Late dead space fraction (fDlate) before and after pulmonary embolectomy

This report presents data on the late dead space fraction (fDlate) of a patient submitted to surgical pulmonary embolectomy. Pulmonary thromboembolism (PTE) was diagnosed by echo-Doppler ultrasound of the lower limbs, lung scintigraphy, computerized helical tomography and angiography. The fDlate was calculated based on volumetric capnography as well as on arterial blood gases according to ERIKSSON et al. [1]. The preoperative fDlate value was 0.16, which was considered positive for the diagnosis of PTE, as it was higher than the cut-off point of 0.12. The postoperative fDlate value was - 0.04, which was below 0.12 and was characterized as negative. The agreement of fDlate with the imaging results confirms the validity of this new, noninvasive diagnostic tool.Este relato de caso apresenta os resultados da fDlate (fração tardia de espaço morto) em um paciente submetido a embolectomia por tromboembolismo pulmonar (TEP). O TEP foi diagnosticado por ultrassonografia ecodoppler de membros inferiores, cintilografia pulmonar, tomografia helicoidal computadorizada e arteriografia pulmonar. O cálculo da fDlate se baseou na capnografia volumétrica e na gasometria arterial de acordo com ERIKSSON et al. [1]. A fDlate pré-operatória foi de 0,16 e foi considerada positiva por estar acima do valor de corte de 0,12. A fDlate pós-operatória foi de - 0,04, um valor inferior ao valor de corte de 0,12 e foi caracterizada como negativa. A correlação da fDlate com os resultados de imagem confirma a validade desta nova ferramenta diagnóstica não-invasiva.818

The effect of subconjunctival bevacizumab on corneal neovascularization, inflammation and re-epithelization in a rabbit model

PURPOSE: To evaluate the use of subconjunctival bevacizumab on corneal neovascularization in an experimental rabbit model for its effect on vessel extension, inflammation, and corneal epithelialization. METHODS: In this prospective, randomized, blinded, experimental study, 20 rabbits were submitted to a chemical trauma with sodium hydroxide and subsequently divided into two groups. The experimental group received a subconjunctival injection of bevacizumab (0.15 m; 3.75 mg), and the control group received an injection of 0.15 ml saline solution. After 14 days, two blinded digital photograph analyses were conducted to evaluate the inflammation/diameter of the vessels according to pre-established criteria. A histopathological analysis of the cornea evaluated the state of the epithelium and the number of polymorphonuclear cells. RESULTS: A concordance analysis using Kappa's statistic showed a satisfactory level of agreement between the two blinded digital photography analyses. The neovascular vessel length was greater in the control group (p<0.01) than in the study group. However, the histopathological examination revealed no statistically significant differences between the groups in terms of the state of the epithelium and the number of polymorphonuclear cells. CONCLUSIONS: Subconjunctival bevacizumab inhibited neovascularization in the rabbit cornea. However, this drug was not effective at reducing inflammation. The drug did not induce persistent corneal epithelial defects

Environmental education in São Gabriel da Palha, Espírito Santo, Brazil: An analysis of the municipal solid waste management / Educação ambiental em São Gabriel da Palha, Espírito Santo, Brazil: Uma análise da gestão municipal de resíduos sólidos

Due to the creation of Law No.12,305/2010, responsible for establishing the National Policy on Solid Waste, the existence of open dumps in Brazil came into question, since it became prohibited, which consequently brought the need to change the form of solid waste management in the country. From this perspective, the Association of Recyclable Materials Collectors (ASCAT) was established with the responsibility for carrying out various activities with waste. In the municipality of São Gabriel da Palha, the ASCAT was installed in the former dependencies of the open dump. With the enactment of Law No. 12,305/2010, the site underwent some changes, and the solid waste was destined for trenches that were later grounded. However, it can be seen from a street-based approach, that a significant part of the population believes that ASCAT still works on an open dump. In this way, this article proposes to present a synthesis about the reasons that cause the lack of knowledge of the citizens on subjects related to the correct destination of garbage in the municipality itself, as well as a presentation of the work of ASCAT and, finally, a study of the area where the waste was dumped

