Mechanical ventilation pneumonia (VAP) is defined as pneumonia that develops 48 hours after the beginning of invasive mechanical ventilation, and is considered up to 48 hours after extubation. Patients using the orotracheal tube (TOT) presented a deficit for self-care, showing a greater susceptibility to biofilm accumulation in the buccal cavity, favoring the incidence of nosocomial pneumonia in the Intensive Care Unit (ICU). Thus, this study aimed to carry out a systematic review on the main oral prophylactic methods used in the prevention of VAP. Search sources were PubMed, Scopus and Cochrane databases from May 23, 2017 through May 26 of this year. The selected studies evaluated the efficacy of oral antimicrobials in mechanically ventilated patients in controlled randomized controlled trials (RCTs) according to inclusion criteria. Papers presenting non-established themes, animal studies, patents and systematic reviews were excluded from the process. After analyzing the data, the articles were classified according to the level of evidence. The results showed that of the 503 abstracts found, of these, 15 articles included the review criteria. The selected studies indicated as prophylactic oral methods used in ECRC: chlorhexidine, Listerine, iodo-povidine and ceftazidime. It was observed in the 15 chosen articles that 8 presented unsatisfactory results for the reduction of VAP. In this perspective, the oral prophylactic methods applied in patients admitted to the ICU found in clinical trials were not favorable to the reduction of VAP indexes. / A pneumonia associada à ventilação mecânica (PAVM) é definida como a pneumonia que se desenvolve 48 horas a partir do início da ventilação mecânica invasiva, sendo considerada até 48 horas após a extubação. Os pacientes em uso do tubo orotraqueal (TOT) apresentam déficit para o autocuidado, exibindo maiorsusceptibilidade ao acúmulo de biofilme na cavidade bucal favorecendo a incidência das pneumonias nosocomiais em Unidade de Terapia Intensiva (UTI). Assim, este trabalho teve como objetivo realizar uma revisão sistemática sobre os principais métodos profiláticos orais utilizados na prevenção da PAVM. As fontes de busca foram as bases PubMed, Scopus e Cochrane de 23 de maio de 2017 até 26 de maio do corrente ano. Os estudos selecionados avaliaram a eficácia dos antimicrobianos orais em pacientes sob ventilação mecânica em ensaios clínicos randomizados controlados (ECRC) de acordo com os critérios de inclusão. Os trabalhos que apresentaram temas não relacionados ao estabelecido, estudos com animais, patentes e revisões sistemáticas foram excluídos do processo. Após análise dos dados os artigos foram classificados quanto ao nível de evidência. Os resultados mostraram que dos 503 resumos encontrados, destes, 15 artigos contemplaram os critérios da revisão. Os estudos selecionados apontaram como métodos profiláticos orais utilizados nos ECRC: a clorexidina, Listerine, iodo-povidine e ceftazidima. Foi observado nos 15 artigos elegidos que 8 apresentaram resultados não satisfatórios para a redução da PAVM. Nesta perspectiva, os métodos profiláticos orais aplicados nos pacientes admitidos na UTI encontrados nos ensaios clínicos não foram favoráveis à redução dos índices de PAVM. / Lagarto, SE

Orientador: Yvens Barbosa Fernandes, Sebastião Araujo / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-08T19:37:05Z (GMT). No. of bitstreams: 1 Pasini_RenataLenize_M.pdf: 1921410 bytes, checksum: 17bcb0d3a217f0284da26d92e3b8a5da (MD5) Previous issue date: 2007 / Resumo: A traqueostomia é um procedimento comumente realizado em pacientes dependentes da ventilação mecânica (VM), internados em Unidade de Terapia Intensiva (UTI). Alguns autores acreditam que a realização precoce desse procedimento em tais pacientes diminui o tempo de dependência do aparelho ventilatório, bem como apresenta outros benefícios associados. Entretanto, o período mais adequado para a realização do procedimento ainda não se encontra bem estabelecido para pacientes com traumatismo craniencefálico (TCE), o que justificou a realização do presente estudo, cujo objetivo foi avaliar a influência da traqueostomia no tempo de ventilação mecânica e tempo de internação hospitalar de pacientes com TCE. Foi realizado um estudo prospectivo e não