Comparison between two methods for cardiac output measurement in propofol-anesthetized dogs: thermodilution and Doppler

ObjectiveTo compare cardiac output (CO) measured by Doppler echocardiography and thermodilution techniques in spontaneously breathing dogs during continuous infusion of propofol. To do so, CO was obtained using the thermodilution method (CO(TD)) and Doppler evaluation of pulmonary flow (CO(DP)) and aortic flow (CO(DA)).Study designProspective cohort study.AnimalsEight adult dogs weighing 8.3 +/- 2.0 kg.MethodsPropofol was used for induction (7.5 +/- 1.9 mg kg-1 IV) followed by a continuous rate infusion at 0.7 mg kg-1 minute-1. The animals were positioned in left lateral recumbency on an echocardiography table that allowed for positioning of the transducer at the 3rd and 5th intercostal spaces of the left hemithorax for Doppler evaluation of pulmonary and aortic valves, respectively. CO(DP) and CO(DA) were calculated from pulmonary and aortic velocity spectra, respectively. A pulmonary artery catheter was inserted via the jugular vein and positioned inside the lumen of the pulmonary artery in order to evaluate CO(TD). The first measurement of CO(TD), CO(DP) and CO(DA) was performed 30 minutes after beginning continuous infusion (T0) and then at 15-minute intervals (T15, T30, T45 and T60). Numeric data were submitted to two-way anova for repeated measurements, Pearson's correlation coefficient and Bland & Altman analysis. Data are presented as mean +/- SD.ResultsAt T0, CO(TD) was lower than CO(DA). CO(DA) was higher than CO(TD) and CO(DP) at T30, T45 and T60. The difference between the CO(TD) and CO(DP), when all data were included, was -0.04 +/- 0.22 L minute-1 and Pearson's correlation coefficient (r) was 0.86. The difference between the CO(TD) and CO(DA) was -0.87 +/- 0.54 L minute-1 and r = 0.69. For CO(TD) and CO(DP), the difference was -0.82 +/- 0.59 L minute-1 and r = 0.61.ConclusionDoppler evaluation of pulmonary flow was a clinically acceptable method for assessing the CO in propofol-anesthetized dogs.

The effects of 2 levels of the inspired oxygen fraction on blood gas variables in propofol-anesthetized dogs with high intracranial pressure

The influence of 2 different levels of the inspired oxygen fraction (FiO(2)) on blood gas variables was evaluated in dogs with high intracranial pressure (ICP) during propofol anesthesia (induction followed by a continuous rate infusion [CRI] of 0.6 mg/kg/min) and intermittent positive pressure ventilation (IPPV). Eight adult mongrel dogs were anesthetized on 2 occasions, 21 d apart, and received oxygen at an FiO(2) of 1.0 (G100) or 0.6 (G60) in a randomized crossover fashion. A fiberoptic catheter was implanted on the surface of the right cerebral cortex for assessment of the ICP. An increase in the ICP was induced by temporary ligation of the jugular vein 50 min after induction of anesthesia and immediately after baseline measurement of the ICP. Blood gas measurements were taken 20 min later and then at 15-min intervals for 1 h. Numerical data were submitted to Morrison's multivariate statistical methods. The ICP, the cerebral perfusion pressure and the mean arterial pressure did not differ significantly between FiO(2) levels or measurement times after jugular ligation. The only blood gas values that differed significantly (P < 0.05) were the arterial oxygen partial pressure, which was greater with G100 than with G60 throughout the procedure, and the venous haemoglobin saturation, that was greater with G100 than with G60 at M0. There were no significant differences between FiO(2) levels or measurement times in the following blood gas variables: arterial carbon dioxide partial pressure, arterial hemoglobin saturation, base deficit, bicarbonate concentration, pH, venous oxygen partial pressure, venous carbon dioxide partial pressure and the arterial-to-end-tidal carbon dioxide difference.

Técnica para avaliação da pressão arterial pulmonar de equinos durante o exercício progressivo em esteira rolante

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Bispectral index in dogs with high intracranial pressure, anesthetized with propofol and submitted to two levels of FiO2

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Alternative Intrabladder Manometry Technique for the Indirect Measurement of Intra-abdominal Pressure in Horses

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Agir, aprender, formar, intervir, agir uma experiência dos consultores internos na gestão do conhecimento da Petrobrás UN-RNCE