Model of single-sized endotracheal tube for adults

Simular diferentes diâmetros de tubos endotraqueais e verificar os aspectos fluidinâmicos, considerando medições de fluxo e resistência. Foi utilizado um software de fluidinâmica para calcular o fluxo médio e a resistência das vias aéreas nos tubos endotraqueais com diâmetro de 6,0, 7,0, 7,5, 8,0, 9,0 e 10,0mm, em temperatura corporal normal e pressão constante. As mesmas medidas foram realizadas na fusão dos primeiros 22cm de um tubo endotraqueal de 9,0 e 10,0mm de diâmetro, com a parte terminal em 12cm de um tubo endotraqueal de 6,0 e 7,0mm de diâmetro. A fusão dos primeiros 22cm de um tubo endotraqueal de diâmetro 10,0 mm com a parte terminal em 12cm de um tubo endotraqueal de 6,0mm de diâmetro, preservando o comprimento total de 34cm, gerou fluxo médio e resistência de vias aéreas semelhantes aos de um tubo endotraqueal convencional de 7,5mm. Um tubo endotraqueal de tamanho único pode facilitar a intubação endotraqueal, sem causar aumento de resistência na via aérea1814To simulate different diameters of endotracheal tubes and to verify the fluid dynamics aspects by means of flow and resistance measurements. Fluid dynamics software was used to calculate mean flow and airway resistance in endotracheal tube with a diameter of 6.0, 7.0, 7.5, 8.0, 9.0 and 10.0mm at normal body temperature and under constant pressure. The same measurements were taken in the fusion of the first 22cm of a 9.0mm endotracheal tube with 10.0mm diameter, and with the end part in 12cm of a 6.0mm endotracheal tube with 7.0mm diameter. The fusion of the first 22cm of an endotracheal tube of 10.0mm diameter with the terminal part in 12cm of an endotracheal tube of 6.0mm diameter, preserving the total length of 34cm, generated average flow and airway resistance similar to that of a conventional 7.5mm endotracheal tube. This simulation study demonstrates that a single-sized endotracheal tube may facilitate endotracheal intubation without causing increased airway resistance

Petco(2), Vco2 and corpp values in the successful prediction of the return of spontaneous circulation: an experimental study on unassisted induced cardiopulmonary arrest

During cardiac arrest, end-tidal CO2 (PetCO(2)), VCO2 and coronary perfusion pressure fall abruptly and tend to return to normal levels after an effective return of spontaneous circulation. Therefore, the monitoring of PetCO(2) and VCO2 by capnography is a useful tool during clinical management of cardiac arrest patients. To assess if PetCO(2), VCO2 and coronary perfusion pressure are useful for the prediction of return of spontaneous circulation in an animal model of cardiac arrest/cardiopulmonary resuscitation treated with vasopressor agents. 42 swine were mechanically ventilated (FiO(2)=0.21). Ventricular fibrillation was induced and, after 10 min, unassisted cardiac arrest was initiated, followed by compressions. After 2 min of basic cardiopulmonary resuscitation, each group received: Adrenaline, Saline-Placebo, Terlipressin or Terlipressin + Adrenaline. Two minutes later (4th min of cardiopulmonary resuscitation), the animals were defibrillated and the ones that survived were observed for an additional 30 min period. The variables of interest were recorded at the baseline period, 10 min of ventricular fibrillation, 2nd min of cardiopulmonary resuscitation, 4th min of cardiopulmonary resuscitation, and 30 min after return of spontaneous circulation. PetCO(2) and VCO2 values, both recorded at 2 min and 4 min of cardiopulmonary resuscitation, have no correlation with the return of spontaneous circulation rates in any group. On the other hand, higher values of coronary perfusion pressure at the 4th min of cardiopulmonary resuscitation have been associated with increased return of spontaneous circulation rates in the adrenaline and adrenaline + terlipressin groups. Although higher values of coronary perfusion pressure at the 4th min of cardiopulmonary resuscitation have been associated with increased return of spontaneous circulation rates in the animals that received adrenaline or adrenaline + terlipressin, PetCO(2) and VCO2 have not been shown to be useful for predicting return of spontaneous circulation rates in this porcine model316468473FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESP07/08315-0Fundo de Apoio ao Ensino, Pesquisa e Extensao (Faepex)-Unicam

