00004E"
    "url" => "/21735115/0000001200000003/v1_201305151422/S217351150670402X/v1_201305151422/pt/main.assets"
  ]
  "pt" => array:15 [
    "idiomaDefecto" => true
    "titulo" => "Ventilação mecânica e obstinação terapêutica ou distanásia, a dialéctica da alta tecnologia em medicina intensiva"
    "tieneTextoCompleto" => 0
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "281"
        "paginaFinal" => "291"
      ]
    ]
    "autores" => array:1 [
      0 => array:2 [
        "autoresLista" => "Filipe Monteiro"
        "autores" => array:1 [
          0 => array:3 [
            "nombre" => "Filipe"
            "apellidos" => "Monteiro"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "fn0005"
              ]
            ]
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "en" => array:1 [
        "titulo" => "Mechanical ventilation and medical futility or dysthanasia&#44; the dialectic of high technology in intensive medicine"
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2006-03-08"
    "fechaAceptado" => "2006-03-30"
    "PalabrasClave" => array:2 [
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec158701"
          "palabras" => array:4 [
            0 => "&#201;tica"
            1 => "obstina&#231;&#227;o terap&#234;utica"
            2 => "distan&#225;sia"
            3 => "medicina intensiva"
          ]
        ]
      ]
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Key-words"
          "identificador" => "xpalclavsec158702"
          "palabras" => array:4 [
            0 => "Ethics"
            1 => "medical futility"
            2 => "dysthanasia"
            3 => "intensive medicine"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "pt" => array:2 [
        "titulo" => "Resumo"
        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Distan&#225;sia ou qualquer um dos seus sin&#243;nimos &#233; uma consequ&#234;ncia do excesso terap&#234;utico em rela&#231;&#227;o ao progn&#243;stico esperado&#46; A obstina&#231;&#227;o terap&#234;utica &#233; um dos dilemas &#233;ticos mais angustiantes no quotidiano de medicina intensiva&#44; apesar de a sua aprecia&#231;&#227;o encontrar um suporte normativo em v&#225;rias institui&#231;&#245;es e organiza&#231;&#245;es&#46; A manuten&#231;&#227;o ou n&#227;o suspens&#227;o da ventila&#231;&#227;o mec&#226;nica numa determinada circunst&#226;ncia de fim de vida pode ser considerado como um exemplo paradigm&#225;tico de obstina&#231;&#227;o terap&#234;utica&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A compreens&#227;o desta postura passa pela an&#225;lise e reflex&#227;o do acto m&#233;dico &#224; luz de alguns conceitos &#233;tico-filos&#243;ficos&#46;</p>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Dysthanasia or any of its synonyms is a consequence of excessive technical science&#44; without any reasonable chance of achieving a therapeutic benefit for the patient&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Medical futility is a distressing ethical dilemma of intensive care medicine&#46; Its recognition has led to a precept support in various institutions and organizations&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Not withdrawing or withholding mechanical ventilation in certain circumstances can be considered as a paradigmatic model of medical futility&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The understanding of this posture implies a philosophical approach and reflexion of medical practice&#46;</p>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#42;"
        "nota" => "<p class="elsevierStyleNotepara">Assistente Hospitalar Graduado no Servi&#231;o de Pneumologia do Hospital de Santa Maria&#44; Lisboa&#46; Mestre em Bio&#233;tica&#46;</p>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliografia"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:25 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ethics and decision making in end stage lung disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46;K&#46; Simonds"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Thorax"
                        "fecha" => "2003"
                        "volumen" => "58"
                        "paginaInicial" => "272"
                        "paginaFinal" => "277"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12612311"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Respiratory failure from severe <span class="elsevierStyleItalic">Pneumocystis carinii</span> pneumonia&#58; entering the third era"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46;M&#46; Watcher"
                            1 => "J&#46;M&#46; Luce"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1994"
                        "volumen" => "106"
                        "paginaInicial" => "1313"
                        "paginaFinal" => "1315"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7956373"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Decreasing frequency but worsening mortality of acute respiratory failure secondary to AIDS-related <span class="elsevierStyleItalic">Pneumocystis carinii</span> pneumonia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:1 [
                            0 => "P&#46;H&#46; Hawley"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1994"
                        "volumen" => "106"
                        "paginaInicial" => "1456"
