Parâmetros reprodutivos e produtivos em vacas leiteiras de manejo free stall

Avaliou-se parâmetros reprodutivos e produtivos em vacas da raça Holandês-PB no pós-parto imediato, manejadas em free stall . Utilizou-se 51 vacas entre primíparas e pluríparas. Os valores obtidos foram: escore de condição corporal ao parto 3,47±0,4; intervalos do parto à primeira ovulação 5,89±3,4 semanas; ao primeiro serviço 112,5±57,0 dias; a taxa de gestação ao primeiro serviço foi 43,6% e no período experimental 76,4%, não sendo observada diferença para ordens de parto (P>0,05). A produção de leite acumulada à concepção, produção diária leite até a concepção e produção de leite ajustado para 305 foi respectivamente, 3.335,6±1.488,4; 25,8±5,4 e 7.424,0±1.877,8 litros. Conclui-se que no manejo de Free stall , a detecção de estro, foi o principal fator limitante para alcançar melhor eficiência reprodutiva.The reproductive and productive parameters in postpartum of 51 primiparous and pluriparous Holstein cows housed in free stall were obtained. The values measured were: body condition score at parturition (3.47±0.4), interval from parturition to first ovulation (5.89±3.4 weeks), interval parturition at first service (112.5±57.0 days), first-service pregnancy rate (43.6%) and during the experimental period (76.4%). No difference was found between parturition order (P>0.05). The accumulated milk production until conception time, daily production until conception time, and adjusted 305-day milk production was respectively 3,335.6±1,488.4; 25.8±5.4 and 7,424.0±1,877.8 liters. In free stall of this study the estrus detection was the most limiting factor to improve the reproductive efficiency

Sustained oxygenation improvement after first prone positioning is associated with liberation from mechanical ventilation and mortality in critically ill COVID-19 patients: a cohort study

