90 research outputs found
Ventilator-Associated Lung Injury during Assisted Mechanical Ventilation.
No full textAssisted mechanical ventilation (MV) may be a favorable alternative to controlled MV at the early phase of acute respiratory distress syndrome (ARDS), since it requires less sedation, no paralysis and is associated with less hemodynamic deterioration, better distal organ perfusion, and lung protection, thus reducing the risk of ventilator-associated lung injury (VALI). In the present review, we discuss VALI in relation to assisted MV strategies, such as volume assist-control ventilation, pressure assist-control ventilation, pressure support ventilation (PSV), airway pressure release ventilation (APRV), APRV with PSV, proportional assist ventilation (PAV), noisy ventilation, and neurally adjusted ventilatory assistance (NAVA). In summary, we suggest that assisted MV can be used in ARDS patients in the following situations: (1) Pao 2/Fio 2 >150 mm Hg and positive end-expiratory pressure ≥ 5 cm H2O and (2) with modalities of pressure-targeted and time-cycled breaths including more or less spontaneous or supported breaths (A-PCV [assisted pressure-controlled ventilation] or APRV). Furthermore, during assisted MV, the following parameters should be monitored: inspiratory drive, transpulmonary pressure, and tidal volume (6 mL/kg). Further studies are required to determine the impact of novel modalities of assisted ventilation such as PAV, noisy pressure support, and NAVA on VAL
Social media revolutions
No full textThis commentary explores how, despite the best efforts of social change groups, governments and marketing communications professionals, having people change their minds remains difficult. The author explores how social media served as a means for the “Arab Spring” movements in Egypt and Tunisia to communicate with Western media, thus raising the profile of the movement and keeping it top of the public, media and policy agendas. The author puts forward the idea that professional communicators should use hope instead of fear when marketing an idea.
©Journal of Professional Communication, all rights reserved
Effects of sigh during pressure control and pressure support ventilation in pulmonary and extrapulmonary mild acute lung injury
No full textIntroductionSigh improves oxygenation and lung mechanics during pressure control ventilation (PCV) and pressure support ventilation (PSV) in patients with acute respiratory distress syndrome. However, so far, no study has evaluated the biological impact of sigh during PCV or PSV on the lung and distal organs in experimental pulmonary (p) and extrapulmonary (exp) mild acute lung injury (ALI).MethodsIn 48 Wistar rats, ALI was induced by Escherichia coli lipopolysaccharide either intratracheally (ALIp) or intraperitoneally (ALIexp). After 24 hours, animals were anesthetized and mechanically ventilated with PCV or PSV with tidal volume of 6 mL/kg, FiO2¿=¿0.4, and PEEP¿=¿5 cmH2O for 1 hour. Both ventilator strategies were then randomly assigned to receive periodic sighs (10 sighs/hour, Sigh) or not (non-Sigh, NS). Ventilatory and mechanical parameters, arterial blood gases, lung histology, interleukin (IL)-1ß, IL-6, caspase-3, and type III procollagen (PCIII) mRNA expression in lung tissue, and number of apoptotic cells in lung, liver, and kidney specimens were analyzed.ResultsIn both ALI etiologies: 1) PCV-Sigh and PSV-Sigh reduced transpulmonary pressure, and 2) PSV-Sigh reduced the respiratory drive compared to PSV-NS. In ALIp: 1) PCV-Sigh and PSV-Sigh decreased alveolar collapse as well as IL-1ß, IL-6, caspase-3, and PCIII expressions in lung tissue, 2) PCV-Sigh increased alveolar-capillary membrane and endothelial cell damage, and 3) Abnormal myofibril with Z-disk edema was greater in PCV-NS than PSV-NS. In ALIexp: 1) PSV-Sigh reduced alveolar collapse, but led to damage to alveolar-capillary membrane, as well as type II epithelial and endothelial cells, 2) PCV-Sigh and PSV-Sigh increased IL-1ß, IL-6, caspase-3, and PCIII expressions, and 3) PCV-Sigh increased the number of apoptotic cells in the lung compared to PCV-NS.ConclusionsIn these models of mild ALIp and ALIexp, sigh reduced alveolar collapse and transpulmonary pressures during both PCV and PSV; however, improved lung protection only during PSV in ALI
Biphasic positive airway pressure minimizes biological impact on lung tissue in mild acute lung injury independent of etiology
No full textAbstract\ud
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Introduction\ud
