Sentença judicial em mandado de injunção: efeitos das decisões do STF no controle da omissão inconstitucional

Diante da ausência de um entendimento consolidado entre os membros do Supremo Tribunal Federal sobre o efeito de suas decisões no controle da omissão constitucional, o presente trabalho tem como objeto de estudo a teoria da resolutividade, como sendo a mais adequada no contexto do Estado Constitucional. A relevância do tema encontra-se na importância de dar efetividade aos direitos obstados por uma omissão inconstitucional, sem ferir o disposto na Constituição Federal de 1988, em especial o princípio da separação dos poderes. Pretende-se fazer uma análise da passagem do Estado de Direito para o Estado Constitucional, para perceber que o Estado Constitucional não é caracterizado somente por uma plena normatividade, mas também por uma Constituição capaz de garantir os direitos fundamentais. O presente trabalho estuda também o constitucionalismo dirigente apresentado por Canotilho, pois a Constituição Dirigente não se contém em dispor sobre instruções políticas, mas carrega em seu conteúdo diretrizes a serem seguidas pelo Estado, para que ele possa cumprir as normas de direitos fundamentais. Após essas análises, trata-se acerca da teoria da omissão inconstitucional e sobre a dogmática processual de dois instrumentos jurídicos presentes na Constituição brasileira responsáveis pelo controle dessas omissões: a ação de inconstitucionalidade por omissão e o mandado de injunção. Em seguida, o trabalho expõe as teses jurídicas presentes no Brasil sobre os efeitos da decisão do Poder Judiciário proferida em mandado de injunção, bem como aborda a evolução da jurisprudência do Supremo Tribunal Federal acerca da natureza jurídica da sentença judicial em mandado de injunção, momento esse em que é possível perceber a existência de uma divergência sobre a posição a ser adotada. A conclusão final desse trabalho é de que a teoria da resolutividade é a mais adequada no contexto do Estado Constitucional, pois essa é a única posição que permite que o Poder Judiciário possa exercer o resguardo dos direitos e garantias fundamentais sem ferir o princípio da separação dos poderes

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.13Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt