Origem física das curvas sigmoidais respiratórias pressão-volume: recrutamento alveolar e elasticidade não-linear

An important unsolved problem in medical science concerns the physical origin of the sigmoidal shape of pressure volume curves of healthy (and some unhealthy) lungs. Such difficulties are expected because the lung, which is the most important structure in the respiratory system, is extremely complex. Its rheological properties are unknown and seem to depend on phenomena occurring from the alveolar scale up to the thoracic scale. Conventional wisdom holds that linear response, i.e., Hooke s law, together with alveolar overdistention, play a dominant role in respiration, but such assumptions cannot explainthe crucial empirical sigmoidal shape of the curves. In this doctorate thesis, we propose an alternative theory to solve this problem, based on the alveolar recruitment together with the nonlinear elasticity of the alveoli. This theory suggests that recruitment may be the predominant factor shaping these curves in the entire range of pressures normally employed in experiments. The proposed model correctly predicts the observed sigmoidal pressure volume curves, allowing us to discuss adequately the importance of this result, as well as its implications for medical practice

Acurácia dos indicadores clínicos do diagnóstico de enfermagem volume de líquidos excessivo em pacientes submetidos à hemodiálise

Trasnversal study, with the objective of evaluating the accuracy of clinical indicators of nursing diagnosis excessive fluid volume in patients undergoing hemodialysis. The study occurred in two stages, the first consisted of the evaluation of the diagnostic indicators in study; and the second, the diagnostic inference conducted by nurse diagnosticians. The first stage occurred from december 2012 to april 2013, in a University Hospital and a Hemodialysis Clinic in Northeastern of Brazil, with a sample of 100 chronic renal failure patients on hemodialysis. The data were selected through an interview form and a physical examination, organized into spreadsheets and analyzed as to the presence or absence of the indicators of diagnosis excessive fluid volume. In the second step, the spreadsheets were sent to three nurses diagnosticians, who judged the presence or absence of diagnosis in the clientele searched. This step was conducted from july to september 2013. For analysis of the data, we used descriptive and inferential statistics. In the descriptive analysis, we used measures of central tendency and dispersion. In inferential analysis, we used the tests Chi- square, Fisher and prevalence ratios. The accuracy of the clinical indicators pertaining to the diagnosis were measured as to the specificity, sensitivity, predictive values, likelihood ratios and Diagnostic Odds Ratio. Also developed a logistic regression. The results were organized in tables and discussed with literature. This study was approved by the Ethics Committee in Research of the Federal University of Rio Grande do Norte, with Presentation Certificate for Ethics Appreciation nº 08696212.7.0000.5537. The results revealed that the diagnosis studied was present in 82% of patients. The characteristics with prevalence above 50 % that stood out were: azotemia, decreased hematocrit, electrolyte imbalance, intake exceeds output, anxiety, edema, decreased hemoglobin, oliguria and blood pressure changes. Eight defining characteristics were presented statistically significant association with the nursing diagnosis investigated: pulmonary congestion, intake exceeds output, electrolytes imbalance, jugular vein distension, edema, weight gain over short period of time, agitation and adventitious breath sounds. Among these, the 10 characteristics which showed higher prevalence ratios were: edema and weight gain over short period of time. The features with the highest sensitivity were edema, electrolytes imbalance and intake exceeds output and the standing out with greater specificity were: anasarca, weight gain over short period of time, change in respiratory pattern, adventitious breath sounds, pulmonary congestion, agitation and jugular vein distension. The indicators jugular vein distension, electrolytes imbalance, intake exceeds output, increased central venous pressure and edema, together, were identified in the logistic regression model as the most significant predictors. It is concluded that the identification of accurate clinical indicators allow a good prediction of the nursing diagnosis of excessive fluid volume in patients undergoing hemodialysis in order to assist the nurse in the inference process, which will contribute to the success of patient care. In addition, nurses will consider for diagnostic inference not only his clinical experience, but also scientific evidence of the occurrence of excessive fluid volume, contributing to the control of volemia in these patients

