Refletindo sobre o processo de institucionalização do idoso

Background and objectives: Aging is a natural process that has achieved greater importance and concern from the considerable increase in life expectancy of the population. It is noted that currently there is an increase of studies related to elderly care, especially one who is in a long-stay institution (ILP). The aim of this paper is to discuss the elderly institutionalization process and the characteristics of the family group and profile of the hospitalized population in these institutions. Content: The increase in the elderly population over time is accompanied by changes in family structure and routine, so that, for many families, become unviable meet the needs of the elderly. Thus, the long-stay institutions for the Elderly (ILPIs) constitute an alternative to meet these needs, providing comprehensive care for multidisciplinary teamwork. However, one should pay special attention, so that there is a break in the family ties of the elderly, since the family is an essential tool in the care qualification. Conclusion: It is essential to abandon the concept that by joining the ILPIs the elderly are abandoned and helpless, because with the change in family routine, the implementation of the National Policy for the Elderly and the improvement of institutions, it has become an important alternative to the well-being of the elderly, allowing access to assistance that often do not receive in their home environment, it is important to maintain the family bond, as it constitutes an important tool for the quality of life of the elderly.Justificativa e Objetivo: O envelhecimento é um processo natural que vem obtendo maior relevância e preocupação a partir do aumento considerável da expectativa de vida da população. É observado que atualmente ocorre um aumento de estudos relacionados com o cuidado do idoso, em especial daquele que se encontra em uma Instituição de Longa Permanência (ILP). O objetivo deste artigo é discutir sobre o processo de institucionalização do idoso e sobre as características do grupo familiar e perfil da população internada nestas instituições. Conteúdo: O aumento da população idosa ao longo do tempo é acompanhado por modificações na estrutura e rotina familiar, fazendo com que, para muitas famílias, torne-se inviável atender as necessidades do idoso. Deste modo, as Instituições de Longa Permanência para Idosos (ILPIs) constituem-se em uma alternativa para suprir estas necessidades, proporcionando cuidado amplo pelo trabalho de equipe multidisciplinar. No entanto, deve-se ter uma atenção especial, para que não ocorra uma quebra no vínculo familiar do idoso, visto que a família é uma ferramenta essencial na qualificação do cuidado. Conclusão: É fundamental abandonar o conceito de que ao ingressar nas ILPIs o idoso está abandonado e desamparado, pois com a mudança na rotina familiar, a implantação da Política Nacional do Idoso e o aprimoramento das instituições, esta tornou-se uma alternativa importante para o bem estar do idoso, permitindo acesso a uma assistência que, muitas vezes, não receberia em seu ambiente familiar, sendoimportante a manutenção do vínculo familiar, pois constitui-se em importante ferramenta para a qualidade de vida do idoso

Refletindo sobre o processo de institucionalização do idoso

Justificativa e Objetivo: O envelhecimento é um processo natural que vem obtendo maior relevância e preocupação a partir do aumento considerável da expectativa de vida da população. É observado que atualmente ocorre um aumento de estudos relacionados com o cuidado do idoso, em especial daquele que se encontra em uma Instituição de Longa Permanência (ILP). O objetivo deste artigo é discutir sobre o processo de institucionalização do idoso e sobre as características do grupo familiar e perfil da população internada nestas instituições. Conteúdo: O aumento da população idosa ao longo do tempo é acompanhado por modificações na estrutura e rotina familiar, fazendo com que, para muitas famílias, torne-se inviável atender as necessidades do idoso. Deste modo, as Instituições de Longa Permanência para Idosos (ILPIs) constituem-se em uma alternativa para suprir estas necessidades, proporcionando cuidado amplo pelo trabalho de equipe multidisciplinar. No entanto, deve-se ter uma atenção especial, para que não ocorra uma quebra no vínculo familiar do idoso, visto que a família é uma ferramenta essencial na qualificação do cuidado. Conclusão: É fundamental abandonar o conceito de que ao ingressar nas ILPIs o idoso está abandonado e desamparado, pois com a mudança na rotina familiar, a implantação da Política Nacional do Idoso e o aprimoramento das instituições, esta tornou-se uma alternativa importante para o bem estar do idoso, permitindo acesso a uma assistência que, muitas vezes, não receberia em seu ambiente familiar, sendoimportante a manutenção do vínculo familiar, pois constitui-se em importante ferramenta para a qualidade de vida do idoso

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.13Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt