Drummond, a cidade sem problemas

Este artigo tem por objetivo investigar o espaço configurado por Carlos Drummond de Andrade no poema “Retrato de uma cidade”, do livro Discurso de primavera – e algumas sombras, publicado em 1977. Primeiro, disseca-se a narrativa do poema que diz respeito a um tipo de cidade específico em Drummond (BISCHOF, 2005), a cidade aberta e desejável. Em seguida, desenvolve-se uma reflexão acerca da linguagem transparente (MALARD, 2005) com que se configura a narrativa, numa comparação comoutros tipos de linguagens (‘fechadas’) que configuram outras cidades em Drummond – por exemplo, a cidade temível em oposição à cidade desejável. A partir desses pressupostos, discute-se com base nas reflexões urbanísticas de Lynch (2011) e nas reflexões entre literatura e geografia de Moretti (2003) como tais dimensões, urbanísticas e geográficas, configuram, no poema, um espaço unitário, sem fissuras, e remetem, simultaneamente, a um espaço tanto físico como simbólico, atravessado por uma interpretação de Drummond da cultura carioca no seu todo. Conclui-se que a cidade representada, o “Outro” no poema, é vivenciada pelo eu-lírico como forma de conhecimento desse Outro, forma crítica baseada na noção de ‘desarraigamento’ proposta por Sennett (2003) - em que o ser se abre à recepção de estímulos externos em vez de se proteger de tais estímulos. É nessa abertura à recepção de estímulos externos que o eu-lírico vivencia o espaço urbano em sua unidade física e simbólica

Year in review 2005: Critical Care – resource management

During 2005 Critical Care published several original papers dealing with resource management. Emphasis was placed on sepsis, especially the coagulation cascade, prognosis and resuscitation. The papers highlighted important aspects of the pathophysiology of coagulation and inflammation in sepsis, as well as dealing with the proper use of newly developed compounds. Several aspects of prognosis in critically ill patients were investigated, focusing on biological markers and clinical indexes. Resuscitation received great attention, dealing with the effects of fluid infusion in hemodynamics and the lung. The information obtained can be used to address unknown effects of established therapies, to enlighten current clinical discussion on controversial topics, and to introduce novel medical resources and strategies. Future clinical work will rely heavily on these preclinical and laboratory data

The evolving story of medical emergency teams in quality improvement

Adverse events affect approximately 3% to 12% of hospitalized patients. At least a third, but as many as half, of such events are considered preventable. Detection of these events requires investments of time and money. A report in a recent issue of Critical Care used the medical emergency team activation as a trigger to perform a prospective standardized evaluation of charts. The authors observed that roughly one fourth of calls were related to a preventable adverse event, which is comparable to the previous literature. However, while previous studies relied on retrospective chart reviews, this study introduced the novel element of real-time characterization of events by the team at the moment of consultation. This methodology captures important opportunities for improvements in local care at a rate far higher than routine incident-reporting systems, but without requiring substantial investments of additional resources. Academic centers are increasingly recognizing engagement in quality improvement as a distinct career pathway. Involving such physicians in medical emergency teams will likely facilitate the dual roles of these as a clinical outreach arm of the intensive care unit and in identifying problems in care and leading to strategies to reduce them

An Assessment of H1N1 Influenza-Associated Acute Respiratory Distress Syndrome Severity after Adjustment for Treatment Characteristics

Pandemic influenza caused significant increases in healthcare utilization across several continents including the use of high-intensity rescue therapies like extracorporeal membrane oxygenation (ECMO) or high-frequency oscillatory ventilation (HFOV). The severity of illness observed with pandemic influenza in 2009 strained healthcare resources. Because lung injury in ARDS can be influenced by daily management and multiple organ failure, we performed a retrospective cohort study to understand the severity of H1N1 associated ARDS after adjustment for treatment. Sixty subjects were identified in our hospital with ARDS from “direct injury” within 24 hours of ICU admission over a three month period. Twenty-three subjects (38.3%) were positive for H1N1 within 72 hours of hospitalization. These cases of H1N1-associated ARDS were compared to non-H1N1 associated ARDS patients. Subjects with H1N1-associated ARDS were younger and more likely to have a higher body mass index (BMI), present more rapidly and have worse oxygenation. Severity of illness (SOFA score) was directly related to worse oxygenation. Management was similar between the two groups on the day of admission and subsequent five days with respect to tidal volumes used, fluid balance and transfusion practices. There was, however, more frequent use of “rescue” therapy like prone ventilation, HFOV or ECMO in H1N1 patients. First morning set tidal volumes and BMI were significantly associated with increased severity of lung injury (Lung injury score, LIS) at presentation and over time while prior prescription of statins was protective. After assessment of the effect of these co-interventions LIS was significantly higher in H1N1 patients. Patients with pandemic influenza-associated ARDS had higher LIS both at presentation and over the course of the first six days of treatment when compared to non-H1N1 associated ARDS controls. The difference in LIS persisted over the duration of observation in patients with H1N1 possibly explaining the increased duration of mechanical ventilation