Association of early positive end-expiratory pressure settings with ventilator-free days in patients with coronavirus disease 2019 acute respiratory distress syndrome:A secondary analysis of the Practice of VENTilation in COVID-19 study

BACKGROUND: There is uncertainty about how much positive end-expiratory pressure (PEEP) should be used in patients with acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19). OBJECTIVE: To investigate whether a higher PEEP strategy is superior to a lower PEEP strategy regarding the number of ventilator-free days (VFDs). DESIGN: Multicentre observational study conducted from 1 March to 1 June 2020. SETTING AND PATIENTS: Twenty-two ICUs in The Netherlands and 933 invasively ventilated COVID-19 ARDS patients. INTERVENTIONS: Patients were categorised retrospectively as having received invasive ventilation with higher (n=259) or lower PEEP (n=674), based on the high and low PEEP/FIO2 tables of the ARDS Network, and using ventilator settings and parameters in the first hour of invasive ventilation, and every 8 h thereafter at fixed time points during the first four calendar days. We also used propensity score matching to control for observed confounding factors that might influence outcomes. MAIN OUTCOMES AND MEASURES: The primary outcome was the number of VFDs. Secondary outcomes included distant organ failures including acute kidney injury (AKI) and use of renal replacement therapy (RRT), and mortality. RESULTS: In the unmatched cohort, the higher PEEP strategy had no association with the median [IQR] number of VFDs (2.0 [0.0 to 15.0] vs. 0.0 [0.0 to 16.0] days). The median (95% confidence interval) difference was 0.21 (-3.34 to 3.78) days, P = 0.905. In the matched cohort, the higher PEEP group had an association with a lower median number of VFDs (0.0 [0.0 to 14.0] vs. 6.0 [0.0 to 17.0] days) a median difference of -4.65 (-8.92 to -0.39) days, P = 0.032. The higher PEEP strategy had associations with higher incidence of AKI (in the matched cohort) and more use of RRT (in the unmatched and matched cohorts). The higher PEEP strategy had no association with mortality. CONCLUSION: In COVID-19 ARDS, use of higher PEEP may be associated with a lower number of VFDs, and may increase the incidence of AKI and need for RRT. TRIAL REGISTRATION: Practice of VENTilation in COVID-19 is registered at ClinicalTrials.gov, NCT04346342

Avaliação de cultivares de milho precoce em alguns estados do Nordeste brasileiro.

bitstream/item/88596/1/CPATC-PESQ.-AND.-27-84.pd

A Smart Wireless Car Ignition System for Vehicle Security

Copyright: © 2017 Haider A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.The paper proposes a novel car ignition system to replace the traditional wired technology and enhance vehicle security. This new system uses wireless transmissions to start the engine and hence eliminates the ignition wire behind the dashboard. It also allows the user to set a password of his/her choice to keep the system protected. A theft alarm that goes ‘’ON’’ when an unusual activity is sensed and/or when the wrong password is attempted to unlock the system is integrated in the system. Moreover, important factors such as economic feasibility, adaptability to the new vehicle technologies and customers’ preferences have been taken into consideration in the design of the proposed vehicle security system.Peer reviewedFinal Published versio

International multicentre observational study to evaluate the association between perioperative red blood cell transfusions and 1-year mortality after major cancer surgery (ARCA-1) : Study design, statistical analysis plan and study protocol

Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.Peer reviewedPublisher PD

Driving pressure during general anesthesia for open abdominal surgery (DESIGNATION) : study protocol of a randomized clinical trial

Background Intraoperative driving pressure (Delta P) is associated with development of postoperative pulmonary complications (PPC). When tidal volume (V-T) is kept constant, Delta P may change according to positive end-expiratory pressure (PEEP)-induced changes in lung aeration. Delta P may decrease if PEEP leads to a recruitment of collapsed lung tissue but will increase if PEEP mainly causes pulmonary overdistension. This study tests the hypothesis that individualized high PEEP, when compared to fixed low PEEP, protects against PPC in patients undergoing open abdominal surgery. Methods The "Driving prESsure durIng GeNeral AnesThesIa for Open abdomiNal surgery trial" (DESIGNATION) is an international, multicenter, two-group, double-blind randomized clinical superiority trial. A total of 1468 patients will be randomly assigned to one of the two intraoperative ventilation strategies. Investigators screen patients aged >= 18 years and with a body mass index <= 40 kg/m(2), scheduled for open abdominal surgery and at risk for PPC. Patients either receive an intraoperative ventilation strategy with individualized high PEEP with recruitment maneuvers (RM) ("individualized high PEEP") or one in which PEEP of 5 cm H2O without RM is used ("low PEEP"). In the "individualized high PEEP" group, PEEP is set at the level at which Delta P is lowest. In both groups of the trial, V-T is kept at 8 mL/kg predicted body weight. The primary endpoint is the occurrence of PPC, recorded as a collapsed composite of adverse pulmonary events. Discussion DESIGNATION will be the first randomized clinical trial that is adequately powered to compare the effects of individualized high PEEP with RM versus fixed low PEEP without RM on the occurrence of PPC after open abdominal surgery. The results of DESIGNATION will support anesthesiologists in their decisions regarding PEEP settings during open abdominal surgery

Sistema de produção agrícola, para agricultura familiar no Médio Parnaíba Piauiense.

A agricultura familiar representa 85% dos estabelecimentos rurais do Brasil, concentrando-se a maioria destes estabelecimentos na Região Nordeste, onde a carência de alternativas tecnológicas adequadas às condições sócio-econômico dos agricultores familiares faz com que os mesmos subsistam às custas de métodos extremamente ineficientes de produção agropecuária. No Piauí o sistema de produção agrícola familiar em uso consiste de um consórcio de três ou mais culturas em roça não destocada, cujo preparo da área se resume à derrubada da vegetação e queima. Trata-se de um sistema de agricultura itinerante, no qual, após um ciclo de cultivo, a área é mantida sobre repouso por seis a dez anos, para a regeneração da vegetação. Com base nos dados obtidos em levantamentos efetuados em estabelecimentos rurais, propoi-se o fortalecimento do sistema de produção agrícola familiar já em uso, mediante introdução de tecnologias simples e de fácil execução, que resultem na melhoria da qualidade dos produtos, com agregação de valores e que utilizem recursos disponíveis na propriedade. Encontram-se atualmente em validação os sistemas de produção agrícola (mandioca + arroz e mandioca + feijão), por serem sistemas de produção mais importantes, tanto do ponto de vista da alimentação, como da comercialização. A melhoria de um sistema de produção na agricultura familiar deve, prioritariamente, permitir o aumento da produção através do aprimoramento da sua eficiência e não através do aumento da entrada de insumos. A Embrapa Meio-Norte, preconiza que as tecnologias devem ser integradas aos múltiplos componentes da pequena propriedade, como o uso racional e eficiente dos recursos nela existentes, objetivando a produção sustentável para o consumo e venda do excedente, sem comprometer os meios de produção