intervencionista, em que foram avaliados 33 pacientes com TCE de moderado a grave, cuja pontuação na escala de coma de Glasgow (ECG) foi = 10, com idade entre 14 e 80 anos e necessidade de traqueostomia. Os pacientes foram distribuídos em três grupos determinados a partir do momento da realização da traqueostomia: traqueostomia precoce (TP), realizada até o 6º dia de VM; traqueostomia intermediária (TI), realizada entre o 7° e 11° dias de VM; e a traqueostomia tardia (TT), realizada após o 12° dia de VM. Dos 33 pacientes avaliados, 28 eram do sexo masculino, com idade média de 30,7 ± 14,0 anos para a TP; 39,0 ± 18,4 anos para a TI e 37,7 ± 18,4 anos para a TT. No grupo submetido à traqueostomia precoce houve redução do tempo de ventilação mecânica e tendência a uma diminuição do tempo de internação hospitalar. O momento de realização da traqueostomia não influenciou na incidência de infecção pulmonar e mortalidade / Abstract: Tracheostomy has been performed frequently in ventilator-dependent patients in intensive care unit (ICU). Some authors believe that early tracheostomy can reduce mechanical ventilation (MV) time and can provide other associated benefits. However, its influence on weaning from MV is not clear in pacients with traumatic brain injury (TBI). The aim of this study was to evaluate the influence of tracheostomy on MV weaning in TBI patients. It was a prospective and non interventional study; including 33 patients with TBI (GCS < 10), aging between 14 and 80 years and that were submitted to a tracheostomy. The patients had been distributed into three groups: early tracheostomy (ET) (performed until 6th day of MV); intermediate tracheostomy (IT) (performed from the 7th to 11th day of MV) and late tracheostomy (LT) (performed after the 12th day of MV). Of the 33 evaluated patients, 28 were male and 5 female, aging 30.7 ± 14.0 years in ET group; 39.0 ± 18.4 years in IT group; and 37.7 ± 18.4 years in LT group. In the ET group, those patients with lower GCS and higher APACHE II at admission have shown a lesser hospital length of stay (HLOS); the IT group has shown a lesser HLOS in younger individuals and with lower APACHE II values. Regarding total MV time (orotracheal tube + tracheostomy), ET group has shown a lesser average time in relation to the other groups. However weaning times with tracheostomy alone were not different between groups. Also, pulmonary infection incidences have not been different between groups. Early tracheostomy can reduce total MV time and HLOS in patients with severe TBI, but it appears to have no influence on weaning time, incidence of pulmonary infection and mortality / Mestrado / Ciencias Biomedicas / Mestre em Ciências Médicas

O desmame é a transição da ventilação mecânica para a espontânea ao final da assistência ventilatória artificial. Não existem estudos específicos sobre esta fase de transição na espécie equina porém, os elevados valores na tensão de dióxido de carbono arterial (PaCO2) ao desmame e os baixos valores na tensão de oxigênio arterial (PaO2) na recuperação pós-anestésica (RPA) refletem a necessidade do estudo de modalidades mais seguras de desmame. Sendo assim, este estudo objetivou comparar dois diferentes protocolos de desmame da ventilação mecânica em equinos hígidos. Para tanto, foram utilizados 20 equinos, de 5±2 anos de idade e pesando 456±90 kg, submetidos a procedimento cirúrgico em decúbito dorsal. Os animais foram divididos aleatoriamente em 2 grupos de acordo com o protocolo de desmame, sendo considerado Grupo Controle os animais que foram submetidos a diminuição gradual da frequência respiratória (FR) isoladamente e Grupo PSV os animais que foram submetidos à redução da FR associada à administração de pressão de suporte ventilatório (PSV). Avaliou-se os parâmetros cardiovasculares, de ventilação, de oxigenação e metabólicos durante o desmame, a desconexão da ventilação mecânica e a RPA. Ao final do desmame, o Vexp (12,49±1,93 L) e o VT (28,10±6,17 mL/kg) do Grupo PSV foram superiores aos do Grupo Controle (Vexp de 7,66±2,66 L e VT de 16,88±4,30 mL/kg). Durante o desmame, a PaCO2 aumentou 29% (de 44±3 mmHg para 57±6 mmHg) e houve diminuição de 28% da relação PaO2/FiO2 (de 391±68 mmHg para 280±28) e de 9% da SaO2 (de 100±1% para 91±3%) apenas no Grupo Controle. Na RPA houve