                        "paginaFinal" => "1459"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7956401"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Length of stay and survival after intensive care for severe <span class="elsevierStyleItalic">Pneumocystis carinii</span> pneumonia&#58; a prospective study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:1 [
                            0 => "S&#46;A&#46; Bozzette"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1992"
                        "volumen" => "101"
                        "paginaInicial" => "1404"
                        "paginaFinal" => "1407"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1582305"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Multicenter outcome study of cancer patients admitted to the intensive care unit&#58; a probability of mortality model"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:1 [
                            0 => "J&#46;S&#46; Groeger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1200/jco.1998.16.2.761"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Oncol"
                        "fecha" => "1998"
                        "volumen" => "16"
                        "paginaInicial" => "761"
                        "paginaFinal" => "770"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9469368"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Withdrawing life support from mechanically ventilated recipients of bone marrow transplants&#58; a case for evidence-based guidelines"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "G&#46;D&#46; Rubenfeld"
                            1 => "S&#46;W&#46; Crawford"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Intern Med"
                        "fecha" => "1996"
                        "volumen" => "125"
                        "paginaInicial" => "625"
                        "paginaFinal" => "633"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8849146"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outcome of patients with idiopathic pulmonary fibrosis admitted to the intensive care unit"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:1 [
                            0 => "G&#46; Saydain"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.2104038"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2002"
                        "volumen" => "166"
                        "paginaInicial" => "839"
                        "paginaFinal" => "842"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12231494"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prognosis of patients with advanced idiopathic pulmonary fibrosis requiring mechanical ventilation for acute respiratory failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:1 [
                            0 => "J&#46;B&#46; Stern"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2001"
                        "volumen" => "120"
                        "paginaInicial" => "213"
                        "paginaFinal" => "219"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11451841"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Survival and prediction of successful ventilator weaning in COPD patients requiring mechanical ventilation for more than 21 days"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:1 [
                            0 => "S&#46; Nava"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "1994"
                        "volumen" => "7"
                        "paginaInicial" => "1645"
                        "paginaFinal" => "1652"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7995395"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Foregoing life support in western European intensive care units&#58; the results of an ethical questionnaire"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;L&#46; Vincent"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:8 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "1999"
                        "volumen" => "27"
                        "numero" => "8"
                        "paginaInicial" => "1626"
                        "paginaFinal" => "1633"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10470775"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0168827808006375"
                          "estado" => "S300"
                          "issn" => "01688278"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Care of the dying&#58; an ethical and historical perspective"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46;T&#46; Cowley"
                            1 => "E&#46; Young"
                            2 => "T&#46;A&#46; Raffin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "1992"
                        "volumen" => "20"
                        "numero" => "10"
                        "paginaInicial" => "1473"
                        "paginaFinal" => "1482"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1395671"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12&#46;"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Plat&#227;o&#46; F&#233;don&#46;&#40;Trad&#46; de T&#46; S&#46; Azevedo&#46; Coimbra&#58; Livraria Minerva&#44; 1998&#58; 130&#41;&#46;"
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#201;tica e Valores Humanos"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "B&#46; Fernandes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Revista da Ordem dos M&#233;dicos"