Biphasic positive airway pressure (BIVENT) is a partial support mode that employs pressure-controlled, time-cycled ventilation set at two levels of continuous positive airway pressure with unrestricted spontaneous breathing. BIVENT can modulate inspiratory effort by modifying the frequency of controlled breaths. Nevertheless, the optimal amount of inspiratory effort to improve respiratory function while minimizing ventilator-associated lung injury during partial ventilatory assistance has not been determined. Furthermore, it is unclear whether the effects of partial ventilatory support depend on acute lung injury (ALI) etiology. This study aimed to investigate the impact of spontaneous and time-cycled control breaths during BIVENT on the lung and diaphragm in experimental pulmonary (p) and extrapulmonary (exp) ALI.\ud
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Methods\ud
This was a prospective, randomized, controlled experimental study of 60 adult male Wistar rats. Mild ALI was induced by Escherichia coli lipopolysaccharide either intratracheally (ALIp) or intraperitoneally (ALIexp). After 24 hours, animals were anesthetized and further randomized as follows: (1) pressure-controlled ventilation (PCV) with tidal volume (Vt) = 6 ml/kg, respiratory rate = 100 breaths/min, PEEP = 5 cmH2O, and inspiratory-to-expiratory ratio (I:E) = 1:2; or (2) BIVENT with three spontaneous and time-cycled control breath modes (100, 75, and 50 breaths/min). BIVENT was set with two levels of CPAP (Phigh = 10 cmH2O and Plow = 5 cmH2O). Inspiratory time was kept constant (Thigh = 0.3 s).\ud
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Results\ud
BIVENT was associated with reduced markers of inflammation, apoptosis, fibrogenesis, and epithelial and endothelial cell damage in lung tissue in both ALI models when compared to PCV. The inspiratory effort during spontaneous breaths increased during BIVENT-50 in both ALI models. In ALIp, alveolar collapse was higher in BIVENT-100 than PCV, but decreased during BIVENT-50, and diaphragmatic injury was lower during BIVENT-50 compared to PCV and BIVENT-100. In ALIexp, alveolar collapse during BIVENT-100 and BIVENT-75 was comparable to PCV, while decreasing with BIVENT-50, and diaphragmatic injury increased during BIVENT-50.\ud
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Conclusions\ud
In mild ALI, BIVENT had a lower biological impact on lung tissue compared to PCV. In contrast, the response of atelectasis and diaphragmatic injury to BIVENT differed according to the rate of spontaneous/controlled breaths and ALI etiology.The authors express their gratitude to Andre Benedito da Silva for animal care, Ana Lucia Neves da Silva for help with microscopy, Moira Elizabeth Schottler and Claudia Buchweitz for assistance in editing the manuscript and MAQUET for providing technical support. This study was supported by Centers of Excellence Program (PRONEX-FAPERJ), Brazilian Council for Scientific and Technological Development (CNPq), Rio de Janeiro State Research Supporting Foundation (FAPERJ), São Paulo State Research Supporting Foundation (FAPESP), National Institute of Science and Technology of Drugs and Medicine (INCT-INOFAR), Coordination for the Improvement of Higher Level Personnel (CAPES), and the European Community’s Seventh Framework Programme (TARKINAID, FP7-2007-2013)
Assisted ventilation modes reduce the expression of lung inflammatory and fibrogenic mediators in a model of mild acute lung injury.
No full textPURPOSE:
The goal of the study was to compare the effects of different assisted ventilation modes with pressure controlled ventilation (PCV) on lung histology, arterial blood gases, inflammatory and fibrogenic mediators in experimental acute lung injury (ALI).
METHODS:
Paraquat-induced ALI rats were studied. At 24 h, animals were anaesthetised and further randomized as follows (n = 6/group): (1) pressure controlled ventilation mode (PCV) with tidal volume (V (T)) = 6 ml/kg and inspiratory to expiratory ratio (I:E) = 1:2; (2) three assisted ventilation modes: (a) assist-pressure controlled ventilation (APCV1:2) with I:E = 1:2, (b) APCV1:1 with I:E = 1:1; and (c) biphasic positive airway pressure and pressure support ventilation (BiVent + PSV), and (3) spontaneous breathing without PEEP in air. PCV, APCV1:1, and APCV1:2 were set with P (insp) = 10 cmH(2)O and PEEP = 5 cmH(2)O. BiVent + PSV was set with two levels of CPAP [inspiratory pressure (P (High) = 10 cmH(2)O) and positive end-expiratory pressure (P (Low) = 5 cmH(2)O)] and inspiratory/expiratory times: T (High) = 0.3 s and T (Low) = 0.3 s. PSV was set as follows: 2 cmH(2)O above P (High) and 7 cmH(2)O above P (Low). All rats were mechanically ventilated in air and PEEP = 5 cmH(2)O for 1 h.
