VIOLÊNCIA CONTRA A MULHER: O CUIDADO PRÉ-NATAL E A IMPORTÂNCIA DA ATUAÇÃO HUMANIZADA

Objective: We aimed to analyze and identify the behaviors and strategies used by health professionals in the face of domestic violence during prenatal care. Results: It was observed in the literature that up to 59% of women, in various socioeconomic and cultural situations, will experience some moment of violence at least once in their lives, and it may be during the pregnancy period. It has been shown that the prevalence of physical violence in Brazil was 8% in the city of São Paulo and 11% in the Zona da Mata of the state of Pernambuco. According to the United Nations (UN), in 2016, Brazil was in 5th place in the world ranking of countries with the highest rates of violence against women. Final Considerations: Violence against women, in itself, is a complex and impactful social problem; when this violence happens during pregnancy, it is even more traumatic, with physical and psychological consequences not only for her but also for her children. The study demonstrated the importance of the humanized and holistic performance of health professionals who will accompany this pregnant woman, being fundamental to detect and intervene, aiming at a better quality of life.Objetivo: Se pretende analizar e identificar las conductas y estrategias utilizadas por los profesionales de la salud ante la violencia doméstica durante el prenatal. Resultados: Se observó en la literatura que hasta el 59% de las mujeres, en diversas situaciones socioeconómicas y culturales, experimentarán algún momento de violencia al menos una vez en su vida, y puede ser durante el período de embarazo. Se demostró que la prevalencia de la violencia física en Brasil era del 8% en la ciudad de São Paulo y del 11% en la Zona da Mata del Estado de Pernambuco. Según la Organización de las Naciones Unidas (ONU), en 2016, Brasil ocupó el 5º lugar en el ranking mundial de países con mayor índice de violencia contra las mujeres. Consideraciones finales: La violencia contra la mujer, en sí misma, es un problema social complejo y de gran impacto; cuando esta violencia ocurre durante el embarazo, es aún más traumática, con consecuencias físicas y psicológicas no sólo para ella sino también para sus hijos. El estudio demostró la importancia de la actuación humanizada y holística de los profesionales de la salud que van a acompañar a esta gestante, siendo esencial para detectar e intervenir, buscando una mejor calidad de vida.Objetivo: Objetiva-se analisar e identificar as condutas e estratégias utilizadas pelos profissionais de saúde diante da violência doméstica durante o pré-natal. Resultados: Observou-se na literatura que até 59% das mulheres, em várias situações socioeconômicas e culturais, passarão por algum momento de violência pelo menos uma vez na vida, podendo ser durante o período de gravidez.  Demonstrou-se que a prevalência de violência física no Brasil, foi de 8% na cidade de São Paulo e 11% na Zona da Mata do Estado de Pernambuco. De acordo com a Organização Nações Unidas (ONU), em 2016, o Brasil encontrava-se em 5º lugar ranking mundial dos países com maior índice de violência contra as mulheres.  Considerações Finais: A violência contra a mulher, por si só, é um problema social, complexo e impactante, quando essa violência acontece no decorrer do período gestacional é ainda mais traumático, com consequências físicas e psicológicas não só para ela como também para os filhos. O estudo demonstrou a importância da atuação humanizada e holística dos profissionais da saúde que acompanharão essa gestante, sendo fundamental para detectar e intervir, visando uma melhor qualidade de vida.Objetivo: Objetiva-se analisar e identificar as condutas e estratégias utilizadas pelos profissionais de saúde diante da violência doméstica durante o pré-natal. Resultados: Observou-se na literatura que até 59% das mulheres, em várias situações socioeconômicas e culturais, passarão por algum momento de violência pelo menos uma vez na vida, podendo ser durante o período de gravidez.  Demonstrou-se que a prevalência de violência física no Brasil, foi de 8% na cidade de São Paulo e 11% na Zona da Mata do Estado de Pernambuco. De acordo com a Organização Nações Unidas (ONU), em 2016, o Brasil encontrava-se em 5º lugar ranking mundial dos países com maior índice de violência contra as mulheres.  Considerações Finais: A violência contra a mulher, por si só, é um problema social, complexo e impactante, quando essa violência acontece no decorrer do período gestacional é ainda mais traumático, com consequências físicas e psicológicas não só para ela como também para os filhos. O estudo demonstrou a importância da atuação humanizada e holística dos profissionais da saúde que acompanharão essa gestante, sendo fundamental para detectar e intervir, visando uma melhor qualidade de vida

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