Endotracheal suction in intubated critically ill adult patients undergoing mechanical ventilation: a systematic review

AIM: identify and analyze in the literature the evidence of randomized controlled trials on care related to the suctioning of endotracheal secretions in intubated, critically ill adult patients undergoing mechanical ventilation. METHOD: the search was conducted in the PubMed, EMBASE, CENTRAL, CINAHL and LILACS databases. From the 631 citations found, 17 studies were selected. RESULTS: Evidence was identified for six categories of intervention related to endotracheal suctioning, which were analyzed according to outcomes related to hemodynamic and blood gas alterations, microbial colonization, nosocomial infection, and others. CONCLUSIONS: although the evidence obtained is relevant to the practice of endotracheal aspiration, the risks of bias found in the studies selected compromise the evidence's reliability.

Vegetation mapping in an area of Ombrophilous Dense Forest at Parque Estadual da Serra do Mar, São Paulo State, Brazil, and floristic composition of the tree component of some physiognomies*

This study aimed to map phytophysiognomies of an area of Ombrophilous Dense Forest at Parque Estadual da Serra do Mar and characterize their floristic composition. Photointerpretation of aerial photographs in scale of 1:35,000 was realized in association with field work. Thirteen physiognomies were mapped and they were classified as Montane Ombrophilous Dense Forest, Alluvial Ombrophilous Dense Forest or Secondary System. Three physiognomies identified at Casa de Pedra streamlet's basin were studied with more details. Riparian forest (RF), valley forest (VF), and hill forest (HF) presented some floristic distinction, as confirmed by Detrended Correspondence Analysis (DCA) and Indicator Species Analysis (ISA) conducted here. Anthropic or natural disturbances and heterogeneity of environmental conditions may be the causes of physiognomic variation in the vegetation of the region. The results presented here may be useful to decisions related to management and conservation of Núcleo Santa Virgínia forests, in general.