INTRODUÇÃO: Diferentes parâmetros hemodinâmicos, incluindo os indicadores estáticos de pré-carga cardíaca como o índice de volume diastólico final ventrículo direito (IVDFVD) e parâmetros dinâmicos como a variação de pressão de pulso (VPP) têm sido usados na tomada de decisão para considerar o processo da expansão volêmica em pacientes em estado grave. O objetivo deste estudo foi comparar a reanimação por fluidos guiados tanto por VPP ou IVDFVD após choque hemorrágico induzido experimentalmente. MÉTODO: vinte e seis suínos anestesiados e ventilados mecanicamente foram alocados em três grupos: controle (Grupo I), VPP (Grupo II) e IVDFVD (Grupo III). Foi induzido choque hemorrágico por retirada de sangue até atingir a pressão arterial média de 40mmhg, que foi mantida por 60 minutos. Parâmetros foram medidos no tempo basal (B), no tempo do choque (Choque 0), sessenta minutos depois do choque (Choque 60), imediatamente depois da ressuscitação com hidroxietilamido 6% (130/0. 4) (R0), uma hora (R60) e duas horas (R120) depois ressuscitação. Os pontos de avaliação da reanimação por fluidos foram determinados pelo retorno aos valores basais iniciais de VPP e IVDFVD. A análise estatística dos dados foi baseada em ANOVA para medidas repetidas seguidos pelo teste de Bonferroni (P<0.05%). RESULTADOS: O volume e tempo para ressuscitação foram maiores no grupo III do que no grupo II (Grupo III = 1305±331ml e Grupo II = 965±245ml; p<0.05 e Grupo III = 24.8± 4.7min e Grupo II = 8.8 ± 1.3 min, p<0.01, respectivamente). Todos os parâmetros estáticos e dinâmicos, bem como os biomarcadores de oxigenação tecidual foram afetados pelo choque hemorrágico e quase todos os parâmetros foram totalmente restaurados após a reanimação em ambos os grupos. CONCLUSÃO: Neste estudo em modelo de choque hemorrágico, a reanimação guiada pelo VPP utilizou menor quantidade de fluido e menor quantidade de tempo do que quando guiado por IVDFVD derivado de cateter de artéria pulmonar. / INTRODUCTION: Different hemodynamic parameters, including static indicators of cardiac preload as right ventricular end-diastolic volume index (RVEDVI) and dynamic parameters as pulse pressure variation (PPV) have been used in the decision-making process regarding volume expansion in critically ill patients. The objective of this study was to compare fluid resuscitation guided by either PPV or RVEDVI after experimentally-induced hemorrhagic shock. METHODS: 26 anesthetized and mechanically ventilated pigs were allocated into control (Group-I), PPV (Group-II) and RVEDVI (Group- III). Hemorrhagic shock was induced by blood withdrawal to target mean arterial pressure of 40mmHg, maintained for 60 minutes. Parameters were measured at baseline, time of shock, sixty minutes after shock, immediately after resuscitation with hydroxyethyl starch 6% (130/0.4), one hour and two hours thereafter. The endpoint of fluid resuscitation was determined as the baseline values of PPV and RVEDVI. Statistical analysis of data was based on ANOVA for repeated measures followed by the Bonferroni test (P<0.05). RESULTS: Volume and time to resuscitation were higher in Group-III than in Group-II (Group-III = 1305±331ml and Group-II = 965±245ml; p<0.05 and Group-IIII = 24.8±4.7min and Group-II = 8.8±1.3 min, p<0.05, respectively). All static and dynamic parameters and biomarkers of tissue oxygenation were affected by hemorrhagic shock and nearly all parameters were restored after resuscitation in both groups. CONCLUSION: In the proposed model of hemorrhagic shock, resuscitation to the established endpoints was achieved within a smaller amount of time and with less volume when guided by PPV than when guided by pulmonary artery catheter-derived RVEDVI.

Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico / Redes coletoras de esgoto sÃo elementos importantes para garantir a saÃde, o bem-estar social e proteÃÃo ao meio ambiente, entretanto, elaborar projetos para desenvolver essas estruturas implica em atividades com etapas muito onerosas e repetitivas. Assim, com o objetivo de reduzir o tempo gasto, garantindo a qualidade e eficiÃncia do projeto final, os programas computacionais vÃm ganhando espaÃo e importÃncia em projetos de engenharia. O programa UFC9, objeto desenvolvido neste trabalho, à um aplicativo desenvolvido nas linguagens AutoLISP, VBA (Visual Basic for Applications) e VB (Visual Basic), o qual possui recursos grÃficos para auxiliar no desenvolvimento de projetos dentro do ambiente AutoCAD. Este trabalho foi desenvolvido para auxiliar no desenvolvimento de projetos de redes coletoras de esgoto nos elementos relacionados a desenho, dimensionamento, quantitativos e orÃamento destes importantes elementos de um sistema de esgotamento sanitÃrio. Em se tratando de desenhos, o software objeto deste trabalho auxilia no traÃado da rede coletora e geraÃÃo de perfis, no caso do dimensionamento, o software permite o dimensionamento da rede considerando ou nÃo o atendimento crÃtico, ou seja, o atendimento de casas em cotas baixas. Outra consideraÃÃo importante à a possibilidade de prever obstÃculos na rede, evitando, assim, problemas durante a execuÃÃo da obra. As planilhas de dimensionamento e de orÃamento geradas pelo programa podem ser exportadas para o Excel, facilitando a elaboraÃÃo de memoriais descritivos e de cÃlculos, alÃm de permitir alteraÃÃes ou complementaÃÃes nos orÃamentos das redes gerados pelo software. / Sewage systems are important elements to ensure the health and social welfare, however, elaborating projects to develop these structures involves activities with very onerous and repetitive steps. Thus, with the objective to reduce the time spent, ensuring quality and efficiency of the final project, computer programs have been gaining space and importance in engineering projects. The program UFC9 is an application developed in languages AutoLISP, VBA (Visual Basic for Applications)and VB (Visual Basic), which has graphics resources to assist in developing projects within the AutoCAD environment. This work was developed to assist in developing projects of sewage systems in the elements related to design, sizing, quantification and budget for these important elements of a sanitary sewage system. In the case of drawings, this software helps in tracing the collection network and profiling, in the case of dimensioning, the software allows the network dimensioning considering or not the critical coverage, in which they are located houses below the pipes. Another important consideration is the possibility of setting obstacles in the network, thus avoiding problems during the execution of the work. The dimensioning worksheets and budget generated by the program can be exported to Excel, facilitating the development of descriptive memorials and calculations, and allow for changes or additions in the budgets of networks generated by the software.

Orientador: Priscila Gava Mazzola / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-22T22:31:21Z (GMT). No. of bitstreams: 1 Rodrigues_AlineTeotonio_M.pdf: 1894224 bytes, checksum: 1ec6d1c2a9f9406db0a14f9f6c410ed6 (MD5) Previous issue date: 2013 / Resumo: A incidência de interações medicamentosas em prescrições de unidades de terapia intensiva (UTI) é conhecidamente superior ao número de interações observado em outros setores hospitalares. O nível de complexidade tecnológica desta unidade, o elevado número de medicamentos a que os pacientes estão expostos e as dificuldades inerentes aos cuidados críticos são fatores que evidenciam a necessidade de elaborada avaliação da farmacoterapia utilizada em medicina intensiva. A atuação do farmacêutico clínico, composta entre outros fatores, pelo rastreamento e detecção de interações medicamentosas potenciais teóricas (IMPT), pode ser vista como uma colaboração importante para a qualidade do serviço e mais uma contribuição para a segurança no uso dos medicamentos em UTI. Este estudo baseia-se na avaliação de uma amostragem de prescrições médicas de UTI e tem por objetivo avaliar a incidência de IMPT em prescrições feitas na Unidade de Terapia Intensiva (UTI) de um hospital da rede pública de saúde (Hospital de Clínicas - UNICAMP), quantificá-las e classificá-las quanto ao seu grau de severidade, traçando com isso um perfil das IMPT presentes nas prescrições deste setor. No período de janeiro a dezembro de 2011 foram avaliadas prescrições de 369 pacientes, todos maiores de 18 anos, média de idade de 57,03 ± 14,62, internados por mais de 24 horas na UTI adulto. Foram prescritos no período avaliado 205 diferentes tipos de medicamentos, média de 13,04 ± 4,26 por prescrição. Entre as prescrições avaliadas 89% apresentaram interações medicamentosas potenciais teóricas, obtendo-se uma média por prescrição de 5,00 ± 5,06. Os 405 tipos de IMPT observadas nas prescrições foram classificadas, utilizando a base de dados Micromedex®, destacando-se