Obtenção de Propriedades Físico-Químicas de Misturas de Hidrocarbonetos em Baixa e Alta Pressão Visando a Caracterização e a Modelagem

The composition of petroleum may change from well to well and its resulting characteristics influence significantly the refine products. Therefore, it is important to characterize the oil in order to know its properties and send it adequately for processing. Since petroleum is a multicomponent mixture, the use of synthetic mixtures that are representative of oil fractions provides a better understand of the real mixture behavior. One way for characterization is usually obtained through correlation of physico-chemical properties of easy measurement, such as density, specific gravity, viscosity, and refractive index. In this work new measurements were obtained for density, specific gravity, viscosity, and refractive index of the following binary mixtures: n-heptane + hexadecane, cyclohexane + hexadecane, and benzene + hexadecane. These measurements were accomplished at low pressure and temperatures in the range 288.15 K to 310.95 K. These data were applied in the development of a new method of oil characterization. Furthermore, a series of measurements of density at high pressure and temperature of the binary mixture cyclohexane + n-hexadecane were performed. The ranges of pressure and temperature were 6.895 to 62.053 MPa and 318.15 to 413.15 K, respectively. Based on these experimental data of compressed liquid mixtures, a thermodynamic modeling was proposed using the Peng-Robinson equation of state (EOS). The EOS was modified with scaling of volume and a relatively reduced number of parameters were employed. The results were satisfactory demonstrating accuracy not only for density data, but also for isobaric thermal expansion and isothermal compressibility coefficients. This thesis aims to contribute in a scientific manner to the technological problem of refining heavy fractions of oil. This problem was treated in two steps, i.e., characterization and search of the processes that can produce streams with economical interest, such as solvent extraction at high pressure and temperature. In order to determine phase equilibrium data in these conditions, conceptual projects of two new experimental apparatus were developed. These devices consist of cells of variable volume together with a analytical static device. Therefore, this thesis contributed with the subject of characterization of hydrocarbons mixtures and with development of equilibrium cells operating at high pressure and temperature. These contributions are focused on the technological problem of refining heavy oil fractions

Avaliação muscular respiratória: adaptação do mano vacuômetro nacional para a avaliação da pressão inspiratória nasal e nível de intensidade da ventilação voluntária máxima em sujeitos saudáveis

The clinical importance of evaluating the respiratory muscles with a variety of tests has been proposed by several studies, once that the combination of several tests would allow a better diagnosis and therefore, a better clinical follow of disorders of the respiratory muscles. This study aimed to evaluate the feasibility of adapting a national electronic manovacuometer to measure the nasal inspiratory pressure (study 1) and analyze the level of load intensity of maximum voluntary ventilation, as well as the variables that may influence this maneuver in healthy subjects (study 2). We studied 20 healthy subjects by a random evaluation of two measures of SNIP in different equipments: a national and an imported. In study 2 it was analyzed the intensity of the load of MVV test, change in pressure developed during the maneuver, the possible differences between genders, and the correlations between the flow developed in the test and the result of MVV. In study 1 it was found the average for both measures of nasal inspiratory pressures: 125 ± 42.4 cmH2O for the imported equipment and 131.7 ± 28.7 cmH2O for the national one. Pearson analysis showed a significant correlation between the average, with a coefficient r = 0.63. The average values showed no significant differences evaluated by paired t test (p> 0.05). In the Bland-Altman analysis it was found a BIAS = 7 cmH2O, SD 32.9 and a confidence interval of - 57.5 cmH2O up to 71.5 cmH2O. In the second study it was found significant differences between the genders in the air volume moved, being higher in males 150.9 ± 13.1 l / min vs 118.5 ± 15.7 L / min for (p = 0.0002, 95% CI 44.85 to 20:05). Regarding the inspiratory and expiratory loading, they were significantly higher in men than in women, peak inspiratory pressure (34.7 ± 5.3 cmH2O vs 19.5 ± 4.2 cmH2O, 95% CI - 18.0 to -12.3, p <0.0001), peak expiratory (33.8 vs. 23.1 ± 5.9 cmH2O ± 5.4 cmH2O, 95% CI -17.1 to - 4.6, p <0.0001), and the delta pressure (59.7 ± 10 cmH2O vs 36.8 ± 8.3 cmH2O, 95% CI 14.5 to 31.2, p <0.0002). The Pearson correlation showed that the flow generated by the maneuver is strongly correlated with the delta-expiratory pressure / inspiratory (r2= 0.83,R = 0.91, 95%IC 0.72 a 0.97 e p< 0.0001).Through these results we suggest that the national electronic manovacuometer is feasible and safe to perform the sniff test in healthy subjects. For the MVV, there are differences between the genders in the intensity of pressure developed during the maneuver. We found a load intensity considered low during the MVV, and found a strong correlation between the flow generated in the test and the delta pressure expiratory / inspiratory

