Uma intervenção educativa para profissionais de saúde na prevenção de pneumonia associada à ventilação mecânica

Quasi-experimental study, prospective with quantitative approach, performed at the Hospital do Coração in Natal, aimed at verified the existence of difference between the care given by health professionals to the patients under mechanical ventilation (MV) in the Intensive Care Unit, before and after an educative intervention. The population was of 31 professionals, with data collected between november 05 of 2007 to march 27 of 2008. The results show a yong population, female gender, middle level of education, nursing technique, working between 05 and 09 years on nursing profession, and 01 to 04 years on Intensive Care Unit; almost all, never had an kind of training over prevent pneumonia associated to mechanical ventilation; from those that had training, occur on the work place with duration from 12 to 24 hours. About endotracheal intubation, the cuff was tested with a sterilized syringe had a positive change after a educative intervention, increased from 75,0% to 100,0%; the sterile guide was used on 75,0% before and 100,0% after an educative intervention. Regarding endotracheal suction procedure, was not informed to the patient on 72,7% before, however was informed on 56,7% after; the hands was not previously washed 68,5% before, however was 63,3% after the procedure; mask was used on 74,2 % opportunities before and 76,7% after; the aspiration catheter had adequated size on 98,9% observation before and 100,0% after; the gaze was sterilized on 95,7% before and 100,0% after; the ventilator was connected to the patient during the aspiration intervals on 94,4% observation before and 100,0% after; the ambu bag was clean and protected on 76,1% before and 85,7% after; the aspiration catheter was discarded after be used on 98,9% before and 100,0% after; FIO2 was turned to the begging value on 32,9% observation before and 12,0% after; before the procedure 71,9% professions washed their hands and 73,3% after; before, notes of aspiration results were performed on 70,8% observation and 86,7% after. Regarding devices used on respiratory tract, aspirator flasks were not swapped on 84,6% observations before and 71,0% after; daily látex extention change was not performed on 93,6% observation before and 87,1% after; the ambu bag change was not performed on 50,0% observation before even if was duty or unprotected and on 75,8% opportunities was changed, after; nebulization was not prepared with sterile fluids or manipulated aseptically on 65,2% observation before, perhaps was on 71,7% after; before nebulizers were not changed on 65,2% observations, perhaps were on 60,9% after. Concerning ventilator breathing circuits, condense fluids cumulated on circuits were removed on 55,0% opportunities before, and 64,0% after; moisturizer was not filled with sterile water when already had small amount of liquid inside on 78,4% observations before, and 90,2% after; MV circuits were changed on 97,0% observations on presence of visible duty or when presents some kind of failure, before and 98,4% after. About body position, on 51,3% observations the decubitus position change were done before and 78,2% after; fowler position was maitened on 95,5% observations before and 98,2% after; Regarding respiratory physiotherapy, enteral diet was not interrupted before respiratory physiotherapy on 94,9% before and 90,0% after; respiratory physiotherapy devices were not disinfected or sterile on 69,6% observations before but they re on 60,0% after; before the cateter was not tested before introduction enteral diet or medications on 100,0% but after was done on 15,2%. About enteral feeding, intestine motility and measure of stomach contents were not done on 100,0% observations before, but was 15,2% after. We conclude that 05 of 07 valuated procedures in relation to MV, had a significant improvement on quality of care given after educative intervention, when compared before intervention

Carga de trabalho de enfermagem e infecções relacionadas à assistência à saúde na unidade de terapia intensiva