a prevalência das IMPT moderadas e graves, presentes em 74% e 67% das prescrições, respectivamente. Além dos dados relativos ao perfil farmacoterapêutico da UTI em estudo, foi observada ainda na pesquisa correlação estatisticamente significativa entre as IMPT e tempo de internação em UTI dos pacientes e o número de medicamentos prescritos. Os resultados encontrados contribuem para o delineamento do perfil de risco relativo às IMPT em terapia intensiva, demonstrando que há uma elevada incidência de interações medicamentosas potenciais moderadas em prescrições de UTI. Ressalta-se com ele a necessidade de atuação do farmacêutico clínico nesta área, a fim de contribuir com a equipe multidisciplinar na redução de riscos provenientes da terapia medicamentosa / Abstract: The incidence of drug interactions in prescriptions of intensive care units (ICU) is known to exceed the number of interactions than the observed in other hospital settings. The level of technological complexity of this unit, the elevated number of drugs to which patients are exposed and the difficulties inherent in critical care are factors that highlight the need for elaborated evaluation of pharmacotherapy used in intensive care medicine. The role of the clinical pharmacist, composed among other factors, by tracking and detection of theoretical potential drug interactions (TPDI), can be seen as an important contribution to the quality of service and as another security barrier to the use of medication in the ICU. This study is based on the evaluation of a sample of medical prescriptions of ICU and aims to assess the existence of theoretical potential drug interactions in prescriptions made in the Intensive Care Unit (ICU) of a public health hospital (Clinic Hospital - UNICAMP), to quantify and classify them as to their degree of severity, tracing with it a profile of present TPDI in this setting. From January to December 2011, prescriptions of 369 patients were evaluated, all over 18 years old, mean age of 57.03 ± 14.62, hospitalized for more than 24 hours in adult ICU. Two hundred five different types of drugs were prescribed in the study period, average of 13.04 ± 4.26 per prescription. Among the evaluated prescriptions, 89% presented theoretical potential drug interactions, resulting in an average of 5.00 ± 5.06 per prescription. The 405 types of observed TPDI in the prescriptions were classified using database Micromedex ®, highlighting the prevalence of moderate and severe TPDI present in 74% and 67% of prescriptions, respectively. In addition to the data on pharmacotherapeutic profile of ICU under study, it was observed in the survey statistically significant correlation between TPDI and duration of hospital stay in the ICU and the number of prescription drugs. The results contribute to design the relative risk profile of TPDI in intensive care, showing that there is a high incidence of moderate potential drug interactions in prescriptions of ICU. The results emphasized the need for performance of the clinical pharmacist in this area, in order to contribute to the multidisciplinary team to reduce risks from drug therapy / Mestrado / Ciencias Biomedicas / Mestra em Ciências Médicas

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Inledning: En patientsäker vård bygger på korrekt information och att den informationen överförs på ett tillfredsställande sätt för att inga viktiga delar ska missas. Vårdprocessen är komplex och innehåller många viktiga bitar som behövs för en patientsäker vård. Vid omhändertagandet av en kritiskt sjuk patient arbetar vårdpersonalen ofta i team bestående av olika specialiteter och yrkeskategorier, vilka är beroende av en effektiv kommunikation och god samarbetsförmåga. En kritiskt sjuk patient flyttas ofta mellan olika enheter och vårdkedjan innebär ofta många överrapporteringar utmed vägen. Vid varje överflyttning finns en risk att något missas som kan få konsekvenser för den fortsatta vården. Syftet med den här studien var att identifiera riskfaktorer för patientsäkerheten vid överrapportering av kritiskt sjuka patienter. Metod: Författarna har använt sig av integrerad litteraturstudie för att kunna använda olika typer av studier. Resultat: Studiens resultat presenteras i fyra kategorier: Störningar, Brister i organisationen, Avsaknad av struktur för överrapportering och Samarbetssvårigheter. Konklusion: Riskfaktorer för patientsäkerheten vid överrapportering innefattar olika typer av störningar såsom bullrig miljö och avbrott i rapporten. Brister i organisationen yttrade sig som ett missnöje över att det inte gavs utrymme att förbereda sig och utföra överrapporteringen optimalt. Själva överrapporteringen verkade sakna struktur, en del använde checklistor andra improviserade rapporten. Vårdpersonalen tycktes även sakna ett gemensamt språk och hade en bristande respekt och förståelse för varandras arbetsuppgifter. / Introduction: Correct information and safe transmission of information without information loss are necessary for patient safety. The care process is complex and consists of many important pieces needed for a patient safe care. While caring for a critically ill patient, the caregivers often work in teams consisting of different medical specialties and disciplines. They are depending on an effective communication and smooth cooperative ability. A critically ill patient is often transmitted to several different units along the caregiving pathway. At every transmission there is a risk of information loss that may result in consequences during further caregiving process. The Aim of this study was to identify risk factors for patient safety at the handover of critically ill patients.  