Efeitos agudos de diferentes intensidades de pressão expiratória positiva sobre os volumes pulmonares em pacientes com acidente vascular encefálico

observar os efeitos agudos de diferentes intensidades de Pressão Expiratória Positiva (PEP) sobre a cinemática do complexo toracoabdominal de pacientes acometidos por Acidente Vascular Encefálico (AVE). Métodos: Foram selecionados 21 indivíduos com AVE e 16 indivíduos saudáveis pareados por idade sexo e IMC para grupo controle. Avaliamos função pulmonar, pressões dos músculos respiratórios e os volumes pulmonares por meio da Pletismografia Optoeletrônica durante três diferentes intensidades de PEP 10, 15 e 20 cmH2O. Resultados: o efeito da PEP no volume corrente (VC) do grupo AVE em relação ao grupo controle foi diferente. Enquanto o grupo controle aumentou o VC em relação a respiração tranquila em 343%, 395,2% e 431,8% nas PEP10, PEP15 e PEP20 cmH2O o grupo AVE aumento 186%, 218.8% e 209.5% (p < 0.0001). A PEP também influenciou de forma diferente em relação ao Tempo inspiratório com intensidades diferentes no grupo controle e AVE (p < 0.0001). No ciclo de trabalho foi observado um aumento no grupo controle nas PEP10 (p < 0.001) e PEP15 (p < 0.05) e no grupo AVE foi observada uma redução PEP20 (p < 0.01) quando comparada com a respiração tranquila. Os volumes operacionais do grupo AVE foi observado aumento do volume inspiratório final da parede torácica (Vifpt) e do Volume expiratório final da parede torácica (Vefpt) diferente do grupo controle que gerou aumento do Vifpt acompanhado de diminuição do Vefpt durante as três intensidades de PEP. Conclusão: A hiperinsuflação observada no grupo AVE demonstra que essa terapêutica deve ser utilizada com cautela especialmente nas intensidades maiores que 10 cmH2O para essa população

Análise da distribuição do volume pulmonar total e compartimental de crianças com peso normal e obesidade em diferentes posturas