This research aims at studying the formation of internal consultants in organizational setting in the joint resolution of problems, around the conversion of knowledge. The objective of research is to understand and explain the meanings attributed by Petrobras internal consultants to their practice and training for the conversion process of tacit knowledge into explicit, around the joint resolution of their problems with their collaborators. It has directed the next question: what the meanings assigned by the consultants of Unidade de Negócios Rio Grande do Norte e Ceara (UN-RNCE) in Knowledge Management (KM), for their interventionist and formative practices in problem solving, as well as conversion of tacit knowledge in explicit? This paper has assumed that there is a dual logic integrated into its daily practices: solving troubles and converting knowledge. The thesis has considered the daily practices of these consultants are characterized as epistemic spaces and permanent education through the conversion of knowledge. It has adopted the principles of multi-referential approach as foundations, regarding the translation of a variety of angles, perspectives and prospects which allow the interpretation and understanding of complex issues that are part of conversion of knowledge. The understanding and explanation of the senses are based on the methodology of the comprehensive interview; taking ownership is the sensitive listening for comprehensive interpretation of oral discourses of ten consultants, in addition to the autoscopy that putting into practice, thus, the stance of the researcher as an intellectual craftsman. Furthermore, it has assessed that the limits and possibilities for training and learning in the conversion of knowledge arise, on one hand from a predominantly driven training culture by the paradigm of technical rationality and one the other hand, from a set of relationship to knowledge and relation to know , revealed in the search for training in other dimensions. There are tensions between the local and global demands located in a situation marked by a systemic organization of knowledge. However, the context is perceived by researchers as impregnated by the discontinuity, unpredictability and uncertainty; mobilizing a number of elements necessary for the mediation in training practices of these consultants. Finally, it has set an instrumental and technological support, restricting the formation and undermining the position of the consultancy as nuclear function in Knowledge Management

Educação - Corporeidade - Lazer: saber da experiência cultural em prelúdio

In the passage of life, the labyrinth of songs and corners are propitious ways for a better comprehension, perception and incorporation of learnings that emerge from our subjectiveness in a magic caught by senses. Eyesight, taste, hearing, touch and smell in communication with the world, put us in front of cultural diversities. The ludicity accumulated by experiences promote the flow of hilarious and concrete discoveries that express themselves in work and leisure demonstrations. Such reflections emerge indicators to the problematic construction centralized in the incorporation of cultural experience knowledge to the formation process and professional interventions in this rule and area. From this significant problematic, aiming to deepen studies, we favored leisure as field of investigative production in full expansion. This, for sure, was an exercise of qualification that guided us through meander of education and made us dip into studies about the corporeity. A research in which the scenery was painted and constructed with the complicity of the culture lived with shine, colors, rhythm and drummings of one of the most present cultural cycles: carnival. Recognized as a stimulant for beauty, participation, socialization, and helped us to enter in the essence of gestures and expressions of corporeity, to think, elaborate and socialize a critic-scientific knowledge which, appropriating from the rhythm of colors, of sounds, of tonalities, of senses and of meanings impregnated in the web of life. All these things seduced the researcher, making imagination flow amid ludic-creative dialogues with the imaginary of researchers creation and production in the rule and area of leisure, education and corporeity. Option that made us outline as objective to investigate and interpret how leisure teachers-researchers, from their studies, researches and interventions, locate and incorporate the knowledge from cultural experience to the formation process and intervention of professionals in this rule and in this area, emphasizing the contributions from this knowledge to fence and qualify this praxis. So, as living each cultural scenery, each epistemological contribution was feeding the production with images of the different versions of the Brazilian breedings, creating and raising expectations and new discoveries and newcomers. With the seriousness of a scientific study, we lived an xxiii academic experience with complex intensity, rigor and coherence, eliminating, step by step, the risks and limitations always present in a work of this magnitude. However, we weren t, even for one moment, alone. Our epistemic regard always maintained mediated by the principles of a methodological approach - the Etnomethodology, that while central guide provided us clues to unveil the lived world by our people-playful , in a universe of 15 members, that allowed themselves to comprehend, comment, analyze. This way, grasping the object in interactions arised and provoked by narrative interview, it was systematically dialected by (re) interpretation of images and formulations of people-playful, enriched by their beliefs, myths, conceptions and rituals inherent to knowledge from cultural experience, which each one attuned with Brazilian and international history, in a mixture of senses echoed from songs and tales. Inspired in drummings and percussions, clothing and choreographies of gestures and expressions, in mixtures produced in unit interactions in the multiplicity shown as necessary requests to the totality of life, with ludicity the rescue of the past, the conquest of present and the construction of future was the axle guide. This rich process of scientific creation made us realize that is possible qualify and empower the praxis in the rule and area of leisure incorporating the knowledge from cultural experience. What also becomes possible is the recuperation of objective revolutionaries and changing conditions of praxis itself with the view of strengthening and triggerment of vital elements in the rule and area of leisure. We also reaffirm that from this praxis emerge elements necessary to human formation in plenitude, by the appropriation of knowledge that guide the facing of challenges of a complex and plural world that valorize education, corporeity and leisure

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

Infecção do trato urinário associada à sondagem vesical numa unidade de terapia intensiva