Method: This is an integrative review, which is a method for literature review that allows the use of different types of studies. Result: The result of this study is presented in four categories: Interruptions, Organization flaws, Lack of structure for handover and Cooperative difficulties. Conclusion: Risk factors for patient safety during handover included interruptions such as noisy environment and disruptions. The studies showed a dissatisfaction with the lack of space and time for preparation and to perform the handover optimally. The handover seemed to lack structure. Some used checklists, others improvised the handover. They seemed to be missing a common language and also a lack of respect and understanding for each other’s work assignments.

M.Cur / According to data from the Centers for Disease Control and Prevention’s(CDC) National Nosocomial Infections Surveillance System of 1996, Pseudomonas aeruginosa(P. aeruginosa) can be rated as the number two cause of nosocomial pneumonia(Chen & Rudoy,2006). Nosocomial pneumonia increases hospital cost and morbidity and mortality in patients. Most of the patients in the critical care unit are immune compromised because of underlying illnesses. Antibiotics eliminates the patient’s normal flora which causes opportunity for pathogens to colonise. Indwelling procedures like endotracheal intubation cause a point of entrance for pathogens like P.aeruginosa. The endotracheal tube bypasses the normal physiological processes and inhibits the cough reflex. It is the nurse’s responsibility to remove secretion through endotracheal suctioning. During the past ten years the closed suction method was increasingly implemented to remove secretions because studies showed closed suction caused less infection than open suction. In a spesific critical care unit in a private hospital in Pretoria the nurses are of the opinion that closed suctioning does not effectively remove secretion. Patients are therefore suctioned open which can cause air contamination because the colonised ventilator circuit is opened. The following question can be asked in view of the above arguments and problem statement: Is there a difference in aircontamintion between open and closed suctioning? The aim of the study is to determine whether any difference in air contamination exists between open and closed suctioning in a spesific critical care unit in Pretoria. v A comparitive contextual design with crossover methods was used. Patients are allocated to group 1 or group 2 through random sampling. An air exstractor is used to take airsamples before, during and after suctioning. There was no significant difference in terms of air contamination for open and closed suction. This is probably because of too small a sample. The null hypothesis is accepted and that is there is no significant difference in air contamination between open and closed suction.

M.Cur. (Intensive Care Nursing) / The problem of intensive care nurses leaving the profession due to non-conducive working environments and uncompetitive conditions of employment is becoming more alarming and is therefore as relevant as ever. The researcher is concerned about the quality of nurse-awareness nurses create in order to practice quality nurse care. Confusion among nurses about their professional rights and responsibilities adds fuel to the fire. The management of health care services is at times not sensitive to the needs of nurses, and nurses are not always recognized for their inherent professional worth. In the adult intensive care unit at which the researcher practices as unit manager she perceived her colleagues to be experiencing some sort of emotional and spiritual discomfort in going about their daily activities. As the researcher felt responsible for the well-being of the staff in the unit she decided to investigate the phenomenon via a formal research study. The objectives of the study were two-fold: Firstly to explore and describe the registered nurse's experience of nursing in the intensive care unit and then to use the information obtained to describe guidelines for the compilation of a support programme for the nurses nursing in the unit The research questions that were generated are: How do registered nurses in the intensive care unit experience nursing there and how can the information be utilized to describe guidelines to support these nurses? The researcher used an exploratory, descriptive, contextual and phenomenological qualitative design to answer these research questions. Phenomenological interviews were conducted with five interviewees who had been possessively selected.