hipoxemia transitória no Grupo Controle após 15 (PaO2 de 48±5 mmHg) e 35 minutos (PaO2 de 57±7 mmHg) da desconexão do ventilador, e no Grupo PSV obteve-ve relação PaO2/FiO2 e SaO2 superior à do Grupo Controle durante a RPA. Concluiu-se que o uso da PSV no desmame foi capaz de manter os parâmetros ventilatórios e de oxigenação adequados durante todos os momentos de avaliação, e o desmame por redução gradativa da FR não impediu a ocorrência de hipercapnia transitória ao final do desmame e hipoxemia transitória na RPA. Considerando-se a higidez dos animais, estas alterações foram revertidas sem intervenção clínica, mas devem ser consideradas em animais debilitados. / Weaning from mechanical ventilation is the transition from mechanical to spontaneous ventilation at the end of the ventilatory support. There are no specific studies about this transition phase in horses. However, high tension of carbon dioxide pressure (PaCO2) at weaning and low values of arterial oxygen tension (PaO2) during recovery from anaesthesia suggest the need to study safer modalities of weaning. The scope of this study was to compare two weaning protocols from mechanical ventilation in healthy horses. With this purpose we studied 20 horses with a mean age of 5±2 years and a mean weight of 456±90 kg, scheduled to surgery in dorsal recumbency. Animals were randomly assigned one of the 2 weaning protocols, considering from Control Group those animals submitted to gradual decrease in respiratory rate (RR) set alone and from PSV Group those animals submitted to gradual decrease in RR associated with pressure support ventilation (PSV) administration. We evaluated cardiovascular, ventilatory, oxygenation and metabolic parameters during weaning, ventilator disconnection and recovery from anaesthesia. At the end of weaning, Vexp (12,49±1,93 L) and VT (28,10±6,17 mL/kg) of PSV Group were superior to the Control Group (Vexp of 7.66±2.66 L and VT of 16.88±4.30 mL/kg). During weaning PaCO2 increased by 29% (44±3 mmHg to 57±6 mmHg) and there was increasing PaO2/FiO2 ratio by 28% (391±68 mmHg to 280±28) and SaO2 by 9% (100±1% to 91±3%) only in Control Group. In the recovery phase there was transient hypoxemia in Control Group after 15 (PaO2 of 48±5 mmHg) and 35 minutes (PaO2 of 57±7 mmHg) of ventilator disconnection, and PaO2/FiO2 ratio and SaO2 in PSV Group were superior to the Control Group in the recovery phase. We conclude that the use of PSV in the weaning from mechanical ventilation phase was capable to remain ventilatory and oxygenation parameters appropriate in all evaluations, and weaning only by gradual decrease of RR did not prevent the occurrence of transient hypercapnia at the end of weaning and transient hypoxemia in the recovery from anaesthesia. Considering the healthiness of the animals, these changes were reversed without clinical intervention, but should be considered important recovery events in critical horses.

A monitorização após o parto é necessária a manutenção da vida nos bezerros clonados. É imperativo que os protocolos e procedimentos, bem como a avaliação clínica dos sistemas cardiovascular e respiratório sejam aprimorados para a sobrevida dos clones. As avaliações que permitam averiguar a capacidade de oxigenação dos pulmões são de crucial importância na assistência ao neonato, sendo que para essa finalidade tem-se recomendado a utilização da hemogasometria. O estudo foi dividido em quatro capítulos, sendo o 1 º Capítulo: Comparação das diferenças da adaptação neonatal de bezerros da raça Nelore(n=10) e de bezerros da raça Holandesa(n=10) nas trocas gasosas e nos parâmetros hemodinâmicos obtidos por meio do cateter de Swan-Ganz, o 2 º Capítulo: Avaliação da hemodinâmica e da hemogasometria de bezerros clonados(n=3), e o 3º Capítulo: Relato da utilização da ventilação mecânica não invasiva - modo CPAP- no tratamento de hipóxia neonatal em 10 bezerros e o 4º Capítulo: Avaliação hemodinâmica e hemogasométrica de bezerros neonatos com distúrbios respiratórios submetidos a ventilação mecânica não invasiva com mascara facial modo ventilatório CPAP (n=12). O objetivo deste trabalho será padronizar a utilização de ventiladores em bezerros neonatos dando o suporte respiratório necessário, avaliando hemodinâmicas da pressão da artéria pulmonar, freqüência cardíaca, débito