none95noBackground: Prone positioning (PP) has been used to improve oxygenation in patients affected by the SARS-CoV-2 disease (COVID-19). Several mechanisms, including lung recruitment and better lung ventilation/perfusion matching, make a relevant rational for using PP. However, not all patients maintain the oxygenation improvement after returning to supine position. Nevertheless, no evidence exists that a sustained oxygenation response after PP is associated to outcome in mechanically ventilated COVID-19 patients. We analyzed data from 191 patients affected by COVID-19-related acute respiratory distress syndrome undergoing PP for clinical reasons. Clinical history, severity scores and respiratory mechanics were analyzed. Patients were classified as responders (≥ median PaO2/FiO2 variation) or non-responders (< median PaO2/FiO2 variation) based on the PaO2/FiO2 percentage change between pre-proning and 1 to 3 h after re-supination in the first prone positioning session. Differences among the groups in physiological variables, complication rates and outcome were evaluated. A competing risk regression analysis was conducted to evaluate if PaO2/FiO2 response after the first pronation cycle was associated to liberation from mechanical ventilation. Results: The median PaO2/FiO2 variation after the first PP cycle was 49 [19–100%] and no differences were found in demographics, comorbidities, ventilatory treatment and PaO2/FiO2 before PP between responders (96/191) and non-responders (95/191). Despite no differences in ICU length of stay, non-responders had a higher rate of tracheostomy (70.5% vs 47.9, P = 0.008) and mortality (53.7% vs 33.3%, P = 0.006), as compared to responders. Moreover, oxygenation response after the first PP was independently associated to liberation from mechanical ventilation at 28 days and was increasingly higher being higher the oxygenation response to PP. Conclusions: Sustained oxygenation improvement after first PP session is independently associated to improved survival and reduced duration of mechanical ventilation in critically ill COVID-19 patients.noneScaramuzzo G.; Gamberini L.; Tonetti T.; Zani G.; Ottaviani I.; Mazzoli C.A.; Capozzi C.; Giampalma E.; Bacchi Reggiani M.L.; Bertellini E.; Castelli A.; Cavalli I.; Colombo D.; Crimaldi F.; Damiani F.; Fusari M.; Gamberini E.; Gordini G.; Laici C.; Lanza M.C.; Leo M.; Marudi A.; Nardi G.; Papa R.; Potalivo A.; Russo E.; Taddei S.; Consales G.; Cappellini I.; Ranieri V.M.; Volta C.A.; Guerin C.; Spadaro S.; Tartaglione M.; Chiarini V.; Buldini V.; Coniglio C.; Moro F.; Barbalace C.; Citino M.; Cilloni N.; Giuntoli L.; Bellocchio A.; Matteo E.; Pizzilli G.; Siniscalchi A.; Tartivita C.; Matteo F.; Marchio A.; Bacchilega I.; Bernabe L.; Guarino S.; Mosconi E.; Bissoni L.; Viola L.; Meconi T.; Pavoni V.; Pagni A.; Pompa Cleta P.; Cavagnino M.; Malfatto A.; Adduci A.; Pareschi S.; Melegari G.; Maccieri J.; Marinangeli E.; Racca F.; Verri M.; Falo G.; Marangoni E.; Boni F.; Felloni G.; Baccarini F.D.; Terzitta M.; Maitan S.; Becherucci F.; Parise M.; Masoni F.; Imbriani M.; Orlandi P.; Monetti F.; Dalpiaz G.; Golfieri R.; Ciccarese F.; Poerio A.; Muratore F.; Ferrari F.; Mughetti M.; Franchini L.; Neziri E.; Miceli M.; Minguzzi M.T.; Mellini L.; Piciucchi S.; Bartolucci M.Scaramuzzo G.; Gamberini L.; Tonetti T.; Zani G.; Ottaviani I.; Mazzoli C.A.; Capozzi C.; Giampalma E.; Bacchi Reggiani M.L.; Bertellini E.; Castelli A.; Cavalli I.; Colombo D.; Crimaldi F.; Damiani F.; Fusari M.; Gamberini E.; Gordini G.; Laici C.; Lanza M.C.; Leo M.; Marudi A.; Nardi G.; Papa R.; Potalivo A.; Russo E.; Taddei S.; Consales G.; Cappellini I.; Ranieri V.M.; Volta C.A.; Guerin C.; Spadaro S.; Tartaglione M.; Chiarini V.; Buldini V.; Coniglio C.; Moro F.; Barbalace C.; Citino M.; Cilloni N.; Giuntoli L.; Bellocchio A.; Matteo E.; Pizzilli G.; Siniscalchi A.; Tartivita C.; Matteo F.; Marchio A.; Bacchilega I.; Bernabe L.; Guarino S.; Mosconi E.; Bissoni L.; Viola L.; Meconi T.; Pavoni V.; Pagni A.; Pompa Cleta P.; Cavagnino M.; Malfatto A.; Adduci A.; Pareschi S.; Melegari G.; Maccieri J.; Marinangeli E.; Racca F.; Verri M.; Falo G.; Marangoni E.; Boni F.; Felloni G.; Baccarini F.D.; Terzitta M.; Maitan S.; Becherucci F.; Parise M.; Masoni F.; Imbriani M.; Orlandi P.; Monetti F.; Dalpiaz G.; Golfieri R.; Ciccarese F.; Poerio A.; Muratore F.; Ferrari F.; Mughetti M.; Franchini L.; Neziri E.; Miceli M.; Minguzzi M.T.; Mellini L.; Piciucchi S.; Bartolucci M