Introdução: A obesidade infantil apresenta incidência crescente e as possíveis comorbidades, como alteração da função respiratória, estão cada vez mais presente nessa faixa etária. O tecido adiposo impõe carga ao sistema respiratório o que leva a um padrão restritivo. Essa condição sofre alterações com as mudanças posturais, onde a gravidade influencia o padrão respiratório de acordo com o posicionamento adotado. Objetivo: Avaliar a distribuição dos volumes total e regional e o movimento tóracoabdominal de crianças e adolescentes que estão acima do peso nas posturas supino e sentado. Métodos: Cinqüenta e duas crianças/adolescentes (8-12 anos) divididas em três grupos: Grupo Obeso (GO=22); Grupo Sobrepeso (GSP=9); Grupo Controle (GC=21) foram avaliadas quanto às medidas antropométricas, teste de função pulmonar, exame das pressões respiratórias máxima e a pletismografia optoeletrônica em duas posturas, supino e sentado, durante a respiração tranquila. Resultados: As crianças que estão obesas apresentaram maiores valores em relação ao GSP e GC das seguintes variáveis espirométricas: volume expiratório forçado no primeiro segundo (VEF1) (p<0.05) e capacidade vital forçada (CVF) (p<0.01). No exame de manovacuometria o GO apresentou um aumento na pressão inspiratória máxima (PImáx) (p<0.01) em comparação com os outros grupos. Quanto à distribuição do volume corrente, o GO possui uma maior contribuição do compartimento abdominal (AB) na postura supina (p<0.05) em relação ao GC e GSP, enquanto que na postura sentada os grupos não diferiram em relação à distribuição dos volumes. O GO apresentou maior assincronia na postura supina (p<0.05) e maior velocidade de encurtamento (p<0.05) em relação os outros grupos. Conclusão: A obesidade em crianças/adolescentes não provoca prejuízos na função pulmonar, incrementa a força muscular inspiratória, aumenta a participação do compartimento AB e a assincronia no MTA na postura em supino, conclui-se que a postura supina associada à obesidade provoca aumento da sobrecarga do diafragma, desfavorecendo o desempenho do sistema respiratório.

Avaliação da pressão inspiratória nasal sniff na população obesa

Introdução: a avaliação da pressão inspiratória nasal (SNIP) é considerada uma manobra complementar da Pressão Inspiratória Máxima estática (PImax) em várias condições clínicas, porém não há relatos na obesidade. Por outro lado, a obesidade tem um importante impacto nos músculos respiratórios especialmente com maiores gordura abdominal o que provavelmente pode ser detectado na avaliação da SNIP que mensura mais precisamente a pressão diafragmática. Objetivo: analisar em obesos a relação entre SNIP e variáveis respiratórias e marcadores de adiposidade. Material e Método: num estudo transversal um total de 92 obesos (38.3±10.2 anos) sem história de doença respiratória ou cardíaca diagnosticada. Foram avaliados na espirometria (capacidade vital forçada-CVF; volume expiratório forçado no primeiro segundo-VEF1; volume de reserva expiratório-VRE) e pressões respiratórias estática (PImax, PEmax e SNIP) e dinâmica (ventilação voluntária máxima-VVM). Sendo considerados os marcadores de adiposidade: índice de adiposidade corporal-IAC; índice de massa corporal-IMC e circunferências do quadril (CQ), cintura (CC) e pescoço (CP). Resultados: 65 obesos mórbidos (IMC=50.8±8.1Kg/m2) e 27 obesos não mórbidos (IMC=35.6±2.7Kg/m2) foram homogêneos (p>0.05) na SNIP (99.1±24.5cmH2O, 87% do predito) e PImax (107.3±26.4cmH2O, 109% do predito). Existe correlação (r=0.5) entre SNIP e PImax somente no grupo de obesos mórbidos. De acordo com as correlações houve associação entre variáveis respiratórias (CVF r=0.48; VEF1 r=0.54; e VVM r=0.54), valores antropométricos (idade r=-0.44) e SNIP somente para os obesos mórbidos. Esses achados foram certificados quando também comparados a quantidade de gordura ao redor do pescoço (CP≥43cm). O modelo de regressão linear stepwise mostrou que a VVM parece ser o melhor preditor para explicar a SNIP nos obesos mórbidos. Nestes obesos a SNIP foi levemente mais baixa (87%predito) que os valores esperados para indivíduos brasileiros saudáveis. Conclusão: em obesos mórbidos a SNIP é moderadamente relacionada a PImax. A SNIP parece ser mais relacionada a VVM que à marcadores de adiposidade.