In recent decades, the search for quality care has been widely discussed by the institutions and health professionals. In this context, it is the nurse coordinator of the process of providing nursing staff, reflecting the commitment to quality of care. In this process, it is the appearance of Infections Related to health care and its potential association with the workload in nursing as a valuable indicator of quality of care. Thus, this research contributes to studies to characterize the demand of nursing work to promote a safe healthcare practice. This study aimed to identify the association of nursing workload with the number of cases of Ventilator-Associated Pneumonia, urinary tract infection and central venous catheter infection in the intensive care unit. This is a quantitative research approach, descriptive, cross-sectional and prospective, held at Unimed Hospital in Natal-RN. The study population consisted of all patients treated in the Intensive Care Unit, Hospital for a period of 90 consecutive days in 2011. The convenience sample was compostapelos patients admitted to the ICU during the period of data collection, a total sample of 286 patients. To perform the data analysis software were used: Statistica 6.0, SPPS (Statistical Package for Social Sciences) version 17.0 (2004) and Excel 2007. In the descriptive analysis, we used Measures of Central Tendency and Measures of Dispersion or Variability and the use of nonparametric tests. Of the 286 patients, 88 were from the ICU and 198 ICU II II. Males predominated in the ICU I (51.1%) and female ICU II (57.6%) patients in the ICU I were aged 61-80 years (39.8%) followed by greater than 80 years (39.8%). In the ICU II, most of the patients were aged 61-80 years (38.9%) and then from 41 to 60 years (24.2%). In relation to the class of TISS inlet predominant class II in the two ICUs (59.1%), followed by Class III also in the two units (34.6%). Most patients (70.6%) out of the ICUs belonging to class II TISS. In the ICU I, the average number of forms of the TISS 28 was 6, has in ICU II this value drops to 3.2 forms. The overall mean was 19.9 TISS points in ICU patients I and ICU II.the 17 points in the average hours required to provide adequate nursing care to patients in the ICU I found that is 10 , 7 hours, and the ICU II 9.2 hours. It was found that the time provided by the nursing staff were higher in ICU II, with an average of 19 hours available for nurses in this sector. In the ICU I, which showed higher need of available hours, it was found that the mean value of 12.7 available hours. It was found that only 2.4% of patients had these units Ventilator-Associated Pneumonia, 1.0% were infected central venous catheter and 1.4% of patients had urinary tract infection. Infection associated with health care occurs, on average, on the tenth day of hospitalization. In the ICU II, this average value extends to the twelfth day with an excess of 2.7 hours of nursing care while in ICU I value decays to the ninth day of hospitalization with a deficiency of 12-hour assistance. It is concluded that patients generally showed a need for classification of semi-intensive care and has been assisted in their need to load. As for his association with the Related Infections Health will assist this analysis could not be performed due to the small number of notifications in this period. It is suggested further study how other factors related to infections me a longer period of analysis

Distribuição regional da ventilação pulmonar em indivíduos com insuficiência cardíaca crônica após serem submetidos a um programa de treinamento da musculatura inspiratória e sua correlação com dados funcionais

Introduction: Chagas Disease is a serious public health problem, with 5 million infected individuals in Brazil. Of these, approximately 30% develop chronic Chagas cardiomyopathy (CCC), where the main symptoms are fatigue and dyspnea. Objective: To correlate maximal exercise capacity with pulmonary function, inspiratory muscle strength and quality of life in patients with CCC. Methodology: Twelve individuals suffering from CCC were evaluated (7 men), with a mean age of 54.91± 8.60 years and the following inclusion criteria: functional class II and III according to the New York Heart Association (NYHA); left ventricle ejection fraction below 45%; clinical stability (> 3 months); symptom duration > 1 year, body mass index (BMI) < 35Kg/m2 and non-smokers or ex-smokers with a history of smoking <10 packs/day. All subjects were submitted to spirometry, manometer testing, maximal cardiopulmonary exercise testing (CPX) and a quality of life questionnaire (Minnesota). Results: A negative correlation was observed between VO2máx and MLHFQ scores (r=-0.626; p=0.03) and a positive association with MIP (r=0.713; p=0.009). Positive correlations were also recorded between MIP and spirometric variables [FEV1(r=0.825;p=0.001 ), FVC(r=0.66;p=0.01 and FEF25-75%(r=0.639;p=0.02)]. Conclusion: The present study demonstrated that in patients with CCC: VO2MAX is directly related to inspiratory muscle strength and quality of life, while deteriorating lung function is directly associated with respiratory muscle weakness

Recomendações para o desenvolvimento de uma ferramenta de suporte às primeiras decisões projetuais visando ao desempenho energético de edificações de escritório em clima quente

PEDRINI, Aldomar; SZOKOLAY, Steven. Recomendações para o desenvolvimento de uma ferramenta de suporte às primeiras decisões projetuais visando ao desempenho energético de edificações de escritório em clima quente. Ambiente Construído, Porto Alegre, v. 5, n. 1, p.39-54, jan./mar. 2005. Trimestral. Disponível em: . Acesso em: 04 out. 2010.