Health-related quality of life profiles, trajectories, persistent symptoms and pulmonary function one year after ICU discharge in invasively ventilated COVID-19 patients, a prospective follow-up study

none112siBackground: Health-related quality of life (HRQoL) impairment is often reported among COVID-19 ICU survivors, and little is known about their long-term outcomes. We evaluated the HRQoL trajectories between 3 months and 1 year after ICU discharge, the factors influencing these trajectories and the presence of clusters of HRQoL profiles in a population of COVID-19 patients who underwent invasive mechanical ventilation (IMV). Moreover, pathophysiological correlations of residual dyspnea were tested. Methods: We followed up 178 survivors from 16 Italian ICUs up to one year after ICU discharge. HRQoL was investigated through the 15D instrument. Available pulmonary function tests (PFTs) and chest CT scans at 1 year were also collected. A linear mixed-effects model was adopted to identify factors associated with different HRQoL trajectories and a two-step cluster analysis was performed to identify HRQoL clusters. Results: We found that HRQoL increased during the study period, especially for the significant increase of the physical dimensions, while the mental dimensions and dyspnea remained substantially unchanged. Four main 15D profiles were identified: full recovery (47.2%), bad recovery (5.1%) and two partial recovery clusters with mostly physical (9.6%) or mental (38.2%) dimensions affected. Gender, duration of IMV and number of comorbidities significantly influenced HRQoL trajectories. Persistent dyspnea was reported in 58.4% of patients, and weakly, but significantly, correlated with both DLCO and length of IMV. Conclusions: HRQoL impairment is frequent 1 year after ICU discharge, and the lowest recovery is found in the mental dimensions. Persistent dyspnea is often reported and weakly correlated with PFTs alterations. Trial registration: NCT04411459.mixedGamberini L.; Mazzoli C.A.; Prediletto I.; Sintonen H.; Scaramuzzo G.; Allegri D.; Colombo D.; Tonetti T.; Zani G.; Capozzi C.; Dalpiaz G.; Agnoletti V.; Cappellini I.; Melegari G.; Damiani F.; Fusari M.; Gordini G.; Laici C.; Lanza M.C.; Leo M.; Marudi A.; Papa R.; Potalivo A.; Montomoli J.; Taddei S.; Mazzolini M.; Ferravante A.F.; Nicali R.; Ranieri V.M.; Russo E.; Volta C.A.; Spadaro S.; Tartaglione M.; Chiarini V.; Buldini V.; Coniglio C.; Moro F.; Orlando S.; Fecarotti D.; Cilloni N.; Giuntoli L.; Bellocchio A.; Matteo E.; Pizzilli G.; Siniscalchi A.; Tartivita C.; Cavalli I.; Castelli A.; Marchio A.; Bacchilega I.; Bernabe L.; Facondini F.; Morini L.; Bissoni L.; Viola L.; Meconi T.; Pavoni V.; Venni A.; Pagni A.; Cleta P.P.; Cavagnino M.; Guzzo A.; Malfatto A.; Adduci A.; Pareschi S.; Bertellini E.; Maccieri J.; Marinangeli E.; Racca F.; Verri M.; Falo G.; Marangoni E.; Ottaviani I.; Boni F.; Felloni G.; Baccarini F.D.; Terzitta M.; Maitan S.; Tutino L.; Senzi A.; Consales G.; Becherucci F.; Imbriani M.; Orlandi P.; Candini S.; Golfieri R.; Ciccarese F.; Poerio A.; Muratore F.; Ferrari F.; Mughetti M.; Giampalma E.; Franchini L.; Neziri E.; Miceli M.; Minguzzi M.T.; Mellini L.; Piciucchi S.; Monari M.; Valli M.; Daniele F.; Ferioli M.; Nava S.; Lazzari Agli L.A.; Valentini I.; Bernardi E.; Balbi B.; Contoli M.; Padovani M.; Oldani S.; Ravaglia C.; Goti P.Gamberini L.; Mazzoli C.A.; Prediletto I.; Sintonen H.; Scaramuzzo G.; Allegri D.; Colombo D.; Tonetti T.; Zani G.; Capozzi C.; Dalpiaz G.; Agnoletti V.; Cappellini I.; Melegari G.; Damiani F.; Fusari M.; Gordini G.; Laici C.; Lanza M.C.; Leo M.; Marudi A.; Papa R.; Potalivo A.; Montomoli J.; Taddei S.; Mazzolini M.; Ferravante A.F.; Nicali R.; Ranieri V.M.; Russo E.; Volta C.A.; Spadaro S.; Tartaglione M.; Chiarini V.; Buldini V.; Coniglio C.; Moro F.; Orlando S.; Fecarotti D.; Cilloni N.; Giuntoli L.; Bellocchio A.; Matteo E.; Pizzilli G.; Siniscalchi A.; Tartivita C.; Cavalli I.; Castelli A.; Marchio A.; Bacchilega I.; Bernabe L.; Facondini F.; Morini L.; Bissoni L.; Viola L.; Meconi T.; Pavoni V.; Venni A.; Pagni A.; Cleta P.P.; Cavagnino M.; Guzzo A.; Malfatto A.; Adduci A.; Pareschi S.; Bertellini E.; Maccieri J.; Marinangeli E.; Racca F.; Verri M.; Falo G.; Marangoni E.; Ottaviani I.; Boni F.; Felloni G.; Baccarini F.D.; Terzitta M.; Maitan S.; Tutino L.; Senzi A.; Consales G.; Becherucci F.; Imbriani M.; Orlandi P.; Candini S.; Golfieri R.; Ciccarese F.; Poerio A.; Muratore F.; Ferrari F.; Mughetti M.; Giampalma E.; Franchini L.; Neziri E.; Miceli M.; Minguzzi M.T.; Mellini L.; Piciucchi S.; Monari M.; Valli M.; Daniele F.; Ferioli M.; Nava S.; Lazzari Agli L.A.; Valentini I.; Bernardi E.; Balbi B.; Contoli M.; Padovani M.; Oldani S.; Ravaglia C.; Goti P