cardíaco por meio da utilização do cateter de Swan-Ganz, a hemogasometria de sangue arterial para avaliação dos distúrbios respiratórios e obtenção dos valores de normalidade dos parâmetros, além de conhecer a adaptação neonatal das raças Nelore e holandesa. Foram determinadas média pressão artéria pulmonar, pressão artéria pulmonar ocluída, pressão ventrículo direito, pressão átrio direito, temperatura, pH, pCO2, pO2, HCO3, BE, SO2. Os animais foram ventilados modo CPAP- ventilação mecânica não invasiva com mascara facial com pressão positiva no final da expiração(PEEP). / Monitoring after calving is required for the maintenance of life in cloned calves. It is imperative that protocols and procedures, as well as the clinical assessment of cardiovascular and respiratory systems are improved for the survival of clones. Evaluations in order to verify the oxygenation capacity of lungs are crucial in neonatal care, and for this purpose has recommended the use of blood gas analysis. The study was divided into four chapters, the 1st chapter: Comparison of differences in neonatal adaptation of Nellore calves (n = 10) and Holstein calves (n = 10) in gas exchange and hemodynamic parameters obtained by through the Swan-Ganz, the 2nd Chapter: hemodynamic evaluation and blood gas analysis of cloned calves (n = 3), and the 3rd Chapter: Reporting the use of noninvasive mechanical ventilation - CPAP- in the treatment of neonatal hypoxic 10 calves and Chapter 4: hemodynamic evaluation and hemogasometric of newborn calves with respiratory disorders underwent noninvasive ventilation with face mask ventilation mode CPAP (n = 12). The purpose of this study is to standardize the use of mechanical ventilators in newborn calves giving the required respiratory support, evaluating hemodynamic pulmonary artery pressure, heart rate, cardiac output by using of the Swan-Ganz catheter, arterial blood gas analysis to evaluation of respiratory disorders and obtaining the parameters normal values, and know the neonatal adaptation of Nellore and Hostein Frisian races. They were determined means of pulmonary artery pressure, pulmonary artery wedge pressure, right ventricular pressure, right atrial pressure, temperature, pH, pCO2, pO2, HCO 3, BE, SO 2. The animals were ventilated CPAP- noninvasive ventilation mode with face mask with positive pressure at the end of expiration (PEEP)

La dysfonction diaphragmatique, au même titre que la neuromyopathie de réanimation qui touche les membres périphériques sont des causes fréquemment impliquées dans l'échec du sevrage de la ventilation mécanique. Des données suggèrent que ces deux atteintes sont le reflet d'une même affection ayant un tropisme respiratoire et locomoteur. Cette thèse met en évidence que la dysfonction diaphragmatique et la neuromyopathie de réanimation sont deux atteintes distinctes dont la coexistence est relativement faible. De plus, la dysfonction diaphragmatique a un impact délétère plus important sur le sevrage et le pronostic vital que la neuromyopathie de réanimation. Toutefois, le niveau de fonction diaphragmatique requis pour permettre une séparation du ventilateur est plus faible que le niveau de fonction définissant la dysfonction diaphragmatique. Ce travail montre également que l'exploration de la fonction diaphragmatique peut être simplifiée par l'utilisation de l'échographie et de l'électromyographie du diaphragme. / Diaphragm dysfunction and critical illness associated neuropathy and myopathy are frequently suspected to cause weaning failure from mechanical ventilation. Some data suggest that both may be gathered into a same entity with two localisations, respiratory and peripheral. This thesis highlights that diaphragm dysfunction and critical illness neuromyopathy are two distinct diseases that don’t frequently coexist. In addition, diaphragm dysfunction has a more severe impact on weaning outcome and prognosis than critical illness associated neuromyopathy and myopathy. However, the level of diaphragm function required to ensure safe mechanical ventilation discontinuation is lower than the level of diaphragm function defining diaphragm dysfunction. This work also shows that investigating diaphragm function may be simplified by the use of ultrasound and diaphragm electromyogram activity.