Bakgrund Mobila Intensivvårds Grupper (MIG) är idag etablerade på flera svenska sjukhus. MIG bidrar till att minska antalet hjärtstopp och till att patienter som är på väg att försämras upptäcks tidigare. MIG innebär också en trygghet för avdelningspersonalen. Delaktighet i MIG är en naturlig del i intensivvårdssjuksköterskans arbetsuppgifter. Syfte Att beskriva intensivvårdssjuksköterskors erfarenheter av interaktionen med avdelningspersonalen vid MIG-uppdrag. Metod En kvalitativ studie med semistrukturerade intervjuer har utförts vid två sjukhus. Resultatet har analyserats med kvalitativ innehållsanalys. Resultat Två teman framkom vid analysen, Betydelsen av interaktion för en sammanlänkad och säker vård samt Samspelsbefrämjande faktorer. Respondenterna anser avdelningspersonalens närvaro och engagemang som väsentlig vid MIG-uppdraget för att patienten ska få en sammanlänkad och säker vård. Respondenterna upplever att avdelningspersonalen ibland inte förstår vikten av deras närvaro och att MIG då behöver arbeta aktivt för att få avdelningspersonalen mer engagerad. Det interprofessionella samarbetet gagnar inte enbart patienten utan gynnar även den professionella utvecklingen genom utbyte av kunskap. För att interaktionen ska fungera optimalt krävs att MIG bekräftar avdelningspersonalen och att alla involverade vid MIG-uppdraget har en gemensam bild av situationen och delar samma mål med vården. Resultatet diskuterades utifrån den teoretiska referensramen Relationship Centered Care. Slutsats Interaktionen vid MIG-uppdrag fungerar väl när MIG och avdelningspersonalen samarbetar och kompletterar varandra. Välfungerande samarbete och sammanlänkad vård i samband med MIG-uppdrag leder till ökad patientsäkerhet. Klinisk betydelse Samarbetet vid MIG-uppdrag stärks genom utbildning och praktisk träning i interprofessionellt samarbete. Genom mer utbildning, tydligare kommunikation från MIG och ökad återkoppling kan avdelningspersonalen få en större förståelse för vikten av deras delaktighet vid MIG-uppdragen. / Background Mobile Emergency Teams (MET) are established at several Swedish hospitals. MET helps to reduce the number of cardiac arrest and patients who are about to deteriorate are detected earlier. MET also means security for the staff at general wards. Being involved in the MET is a natural part of the critical care nurse's work assignments. Aim To describe the critical care nurses' experiences of interaction with the staff at general wards during MET- assignments. Method A qualitative study using semi-structured interviews was carried out at two hospitals. The collected data were analyzed by qualitative content analysis. Results Two themes emerged from the analysis, The importance of interaction for an interconnected and safe healthcare and Teamwork promoting factors. Respondents believe attendance and commitment from the staff at general wards as important in MET- assignments for the patient to get interconnected and safe care. Respondents experience that ward staff sometimes don´t understand the importance of their presence and that MET then need to work actively to get the ward staff more committed. The interprofessional collaboration is not only beneficial for the patient but it also promotes the professional development through the exchange of knowledge. For the interaction to work optimally it requires MET to confirm the staff at general wards and that everyone involved in the MET-assignment has a mutual perception of the situation and the goal with the treatment. The results were discussed using the theoretical framework Relationship Centered Care. Conclusion The interaction in MET-assignments works well when MET and the staff at general wards work together and complement each other. Effective collaboration and interconnected healthcare during MET-assignments increases patient safety. Clinical significance The collaboration during MET-assignments can be strengthened through education and practical training in interprofessional collaboration. Through more training, clearer communication from MET and increased feedback can the staff at general wards gain a greater understanding of the importance of their participation in MET-assignments.