Ventilação e prescrições urbanísticas: uma aplicação simulada para a Orla da Praia do Meio em Natal/RN

This work analyses a study on natural ventilation and its relation to the urban legislation versus the building types in an urban fraction of coastal area of Praia do Meio in the city of Natal/RN, approaching the type or types of land use most appropriate to this limited urban fraction. The objective of this study is to analyse the effects of the present legislation as well as the types of buildings in this area on the natural ventilation. This urban fraction was selected because it is one of the sites from where the wind flows into the city of Natal. This research is based on the hypothesis stating that the reduction on the porosity of the urban soil (decrease in the set back/boundary clearance), and an increase in the form (height of the buildings) rise the level of the ventilation gradient, consequently causing a reduction on the wind speed at the lowest part of the buildings. Three-dimensional computational models were used to produce the modes of occupation allowed in the urban fraction within the area under study. A Computational Fluid Dynamics (CFD) software was also used to analyse the modes of land occupation. Following simulation, a statistical assessment was carried out for validation of the hypothesis. It was concluded that the reduction in the soil porosity as a consequence of the rates that defined the minimum boundary clearance between the building and the boundary of the plot (and consequently the set back), as well as the increase in the building form (height of the buildings) caused a reduction in the wind speed, thus creating heat islands

Análise de métodos para aplicação de ventilação natural em projetos de edificações em Natal-RN

Natural ventilation is an efficient bioclimatic strategy, one that provides thermal comfort, healthful and cooling to the edification. However, the disregard for quality environment, the uncertainties involved in the phenomenon and the popularization of artificial climate systems are held as an excuse for those who neglect the benefits of passive cooling. The unfamiliarity with the concept may be lessened if ventilation is observed in every step of the project, especially in the initial phase in which decisions bear a great impact in the construction process. The tools available in order to quantify the impact of projected decisions consist basically of the renovation rate calculations or computer simulations of fluids, commonly dubbed CFD, which stands for Computational Fluid Dynamics , both somewhat apart from the project s execution and unable to adapt for use in parametric studies. Thus, we chose to verify, through computer simulation, the representativeness of the results with a method of simplified air reconditioning rate calculation, as well as making it more compatible with the questions relevant to the first phases of the project s process. The case object consists of a model resulting from the recommendations of the Código de Obras de Natal/ RN, customized according to the NBR 15220. The study has shown the complexity in aggregating a CFD tool to the process and the need for a method capable of generating data at the compatible rate to the flow of ideas and are discarded during the project s development. At the end of our study, we discuss the necessary concessions for the realization of simulations, the applicability and the limitations of both the tools used and the method adopted, as well as the representativeness of the results obtained

Análise de componentes arquitetônicos para potencialização da ventilação natural com ênfase em captadores de vento

The building envelope is the principal mean of interaction between indoors and environment, with direct influence on thermal and energy performance of the building. By intervening in the envelope, with the proposal of specific architectural elements, it is possible to promote the use of passive strategies of conditioning, such as natural ventilation. The cross ventilation is recommended by the NBR 15220-3 as the bioclimatic main strategy for the hot and humid climate of Natal/RN, offering among other benefits, the thermal comfort of occupants. The analysis tools of natural ventilation, on the other hand, cover a variety of techniques, from the simplified calculation methods to computer fluid dynamics, whose limitations are discussed in several papers, but without detailing the problems encountered. In this sense, the present study aims to evaluate the potential of wind catchers, envelope elements used to increase natural ventilation in the building, through CFD simplified simulation. Moreover, it seeks to quantify the limitations encountered during the analysis. For this, the procedure adopted to evaluate the elements implementation and efficiency was the CFD simulation, abbreviation for Computer Fluid Dynamics, with the software DesignBuilder CFD. It was defined a base case, where wind catchers were added with various settings, to compare them with each other and appreciate the differences in flows and air speeds encountered. Initially there has been done sensitivity tests for familiarization with the software and observe simulation patterns, mapping the settings used and simulation time for each case simulated. The results show the limitations encountered during the simulation process, as well as an overview of the efficiency and potential of wind catchers, with the increase of ventilation with the use of catchers, differences in air flow patterns and significant increase in air speeds indoors, besides changes found due to different element geometries. It is considered that the software used can help designers during preliminary analysis in the early stages of design

Ventilação e prescrições urbanísticas: uma aplicação simulada no bairro de Petrópolis em Natal/RN

The present work studies the natural ventilation and its relationship with the urban standards, which establishes the form of occupation and use of the land in our cities. The method simulates the application of the urban standards of the City Master Plan over the last three years. The simulation takes place in the District of Petrópolis, in the city of Natal , Brazil and analyses the effects of the standards of natural ventilation. The formulated hypothesis states that the reductions in the urban spaces between buildings rises up the vertical profile of ventilation, reducing, therefore, the velocity of the wind at the lower levels of the buildings. To develop the study, occupation models were built, using computerized, three-dimensional models. These occupation models were analyzed using the CFD (Computational Fluid Dynamics) code. The conclusion is that the more we reduce the urban space between buildings, the more we reduce the wind speed in constructed areas, increasing, therefore, the possibility to generate heat islands