Konsekvenserna av långvarig ventilatorbehandling i form av ökat antal komplikationer och ökade kostnader är väl dokumenterade. Patienten behöver tränas ur ventilatorn med en adekvat metod, utan fördröjning. Urträningsprotokoll kan minska risken för ineffektiv vård och medicinska misstag genom att tillhandahålla en enhetlig strategi och gemensam terminologi. Syftet med studien var att beskriva innehållet i de ventilatorurträningsprotokoll som förekommer inom Svenskintensivvård. Studien utgjordes av en totalundersökning där samtliga svenska intensivvårdsavdelningar tillfrågades om de hade urträningsprotokoll. Protokollen analyserades utifrån manifest innehållsanalys. Fyra kategorier av urträningsprocessen urskiljdes: kriterier för urträningstart, åtgärder, utmattningskriterier och extubationskriterier. En dryg femtedel (21 %) av intensivvårdsavdelningarna i Sverige visade sig ha ett urtränings-protokoll. I de 16 protokollen återfanns 31 kriterier för urträningsstart, 8 åtgärder, 24 utmattningskriterier och 9 extubationskriterier. De vanligaste kriterierna för urträningstart samt utmattningskriterier stämde väl överens med vad internationella studier rekommenderar, emellertid har vissa urträningsprotokoll inkluderat ett stort antal av dessa kriterier. Trots detta återfanns inget kriterium i samtliga urträningsprotokoll. Prognoskriterier saknades i det närmaste helt i de svenska urträningsprotokollen. Åtgärderna uppvisar en mer samlad strategi där samtliga hade som första åtgärd att sänka andningsunderstödet, men även här hade vissa urträningsprotokoll inkluderat ett stort antal åtgärder. Terminologin som används var inte enhetlig vilket kan försvåra kvalitetssäkringen av protokollen. / The consequences of extended mechanical ventilation in the form of increased number of complications and high costs are well documented. The patient needs to wean with an adequate method without delay. Weaning protocols can reduce the risk of ineffective care and medical errors by providing common weaning strategy and terminology. The purpose of this study was to describe the contents of weaning protocols in Swedish intensive care units. The study consisted of a total survey, and all Swedish intensive care units were asked if they had weaning protocols. The protocols were analyzed on the basis of manifest content analysis. Four categories of the weaning process distinguished: readiness to wean criteria, guidelines for reduction in ventilatory support, fatigue criteria and extubation criteria. One fifth (21 %) of intensive care units in Sweden had a weaning protocol. In the 16 protocols 31 readiness to wean criteria, 8 methods for reduction of ventilatory support, 24 fatigue criteria and 9 extubation criteria where found. The most common readiness to wean criteria and fatigue criteria are well in line with what international studies recommends, however some weaning protocols included a large number of these criteria. Despite this no criteria occurs in all weaning protocols. Criteria to predict weaning outcome is almost completely missing in Swedish weaning protocols. The methods for reduction of ventilatory support showed a more united approach in which all lower ventilatory support as a first step. Even in this category some weaning protocols had included a large variety in methods for reduction of ventilatory support. The terminology used in the weaning protocols varies which makes quality evaluation difficult.