Estudo do comportamento da sinterização de compactos de cavacos de um aço SAE 1050 obtidos sob alta pressão

From an economic standpoint, the powder metallurgy (P/M) is a technique widely used for the production of small parts. It is possible, through the P/M and prior comminution of solid waste such as ferrous chips, produce highly dense sintered parts and of interest to the automotive, electronics and aerospace industries. However, without prior comminution the chip, the production of bodies with a density equal to theoretical density by conventional sintering techniques require the use of additives or significantly higher temperatures than 1250ºC. An alternative route to the production of sintered bodies with high density compaction from ferrous chips (≤ 850 microns) and solid phase sintering is a compression technique under high pressure (HP). In this work, different compaction pressures to produce a sintered chip of SAE 1050 carbon steel were used. Specifically, the objective was to investigate them, the effect of high pressure compression in the behavior of densification of the sintered samples. Therefore, samples of the chips from the SAE 1050 carbon steel were uniaxially cold compacted at 500 and 2000 MPa, respectively. The green compacts obtained were sintered under carbon atmosphere at 1100 and 1200°C for 90 minutes. The heating rate used was 20°C/min. The starting materials and the sintered bodies were characterized by optical microscopy, SEM, XRD, density measurements (geometric: mass/volume, and pycnometry) and microhardness measurements Vickers and Rockwell hardness. The results showed that the compact produced under 2000 MPa presented relative density values between 93% and 100% of theoretical density and microhardness between 150 HV and 180 HV, respectively. In contrast, compressed under 500 MPa showed a very heterogeneous microstructure, density value below 80% of theoretical density and structural conditions of inadequate specimens for carrying out the hardness and microhardness measurements. The results indicate that use of the high pressure of ferrous chips compression is a promising route to improve the sinterability conditions of this type of material, because in addition to promoting greater compression of the starting material, the external tension acts together with surface tension, functioning as the motive power for sintering process. Additionally, extremely high pressures allow plastic deformation of the material, providing an intimate and extended contact of the particles and eliminating cracks and pores. This tends to reduce the time and / or temperature required for good sintering, avoiding excessive grain growth without the use of additives. Moreover, higher pressures lead to fracture the grains in fragile or ductile materials highly hardened, which provides a starting powder for sintering, thinner, without the risk of contamination present when previous methods are used comminution of the powder.

Influência da pressão e da vazão de concentrado sobre o desempenho de ultrafiltração no pós-tratamento de esgotos

Despite the numerous advantages resulting from the use of membrane filters technology, intrinsic limitations fouling process become relevant to its applicability. The control of operating conditions is an important tool to mitigate fouling and achieve good levels of efficiency. In this sense, the objective of this study was to investigate the effect of transmembrane pressure and concentrate flow in the performance of ultrafiltration, applied to the post-treatment of domestic sewage. The process was evaluated and optimized by varying the pressure (0.5 and 1.5 bar) and the concentrate flow (300 and 600 L/h), using a 22 factorial design, in order to investigate the effects on the permeate flow and quality of effluents generated at each operating condition. We evaluated the following quality indicators for permeate: pH, electrical conductivity, total suspended solids, turbidity, calcium and Chemical Oxygen Demand (COD). In all tests, we observed marked reduction in the permeate flux at the early stages, followed by a slow decline that lasted until it reaches a relatively constant level, around 120 minutes of filtration. The increased pressure resulted in a higher initial permeate flux, but the decrease of the flow with time is greater for tests at higher pressure, indicating a more pronounced fouling process. On the other hand, increasing the concentrate flow resulted in a slower decline in permeate flux with the filtration time. Regarding the quality of permeate, the transmembrane pressure of 0,5 bar was the one that allowed better results, and was statistically confirmed through the two-way ANOVA test with repeated measures, significant effect of pressure on the turbidity of the permeate. The concentrate flow, in turn, showed no significant influence on any of the quality parameters. Thus, we conclude that, from an economic and environmental point of view, it is more interesting to operate ultrafiltration membrane system with a lower concentrate flow associated with a low transmembrane pressure, since under these conditions will produce less waste, and the permeate will present lower concentrations of the analyzed constituent, especially lower turbidity.