Evaluation of respiratory impairment in patients with systemic lupus erythematosus with the six-minute walk test

AbstractObjectiveEvaluate SLE stable patients, without overt respiratory compromise, by means of 6MWT.Casuistic and methodsForty-five stable SLE patients were enrolled. The ATS/ERS protocol for 6MWT, was used and two parameters with cut-off points were chosen.ResultsForty-two patients were women. The mean age was 39 ± 11.4 years; mean duration of disease, 121 ± 93.1 months; mean value of MRC, 2 ± 0; mean FVC, 85.9 ± 34.2%; mean FEV1, 67.5 ± 21.6%; mean MIP, 82 ± 58.4%; mean MEP, 78 ± 37.3%; mean heart rate at rest, 75 ± 12.8 bpm; mean respiratory rate at rest, 19 ± 5.3 bpm; mean 6MWD, 478 ± 82 m; mean SpO2 at rest was 98 ± 0.8%; mean fall in SpO2, 4 ± 6 points. When the study population was divided according to the 400-m walk distance cut-off value, the heart rate immediately before the test was significant lower in those participants who walked less than 400 m (p = 0.0043), just like the value of Borg scale (p = 0.0036); according to the presence of saturation ≥ 4, heart rate at the end of the test was significantly higher in those participants who were showing desaturation (p = 0.0170); MEP (p = 0.0282) and 6MWD (p = 0.0291) were signifi- cantly lower, and MIP showed a tendency towards being smaller (p = 0.0504). FVC < normal inferior limit was significantly associated with the group with desaturation (p = 0.0274).ConclusionCompared to 6MWD, desaturation was better suited to find the patients with the most compromised indexes in respiratory function tests

Eficácia do balonete do tubo endotraqueal sobre a traqueia: aspectos físicos e mecânicos