RESULTS:
Assisted ventilation modes led to better functional improvement and less lung injury compared to PCV. APCV1:1 and BiVent + PSV presented similar oxygenation levels, which were higher than in APCV1:2. Bivent + PSV led to less alveolar epithelium injury and lower expression of tumour necrosis factor-alpha, interleukin-6, and type III procollagen.
CONCLUSIONS:
In this experimental ALI model, assisted ventilation modes presented greater beneficial effects on respiratory function and a reduction in lung injury compared to PCV. Among assisted ventilation modes, Bi-Vent + PSV demonstrated better functional results with less lung damage and expression of inflammatory mediators
Effects of Ultraprotective Ventilation, Extracorporeal Carbon Dioxide Removal, and Spontaneous Breathing on Lung Morphofunction and Inflammation in Experimental Severe Acute Respiratory Distress Syndrome
No full textBACKGROUND:: To investigate the role of ultraprotective mechanical ventilation (UP-MV) and extracorporeal carbon dioxide removal with and without spontaneous breathing (SB) to improve respiratory function and lung protection in experimental severe acute respiratory distress syndrome.
METHODS:: Severe acute respiratory distress syndrome was induced by saline lung lavage and mechanical ventilation (MV) with higher tidal volume (VT) in 28 anesthetized pigs (32.8 to 52.5 kg). Animals (n = 7 per group) were randomly assigned to 6 h of MV (airway pressure release ventilation) with: (1) conventional P-MV with VT ≈6 ml/kg (P-MVcontr); (2) UP-MV with VT ≈3 ml/kg (UP-MVcontr); (3) UP-MV with VT ≈3 ml/kg and SB (UP-MVspont); and (4) UP-MV with VT ≈3 ml/kg and pressure supported SB (UP-MVPS). In UP-MV groups, extracorporeal carbon dioxide removal was used.
RESULTS:: The authors found that: (1) UP-MVcontr reduced diffuse alveolar damage score in dorsal lung zones (median[interquartile]) (12.0 [7.0 to 16.8] vs. 22.5 [13.8 to 40.8]), but worsened oxygenation and intrapulmonary shunt, compared to P-MVcontr; (2) UP-MVspont and UP-MVPS improved oxygenation and intrapulmonary shunt, and redistributed ventilation towards dorsal areas, as compared to UP-MVcontr; (3) compared to P-MVcontr, UP-MVcontr and UP-MVspont, UP-MVPS yielded higher levels of tumor necrosis factor-α (6.9 [6.5 to 10.1] vs. 2.8 [2.2 to 3.0], 3.6 [3.0 to 4.7] and 4.0 [2.8 to 4.4] pg/mg, respectively) and interleukin-8 (216.8 [113.5 to 343.5] vs. 59.8 [45.3 to 66.7], 37.6 [18.8 to 52.0], and 59.5 [36.1 to 79.7] pg/mg, respectively) in dorsal lung zones.
CONCLUSIONS:: In this model of severe acute respiratory distress syndrome, MV with VT ≈3 ml/kg and extracorporeal carbon dioxide removal without SB slightly reduced lung histologic damage, but not inflammation, as compared to MV with VT = 4 to 6 ml/kg. During UP-MV, pressure supported SB increased lung inflammatio
Creche como ambiente facilitador: o cuidado no contexto da educação infantil
No full textThe first year of life is a time of extreme importance regarding the development of emotional, cognitive and psychomotor aspects of human beings. This development, however, cannot be considered apart from the relationship between the baby and his caregiver. Winnicott, English pediatrician and psychoanalyst, whose theory we based this work, draws attention to the relational aspect of psychic structuring, stating that babies cannot be studied apart from interactions in which and from which they develop. The author believes that human beings are born with tendencies towards growth and development; however, they are dependent on certain favorable conditions, which he calls 'enabling environment'. This concept refers, to not only the physical environment and the care itself, but also speaks about the emotional atmosphere in which it is offered. The aim of this paper is to present a reflection on the concept of ‘enabling environment’, relating it to the care of babies up to one year of age, in the context of early childhood education. We also seek to trace care practices in different historical moments of the infant education in Brazil, drawing attention to the historical and social character of non-prestige that tasks involving care are still perceived today. The methodology used is non-systematic bibliographical research. The discussion points to the need for a redefinition of care practices in early childhood education, particularly in the nursery segments. We propose the construction of an ‘enabling environment’ is critical and should target not only babies but also educators.O primeiro ano de vida constitui um período de extrema importância no que diz respeito ao desenvolvimento dos aspectos emocionais, psicomotores e cognitivos do ser humano. Esse desenvolvimento, porém, não se dá isoladamente da relação de cuidado em que o bebê está inserido. Winnicott, pediatra e psicanalista inglês, cuja