                        "fecha" => "1991"
                        "paginaInicial" => "6"
                        "paginaFinal" => "8"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Qualidade de vida em vida com limites"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46; Biscaia"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ac&#231;&#227;o M&#233;dica"
                        "fecha" => "1992"
                        "volumen" => "3"
                        "paginaInicial" => "5"
                        "paginaFinal" => "14"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15&#46;"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "&#171;Catecismo da Igreja Cat&#243;lica&#187;&#46; Gr&#225;fica de Coimbra&#44; 1993&#46; par&#225;grafos 2277-2279&#58; 486-487&#46;"
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16&#46;"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Igreja Cat&#243;lica&#44; Papa Jo&#227;o Paulo II&#46; O Evangelho da Vida&#46; Lisboa&#58; Editora Rei dos Livros 1995&#58; 115&#46;"
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Portugal&#44; hoje&#58; o medo de existir"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46; Gil"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2004"
                        "editorial" => "Rel&#243;gio d&#8217;&#193;gua Editores"
                        "editorialLocalizacion" => "Lisboa"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Filosofia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Antunes"
                            1 => "A&#46; Estanqueiro"
                            2 => "M&#46; Vidigal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2000"
                        "editorial" => "Editorial Presen&#231;a"
                        "editorialLocalizacion" => "Lisboa"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reformar o Pensamento"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "E&#46; Morin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "1999"
                        "editorial" => "Instituto Piaget"
                        "editorialLocalizacion" => "Lisboa"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20&#46;"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Santos L&#46; &#201;tica da investiga&#231;&#227;o biom&#233;dica&#58; m&#243;dulo IX&#46; Lisboa&#58; Fac Med Lisboa 2000-2001&#46; II Mestrado em Bio&#233;tica&#46; p&#46; 1&#46;"
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21&#46;"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Vasconcelos P&#46; A rela&#231;&#227;o t&#237;pica do doente com o m&#233;dico&#58; m&#243;dulo IV&#46; Lisboa&#46; Fac Med Lisboa 2000-2001&#46; II Mestrado em Bio&#233;tica&#44; p&#46; 6&#46;"
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sa&#250;de para todos"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "V&#46;F&#46; Pinto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "1999"
                        "editorial" => "Edi&#231;&#245;es Paulus"
                        "editorialLocalizacion" => "Apela&#231;&#227;o"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23&#46;"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => """
                    &#171;Informa&#231;&#245;es ao Cidad&#227;o&#46; Carta dos Direitos e Deveres dos Doentes&#187; &#91;<span class="elsevierStyleItalic">online</span>&#93;&#46; Dispon&#237;vel na World Wide Web em&#58; \n
                    <www.dgsaude.pt>\n
                     &#46;\n
                    </www.dgsaude.pt>
                    """
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A nega&#231;&#227;o da morte"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Becker E"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:4 [
                        "edicion" => "2&#46;&#170; edi&#231;&#227;o&#46;"
                        "fecha" => "1995"
                        "editorial" => "Editora Record"
                        "editorialLocalizacion" => "Rio de Janeiro"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Vida e morte&#58; sentido e esperan&#231;a"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;R&#46; Almeida"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "1989"
                        "editorial" => "Edi&#231;&#245;es Salesianas"
                        "editorialLocalizacion" => "Porto"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "pt"
  "url" => "/21735115/0000001200000003/v1_201305151422/S2173511506704031/v1_201305151422/pt/main.assets"
  "Apartado" => array:4 [
    "identificador" => "9565"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Artigo de Opini&#227;o"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735115/0000001200000003/v1_201305151422/S2173511506704031/v1_201305151422/pt/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511506704031?idApp=UINPBA00004E"
]
Share
Journal Information
Vol. 12. Issue 3.
Pages 281-291 (May - June 2006)
Share
Share
Download PDF
More article options
Vol. 12. Issue 3.
Pages 281-291 (May - June 2006)
Full text access
Ventilação mecânica e obstinação terapêutica ou distanásia, a dialéctica da alta tecnologia em medicina intensiva
Mechanical ventilation and medical futility or dysthanasia, the dialectic of high technology in intensive medicine
Visits
887
Filipe Monteiro*
This item has received
Article information
Resumo