A descriptive, quantitative approach and non-participant observation study, which was aimed at analyzing the association between knowledge and practice of inclusion and maintenance of urinary catheter by nursing professionals in the occurrence of urinary tract infection, performed in the ICU of Onofre Lopes University Hospital in Natal / RN. The original sample was composed of 42 nursing staff professional, five (5) nurses and 37 nursing technicians, 27 of them were outsourced (FUNPEC and IEL fellows) and 10 servers UFRN. Data collection was performed using two instruments, the first observation procedures used in the insertion and manipulation of indwelling urinary catheter (IUC) and the second with a questionnaire that addressed the characterization data of respondents, knowledge and conduct the insertion and manipulation of the IUC. The results were tabulated in Microsoft Excel and analyzed using SPSS software, version 15.0. We found the prevalence of institutional staff members on outsourcing - IEL and FUNPEC - (64.3%) were female (69.0%), aged 21 to 35 years (59.5%) and with mid-level education (88.1%). As to knowledge, we found that the nurses had levels of good to excellent and the nursing technicians, to regulate the poor. The nurses made a mistake when choosing IUC (40.0%) and washing hands (30.0%) and technicians on hand washing (74.4%) and the contents of the tray (34.7%). In relation to the conduct of insertion of IUC, the nurses made a mistake when choosing SVD (66.7%) and washing hands (57.1%). Regarding the handling of IUC/drainage system, the technicians were wrong more about washing their hands (56.0%). Analyzing the misconduct to the categorization of knowledge, we saw that the nursing staff who had missed more had inadequate knowledge (ρ = 0.001). At the end we found the risk of a patient to acquire UTI is higher in two and a half times when there is a large number of mismatches, patient spends more time using the IUC and hospitalized in the ICU. As regards the study hypotheses, we accept the alternative hypothesis and reject the null hypothesis proposed at the start of this research, where the number of gaps in knowledge and behavior increases the incidence of urinary tract infection.

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

Cuidado de enfermagem ao potencial doador de órgãos em morte encefálica: uma reflexão sobre a prática

Despite of the technological advances that favor the transplant process, there are issues of effectiveness of care necessary for the maintenance of potential organ donors with brain death, which contribute to the no realization of transplants of organs and tissues of these patients. It is presupposed that the problems could be related to perceptions and understandings that the professionals of the units of internment have about the care required by the diagnosis of brain death. The aim of this study was to understand the meaning of the nursing care of the potential organ donor with brain death to the nursing staff. Descriptive study with qualitative approach guided by Action Science Theory and the critic-reflexive research methodology accomplished with five nurses and 19 nursing technicians from Operative Rehabilitation Center in a public hospital at Natal / RN, Brazil, between March and May 2013. Data were collected through semi-structured interviews with individual reflection about the care and through group interview, after approval by the Ethics and Research Committee, CAAE No.: 04255612.7.0000.5537. The analysis was performed in a thematic way according to Bardin. During the group meeting the participants were driven in a discussion about the need for change and how to perform them. The results indicate that the professionals actions are consistent with those required for maintenance of potential organ donors, although the material and human resources are not adequate. That situation leads the professionals to develop a meaning of care as one labor more, demanding more than they can give. They express beliefs and feelings concerning the hope that their care brings a greater good that is to save lives. The reflection for a possible change of action was difficult to accomplish due to professionals not to be able to self evaluate, what lead to direct your changes suggestions for other team members. It is concluded that the care provided to these patients is a difficult care, evidenced by suffering both death situation of the person cared and pain of their families, as the dehumanizing conditions of work, helping themselves to keep distance from patients to not suffer so much. The knowledge impregnated in their act, are scientific, ethical, aesthetic and personal kind with a predominance of the scientific followed by the personal. The study was also relevant to the practice of nursing in maintaining the potential donor, in that it allowed the identification of the knowledge used by nurses in their care practice and the meaning understanding of the professionals on the care provided, as a good action that brings satisfaction when the transplanting is executed. Other experiences are suggested with the critic-reflexive research methodology, both in research as in teaching nursing

The adrenergic regulation of the cardiovascular system in the South American rattlesnake, Crotalus durissus

The present study investigates adrenergic regulation of the systemic and pulmonary circulations of the anaesthetised South American rattlesnake, Crotalus durissus. Haemodynamic measurements were made following bolus injections of adrenaline and adrenergic antagonists administered through a systemic arterial catheter. Adrenaline caused a marked systemic vasoconstriction that was abolished by phentolamine, indicating this response was mediated through alpha-adrenergic receptors. Injection of phentolamine gave rise to a pronounced vasodilatation (systemic conductance (G(sys)) more than doubled), while injection of propranolol caused a systemic vasoconstriction, pointing to a potent alpha-adrenergic, and a weaker beta-adrenergic tone in the systemic vasculature of Crotalus. Overall, the pulmonary vasculature was far less responsive to adrenergic stimulation than the systemic circulation. Adrenaline caused a small but non-significant pulmonary vasodilatation and there was tendency of reducing this dilatation after either phentolamine or propranolol. Injection of phentolamine increased pulmonary conductance (G(pul)), while injection of propranolol produced a small pulmonary constriction, indicating that alpha-adrenergic and beta-adrenergic receptors contribute to a basal regulation of the pulmonary vasculature. Our results suggest adrenergic regulation of the systemic vasculature, rather than the pultrionary, may be an important factor in the development of intracardiac shunts. (c) 2007 Elsevier B.V. All rights reserved.