teoria tomamos por base nesse trabalho, chama atenção para o caráter relacional da estruturação psíquica ao afirmar que o bebê não pode ser estudado à parte das interações nas quais e das quais ele se desenvolve. O autor entende que o ser humano já nasce com tendências no sentido do crescimento e desenvolvimento que, no entanto, só se confirmarão dadas certas condições favoráveis, constituindo o que ele chama de ‘ambiente facilitador’. Este é entendido não somente como o ambiente físico e o cuidado em si, mas também a atmosfera afetiva no qual ele é oferecido. O objetivo desse trabalho é tecer uma reflexão sobre o conceito de ambiente facilitador no atendimento de bebês de até um ano de idade no contexto da educação infantil. Buscamos também traçar o lugar que as práticas de cuidado assumiram nos diferentes momentos históricos da creche no Brasil, chamando atenção para o caráter sócio histórico do desprestígio com que as tarefas envolvendo o cuidar são percebidas ainda hoje. A metodologia adotada é a pesquisa bibliográfica exploratória não sistemática. A discussão aponta para a necessidade de uma ressignificação das práticas de cuidado na educação infantil, principalmente nos segmentos da creche. Propomos que a construção de um ambiente facilitador é fundamental e deve ter como alvo não somente os bebês, mas também as educadoras
Modelling and simulation of fluidized-bed boilers and gasifiers for carbonaceous solids.
No full textSUMMARY
A comprehensive computer simulation program that
can deal with a wide range of different operating
conditions in fluidized bed combustion and gasification has
been developed.
It includes the possibility of simulating
operations with various types of coal, charcoal or wood and
can predict the behaviour of a real unit by giving several
important performance parameters, such as:
(a) Emulsion and bubble gas composition profiles throughout
the bed height. The components included are: CO2 , CO, 02,
N 2 , H2 0, H2 , CH4 , SO2 , NO, C2 H 6 , H2 S, NH3 and Tar.
(b) Gas phase composition throughout the freeboard height.
(c) Solid compositions of the coal (or any other
carbonaceous material), limestone and inert in the bed and
throughout the freeboard. The considered components are: C,
H, 0, N, S, ash, volatiles, moisture in the coal, CaCO3,
CaO, CaSO4 , moisture in the limestone, Si0 2 , and moisture
in the inert.
(d) Temperature profiles of all phases throughout the bed
and the freeboard.
(e) Solid particle size distributions in the bed and in the
freeboard sections. The considered effects are:
elutriation, entrainment, attrition and recycling in all
the three possible types of solid phases present;
(f) Heat transfered to water/steam inside the tubes, steam
production and tube surface temperatures in the case of
boiler simulation
Influências dos fatores organizacionais no estresse de profissionais bombeiros
No full textDissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Filosofia e Ciências Humanas. Programa de Pós-Graduação em Psicologia.A pesquisa realizada com os integrantes do Corpo de Bombeiros Militar do Estado Alfa tinha por objetivo a identificação, por meio da percepção dos bombeiros, dos principais fatores organizacionais que estavam associados ao estresse profissional, nas suas atividades de trabalho. A investigação sobre o estresse psicológico foi estruturada em duas etapas. A primeira etapa do programa de pesquisa foi desenvolvida com a aplicação do Inventário de Sintomas de Stress para Adultos de Lipp - ISSL (1998). O instrumento de pesquisa serviu para a identificação dos sintomas e os níveis (fases) de estresse na amostra de bombeiros que desempenhavam atividades operacionais e administrativas, em cinco locais diferentes dos municípios "A" e "B". Na segunda etapa da pesquisa foi utilizada a técnica de entrevista semi-estruturada com 28 bombeiros identificados com sintomas de estresse, os quais foram reunidos em cinco grupos-alvo, conforme as fases de estresse em que se encontravam. O roteiro da entrevista semi-estruturada foi elaborado com base nos fatores do modelo teórico de Maslach e Leiter (1999), utilizados para avaliar o bem-estar das pessoas: trabalho, remuneração, equidade, valores, união e controle. Foram identificados 130 bombeiros com sintomas de estresse, dentre os 235 participantes da pesquisa, com a distribuição das ocorrências nas quatro fases do ISSL. Os resultados mostraram que 55,31 % dos bombeiros com estresse eram profissionais com a idade média de 37,7 anos e com tempo médio de serviço de 16 anos. A análise do conteúdo informacional reportado pelos bombeiros participantes dos cinco grupos-alvo destacou o fator das relações de trabalho, a sobrecarga de serviço, a qualificação profissional e a falta de um suporte psicológico, como os principais fatores associados ao estresse profissional. O instrumento e a técnica utilizados no desenvolvimento do programa de pesquisa mostraram-se adequados para a identificação dos principais fatores que estavam associados ao estresse profissional em bombeiros nas suas atividades de trabalho