[EN] Intensive (broiler) poultry farming is a strategic sector for the economy and development of many countries and regions, including Spain and the Valencian Community region. Intensive production consists of keeping the animals in specific buildings (broiler buildings) under a controlled indoor microclimate. Two main options are found regarding the ventilation systems: production in broiler buildings with natural ventilation and production in broiler buildings with mechanical ventilation (commonly with negative depression by exhaust fans). Inadequate design is the main cause of thermal stress and the mortality of broilers. In this sense, one solution to decrease the broilers' heat stress and mortality consists of assisting in their biological thermoregulation by increasing the air velocity over them. In this PhD dissertation, the ventilation (ranges of the air velocity and its distribution, mainly at the level and plane where the broilers are located) in the main mechanical ventilation systems installed in the broiler buildings is characterised and analysed. Despite the magnitude of the current difficulties (broilers' thermal stress and mortality) and society's sensitivity regarding aspects of animal welfare, to date, the different mechanical ventilation systems in the different types of broiler building have not been characterised and analysed with scientific scrupulousness. In this PhD dissertation, the three most relevant types have been studied: cross, tunnel and single-sided. The methodological approach has been very similar in all the cases of study: some measurements by means a multi-sensor system (with our own original design and building) has been used for isotemporal recordings, the corresponding Computational Fluid Dynamics (CFD) simulations have been carried out and finally these simulations have been validated. These validations were carried out by means of two statistical techniques: by means of linear regression techniques and by means of a study of the significance (in an analysis of the variance) for the method used (sensors or CFD) in each different proposed validation model. Having validated these CFD results, CFD techniques can safely be used to characterise and analyse the ventilation in all the indoor space of the broiler buildings (sensors only allow it to be characterised in their physical locations). The first case studied involves a broiler building which has a cross mechanical ventilation system (commonplace in Mediterranean climates) installed. The conclusions from this study show that this ventilation system is adequate for broiler rearing during nearly the whole year in mild climatic locations (e.g. Mediterranean climate). However, on certain days or in periods of heat (summer), it would not be adequate because it cannot reach high enough air velocity values to reduce the heat stress on the broilers. The second case studied is a broiler building with tunnel mechanical ventilation installed. The conclusions from this study show that it is less suitable than the first one analysed (cross mechanical ventilation) for broiler rearing over nearly the whole year in mild climatic locations. However, on certain days or in periods of heat (summer), it is very suitable because it can reach higher air velocity values to reduce the heat stress on the broilers. The third case studied is a broiler building with single-sided mechanical ventilation installed. The conclusions from this study show that this ventilation system is suitable for broiler rearing almost throughout the year in mild climatic locations. However, on certain days or in periods of heat (summer), it would be not adequate because it cannot reach high enough air velocity values to reduce the heat stress. / [ES] La avicultura intensiva del pollo de carne (broiler) es un sector estratégico en la economía y desarrollo de muchos países y regiones, entre ellos España y la Comunidad Valenciana. La producción intensiva del broiler se da confinando al animal en edificios específicos (granjas de pollos) bajo un microclima interno controlado. Tiene dos variantes fundamentales en función de su sistema de ventilación: producción en granjas con ventilación natural y producción en granjas con ventilación mecánica (generalmente por depresión negativa mediante ventiladores de extracción). Un inadecuado diseño de la ventilación es la causa principal del estrés térmico y de la mortalidad de los pollos. En este sentido, una solución para disminuir el estrés térmico por calor y la mortalidad de los pollos es ayudar en su termorregulación biológica mediante un aumento de la velocidad del aire sobre ellos. En esta tesis doctoral, se ha caracterizado y analizado la ventilación (rangos de velocidad del aire y su distribución, especialmente al nivel de presencia del pollo) en los principales sistemas de ventilación mecánicos instalados en las granjas de pollos. Pese a la envergadura de la actual problemática (estrés térmico y mortalidad de los pollos) y la sensibilidad de la sociedad hacia los aspectos del bienestar animal, hasta la fecha no se han caracterizado y analizado con rigurosidad científica los diferentes sistemas de ventilación mecánicos en las diferentes tipologías de granjas de pollos. En esta tesis doctoral se han estudiado los tres más relevantes: cruzado, túnel y de pared única. El