Efeito da restrição alimentar qualitativa no desempenho, na incidência de distúrbios metabólicos e no rendimento de carcaça em frangos de corte Qualitative feed restriction effects on growth performance, metabolic disorders and carcass traits of broiler chickens

Este estudo foi realizado para avaliar o desempenho, o controle da manifestação de doenças metabólicas e o rendimento de carcaça de frangos de corte machos submetidos à restrição alimentar no período de 8 a 14 dias de idade. A restrição nutritiva da dieta foi obtida diluindo-se a dieta inicial (21,5% PB e 3050 kcal/kg EM) com 25 e 50% de casca de soja. Os tratamentos de restrição envolveram a oferta dessas dietas de forma contínua ou intercalada (com a dieta inicial não-diluída). Após o período de restrição, as aves retornaram ao consumo da ração inicial até os 21 dias de idade. No período seguinte, 22 a 35 dias de idade, as aves receberam ração de crescimento (21% PB e 3200 kcal/kg EM) e de 36 a 42 dias, ração final (19% PB e 3200 kcal/kg de EM). Após terem sido submetidas à restrição alimentar, as aves mostraram pesos corporais inferiores aos das aves do tratamento controle em todas as idades avaliadas. A diluição da dieta não influenciou a manifestação da síndrome ascítica ou morte súbita. Não houve diferença no rendimento de carcaça, peito e coxas. O conteúdo em gordura abdominal não mostrou diferenças consistentes entre tratamentos. Os tratamentos em que se utilizou a diluição com 50% de casca de soja apresentaram menor margem bruta. A estratégia nutricional, para reduzir as perdas por mortalidades de origem metabólica e o teor de gordura abdominal na carcaça foi acompanhada por perdas em termos de desempenho das aves.<br>This experiment was conducted to evaluate the performance, control of the of metabolic diseases incidence, and carcass yield of male broiler chickens allotted to a feed restriction from 8-14 days of age. The nutrient restriction was achieved by feeding a starter diet (21,5% CP and 3050 ME, kcal/kg) with 25 or 50% soybean hulls. The treatment of restriction involved the feeding of these diets either on continuously or intercalated form (with the non-diluted starter diet). After the restriction period, the birds returned to the regular starter diet up to 21 days of age. In the following period, from 22 to 35 days of age, the birds were fed a growing diet (21% CP - 3200 ME, kcal/kg) and from 36 to 42 days, a finishing diet (19% CP - 3200 ME, kcal/kg). After they have been submitted to the feed restriction, the birds showed lower body weights as compared to the control treatment for all ages. The diet dilution did not influence the incidence of ascites or sudden death syndromes. There were no differences on carcass breast or thigh yield. Abdominal fat content presented no consistent differences among treatment. The treatments with diet dilution of 50% of soybean hulls resulted on inferior gross margin. The nutritional strategy to reduce the losses by metabolic diseases and the abdominal carcass fat content was accomplished by losses on the performance of the birds

Efeito da restrição alimentar qualitativa sobre o ganho compensatório em frangos de corte Effects of qualitative feed restriction on compensatory growth in the broiler chicken

No presente estudo, aplicou-se a diluição qualitativa da dieta com o objetivo de determinar os efeitos das diferentes diluições (25% e 50%) das rações no desempenho de frangos de corte criados até 42 dias de idade. Utilizou-se, para a diluição, casca de soja na dieta inicial (21,5% de PB e 3.050 kcal/kg de EM), e os tratamentos experimentais foram baseados nessas dietas e distribuídos de forma contínua, durante sete dias, ou de forma intercalada, com a ração não diluída. Os tratamentos aplicados foram: T1: ração inicial (testemunha); T2 e T3: ração inicial diluída com 25% e 50% de casca de soja, respectivamente, fornecida durante sete dias; T4 e T5: ração inicial diluída com 25% e 50% de casca de soja, respectivamente, fornecida nos dias 7, 9, 11 e 13, intercalada com a ração testemunha nos dias 8,10 e 12. As aves sob restrição alimentar mostraram pesos corporais menores (P<0,05) em comparação com as aves do tratamento-testemunha. Não houve diferenças quanto a conversão alimentar acumulada (0-42 dias) entre os tratamentos da restrição. O oferecimento de forma intercalada das rações diluídas conferiu menores perdas no ganho de peso e no peso corporal. Não houve diferença quanto a mortalidades entre os tratamentos. As aves não apresentaram crescimento compensatório, o que parece estar associado ao padrão de curva de crescimento apresentada pela linhagem.<br>An experiment was conducted to determine the effects of the diet dilution on performance of broiler chickens until 42 days of age. Nutrient restriction was achieved by feeding a starter diet (CP 21.5% and ME 3,050 kcal/kg) in which the major ingredients were replaced with 25% or 50% of soybean hulls. Four treatments involved feeding the diluted diets for seven days (7-14 days of age), either continuous or split into periods with the undiluted diet (control). The treatments were: T1: control diet; T2 and T3: diluted diet (25% and 50% of soybean hulls, respectively) 7-14 days; T4 and T5: diluted diet (25% and 50% of soybean hulls, respectively) on days 7, 9, 11 and 13 alternating with T1 (on days 8, 10 and 12). The birds fed with diluted diets exhibited lower mean body weights (P<0.05) than controls. Feed conversion ratios from 0-42 days of age for restricted broilers were not different. Varying the period of nutrient restriction did not affect adversely body weight and body weight gain. There was no statistical difference in the overall mortality through 0-42 days among the dietary treatments. Compensatory growth was not observed, and this result could be associated with the pattern of growth curve exhibited by the hybrids used in this experiment