Introduction: The inflation pressure of the endotracheal tube cuff can cause ischemia of the tracheal mucosa at high pressures; thus, it can cause important tracheal morbidity and tracheal microaspiration of the oropharyngeal secretion, or it can even cause pneumonia associated with mechanical ventilation if the pressure of the cuff is insufficient. Objective: In order to investigate the effectiveness of the RUSCH® 7.5 mm endotracheal tube cuff, this study was designed to investigate the physical and mechanical aspects of the cuff in contact with the trachea. Methods: For this end, we developed an in vitro experimental model to assess the flow of dye (methylene blue) by the inflated cuff on the wall of the artificial material. We also designed an in vivo study with 12 Large White pigs under endotracheal intubation. We instilled the same dye in the oral cavity of the animals, and we analyzed the presence or not of leakage in the trachea after the region of the cuff after their deaths (animal sacrifice). All cuffs were inflated at the pressure of 30 cmH2O. Results: We observed the passage of fluids through the cuff in all in vitro and in vivo experimental models. Conclusion: We conclude that, as well as several other cuff models in the literature, the RUSCH® 7.5 mm tube cuffs are also not able to completely seal the trachea and thus prevent aspiration of oropharyngeal secretions. Other prevention measures should be taken.The inflation pressure of the endotracheal tube cuff can cause ischemia of the tracheal mucosa at high pressures, thus, it can cause important tracheal morbidity and tracheal microaspiration of the oropharyngeal secretion, or it can even cause pneumonia a294552558SEM INFORMAÇÃOSEM INFORMAÇÃODobell, A.R., The origins of endotracheal ventilation (1994) Ann Thorac Surg, 58 (2), pp. 578-584Mehta, S., Tracheal tube cuff pressure (1989) Anaesthesia, 44 (12), pp. 1001-1002Mehta, S., Mickiewicz, M., Pressure in large volume, low pressure cuffs: Its significance, measurement and regulation (1985) Intensive Care Med, 11 (5), pp. 267-272Luna, C.M., Legarreta, G., Esteva, H., Laffaire, E., Jolly, E.C., Effect of tracheal dilatation and rupture on mechanical ventilation using a low-pressure cuff tube (1993) Chest, 104 (2), pp. 639-640Bernhard, W.N., Yost, L., Turndorf, H., Danziger, F., Cuffed tracheal tubes--physical and behavioral characteristics (1982) Anesth Analg, 61 (1), pp. 36-41Nordin, U., The trachea and cuff-induced tracheal injury. An experimental study on causative factors and prevention (1977) Acta Otolaryngol Suppl, 345, pp. 1-71Sole, M.L., Su, X., Talbert, S., Penoyer, D.A., Kalita, S., Jimenez, E., Evaluation of an intervention to maintain endotracheal tube cuff pressure within therapeutic range (2011) Am J Crit Care, 20 (2), pp. 109-117Benumof, J.L., Cooper, S.D., Quantitative improvement in laryngoscopic view by optimal external laryngeal manipulation (1996) J Clin Anesth, 8 (2), pp. 136-140Keller, C., Brimacombe, J., Boehler, M., Loeckinger, A., Puehringer, F., The influence of cuff volume and anatomic location on pharyngeal, esophageal, and tracheal mucosal pressures with the esophageal tracheal combitube (2002) Anesthesiology, 96 (5), pp. 1074-1077Cooper, J.D., Grillo, H.C., The evolution of tracheal injury due to ventilatory assistance through cuffed tubes: A pathologic study (1969) Ann Surg, 169 (3), pp. 334-348Seegobin, R.D., Van Hasselt, G.L., Endotracheal cuff pressure and tracheal mucosal blood flow: Endoscopic study of effects of four large volume cuffs (1984) Br Med J (Clin Res Ed), 288 (6422), pp. 965-968Joseph, N.M., Sistla, S., Dutta, T.K., Badhe, A.S., Parija, S.C., Ventilator-associated pneumonia: A review (2010) Eur J Intern