Processo de trabalho e saúde do professor do ensino médio: uma abordagem ergonômica
No full textTese (doutorado) - Universidade Federal de Santa Catarina, Centro Tecnológico. Programa de Pós-Graduação em Engenharia de Produção.O trabalho do professor, assim como o trabalho do engenheiro, do médico, do mecânico, etc., assemelha-se de uma forma geral, pelo menos em um ponto: a existência fundamental das relações entre as exigências do trabalho e as condições de realização do trabalho, as quais se denominam genericamente de cargas de trabalho, conseqüência dos constrangimentos impostos ao trabalhador durante a realização do trabalho. Este estudo teve como objetivo caracterizar as cargas de trabalho existentes no trabalho docente do ensino médio do Instituto Estadual de Educação do Estado de Santa Catarina. Buscou-se também levantar os possíveis distúrbios provenientes de estratégias limitantes. Pretendeu-se responder à seguinte questão de pesquisa: quais as estratégias operatórias utilizadas, pelos professores do ensino médio do IEE, no enfrentamento dos constrangimentos da situação de trabalho e a influência dessas estratégias no processo saúde/doença do professor? Para responder essa pergunta, foi utilizada, como base para este entendimento, a metodologia de Análise Ergonômica do Trabalho (AET) e aplicação do conceito de carga de trabalho. Por meio do detalhamento da situação e do levantamento de elementos caracterizadores da carga de trabalho, pretendeu-se mostrar a relação do contexto com a atividade e o que isto resulta na Carga de Trabalho. Os resultados apontam que o trabalho docente apresenta, basicamente, cargas cognitivas, psíquicas, fisiológicas e físicas e que estas se manifestam em vários níveis, no nível do ambiente, no nível do comportamento, no nível das capacidades, no nível das crenças e valores e no nível da identidade. Também foi possível constatar que o uso de estratégias limitantes (ou ineficientes) intensifica a carga de trabalho e conseqüentemente o aumento da possibilidade do surgimento de alguns distúrbios potencialmente prejudiciais à saúde do professor. A existência da elevada intensidade das cargas de trabalho fica evidente nessa atividade, porém o grau de intensidade dessa carga (moderada ou alta) irá depender das estratégias utilizadas pelos professores. The teacher's occupation, such as the engineer's, doctor's, lathe operator's occupation, etc., are in general similar towards at least one aspect: the fundamental existence of relationships between work requirements and the conditions for the accomplishment of the activities. These relationships are generically termed as work load and they are consequence of constraints imposed to the worker during the accomplishment of his activities, in this case, the teaching activity. Survey and analysis of teaching loads allow determining elements related to the perception of working conditions, risks and evidences related to occupational illness. This study aimed the characterization of work loads on the teaching activities of a high school located in Santa Catarina State. This study also intended to survey possible disturbs resulting from limiting strategies. The research aimed to come up with an answer to the following questions: which are the operational strategies utilized by the high school teacher in order to deal with constraints on the working environment and what is influence of these strategies on the health/illness teacher's condition. In order to obtain answers, the Working Ergonomic Analysis (WEA) methodology and the application of the working load concept were used as basis for understanding. By means of the situation analysis and through the assessment of the teaching load characterizing aspects, the study intended to point out the relation existing between the teaching context and the teaching activity and further to determine their result on the work load. The results point out that the teaching activity basically has cognitive, psychic, physiologic and physical loads and these loads appear in different levels, such as on the working environment, on the behavioral, capability; beliefs and value, and identity levels. It was also possible to find out that the use of limiting (or inefficient) strategies intensifies the working load and consequently increases the possibility of appearance of potentially harmful disturbs to the teacher's health. The existence of these intensive loads is self evidentiary in this activity; however, the degree of this load (moderate or high) will depend on the strategies utilized by teachers
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