Mechanical ventilation (MV) is one of the most frequently used treatment modalities in the intensive care unit (ICU) (Burns, 2005:14). Up to 90% of critically ill patients in ICUs globally are connected to a mechanical ventilator. Although mechanical ventilation is a lifesaving intervention, it is expensive and is associated with diverse complications (Mclean, Jensen, Schroeder, Gibney & Skjodt, 2006: 299). Ventilator-associated pneumonia (VAP) accounts for 25% of all infections in ICU, with global crude mortality figures estimated at 20-70% (Craven, 2006:251). Minimising the time that a patient is connected to a mechanical ventilator to the absolute minimum can have considerable benefits in terms of decreased mortality and morbidity, as well as a decreased length of ICU stay and lower hospital costs. Critically ill patients therefore need to be weaned from the mechanical ventilator as soon as their condition that warranted the need for mechanical ventilation is stabilized. The process of weaning the critically ill patient from mechanical ventilation constitutes a significant proportion of total ventilator time. As professional nurses attend to the mechanically ventilated patient 24 hours a day, they have a vital role to play in the collaborative management of the patient requiring weaning from mechanical ventilation. The objectives of this study were to explore and describe the professional nurses’ knowledge regarding weaning the critically ill patient from mechanical ventilation. Based on the results, recommendations in the form of a protocol were made in order to improve the professional nurses’ knowledge and enhance the care of the mechanically ventilated patient. A quantitative design, which was exploratory, descriptive and contextual in nature, was utilised for the study. The data collection instrument of choice was a self-administered questionnaire. Convenience, non-probability sampling was the sampling method chosen for the purpose of this study. Collected data were analysed with the assistance of a statistician using descriptive and inferential statistics. Results were displayed in the form of graphs and tables. The results obtained in the study, combined with data from the literature review, were used to develop recommendations to enhance vi professional nurses’ knowledge regarding weaning the critically ill patient from mechanical ventilation. The recommendations were presented in the form of a protocol based on the available evidence. Ethical principles as they relate to conducting research were adhered to throughout the study.

Background: Spinal Cord Injuries (SCIs) are traumatic, life-changing injuries that can affect every aspect of an individual's life and can lead to death if not treated timeously and appropriately. Respiratory complications occur frequently after the SCI and are the leading cause of mortality and morbidity. Respiratory complications are predictable based on the neurological level of impairment of the spinal cord lesion; the higher the neurological injury, the more severe the respiratory complication. Changes in pulmonary function, poor cough, hypersecretion, immobility and bronchospasm all contribute to the development of respiratory complications. If the patient is unable to protect his/her airway or if respiratory failure occurs, mechanical ventilation is often required. Many patients require prolonged ventilation and subsequently need to go for tracheostomies. The critical care nurse plays an important role in the early identification of complications and can, therefore, act to limit and prevent these complications, which may be a direct result from the injury or treatment modality such as mechanical ventilation. Respiratory management has been promoted in preventing and treating respiratory complications and is associated with better prognosis in the SCI patient. Design and method: The research study aims to explore and describe existing literature and to make recommendations for the respiratory management of a mechanically ventilated spinal cord injured patient in a critical care unit (CCU). A systematic review was undertaken with clear inclusion and exclusion criteria. Ethical principles were maintained throughout the study. The quality of the study was ensured by critically appraising data that was utilized in the systematic review. It is envisaged that the results from this systematic review will improve the respiratory management of the SCI patient and prevent any variations in practice. Results: Were presented under the following themes: priorities of care for the SCI patient in the acute phase, during the critical care phase and preventative care. Conclusion: The SCI patient regardless of the neurological level or completeness of injury should be admitted to the CCU for intensive ventilatory, cardiopulmonary support and hemodynamic monitoring in order to detect and prevent respiratory complications. The use of larger tidal volumes is associated with improved comfort and less dyspnea however if a patient has acute lung injury or ARDS the use of low tidal volumes 6ml/kg is recommended. Prevention and early identification of respiratory complications is associated with improved outcomes for the SCI patient.