Med, 21 (5), pp. 360-368Dave, M.H., Koepfer, N., Madjdpour, C., Frotzler, A., Weiss, M., Tracheal fluid leakage in benchtop trials: Comparison of static versus dynamic ventilation model with and without lubrication (2010) J Anesth, 24 (2), pp. 247-252Lucangelo, U., Zin, W.A., Antonaglia, V., Petrucci, L., Viviani, M., Buscema, G., Effect of positive expiratory pressure and type of tracheal cuff on the incidence of aspiration in mechanically ventilated patients in an intensive care unit (2008) Crit Care Med, 36 (2), pp. 409-413Young, P.J., Burchett, K., Harvey, I., Blunt, M.C., The prevention of pulmonary aspiration with control of tracheal wall pressure using a silicone cuff (2000) Anaesth Intensive Care, 28 (6), pp. 660-665Dave, M.H., Frotzler, A., Spielmann, N., Madjdpour, C., Weiss, M., Effect of tracheal tube cuff shape on fluid leakage across the cuff: An in vitro study (2010) Br J Anaesth, 105 (4), pp. 538-543Pavlin, E.G., Vannimwegan, D., Hornbein, T.F., Failure of a high-compliance low-pressure cuff to prevent aspiration (1975) Anesthesiology, 42 (2), pp. 216-219Macrae, W., Wallace, P., Aspiration around high-volume, low-pressure endotracheal cuff (1981) Br Med J (Clin Res Ed), 283 (6301), p. 1220Windsor, H.M., Shanahan, M.X., Cherian, K., Chang, V.P., Tracheal injury following prolonged intubation (1976) Aust N Z J Surg, 46 (1), pp. 18-25Lewis, F.R., Jr., Schiobohm, R.M., Thomas, A.N., Prevention of complications from prolonged tracheal intubation (1978) Am J Surg, 135 (3), pp. 452-457Servin, S.O., Barreto, G., Martins, L.C., Moreira, M.M., Meirelles, L., Neto, J.A., Atraumatic endotracheal tube for mechanical ventilation (2011) Rev Bras Anestesiol, 61 (3), pp. 311-319Lima, L.C., Avelar, S.F., Westphal, F.L., Lima, I., Lung nodule, tracheal stenoses and coronary disease: How to approach when are all associated to? (2007) Rev Bras Cir Cardiovasc, 22 (3), pp. 359-361Conti, M., Pougeoise, M., Wurtz, A., Porte, H., Fourrier, F., Ramon, P., Management of postintubation tracheobronchial ruptures (2006) Chest, 130 (2), pp. 412-418Marjot, R., Pressure exerted by the laryngeal mask airway cuff upon the pharyngeal mucosa (1993) Br J Anaesth, 70 (1), pp. 25-29. , Erratum in: Br J Anaesth. 1993;70(6):711Peták, F., Janosi, T.Z., Myers, C., Fontao, F., Habre, W., Impact of elevated pulmonary blood flow and capillary pressure on lung responsiveness (2009) J Appl Physiol (1985), 107 (3), pp. 780-786Iglesias, J.L., Lanoue, J.L., Rogers, T.E., Inman, L., Turnage, R.H., Physiologic basis of pulmonary edema during intestinal reperfusion (1998) J Surg Res, 80 (2), pp. 156-163Dullenkopf, A., Gerber, A., Weiss, M., Fluid leakage past tracheal tube cuffs: Evaluation of the new Microcuff endotracheal tube (2003) Intensive Care Med, 29 (10), pp. 1849-1853Lomholt, N., A device for measuring the lateral wall cuff pressure of endotracheal tubes (1992) Acta Anaesthesiol Scand, 36 (8), pp. 775-778Young, P.J., Pakeerathan, S., Blunt, M.C., Subramanya, S., A low-volume, low-pressure tracheal tube cuff reduces pulmonary aspiration (2006) Crit Care Med, 34 (3), pp. 632-639Blunt, M.C., Young, P.J., Patil, A., Haddock, A., Gel lubrication of the tracheal tube cuff reduces pulmonary aspiration (2001) Anesthesiology, 95 (2), pp. 377-381Sanjay, P.S., Miller, S.A., Corry, P.R., Russell, G.N., Pennefather, S.H., The effect of gel lubrication on cuff leakage of double lumen tubes during thoracic surgery (2006) Anaesthesia, 61 (2), pp. 133-137A pressão de insuflação do balonete (cuff) do tubo endotraqueal tanto pode causar isquemia de mucosa traqueal em pressões elevadas, e assim ocasionar morbidade traqueal importante, quanto pode causar microaspiração traqueal de secreção de orofaringe ou,