Fibras de licuri: um reforço vegetal alternativo de compósitos poliméricos

This research is based, at first, on the seeking of alternatives naturals reinforced in place of polymeric composites, also named reinforced plastics. Therein, this work starts with a whole licuri fiber micro structural characterization, as alternative proposal to polymeric composites. Licuri fiber is abundant on the Bahia state flora, native from a palm tree called Syagrus Coronata (Martius) Beccari. After, it was done only licuri fiber laminar composite developing studies, in order to know its behavior when impregnated with thermofix resin. The composite was developed in laminar structure shape (plate with a single layer of reinforcement) and produced industrially. The layer of reinforcement is a fabric-fiber unidirectional of licuri up in a manual loom. Their structure was made of polyester resin ortofitálica (unsaturated) only reinforced with licuri fibers. Fiber characterization studies were based on physical chemistry properties and their constitution. It was made by tension, scanning electron microscopy (SEM), x-ray diffraction (RDX) and thermal analyses (TG and DTA) tests, besides fiber chemistry analyses. Relating their mechanical properties of strength and hardness testing, they were determined through unit axial tension test and flexion in three points. A study in order to know fiber/matrix interface effects, in the final composites results, was required. To better understand the mechanical behavior of the composite, macroscopic and microscopic optical analysis of the fracture was performed

Análise do comportamento mecânico de espumas cerâmicas a base de alumina obtidas pelo método da réplica

Ceramics with porous cellular structure, called ceramic foams, have a potential use in several applications, such as: thermal insulation, catalyst supports, filters, and others. Among these techniques to obtain porous ceramics the replication method is an important process. This method consists of impregnation of a sponge (usually polymer) with ceramic slurry, followed by a heat treatment, which will happen the decomposition of organic material and sintering the ceramic material, resulting in a ceramic structure which is a replica of impregnated sponge. Knowledge of the mechanical properties of these ceramics is important for these materials can be used commercially. Gibson and Ashby developed a mathematical model to describe the mechanical behavior of cellular solids. This model wasn´t for describing the ceramics behavior produced by the replica method, because it doesn´t consider the defects from this type of processing. In this study were researched mechanical behavior of porous alumina ceramics obtained by the replica method and proposed modifications to the model of Gibson and Ashby to accommodate this material. The polymer sponge used in processing was characterized by thermogravimetric analysis and scanning electron microscopy. The materials obtained after sintering were characterized by mechanical strength tests on 4-point bending and compression, density and porosity and by scanning electron microscopy. From these results it was evaluated the mechanical strength behavior compared to Gibson and Ashby model for solid cellular structure and was proposed a correction of this model through a factor related to struts integrity degree, which consider fissures present in the structure of these materials besides defects geometry within the struts

Envelhecimento ambiental em compósitos poliméricos à base de tecidos de reforços híbridos

The utilization of synthetic fibers for plastic reinforcement is more and more frequent and this growing interest requires that their mechanic behavior under the most variable conditions of structural applications be known. The use of such materials in the open and exposed to the elements is one of them. In this case, it becomes extremely necessary to study their mechanical properties (strength, stiffness) and the mechanism of fracture by which the environment aging them out. In order to do that, the material must be submitted to hot steam and ultraviolet radiation exposure cycles, according to periods of time determined by the norms. This study proposal deals with the investigation of accelerated environmental aging in two laminated polymeric composites reinforced by hybrid woven made up of synthetic fibers. The configurations of the laminated composites are defined as: one laminate reinforced with hybrid woven of glass fibers/E and Kevlar fibers/49 (LHVK) and the other laminate is reinforced with hybrid tissue of glass fibers/E and of carbon fibers AS4 (LHVC). The woven are plane and bidirectional. Both laminates are impregnated with a thermofix resin called Derakane 470-300 Epoxy Vinyl-Ester and they form a total of four layers. The laminates were industrially manufactured and were made through the process of hand-lay-up. Comparative analyses were carried out between their mechanical properties by submitting specimen to uniaxial loading tractions and three-point flexion. The specimen were tested both from their original state, that is, without being environmentally aging out, and after environmental aging. This last state was reached by using the environmental aging chamber