Death in hospital following ICU discharge : insights from the LUNG SAFE study

Altres ajuts: Italian Ministry of University and Research (MIUR)-Department of Excellence project PREMIA (PREcision MedIcine Approach: bringing biomarker research to clinic); Science Foundation Ireland Future Research Leaders Award; European Society of Intensive Care Medicine (ESICM), Brussels; St Michael's Hospital, Toronto; University of Milan-Bicocca, Monza, Italy.Background: To determine the frequency of, and factors associated with, death in hospital following ICU discharge to the ward. Methods: The Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE study was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted across 459 ICUs from 50 countries globally. This study aimed to understand the frequency and factors associated with death in hospital in patients who survived their ICU stay. We examined outcomes in the subpopulation discharged with no limitations of life sustaining treatments ('treatment limitations'), and the subpopulations with treatment limitations. Results: 2186 (94%) patients with no treatment limitations discharged from ICU survived, while 142 (6%) died in hospital. 118 (61%) of patients with treatment limitations survived while 77 (39%) patients died in hospital. Patients without treatment limitations that died in hospital after ICU discharge were older, more likely to have COPD, immunocompromise or chronic renal failure, less likely to have trauma as a risk factor for ARDS. Patients that died post ICU discharge were less likely to receive neuromuscular blockade, or to receive any adjunctive measure, and had a higher pre- ICU discharge non-pulmonary SOFA score. A similar pattern was seen in patients with treatment limitations that died in hospital following ICU discharge. Conclusions: A significant proportion of patients die in hospital following discharge from ICU, with higher mortality in patients with limitations of life-sustaining treatments in place. Non-survivors had higher systemic illness severity scores at ICU discharge than survivors. Trial Registration: ClinicalTrials.gov NCT02010073

Mechanical ventilation in patients with cardiogenic pulmonary edema : a sub-analysis of the LUNG SAFE study

Patients with acute respiratory failure caused by cardiogenic pulmonary edema (CPE) may require mechanical ventilation that can cause further lung damage. Our aim was to determine the impact of ventilatory settings on CPE mortality. Patients from the LUNG SAFE cohort, a multicenter prospective cohort study of patients undergoing mechanical ventilation, were studied. Relationships between ventilatory parameters and outcomes (ICU discharge/hospital mortality) were assessed using latent mixture analysis and a marginal structural model. From 4499 patients, 391 meeting CPE criteria (median age 70 [interquartile range 59-78], 40% female) were included. ICU and hospital mortality were 34% and 40%, respectively. ICU survivors were younger (67 [57-77] vs 74 [64-80] years, p < 0.001) and had lower driving (12 [8-16] vs 15 [11-17] cmHO, p < 0.001), plateau (20 [15-23] vs 22 [19-26] cmHO, p < 0.001) and peak (21 [17-27] vs 26 [20-32] cmHO, p < 0.001) pressures. Latent mixture analysis of patients receiving invasive mechanical ventilation on ICU day 1 revealed a subgroup ventilated with high pressures with lower probability of being discharged alive from the ICU (hazard ratio [HR] 0.79 [95% confidence interval 0.60-1.05], p = 0.103) and increased hospital mortality (HR 1.65 [1.16-2.36], p = 0.005). In a marginal structural model, driving pressures in the first week (HR 1.12 [1.06-1.18], p < 0.001) and tidal volume after day 7 (HR 0.69 [0.52-0.93], p = 0.015) were related to survival. Higher airway pressures in invasively ventilated patients with CPE are related to mortality. These patients may be exposed to an increased risk of ventilator-induced lung injury. Trial registration Clinicaltrials.gov NCT02010073

Resolved versus confirmed ARDS after 24&#160;h: insights from the LUNG SAFE study

Purpose: To evaluate patients with resolved versus confirmed ARDS, identify subgroups with substantial mortality risk, and to determine the utility of day 2 ARDS reclassification. Methods: Our primary objective, in this secondary LUNG SAFE analysis, was to compare outcome in patients with resolved versus confirmed ARDS after 24\ua0h. Secondary objectives included identifying factors associated with ARDS persistence and mortality, and the utility of day 2 ARDS reclassification. Results: Of 2377 patients fulfilling the ARDS definition on the first day of ARDS (day 1) and receiving invasive mechanical ventilation, 503 (24%) no longer fulfilled the ARDS definition the next day, 52% of whom initially had moderate or severe ARDS. Higher tidal volume on day 1 of ARDS was associated with confirmed ARDS [OR 1.07 (CI 1.01\u20131.13), P = 0.035]. Hospital mortality was 38% overall, ranging from 31% in resolved ARDS to 41% in confirmed ARDS, and 57% in confirmed severe ARDS at day 2. In both\ua0resolved and confirmed\ua0ARDS, age, non-respiratory SOFA score, lower PEEP and P/F ratio, higher peak pressure and respiratory rate were each\ua0associated with mortality. In confirmed ARDS, pH and the presence of immunosuppression or neoplasm were also associated\ua0with mortality. The increase in area under the receiver operating curve for ARDS reclassification on day 2 was marginal. Conclusions: ARDS, whether resolved or confirmed at day 2, has a high mortality rate. ARDS reclassification at day 2 has limited predictive value for mortality. The substantial mortality risk in severe confirmed ARDS suggests that complex interventions might best be tested in this population. Trial Registration: ClinicalTrials.gov NCT02010073. \ua9 2018, Springer-Verlag GmbH Germany, part of Springer Nature and ESICM