Uma nova proposta de fluidos de perfuração aquosos à base de polímeros vinílicos e bentonita para poços de alta temperatura e pressão

The advance of drilling in deeper wells has required more thermostable materials. The use of synthetic fluids, which usually have a good chemical stability, faces the environmental constraints, besides it usually generate more discharge and require a costly disposal treatment of drilled cuttings, which are often not efficient and require mechanical components that hinder the operation. The adoption of aqueous fluids generally involves the use of chrome lignosulfonate, used as dispersant, which provides stability on rheological properties and fluid loss under high temperatures and pressures (HTHP). However, due to the environmental impact associated with the use of chrome compounds, the drilling industry needs alternatives that maintain the integrity of the property and ensure success of the operation in view of the strong influence of temperature on the viscosity of aqueous fluids and polymers used in these type fluids, often polysaccharides, passives of hydrolysis and biological degradation. Therefore, vinyl polymers were selected for this study because they have predominantly carbon chain and, in particular, polyvinylpyrrolidone (PVP) for resisting higher temperatures and partially hydrolyzed polyacrylamide (PHPA) and clay by increasing the system's viscosity. Moreover, the absence of acetal bonds reduces the sensitivity to attacks by bacteria. In order to develop an aqueous drilling fluid system for HTHP applications using PVP, HPAM and clay, as main constituents, fluid formulations were prepared and determined its rheological properties using rotary viscometer of the Fann, and volume filtrate obtained by filtration HTHP following the standard API 13B-2. The new fluid system using polyvinylpyrrolidone (PVP) with high molar weight had higher viscosities, gels and yield strength, due to the effect of flocculating clay. On the other hand, the low molecular weight PVP contributed to the formation of disperse systems with lower values in the rheological properties and fluid loss. Both systems are characterized by thermal stability gain up to around 120 ° C, keeping stable rheological parameters. The results were further corroborated through linear clay swelling tests.

Uma nova proposta de fluidos de perfuração aquosos à base de polímeros vinílicos e bentonita para poços de alta temperatura e pressão

The advance of drilling in deeper wells has required more thermostable materials. The use of synthetic fluids, which usually have a good chemical stability, faces the environmental constraints, besides it usually generate more discharge and require a costly disposal treatment of drilled cuttings, which are often not efficient and require mechanical components that hinder the operation. The adoption of aqueous fluids generally involves the use of chrome lignosulfonate, used as dispersant, which provides stability on rheological properties and fluid loss under high temperatures and pressures (HTHP). However, due to the environmental impact associated with the use of chrome compounds, the drilling industry needs alternatives that maintain the integrity of the property and ensure success of the operation in view of the strong influence of temperature on the viscosity of aqueous fluids and polymers used in these type fluids, often polysaccharides, passives of hydrolysis and biological degradation. Therefore, vinyl polymers were selected for this study because they have predominantly carbon chain and, in particular, polyvinylpyrrolidone (PVP) for resisting higher temperatures and partially hydrolyzed polyacrylamide (PHPA) and clay by increasing the system's viscosity. Moreover, the absence of acetal bonds reduces the sensitivity to attacks by bacteria. In order to develop an aqueous drilling fluid system for HTHP applications using PVP, HPAM and clay, as main constituents, fluid formulations were prepared and determined its rheological properties using rotary viscometer of the Fann, and volume filtrate obtained by filtration HTHP following the standard API 13B-2. The new fluid system using polyvinylpyrrolidone (PVP) with high molar weight had higher viscosities, gels and yield strength, due to the effect of flocculating clay. On the other hand, the low molecular weight PVP contributed to the formation of disperse systems with lower values in the rheological properties and fluid loss. Both systems are characterized by thermal stability gain up to around 120 ° C, keeping stable rheological parameters. The results were further corroborated through linear clay swelling tests.