A padronização das decisões judiciais feita pela inteligência artificial: uma crítica para a nova ciência do direito

The standardization of decisions by the informatics of law, aiming at an exact science would result in a science in which progress and transformations would not drive the emergence of new rights or the readjustment of those already established. The present article proposed to examine, by means of a doctrinal-critical analysis, the impacts of the advance of the new automated technique of law, especially considering the configurations of a legal Fordism. We sought to answer what is the possibility of implementing Artificial Intelligence in the civil jurisdictional process and what would be the possible consequences, with regard to the advancement of rights already established and the advent of new rights through jurisdictional provision. The hypothetical-deductive approach was chosen, with the purpose of analyzing the problematic regarding the failures of the Fordist legal science. The monographic and historical methods of procedure were used, together with the bibliographical research technique, for a better analysis of the theme and the basis of the critical-conclusive analysis. Finally, what can be deduced is the need for constant improvement and in-depth studies before the artificial machine, which is not even capable of understanding the basic principles of law as a guarantee of the citizen’s humanity.La estandarización de las decisiones por parte de la informática del derecho, apuntando a una ciencia exacta, resultaría en una ciencia en la que el progreso y las transformaciones no impulsarían el surgimiento de nuevos derechos o el reajuste de los ya establecidos. El presente artículo se propuso examinar, mediante un análisis doctrinal-crítico, los impactos del avance de la nueva técnica automatizada del derecho, especialmente considerando las configuraciones de un fordismo jurídico. Se buscó responder cuál es la posibilidad de implementar la Inteligencia Artificial en el proceso jurisdiccional civil y cuáles serían las posibles consecuencias, en relación con el avance de los derechos ya establecidos y el advenimiento de nuevos derechos a través de la prestación jurisdiccional. Se ha optado por el enfoque hipotético-deductivo, con el fin de analizar la problemática relativa a los fracasos de la ciencia jurídica fordista. Se utilizaron los métodos de procedimiento monográfico e histórico, junto con la técnica de investigación bibliográfica, para un mejor análisis del tema y la base del análisis crítico-conclusivo. Finalmente, lo que se deduce es la necesidad de perfeccionamiento y profundización constante ante la máquina artificial, que ni siquiera es capaz de entender los principios básicos del derecho como garantía de la humanidad del ciudadano.A padronização das decisões por parte da informática do direito, visando uma ciência exata, resultaria em uma ciência em que o progresso e as transformações não impulsariam o aparecimento de novos direitos ou o reajuste dos já estabelecidos. O presente artigo se propôs examinar, através de uma análise doutrinal-crítico, os impactos do avanço da nova técnica automatizada do direito, especialmente considerando as configurações de um fordismo jurídico. Procurou-se responder qual é a possibilidade de aplicar a inteligência artificial no processo jurisdicional civil e quais seriam as possíveis consequências, em relação com o avanço dos direitos já estabelecidos e o aparecimento de novos direitos através da prestação jurisdicional. Foi escolhida como metodologia procedimento monográfico e histórico, junto com a técnica de investigação bibliográfica, para uma melhor análise do tema e análise da base crítico-conclusiva. Finalmente o que se deduz é a necessidade de aperfeiçoamento e ampliação constante face a máquina artificial, que nem sequer é capaz de entender os princípios básicos do direito como garantia da humanidade do cidadão

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

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