Factors influencing liberation from mechanical ventilation in coronavirus disease 2019: multicenter observational study in fifteen Italian ICUs

Background: A large proportion of patients with coronavirus disease 2019 (COVID-19) develop severe respiratory failure requiring admission to the intensive care unit (ICU) and about 80% of them need mechanical ventilation (MV). These patients show great complexity due to multiple organ involvement and a dynamic evolution over time; moreover, few information is available about the risk factors that may contribute to increase the time course of mechanical ventilation. The primary objective of this study is to investigate the risk factors associated with the inability to liberate COVID-19 patients from mechanical ventilation. Due to the complex evolution of the disease, we analyzed both pulmonary variables and occurrence of non-pulmonary complications during mechanical ventilation. The secondary objective of this study was the evaluation of risk factors for ICU mortality. Methods: This multicenter prospective observational study enrolled 391 patients from fifteen COVID-19 dedicated Italian ICUs which underwent invasive mechanical ventilation for COVID-19 pneumonia. Clinical and laboratory data, ventilator parameters, occurrence of organ dysfunction, and outcome were recorded. The primary outcome measure was 28 days ventilator-free days and the liberation from MV at 28 days was studied by performing a competing risks regression model on data, according to the method of Fine and Gray; the event death was considered as a competing risk. Results: Liberation from mechanical ventilation was achieved in 53.2% of the patients (208/391). Competing risks analysis, considering death as a competing event, demonstrated a decreased sub-hazard ratio for liberation from mechanical ventilation (MV) with increasing age and SOFA score at ICU admission, low values of PaO2/FiO2 ratio during the first 5 days of MV, respiratory system compliance (CRS) lower than 40 mL/cmH2O during the first 5 days of MV, need for renal replacement therapy (RRT), late-onset ventilator-associated pneumonia (VAP), and cardiovascular complications. ICU mortality during the observation period was 36.1% (141/391). Similar results were obtained by the multivariate logistic regression analysis using mortality as a dependent variable. Conclusions: Age, SOFA score at ICU admission, CRS, PaO2/FiO2, renal and cardiovascular complications, and late-onset VAP were all independent risk factors for prolonged mechanical ventilation in patients with COVID-19. Trial registration: NCT04411459