Characterization of the flora and structure of the shrub-tree layer in a cerrado area in Pantanal do Poconé, MT

In wetlands as the Pantanal, the floristic composition and community structure respond primarily to the flood pulse and, in order to understand the species that enter this biome, these plant communities need to be floristically and structurally described. Therefore, the objectives of this paper are characterize floristic composition and vegetation structure on a cordilheira (paleolevees), in the Pirizal region, Nossa Senhora do Livramento County, MT; define the type of vegetation and determine whether there is a greater floristic similarity degree between the object of this study and other cerrado s.s. or cerradão areas in Central Brazil. 102 contiguous plots of 20 x 5 m were distributed systematically arranged in six transects towards edge-center-edge cordilheira, thus having a total area of 1,02 ha. For sampling purposes, only individuals with entire stem DBH > 3 cm including dead trees and palms. 82 different species of trees and shrubs were identified, which in turn were spread in 63 genera, 32 families and one unidentified species. Being 37 species characteristics of areas with cerradão, 19 of cerrado s.s., nine distributed both in areas of cerradão and in cerrado s.s., and 10% belonging to the Pantanal wetland environments. Comparing the studied area with other communities across the DCA, the results indicated the existence of two floristic groups relatively distinct, the first formed by areas composed of cerrado s.s. and the second by cerradões areas. Among the areas formed by cerradões, there was a separation of the sampled areas in the region of the Pantanal (wetlands) those occurring elsewhere in the Centro-Oeste (dry land). The vegetation on cordilheira showed greater floristic and structural relationship with cerradões than with cerrado s.s. of west center region of Brazil, and may thus be characterized as a vegetation type of cerradão. The savannas of the Pantanal had a lower floristic relationship with other regions of the Centro-Oeste, this floristic heterogeneity may be related to the flood pulse which acts as a filter for most species in other areas of the Planalto Central.Em áreas úmidas, como o Pantanal, a composição florística e estrutura comunitária respondem principalmente ao pulso de inundação. E para o entendimento das espécies que adentram esse bioma, essas comunidades de plantas precisam ser descritas florística e estruturalmente. O presente estudo teve como objetivos: caracterizar a composição florística e a estrutura da vegetação sobre uma cordilheira na região do Pirizal, Município de Nossa Senhora do Livramento ,MT; definir o tipo de vegetação e determinar se há maior grau de semelhança florística entre a vegetação estudada com outras áreas de cerrado s s. ou de cerradão do Centro-Oeste brasileiro. Foram alocadas 102 parcelas contíguas 20 x 5 m distribuídas sistematicamente em seis transecções dispostas no sentido borda-centro-borda da cordilheira, totalizando 1,02 ha de área amostrada. Mediram-se os indivíduos com DAP >3 cm, incluindo mortos e palmeiras. Foram identificadas 82 espécies arbustivo-arbóreas, distribuídas em 63 gêneros, 32 famílias e uma espécie indeterminada. Sendo 3 espécies características de áreas com cerradão; 19 do cerrado s.s., nove distribuídas tanto em áreas de cerradão quanto em cerrado s.s., e 10% que pertencem a ambientes inundáveis no Pantanal. Comparando a área de estudada com outras comunidades através da DCA, os resultados indicaram a existência de dois grupos florísticos relativamente distintos, o primeiro formado por áreas compostas por cerrado s.s. e o segundo por áreas com cerradão. Entre as áreas formadas por cerradões, ocorreu uma separação das áreas amostradas na região do no Pantanal (áreas inundáveis) daquelas que ocorrem em outras localidades do Centro-Oeste (áreas secas). A vegetação estudada sobre cordilheira apresentou maior relação florística e estrutural com os cerradões do que com os cerrados s.s. do Centro-Oeste, podendo, dessa forma, ser caracterizada como uma fitofisionomia de cerradão. Os cerrados do Pantanal apresentaram menor relação florística com os de outras regiões do Centro-Oeste, essa heterogeneidade florística pode estar relacionada ao pulso de inundação que atua como filtro para a maioria das espécies das outras áreas do Planalto Central

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