Lesão renal aguda após cirurgias não cardíacas: incidência e impacto das disfunções orgânicas extra-renais nos desfechos

Introdução: A permanência de pacientes em Unidades de Terapia Intensiva (UTI) é frequentemente complicada por Lesão Renal Aguda (LRA), principalmente em casos de sepse, baixo débito cardíaco e pós-operatório de grandes cirurgias. Objetivo: Avaliar a incidência, características, desenvolvimento de outras disfunções orgânicas, e desfechos de pacientes com LRA adquirida na UTI após cirurgias não cardíacas. Métodos: Estudo de coorte, prospectivo. Todos os pacientes internados consecutivamente nas UTIs após cirurgias não cardíacas nos meses de abril e maio de 2017 foram analisados quanto ao desenvolvimento ou não de LRA, de outras disfunções orgânicas e ao balanço hídrico. Resultados: A incidência de LRA foi de 16,2%. Os pacientes que desenvolveram LRA no pós-operatório eram mais graves, e diferiram quanto à necessidade de ventilação mecânica (60% vs. 11%, p < 0,001), uso de drogas vasoativas (82% vs. 44%, p = 0,021); presença de infecção (80% vs. 21%, p < 0,001), sepse ou choque séptico (50% vs. 9%, p < 0,001) e a outras complicações pós-operatórias (91% vs. 58%, p = 0,023). Outras disfunções de órgãos e sistemas foram mais fre-quentes nos pacientes com IRA (2 [2-3] vs. 1 [0-1], p < 0,001), particularmente disfunção gas-trointestinal (73% vs. 19%, p < 0,001) e cardiovascular (73% vs. 33%, p = 0,015). O número de pacientes com duas ou mais disfunções orgânicas aumentou de 21% para 82% em pacientes com LRA (RR 3,89, IC: 2,18 – 6,90, p < 0,001). O tempo de internação (13 ± 9 vs. 5 ± 6 dias, p < 0,001) e a mortalidade hospitalar (54,5% vs. 7%, p = 0,013) foram maiores nos pacientes com LRA. Conclusão: Entre pacientes com cirurgias não cardíacas e necessidade de UTI, a incidência de LRA é elevada e associada a complicações de outros sistemas, incluindo os sistemas neurológico, gastrointestinal, respiratório e cardiovascular; somandose a isso, balanço hídrico acumulado positivo, sepse e choque, maior tempo de internação e maiores taxas de mortalidade também foram encontrados nesses pacientes

Low-Level Laser Therapy Reduces Lung Inflammation in an Experimental Model of Chronic Obstructive Pulmonary Disease Involving P2X7 Receptor