Abundância das formas imaturas de Psaroniocompsa incrustata ( Lutz, 1910) (Diptera: Simuliidae) em um criadouro natural no rio Pium/RN, e sua fauna associada

The species psaroniocompsa incrustata (Lutz, 1910) was studied in relation to its abundance in different and seasonal periods, the physico-chemical of the breending ground and the fauna predation added to the immature of the species. The study was developed during eight months, from April to July, 2005 (rainy season) and from October, 2005 to January, 2006 (drought season), in one natural breending ground situated in the Pium river, that is part of the hydrographical basin of the Pirangi river in Rio Grande do Norte. The immature of Simuliidae were collected manually in vegetal substrate. At the same place, it was made one sampling of the associated fauna using Suber collectors and the measurement of the environment variants. It was also made one analysis of the stomach content of possible enemies of the simulídeos, to observe the predation of the associated fauna. It was collected 7.713 samples, all from de species P. Incrustata, it was observed a bigger abundance in the drought season, and the entomologic fauna associated totalizing 20.1314 species, distributed in the kinds: Diptera, Ephemeroptera, Odonata, Trichoptera, e Hemiptera, with a bigger representativity of Dipteros. The analysis of the stomach content of the species from the families Libellulidae and Hydropsychidae showed the presence of the simulídeos in only 4% of the material analysed, therefore it was not confirmed the presence of one efficient biological control of the simulídeos in this breending ground

Biodiversidade e abundância da ictiofauna associada ao cultivo orgânico de Litopenaeus vannamei (Boone, 1931)

The expansion of shrimp farming has caused a series of environmental impacts, often as a result of lack of planning and adequate management. Organic aquaculture has emerged as an alternative to conventional shrimp farming, and differently, aims at the economical, ecological and farming potential of other organisms, such as fishes, oysters and seaweeds. The present study aimed at evaluating the biological diversity and abundance of the ichthyofauna associated to Litopenaeus vannamei organic culture at PRIMAR farm (Rio Grande do Norte, Brazil). The sampling period consisted of four culture cycles (1, 2, 3, and 4) accomplished in four grow-out ponds (V1, V7, V2, and V4) in 2005. The first two culture cycles were carried out during the rainy season, and the last two cycles, during the dry season. Environmental (temperature, salinity, transparency, and rainfall), biodiversity (diversity and uniformity and abundance indexes) of the ichthyofauna, and shrimp productivity data were collected throughout these four culture cycles. The results obtained for the environmental variables showed that both salinity and transparency oscillated in a significant way (p < 0.001) between culture cycles. In relation to the abundance of the ichthyofauna, fifty four species associated to the organic culture of Litopenaeus vannamei were collected and identified at PRIMAR. For the biodiversity criterion, larger species richness (S = 46) and uniformity (E = 0.59 ± 0.16) were observed during cycles 3 and 4 than in cycles 1 and 2 (S = 41 and E = 0.15 ± 0.12). A positive and significant correlation was obtained for the transparency with diversity and uniformity of fish species between cycles 1 and 2 (wet season) and cycles 3 and 4 (dry season) (p < 0.017 - Shannon Index; p < 0.008 - Pielou Index, respectively). A correlation could not be established between shrimp productivity and fish biomass. However, fish biomass decreased from cycles 1 and 2 to cycles 3 and 4, concomitant with an increase in shrimp productivity, most probably due to a higher (from 58.0% to 71.0%) shrimp survival. Regarding the culture potential of the ichthyofauna, three species (Mugil curema, Mugil liza and Chaetodipterus faber) were identified as potential farming alternatives, either singly or in consortium with Litopenaeus vannamei. A fourth species (Centropomus undecimalis) was indicated as an alternative for single culture or in consortium with other fish species. In conclusion, the large diversity of estuarine fishes associated to Litopenaeus vannamei farming observed at PRIMAR clearly indicated the ecological feasibility for organic aquaculture in northeastern Brazil

Infecção hospitalar associada ao uso de cateter venoso central e a quebra de protocolos pelos profissionais de saúde na UTI de um hospital universitário em Natal/RN

