Qualidade e valor nutritivo de silagens de capim-marandu (B. brizantha cv. Marandu) produzidas com aditivos ou forragem emurchecida Quality and nutritive value of marandugrass (Brachiaria brizanthia, cv. Marandu) silage prepared with additive or wilting

Avaliaram-se a qualidade e o valor nutritivo de silagens de capim-marandu produzidas com polpa cítrica (PC) peletizada, com aditivo enzimático-bacteriano (ABE) ou com forragem emuchercida (E): T1 - forragem sem tratamento (controle); T2 - 10% de polpa cítrica peletizada (PC); T3 - aditivo enzimático bacteriano (AEB - SIL-ALL-C4 da Alltech), à base de 5 g/L de água/t de forragem; T4 - forragem picada grosseiramente emurchecida por 4 horas ao sol. O capim foi colhido aos 60 dias de rebrota (24% MS). Para avaliar o consumo e a digestibilidade das silagens, foram utilizados 16 novilhos mestiços com 200 kg de PV, que receberam, além das silagens, 1,0 kg de concentrado/animal/dia. O AEB não afetou a composição da silagem, mas a PC e o E aumentaram o teor de MS de 24% para 31 e 48%, respectivamente, e reduziram o pH e os teores de N-NH3 das silagens, que foram, respectivamente, de 4,17 e 4,58 e 6,78 e 7,99% NT. A PC diminuiu os teores de FDN e FDA em 12 e 4 unidades percentuais. O consumo de MS da silagem produzida com capim emurchecido foi superior (111,8 g MS/PV0,75) ao das silagens controle ou com AEB, mas não diferiu do obtido para a silagem com PC, que também não diferiu das demais. Os tratamentos não afetaram a digestibilidade, cujas médias para MS, PB, CT, FDN, FDA e NDT foram 67,0; 65,4; 68,8; 63,0; 62,5; e 65,6%, respectivamente. A PC e o E reduziram a proteólise e estimularam o consumo. A PC, o E e o AEB não melhoraram o valor nutritivo da silagem de capim-marandu colhido com 24% MS.<br>The objective of this experiment was to evaluate the quality and nutritive value of marandugrass silages. It was evaluated the followings treatments: T1- forage without treatment (control); T2 - 10% of pelleted citric pulp (CiP); T3 - enzymatic bacterial additive (EBA) (SIL-ALL-C4 of Alltech) applied at 5 g/L of water/t of forage; T4 - Coarse chopped forage wilted for 4 hours under the sun. The grass was harvested with 60 days of regrowth (24% DM). The intake and digestibility evaluations were realized in 16 crossbred steers with 200 kg of BW, which received silage plus 1.0 kg of concentrate/animal/day. The EBA did not affect silage composition, but CiP addition and wilting increased the DM silage concentration from 24% (control) to 31 and 48%, respectively. The CiP decreased the NDF and ADF concentration in 12.0 and 4.0 percentage units, respectively. The CiP and wilting decreased the pH values (4.17 and 4.58) and N-NH3 concentration (6.78 and 7.99% TN) of the silages, respectively. Wilting resulted in higher animal intake (111.8 g/DM/LW0,75) compared to control or EBA treatments. Addition of CiP resulted in similar DM intake compared to other silages. The treatments did not affect nutrient digestibility, and the mean digestibility values for DM, CP, TCHO, NDF, ADF and TDN were 67.0, 65.4, 68.8, 63.0, 62.5, and 65.6%, respectively. Proteolysis was not reduced by EBA while CiP or wilting decreased this process, stimulating intake. Addition of CiP, wilting and EBA did not improve the nutritive value of marandugrass silage harvested with 24% DM

Effect of lung recruitment and titrated Positive End-Expiratory Pressure (PEEP) vs low PEEP on mortality in patients with acute respiratory distress syndrome - A randomized clinical trial

IMPORTANCE: The effects of recruitment maneuvers and positive end-expiratory pressure (PEEP) titration on clinical outcomes in patients with acute respiratory distress syndrome (ARDS) remain uncertain. OBJECTIVE: To determine if lung recruitment associated with PEEP titration according to the best respiratory-system compliance decreases 28-day mortality of patients with moderate to severe ARDS compared with a conventional low-PEEP strategy. DESIGN, SETTING, AND PARTICIPANTS: Multicenter, randomized trial conducted at 120 intensive care units (ICUs) from 9 countries from November 17, 2011, through April 25, 2017, enrolling adults with moderate to severe ARDS. INTERVENTIONS: An experimental strategy with a lung recruitment maneuver and PEEP titration according to the best respiratory-system compliance (n = 501; experimental group) or a control strategy of low PEEP (n = 509). All patients received volume-assist control mode until weaning. MAIN OUTCOMES AND MEASURES: The primary outcome was all-cause mortality until 28 days. Secondary outcomes were length of ICU and hospital stay; ventilator-free days through day 28; pneumothorax requiring drainage within 7 days; barotrauma within 7 days; and ICU, in-hospital, and 6-month mortality. RESULTS: A total of 1010 patients (37.5% female; mean [SD] age, 50.9 [17.4] years) were enrolled and followed up. At 28 days, 277 of 501 patients (55.3%) in the experimental group and 251 of 509 patients (49.3%) in the control group had died (hazard ratio [HR], 1.20; 95% CI, 1.01 to 1.42; P = .041). Compared with the control group, the experimental group strategy increased 6-month mortality (65.3% vs 59.9%; HR, 1.18; 95% CI, 1.01 to 1.38; P = .04), decreased the number of mean ventilator-free days (5.3 vs 6.4; difference, −1.1; 95% CI, −2.1 to −0.1; P = .03), increased the risk of pneumothorax requiring drainage (3.2% vs 1.2%; difference, 2.0%; 95% CI, 0.0% to 4.0%; P = .03), and the risk of barotrauma (5.6% vs 1.6%; difference, 4.0%; 95% CI, 1.5% to 6.5%; P = .001). There were no significant differences in the length of ICU stay, length of hospital stay, ICU mortality, and in-hospital mortality. CONCLUSIONS AND RELEVANCE: In patients with moderate to severe ARDS, a strategy with lung recruitment and titrated PEEP compared with low PEEP increased 28-day all-cause mortality. These findings do not support the routine use of lung recruitment maneuver and PEEP titration in these patients. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01374022