Mechanical ventilation in patients with acute respiratory failure

A ventilação mecânica constitui o método usual de suporte para pacientes com insuficiência respiratória aguda. Sua utilização como terapêutica não-farmacológica em pacientes com disfunção sistólica ventricular esquerda tem sido recentemente empregada. Observa-se que tanto a ventilação mecânica invasiva, com uso de pressão expiratória final positiva, quanto a ventilação mecânica não-invasiva, com uso de pressão positiva contínua, modificam a pressão intratorácica, afetando e modificando os gradientes de pressão sobre as câmaras atriais, ventriculares e raiz da aorta. Estes efeitos resultam em alterações hemodinâmicas que contribuem para a melhora dos sintomas em pacientes com insuficiência cardíaca.Mechanical ventilation is normally used as a method of support in patients with acute respiratory failure. Invasive and non-invasive mechanical ventilation can improve the performance of cardiovascular system as a non-pharmacological therapeutic option. Mechanical ventilation with positive end-expiratory pressure or continuous positive airway pressure induces changes in all intrathoracic cardiovascular structures, which can improve the cardiac function and alleviate symptoms of patients with heart failure

Early mobilization in ischemic stroke : a pilot randomized trial of safety and feasibility in a public hospital in Brazil

Abstract Background: The effect of early mobilization after acute stroke is still unclear, although some studies have suggested improvement in outcomes. We conducted a randomized, single-blind, controlled trial seeking to evaluate the feasibility, safety, and benefit of early mobilization for patients with acute ischemic stroke treated in a public teaching hospital in Southern Brazil. This report presents the feasibility and safety findings for the pilot phase of this trial. Methods: The primary outcomes were time to first mobilization, total duration of mobilization, complications during early mobilization, falls within 3 months, mortality within 3 months, and medical complications of immobility. We included adult patients with CT- or MRI-confirmed ischemic stroke within 48 h of symptom onset who were admitted from March to November 2012 to the acute vascular unit or general emergency unit of a large urban emergency department (ED) at the Hospital de Clínicas de Porto Alegre. The severity of the neurological deficit on admission was assessed by the National Institutes of Health Stroke Scale (NIHSS). The NIHSS and modified Rankin Scale (mRS, functional outcome) scores were assessed on day 14 or at discharge as well as at 3 months. Activities of daily living (ADL) were measured with the modified Barthel Index (mBI) at 3 months. Results: Thirty-seven patients (mean age 65 years, mean NIHSS score 11) were randomly allocated to an intervention group (IG) or a control group (CG). The IG received earlier (p = 0.001) and more frequent (p < 0.0001) mobilization than the CG. Of the 19 patients in the CG, only 5 (26%) underwent a physical therapy program during hospitalization. No complications (symptomatic hypotension or worsening of neurological symptoms) were observed in association with early mobilization. The rates of complications of immobility (pneumonia, pulmonary embolism, and deep vein thrombosis) and mortality were similar in the two groups. No statistically significant differences in functional independence, disability, or ADL (mBI ≥ 85) were observed between the groups at the 3-month follow-up. Conclusions: This pilot trial conducted at a public hospital in Brazil suggests that early mobilization after acute ischemic stroke is safe and feasible. Despite some challenges and limitations, early mobilization was successfully implemented, even in the setting of a large, complex ED, and without complications. Patients from the IG were mobilized much earlier than controls receiving the standard care provided in most Brazilian hospitals

PENGARUH KEPUASAN KERJA DAN KOMITMEN ORGANISASI TERHADAP TURNOVER INTENTION PERAWAT DI RUMAH SAKIT EMANUEL KLAMPOK

Penelitian ini bertujuan untuk mengetahui: (1) pengaruh kepuasan kerja terhadap turnover intention pada perawat Rumah Sakit Emanuel Klampok, (2) pengaruh komitmen organisasi terhadap turnover intention pada perawat Rumah Sakit Emanuel Klampok dan (3) pengaruh kepuasan kerja dan komitmen organisasi terhadap turnover intention pada perawat Rumah Sakit Emanuel Klampok. Penelitian ini termasuk penelitian asosiatif kausal dengan menggunakan pendekatan kuantitatif. Data dikumpulkan dengan metode survei. Sampel dalam penelitian ini berjumlah 127 orang dan menggunakan metode sampel acak sederhana. Berdasarkan uji validitas semua item instrumen dinyatakan valid. Hasil Uji reliabilitas diperoleh nilai cronbach alpha variabel turnover intention sebesar 0,906, kepuasan kerja sebesar 0,787, komitmen organisasi sebesar 0,856. Teknik analisis data yang digunakan adalah regresi berganda. Hasil penelitian menunjukkan bahwa : (1) Kepuasan kerja berpengaruh negatif dan signifikan terhadap turnover intention dengan β sebesar -0.153* (*p<0.05; p=0,049). Kontribusi pengaruh kepuasan kerja terhadap turnover intention (∆R2) sebesar 0,023 ; (2) komitmen organisasi berpengaruh negatif dan signifikan terhadap turnover intention dengan β sebesar -0.175* (*p<0.05; p=0,036). Kontribusi pengaruh komitmen organisasi terhadap turnover intention (∆R2) sebesar 0,030; (3) Kepuasan kerja memiliki nilai beta (β) -0,113* (*p<0.05; p=0,021) dan komitmen organisasi memiliki nilai beta (β) -0.142* (*p<0.05; p=0,010) secara bersama-sama memberikan pengaruh negatif dan signifikan terhadap turnover intention.. Kontribusi pengaruh kepuasan kerja dan komitmen organisasi berpengaruh negatif terhadap turnover intention (∆R2) sebesar 0,041