Distanásia ou qualquer um dos seus sinónimos é uma consequência do excesso terapêutico em relação ao prognóstico esperado. A obstinação terapêutica é um dos dilemas éticos mais angustiantes no quotidiano de medicina intensiva, apesar de a sua apreciação encontrar um suporte normativo em várias instituições e organizações. A manutenção ou não suspensão da ventilação mecânica numa determinada circunstância de fim de vida pode ser considerado como um exemplo paradigmático de obstinação terapêutica.

A compreensão desta postura passa pela análise e reflexão do acto médico à luz de alguns conceitos ético-filosóficos.

Palavras-chave:
Ética
obstinação terapêutica
distanásia
medicina intensiva
Abstract

Dysthanasia or any of its synonyms is a consequence of excessive technical science, without any reasonable chance of achieving a therapeutic benefit for the patient.

Medical futility is a distressing ethical dilemma of intensive care medicine. Its recognition has led to a precept support in various institutions and organizations.

Not withdrawing or withholding mechanical ventilation in certain circumstances can be considered as a paradigmatic model of medical futility.

The understanding of this posture implies a philosophical approach and reflexion of medical practice.

Key-words:
Ethics
medical futility
dysthanasia
intensive medicine
Full text is only aviable in PDF
Bibliografia
[1.]
A.K. Simonds.
Ethics and decision making in end stage lung disease.
Thorax, 58 (2003), pp. 272-277
[2.]
R.M. Watcher, J.M. Luce.
Respiratory failure from severe Pneumocystis carinii pneumonia: entering the third era.
Chest, 106 (1994), pp. 1313-1315
[3.]
P.H. Hawley, et al.
Decreasing frequency but worsening mortality of acute respiratory failure secondary to AIDS-related Pneumocystis carinii pneumonia.
Chest, 106 (1994), pp. 1456-1459
[4.]
S.A. Bozzette, et al.
Length of stay and survival after intensive care for severe Pneumocystis carinii pneumonia: a prospective study.
Chest, 101 (1992), pp. 1404-1407
[5.]
J.S. Groeger, et al.
Multicenter outcome study of cancer patients admitted to the intensive care unit: a probability of mortality model.
J Clin Oncol, 16 (1998), pp. 761-770
[6.]
G.D. Rubenfeld, S.W. Crawford.
Withdrawing life support from mechanically ventilated recipients of bone marrow transplants: a case for evidence-based guidelines.
Ann Intern Med, 125 (1996), pp. 625-633
[7.]
G. Saydain, et al.
Outcome of patients with idiopathic pulmonary fibrosis admitted to the intensive care unit.
Am J Respir Crit Care Med, 166 (2002), pp. 839-842
[8.]
J.B. Stern, et al.
Prognosis of patients with advanced idiopathic pulmonary fibrosis requiring mechanical ventilation for acute respiratory failure.
Chest, 120 (2001), pp. 213-219
[9.]
S. Nava, et al.
Survival and prediction of successful ventilator weaning in COPD patients requiring mechanical ventilation for more than 21 days.
Eur Respir J, 7 (1994), pp. 1645-1652
[10.]
J.L. Vincent.
Foregoing life support in western European intensive care units: the results of an ethical questionnaire.
Crit Care Med, 27 (1999), pp. 1626-1633
[11.]
L.T. Cowley, E. Young, T.A. Raffin.
Care of the dying: an ethical and historical perspective.
Crit Care Med, 20 (1992), pp. 1473-1482
[12.]
Platão. Fédon.(Trad. de T. S. Azevedo. Coimbra: Livraria Minerva, 1998: 130).
[13.]
B. Fernandes.
Ética e Valores Humanos.
Revista da Ordem dos Médicos, (1991), pp. 6-8
[14.]
J. Biscaia.
Qualidade de vida em vida com limites.
Acção Médica, 3 (1992), pp. 5-14
[15.]
«Catecismo da Igreja Católica». Gráfica de Coimbra, 1993. parágrafos 2277-2279: 486-487.
[16.]
Igreja Católica, Papa João Paulo II. O Evangelho da Vida. Lisboa: Editora Rei dos Livros 1995: 115.
[17.]
J. Gil.
Portugal, hoje: o medo de existir.
Relógio d’Água Editores, (2004),
[18.]
A. Antunes, A. Estanqueiro, M. Vidigal.
Filosofia.
Editorial Presença, (2000),
[19.]
E. Morin.
Reformar o Pensamento.
Instituto Piaget, (1999),
[20.]
Santos L. Ética da investigação biomédica: módulo IX. Lisboa: Fac Med Lisboa 2000-2001. II Mestrado em Bioética. p. 1.
[21.]
Vasconcelos P. A relação típica do doente com o médico: módulo IV. Lisboa. Fac Med Lisboa 2000-2001. II Mestrado em Bioética, p. 6.
[22.]
V.F. Pinto.
Saúde para todos.
Edições Paulus, (1999),
[23.]
«Informações ao Cidadão. Carta dos Direitos e Deveres dos Doentes» [online]. Disponível na World Wide Web em: .
[24.]
Becker E.
A negação da morte.
2.ª edição., Editora Record, (1995),
[25.]
J.R. Almeida.
Vida e morte: sentido e esperança.
Edições Salesianas, (1989),

Assistente Hospitalar Graduado no Serviço de Pneumologia do Hospital de Santa Maria, Lisboa. Mestre em Bioética.

Copyright © 2006. Sociedade Portuguesa de Pneumologia
Download PDF
Pulmonology
Article options
Tools

Are you a health professional able to prescribe or dispense drugs?