Correlation between Extravascular Lung Water and Oxygenation in ALI/ARDS Patients in Septic Shock: Possible Role in the Development of Atelectasis?

This study aimed to evaluate the relationship between PaO2/FiO2 ratio and extravascular lung water in septic shock- induced acute respiratory distress syndrome in a prospective observational clinical trial. Twenty-three patients suffering from sepsis induced acute respiratory distress syndrome were recruited. All patients were ventilated in pressure control/support mode. Haemodynamic parameters were determined by arterial thermodilution (PiCCO) eight hourly for 72 hours. At the same time blood gas analyses were done and respiratory parameters were also recorded. Data are presented as mean±SD. For statistical analysis Pearson’s correlation test, and analysis of variance (ANOVA) was used respectively. Significant negative correlation was found between extravascular lung water and PaO2/FiO2 (r= –0.355, P<0.001), and significant positive correlation was shown between extravascular lung water and PEEP (r=0.557, P<0.001). A post-hoc analysis was performed when “low” PEEP: <10 cmH2O and “high” PEEP: (10 cmH2O PEEP was applied, and neither the oxygenation, nor the driving pressure or the PaCO2 differed significantly, but the extravascular lung water showed significant difference when “high” or “low” PEEP was applied (13±5 vs 9±2 ml/kg respectively, P=0.001). This study found significant negative correlation between extravascular lung water and PaO2/FiO2. The mechanism by which extravascular lung water affects oxygenation is unknown but the significant positive correlation between PEEP and extravascular lung water shown in this trial suggests that the latter may have a role in the development of alveolar atelectasis

Substituição total do farelo de soja por uréia ou amiréia, em dietas com alto teor de concentrado, sobre a amônia ruminal, os parâmetros sangüíneos e o metabolismo do nitrogênio em bovinos de corte Total replacement of soybean meal by urea or starea in high grain diets on nitrogen metabolism, ruminal ammonia-N concentration and blood parameters in beef cattle

Seis novilhos da raça Nelore, não castrados, com peso médio inicial de 420 kg, distribuídos em delineamento em quadrado latino 3x3 duplicado, foram utilizados para avaliar a substituição total de uma fonte de proteína verdadeira (farelo de soja), em uma dieta deficiente em proteína degradável no rúmen (PDR), por uréia ou amiréia (fontes de nitrogênio não protéico), ambas em uma dieta adequada em PDR. As dietas foram isoprotéicas (13,0%) utilizando-se o bagaço de cana-de-açúcar in natura (BIN) como única fonte de volumoso (20% da MS). Foram avaliados: a concentração de amônia ruminal, nitrogênio uréico plasmático, glicose plasmática e o metabolismo do nitrogênio. Os tratamentos foram: 1) farelo de soja (FS); 2) uréia e 3) amiréia (A-150S). A concentração de nitrogênio amoniacal no fluido ruminal foi superior no tratamento com uréia, comparado ao tratamento com farelo de soja, sendo que o tratamento com amiréia não diferiu dos demais. O tratamento com amiréia apresentou maior perda de N urinário. A retenção de N (g/d e % do consumido) e o valor biológico da proteína (N retido, % do N digerido) foram superiores para o tratamento com uréia, comparado aos demais. A concentração de nitrogênio uréico no plasma e a concentração de glicose plasmática foram similares entre os tratamentos. A substituição total do farelo de soja por uréia, ajustando a PDR na dieta de bovinos de corte, demonstrou ser viável. A uréia na forma convencional apresentou vantagens em relação à amiréia.<br>Six Nellore bulls, with initial body weight of 420 kg, were assigned to a duplicated 3x3 Latin square design to evaluate the effects of replacing a true protein source (soybean meal), of high biological value, in a rumen degradable protein (RDP) deficient diet, by urea or starea (a supposedly slow release nonprotein nitrogen source), both in a RDP adjusted diet. In natura sugarcane bagasse as the only source of forage (20% of DM). Evaluated parameters were: rumen ammonia-N concentration, plasma urea-N, glucose and nitrogen balance. Experimental treatments were: 1) soybean meal (SBM); 2) urea and 3) starea (A-150S). Diets were isonitrogen (13% CP). The rumen ammonia-N concentration was higher in the treatment with urea, compared to the treatment with SBM, and starea showed no difference compared to the others. Starea had higher loss of urinary N. N retention (g/d and % of consumed) and protein biological value (N retention, % of N digestible) were higher for urea treatment, compared to the others. There was no difference on plasma urea-N and glucose concentration among treatments. Total replacement of SBM by urea, adjusting PDR in diets for growing beef cattle, demonstrated to be viable. Conventional urea showed advantage compared to starea