enfoque metodológico en todos los casos de estudio ha sido muy similar: se han realizado unas mediciones mediante un sistema multisensor de registro isotemporal (de diseño y fabricación propios), se han realizado las correspondientes simulaciones Computational Fluid Dynamics (CFD) y finalmente se han validado estas simulaciones. Estas validaciones se han llevado a cabo mediante dos técnicas estadísticas: mediante técnicas de regresión lineal y mediante el estudio de la significatividad (en un análisis de la varianza) de la metodología utilizada (sensores o CFD) en sendos modelos de validación propuestos. Una vez validadas estas simulaciones CFD, se tiene la seguridad de poder utilizarlas para caracterizar y analizar la ventilación en todo el espacio interior de las granjas (los sensores sólo permiten caracterizarla en las localizaciones físicas de los mismos). El primer caso de estudio es el de una granja que tiene instalado un sistema de ventilación mecánico cruzado (habitual en el clima Mediterráneo). Las conclusiones de este estudio demuestran que este sistema de ventilación es adecuado para la crianza del pollo para casi todo el año en localizaciones climáticas templadas (por ejemplo, el clima Mediterráneo). Sin embargo, en días o periodos de calor (verano), no será adecuado porque no se pueden alcanzar valores de velocidad del aire grandes que permiten disminuir el estrés por calor de los pollos. El segundo caso de estudio es el de una granja que instala el sistema de ventilación mecánico túnel. Las conclusiones de este estudio demuestran que es menos apropiado que el anterior (sistema de ventilación mecánico cruzado) para la crianza del pollo durante todo el año en localizaciones climáticas templadas. Sin embargo, en días o periodos de calor (verano), será muy adecuado porque se pueden alcanzar valores de velocidad del aire grandes que permiten disminuir el estrés por calor de los pollos. El tercer caso de estudio es el de una granja que instala el sistema de ventilación mecánico de pared única. Las conclusiones de este estudio demuestran que este sistema de ventilación es adecuado para la crianza del pollo para casi todo el año en localizaciones climáticas templadas. Sin embargo, en días o periodos de calor (verano), no será adecuado porque no se pueden alcanzar valores de ve / [CAT] L'avicultura intensiva del pollastre de carn (broiler) és un sector estratègic en l'economia i desenvolupament de molts països i regions, entre ells Espanya i la Comunitat Valenciana. La producció intensiva del broiler es dóna confinant a l'animal en edificis específics (granges de pollastres) sota un microclima intern controlat. Té dues variants fonamentals en funció del seu sistema de ventilació: producció en granges amb ventilació natural i producció en granges amb ventilació mecànica (generalment per depressió negativa mitjançant ventiladors d'extracció). Un inadequat disseny de la ventilació és la causa principal de l'estrés tèrmic i de la mortalitat dels pollastres. En aquest sentit, una solució per disminuir l'estrés tèrmic per calor i la mortalitat dels pollastres és ajudar en la seua termoregulació biològica mitjançant un augment de la velocitat damunt d'ells. En aquesta tesi doctoral, s'ha caracteritzat i analitzat la ventilació (rangs de velocitat de l'aire i la seua distribució, especialment al nivell de presència del pollastre) en els principals sistemes de ventilació mecànics instal·lats a les granges de pollastres. Malgrat l'envergadura de l'actual problemàtica (estrés tèrmic i mortalitat dels pollastres) i la sensibilitat de la societat envers els aspectes del benestar animal, fins aquesta data no s'han caracteritzat i analitzat amb rigor científic els diferents sistemes de ventilació mecànics a les diferents tipologies de granges de pollastres. En aquesta tesi doctoral han sigut estudiats els tres més rellevants: creuat, túnel i de paret única. L'enfocament metodològic en tots els casos d'estudi ha sigut molt similar: han sigut realitzats uns mesuraments mitjançat us sistema multisensor de registre isotemporal (de disseny i fabricació propis), han sigut realitzades les corresponents simulacions Computational Fluid Dynamics (CFD) i finalment han sigut validades aquestes simulacions. Aquestes validacions s'han dut a terme mitjançant dues tècniques estadístiques: mitjançant tècniques de regressió lineal i mitjançant l'estudi de la significativitat (en una anàlisi de la variància) de la metodologia utilitzada (sensors o CFD) en sengles models de validació proposats. Una vegada validades aquestes simulacions CFD, es té la seguretat de poder utilitzar-les per a caracteritzar i analitzar la ventilació en tot l'espai interior de les granges (els sensors només permeten caracteritzar-la en les localitzacions físiques dels mateixos). El primer cas d'estudi és el d'una granja que té instal·lat un sistema de ventilació mecànic creuat (habitual en el clima Mediterrani). Les conclusions d'aquest estudi demostren que aquest sistema és adequat per a la criança del pollastre durant quasi tot l'any en localitzacions climàtiques moderades (per exemple, el clima Mediterrani). Tanmateix, en dies o períodes de calor (estiu), no serà adequat perquè no es poden obtenir valors de velocitat de l'aire grans que permeten disminuir l'estrés per calor dels pollastres. El segon cas d'estudi