Echocardiographic Doppler estimation of pulmonary artery pressure in critically ill patients with severe hypoxemia

BACKGROUND: In spontaneously breathing cardiac patients, pulmonary artery pressure (PAP) can be accurately estimated from the transthoracic Doppler study of pulmonary artery and tricuspid regurgitation blood flows. In critically ill patients on mechanical ventilation for acute lung injury, the interposition of gas between the probe and the heart renders the transthoracic approach problematic. This study was aimed at determining whether the transesophageal approach could offer an alternative. METHODS: Fifty-one consecutive sedated and ventilated patients with severe hypoxemia (arterial oxygen tension/fraction of inspired oxygen < 300) were prospectively studied. Mean PAP measured from the pulmonary artery catheter was compared with several indices characterizing pulmonary artery blood flow assessed using transesophageal echocardiography: preejection time, acceleration time, ejection duration, preejection time on ejection duration ratio, and acceleration time on ejection duration ratio. In a subgroup of 20 patients, systolic PAP measured from the pulmonary artery catheter immediately before withdrawal was compared with Doppler study of regurgitation tricuspid flow performed immediately after pulmonary artery catheter withdrawal using either the transthoracic or the transesophageal approach. RESULTS: Weak and clinically irrelevant correlations were found between mean PAP and indices of pulmonary artery flow. A statistically significant and clinically relevant correlation was found between systolic PAP and regurgitation tricuspid flow. In 3 patients (14%), pulmonary artery pressure could not be assessed echocardiographically. CONCLUSIONS: In hypoxemic patients on mechanical ventilation, mean PAP cannot be reliably estimated from indices characterizing pulmonary artery blood flow. Systolic PAP can be estimated from regurgitation tricuspid flow using either transthoracic or transesophageal approach. © 2008 American Society of Anesthesiologists, Inc.

A ideologia dos filmes utilizados na educação infantil: uma análise a partir da teoria crítica

This work has as purpose to show what are the influences of media in the education and in the shaping the thinking and understand that ideologies are present in the films used in the classroom in kindergarten. For this, I directed the discussion beginning by concepts as Ideology and its more different definitions by several thinkers over the years, the thinkers of Critical Theory of Frankfurt School, called “frankfurtians” of first and second generation of this school, also making an association between Cinema and Education, evidencing concepts involving this association as Cultural Industry, using films properly in classrooms in kindergarten, with the teacher as mediator and then discussed what amounts of movies on children's education, how they assist and deepen the knowledge developed by students in schools of infantile education. Additionally, they are exposed the different opinions about the subject Film and Education for students from kindergarten, what benefits and what disadvantages in the use of films, the different opinions on the subject. We also discuss, in this work, the ideologies present in three films produced by Walt Disney, they are Cinderella, Snow White and the Seven Dwarfs and Alice in Wonderland, relating them to how they can contribute to the development and learning students in kindergarten. I associated more as possible the previous discussions to analyze the ideologies present in these films, by summarizing these, and decomposing them through an analysis tool called frame. Finally, I completed everything that was discussed and analyzed, which students in kindergarten may develop with the use of films in schools, what they contribute, in some way, for the learning and education of students as viewers using the school as access to different cultures and the teacher as a mediator of this relationship