This is a study descriptive cross-sectional and quantitative approaches, which aimed to analyze the association between hospital infection rate for insertion, maintenance of central venous catheter and the breakdown of protocols (rules and routines) by health professionals assisting patients in the ICU of a university hospital in Natal / RN. The process of data collection was through observation with structured form, refers to medical records and structured questionnaires with health professionals. The results were organized, tabulated, categorized and analyzed using SPSS 14.0. The characterization of the subjects was performed using descriptive and inferential statistics, taking into account the nature of the variables, with analysis of variance (ANOVA) and Spearman correlation test, it was a discussion of the information obtained, considering the mean, standard deviation, coefficient of variance and standard error. The variables that showed a higher level of correlation were treated with the application of significance tests. As the results, 71% of participants were female and 29% male, age ranged from 18 to 85 years (52.6 ± 22.5). The insertion, there was a variation from 0 to 5 errors (1.2 ± 1.4), during maintenance, the average was 2.3 ± 0.9 errors, ranging from 0 to 4. During the insertion and maintenance of CVC, patients who had been an infection ranging from 2 to 9 mistakes (4.2 ± 1.7), since those who did not show the variation goes from 0 to 5 errors (2, 8 ± 1.5). The correlation coefficient between the risk of infection throughout the process and the risk of infection at the insertion showed strong and significant (r = 0.845 p = 0.000) and in relation to risk of infection in maintenance was moderate and significant (r = 0.551 p = 0.001). The mistakes made by professionals in the procedures for insertion and maintenance of the catheter, associated with other conditions, shown as a risk factor for the of IH

Análise cintilográfica da deposição pulmonar de radioaerossol após associação da nebulização através dos dispositivos mesh e jato com a ventilação não invasiva em indivíduos normais e com pneumopatias obstrutivas crônicas

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Morbimortalidade perinatal associada à infecção clamidiana: uma revisão sistemática

Universidade Federal do Rio Grande do Norte

Consequências da colectomia associada à hepatectomia no metabolismo hepático e na forma e função de hemácias em ratos

This study investigated the influence of partial colectomy associated with hepatectomy on the biodistribution of the 99mTc-phytate, on metabolic parameters, as well as labeling and morphology of red blood cells. Wistar rats were distributed into three groups (each with 6), nominated as colectomy, colectomy+hepatectomy and sham. In the 30th postoperative day all rats were injected with 99mTc-phytate 0.1mL i.v. (radioactivity 0.66 MBq). After 15 minutes, liver sample was harvested and weighed. Percentage radioactivity per gram of tissue (%ATI/g) was determined using an automatic gamma-counter. Serum AST, ALT, alkaline phosphatase and red blood cells labeling were determined. The liver %ATI/g and red blood cells labeling were lower in colectomy and colectomy+hepatectomy rats than in sham rats (p <0.05), and no difference was detected comparing the colectomy and colectomy+hepatectomy groups. Red blood cells morphology did not differ among groups. Serum levels of AST, ALT and alkaline fosfatase were significantly higher in colectomy+hepatectomy than in colectomy rats (p<0.001). Hepatectomy associated with colectomy lowered the uptake of radiopharmaceutical in liver and in red blood cells in rats, coinciding with changes in liver enzymatic activity

Determinação dos fatores neuroepidemiológicos das crises convulsivas em recém nascidos internados em unidades de terapia intensiva

O objetivo do nosso projeto foi determinar as características dos recém nascidos com crises convulsivas internados em unidades de terapia intensiva. Foi realizada uma pesquisa multicêntrica, observacional, prospectiva, cuja população alvo foi os recém nascidos com crises convulsivas internados em unidades de terapia intensiva, envolvendo equipe multidisciplinar constituída por neurologista infantil, neonatologistas, intensivistas pediátricos, enfermeiros, técnicos de enfermagem e fisioterapêutas. As crises foram definidas pelo critério clínico, com classificação de Volpe. Variáveis relacionadas à gestação, ao parto, características dos recém nascidos, aspectos das crises convulsivas e mortalidade foram analisadas. Estatística: descritiva (freqüências, medidas de tendência central e dispersão) e análise (teste de probabilidade, teste de risco e de acurácia). Comparamos as crises clínicas entre os recém nascidos de termo e pretermo e observamos diferenças com significância estatística na idade de início das crises, mais tardia nos prematuros, na etiologia predominante: hemorragia peri-intraventricular no prematuro e encefalopatia hipóxico-isquêmica no termo e tipo clínico de crise, clônica no pretermo e sutil no termo. Os testes de acurácia utilizados para determinar se o tipo clínico de crise convulsiva é predictor da etiologia da mesma não revelaram resultados positivos. Quanto às características associadas à mortalidade de prematuros com crise convulsiva, observamos associação entre ventilação mecânica e pneumonia com a mortalidade. Existem diferenças clínicas quando comparamos os recém nascidos pretermo e de termo com crises convulsivas, confirmando dados da literatura