Chronic obstructive pulmonary disease (COPD) is a progressive disease characterized by irreversible airflow limitation, airway inflammation and remodeling, and enlargement of alveolar spaces. COPD is in the top five leading causes of deaths worldwide and presents a high economic cost. However, there are some preventive measures to lower the risk of developing COPD. Low-level laser therapy (LLLT) is a new effective therapy, with very low cost and no side effects. So, our objective was to investigate if LLLT reduces pulmonary alterations in an experimental model of COPD. C57BL/6 mice were submitted to cigarette smoke for 75 days (2x/day). After 60 days to smoke exposure, the treated group was submitted to LLLT (diode laser, 660 nm, 30 mW, and 3 J/cm(2)) for 15 days and euthanized for morphologic and functional analysis of the lungs. Our results showed that LLLT significantly reduced the number of inflammatory cells and the proinflammatory cytokine secretion such as IL-1 beta, IL-6, and TNF-alpha in bronchoalveolar lavage fluid (BALF). We also observed that LLLT decreased collagen deposition as well as the expression of purinergic P2X7 receptor. On the other hand, LLLT increased the IL-10 release. Thus, LLLT can be pointed as a promising therapeutic approach for lung inflammatory diseases as COPD.Sao Paulo Research Foundation (FAPESP) [2012/16498-5, 2012/15165-2]FAPESP [2015/23152-6, 2014/14604-8, 2015/13486-4]Univ Nove Julho UNINOVE, Post Grad Program Biophoton Appl Hlth Sci, Sao Paulo, SP, BrazilBrazilian Inst Teaching & Res Pulm & Exercise Imm, Sao Jose Dos Campos, SP, BrazilUniv Nove Julho UNINOVE, Masters Degree & PhD Program Rehabil Sci, Expt Cardioresp Physiol Lab, Sao Paulo, SP, BrazilUniv Calif San Diego UCSD Hlth Sci, Div Trauma Surg Crit Care Burns & Acute Care Surg, Dept Surg, San Diego, CA USAFed Univ Sao Paulo UNIFESP, Inst Sci & Technol, Sao Jose Dos Campos, SP, BrazilUniv Brasil, Postgrad Program Bioengn, Sao Paulo, SP, BrazilFed Univ Sao Paulo UNIFESP, Postgrad Program Sci Human Movement & Rehabil, Santos, SP, BrazilFed Univ Sao Paulo UNIFESP, Inst Sci & Technol, Sao Jose Dos Campos, SP, BrazilFed Univ Sao Paulo UNIFESP, Postgrad Program Sci Human Movement & Rehabil, Santos, SP, BrazilFAPESP [2012/16498-5, 2012/15165-2]FAPESP [2015/23152-6, 2014/14604-8, 2015/13486-4]Web of Scienc

Synthesis of Controllers for Continuous-Time Delay Systems with Saturating Controls via LMI's

The stabilization of linear continuous-time systems with time delay in the state and subject to saturating controls is addressed. Sufficient conditions obtained via a linear matrix inequality (LMI) formulation are stated to guarantee both the local stabilization and the satisfaction of some performance requirements. The method of synthesis consists in determining simultaneously a state feedback control law and an associated domain of safe admissible states for which the stability of the closed-loop system is guaranteed when control saturations effectively occur

Antiwindup design with guaranteed regions of stability : an LMI-based approach

This note addresses the design of antiwindup gains for obtaining larger regions of stability for linear systems with saturating inputs. Considering that a linear dynamic output feedback has been designed to stabilize the linear system (without saturation), a method is proposed for designing an antiwindup gain that maximizes an estimate of the basin of attraction of the closed-loop system. It is shown that the closed-loop system obtained from the controller plus the antiwindup gain can be modeled by a linear system with a deadzone nonlinearity. A modified sector condition is then used to obtain stability conditions based on quadratic Lyapunov functions. Differently from previousworks these conditions are directly in linear matrix inequality form. Some numerical examples illustrate the effectiveness of the proposed design technique when compared with the previous ones

Local stabilization of discrete-time linear systems with saturating controls : an LMI-Based approach

This note deals with the problem of local stabilization of linear discrete-time systems subject to control saturation.Alinear matrix inequalitie- based framework is proposed in order to compute a saturating state feedback that stabilizes the system with respect to a given set of admissible initial states and, in addition, guarantees some dynamical performances when the system operates in the zone of linear behavior (i.e., when the controls are not saturated)

Polyhedral regions of local stability for linear discrete-time systems with saturating controls

The study and the determination of polyhedral regions of local stability for linear systems subject to control saturation is addressed. The analysis of the nonlinear behavior of the closed-loop saturated system is made by dividing the state space in regions of saturation. Inside each of these regions, the system evolution can be represented by a linear system with an additive disturbance. From this representation, a necessary and sufficient condition relative to the contractivity of a given convex compact polyhedral set is stated. Consequently, the polyhedral set can be associated with a Lyapunov function and the local asymptotic stability of the saturated closed-loop system inside the set is guaranteed. Furthermore, it is shown how, in some particular cases, the compactness condition can be relaxed in order to ensure the asymptotic stability in unbounded polyhedra. Finally, an application of the contractivity conditions is presented in order to determine local asymptotic stability regions for the closed-loop saturated system