Polpa cítrica úmida na terminação de cordeiros confinados:: desempenho e concentração de enzimas hepáticas

A indústria de produção de pectina gera um resíduo composto por pedúnculo, endocarpo, vesículas de suco, columela,&nbsp;sementes e minúsculas frações de epicarpo e mesocarpo de frutas cítricas, denominada Polpa Cítrica Úmida (WCP),&nbsp;que ainda não foi testada como alimento na nutrição de ovinos. Sendo assim, este estudo teve como objetivo avaliar o&nbsp;efeito da substituição parcial do milho pela WCP em dietas contendo elevado teor de concentrado sobre o desempenho&nbsp;e a concentração de enzimas hepáticas de cordeiros confinados. Quarenta e dois cordeiros machos (15 Santa Inês e&nbsp;27 ½ Dorper x Santa Inês), com 24,7 ± 1,5 kg de peso corporal e 60 ± 5 dias de idade foram distribuídos em delineamento&nbsp;de blocos completos casualizados. Dentro de cada bloco (n = 14), os cordeiros foram distribuídos aleatoriamente entreos tratamentos: 0WCP – dieta contendo 75,5% de milho moído, sem a inclusão de WCP; 20WCP – dieta contendo 20%&nbsp;de WCP em substituição ao milho moído; e 40WCP – dieta contendo 40% de WCP em substituição ao milho moído.&nbsp;O experimento teve duração de 70 dias, sendo dividido em 3 períodos experimentais (14 dias de adaptação as dietas&nbsp;e 2 períodos de 28 dias cada). As análises estatísticas foram realizadas utilizando o procedimento MIXED do SAS.&nbsp;Os polinômios ortogonais lineares e quadráticos foram utilizados para avaliar o efeito das dietas. Houve efeito quadrático&nbsp;para o consumo de matéria seca, PB, cinzas, extrato etéreo e CNF. A maior ingestão de MS e PB foi observada para os&nbsp;cordeiros alimentados com 20WCP, entretanto, a dieta controle aumentou o consumo de cinzas, extrato etéreo e CNF.&nbsp;O aumento na inclusão de WCP diminuiu o ganho médio diário e a eficiência alimentar durante o período de adaptação,entretanto, não afetou essas variáveis durante os períodos 1 e 2. Consequentemente, a inclusão de WCP reduziu o peso&nbsp;corporal ao final do período experimental. Não houve efeito das dietas na concentração de gama-glutamil transferase&nbsp;(GGT). Entretanto, houve aumento linear na concentração de aspartato aminotransferase (AST) durante o período de&nbsp;adaptação. Em conclusão, a inclusão de até 40% de WCP nas dietas de terminação para cordeiros confinados diminuiu&nbsp;o desempenho durante o período de adaptação, comprometendo o peso corporal ao final do período experimental,&nbsp;entretanto, não comprometeu a afetou as enzimas hepáticas.&nbsp;Pectin industry generates a citrus pulp residue compounded by peduncle, endocarp, juice vesicles, columella, seeds and&nbsp;tiny fractions of epicarp and mesocarp of citrus fruits, denominated Wet Citrus Pulp (WCP), which has not yet been&nbsp;tested as food for lamb’s nutrition. Thus, this study aimed to determine the effect of partial replacement of ground corn&nbsp;by WCP in high-concentrate diets on the performance and hepatic enzyme concentration of feedlot lambs. Forty-two&nbsp;male lambs (15 Santa Inês and 27 ½ Dorper × Santa Inês), with 24.7 ± 1.5 kg of BW and 60 ± 5 d of age was assigned to&nbsp;a randomized complete block design. Within blocks (n = 14), lambs were randomly assigned to 1 of 3 treatments: 0WCP&nbsp;(control) – diet containing 75.5% ground corn without WCP; 20WCP – diet containing 20% WCP in replacement of&nbsp;ground corn, and 40WCP – diet containing 40% WCP in replacement of ground corn. The experiment lasted 70 days,&nbsp;which was split in 3 experimental periods (14 days of diets’ adaptation and 2 sub-periods of 28 days each). Statistical&nbsp;analyses were performed using the MIXED procedure of the SAS. Orthogonal polynomials for diet response were&nbsp;determined by linear and quadratic effects. There was a quadratic effect for DM, CP, ash, ether extract and NFC intake&nbsp;The highest DM and CP intake was observed for lambs fed 20WCP, however, the control diet increased the ash, ether&nbsp;extract and NFC intake. The increased levels of WCP decreased the ADG and feed efficiency (FE) during the adaptation&nbsp;period, however, did not affect the ADG and FE on periods 1 and 2. Consequently, the increased levels of WCP inclusion&nbsp;decreased linearly the BW. There was no effect of WCP inclusion in diets on Gamma-Glutamyl Transferase (GGT)&nbsp;concentration. However, there was a linear increase for Aspartate Aminotransferase (AST) concentration during the&nbsp;adaptation period, but without difference in other periods. In conclusion, adding up to 40% of WCP in finishing diets&nbsp;for feedlot lambs decrease performance during adaptation period, compromising the final body weight, but without&nbsp;damages effects on liver enzymes