és el d'una granja que instal·la el sistema de ventilació mecànic túnel. Les conclusions d'aquest estudi demostren que és menys adequat que l'anterior (sistema de ventilació mecànic creuat) per a la criança del pollastre durant tot l'any en localitzacions climàtiques moderades. Tanmateix, en dies o períodes de calor (estiu), serà molt adequat perquè es poden obtenir valors de velocitat de l'aire grans que permeten disminuir l'estrés per calor dels pollastres. El tercer cas d'estudi és el d'una granja que instal·la el sistema de ventilació mecànic de paret única. Les conclusions d'aquest estudi demostren que aquest sistema és adequat per a la criança del pollastre durant quasi tot l'any en localitzacions climàtiques moderades. Tanmateix, en dies o períodes de calor (estiu), no serà adequat perquè no es poden obtenir valors de velocitat de l'aire grans que perme / Bustamante García, E. (2015). OPTIMIZACIÓN DE DISEÑO DE GRANJAS AVÍCOLAS DE POLLOS [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/59450 / TESIS

Background: The withdrawal of invasive mechanical ventilation (MV) within the context of withdrawal of life-sustaining measures (WLSM) is common in the intensive care unit (ICU). The method by which invasive MV is withdrawn during WLSM remains an ongoing topic of discussion and research; two methods are terminal weaning (TW) and terminal extubation (TE). Aims: To statistically describe and compare the processes of TW and TE as undertaken in two ICUs. Study Design: A secondary data analysis using data from a longitudinal retrospective chart audit. Results: A total of 78 patient charts were included. MV was withdrawn in 88.5% of patients undergoing WLSM. TW was used in 62.3% of the cases while TE was used in 37.7%. Patients who underwent TW were on average younger, had a longer ICU stay, higher respiratory support requirements, a longer duration of invasive MV, and shorter period from first change in MV parameters to patient death. Conclusion: This study highlights the nuances and complexities within MV withdrawal and WLSM in the ICU.

On a daily basis critically ill paediatric patients are admitted in the Paediatric Critical Care Unit (PCCU). Some of these paediatric patients require cardiothoracic surgery and is mechanically ventilated post-operatively. Chapter one of this study gives an orientation to this research and explains that in order to prevent ventilator associated complications and high hospitalisation costs, the mechanically ventilated paediatric patient following cardiothoracic surgery should be extubated as soon as he/she is ready. Chapter two is dedicated to the available literature on this topic and indicates that literature on extubation criteria for the mechanically ventilated paediatric patient is minimal. The methodology of this study is discussed in detail in Chapter three. Chapter four gives a detailed explanation of the research findings and the researcher included the developed clinical pathway for the extubation of the paediatric patient following cardiothoracic surgery in a private hospital in Gauteng. The relevant clinical pathway functions as a guideline and evidence-based tool in the PCCU. Lastly Chapter five gives a summary of this study and a few recommendations are made. The researcher has included a personal reflection in this Chapter. / Dissertation (MCur)--University of Pretoria, 2014. / tm2015 / Nursing Science / MCur / Unrestricted

Bakgrund: Mekaniskt ventilationsstöd används till patienter för att säkerställa ett tillfredsställande gasutbyte mellan koldioxid och syre. Avvänjningsprocessen från mekaniskt ventilationsstöd är påfrestande för patienten. Sjuksköterskor som arbetar med denna patientkategori ställs in för utmaningar som fodrar stor kunskap.Syfte: Belysa sjuksköterskors upplevelser av att vårda patienter vid avvänjning av mekaniskt ventilationsstöd. Metod: En systematisk litteraturöversikt med kvalitativa artiklar. Resultat: Ur analysen identifierades tre kategorier som var lära känna patienten, beslutsprocessen och optimera förutsättningarna. Konklusion: Kontinuitet och kommunikation i vården av patienten upplevdes som grundläggande för att lära känna patienten och för att bedöma patientens tillstånd. Vidare framkom det svårigheter att använda standardiserade strategier i arbetet med att avvänja patienter från mekaniskt ventilationsstöd. / Background: Mechanical ventilation support is used for patients to ensure a satisfactory gas exchange between carbon dioxide and oxygen. The weaning process from mechanical ventilation support is stressful for the patient. Nurses who work with this patient category are set for challenges that require a great deal of knowledge. Purpose: To shed light on nurses' experiences of caring for patients when weaning mechanical ventilation support. Method: A systematic literature review with qualitative articles. Results: From the analysis, three categories were identified to get to know the patient, the decision-making process and optimize the conditions. Conclusion: Continuity and communication in the care of the patient was perceived as fundamental for getting to know the patient and for assessing the patient's condition. The study described that there were difficulties in using standardized strategies in the work of weaning patients from mechanical ventilation support.