Estudos baseados em parâmetros fisiológicos tem mostrado que a fisioterapia tem papel imperativo na assistência de pacientes pré e pós-operatórios. Os efeitos da assistência fisioterapêutica na unidade de terapia intensiva (UTI) sobre o tempo de ventilação mecânica invasiva (VMI), tempo de internação e mortalidade do paciente crítico não foram elucidados. Tampouco, estudos sobre o impacto do turno diário da assistência fisioterapêutica nestes desfechos tem sido realizados. A despeito disto, e, possivelmente, baseadas na experiência clínica, as UTIs brasileiras adotarão turnos de 18 horas de assistência fisioterapêutica na UTI para atender a uma regulamentação governamental. O objetivo deste estudo foi comparar o efeito da assistência fisioterapêutica na UTI em turno diário de 24 horas (Fisio-24) ao turno diário de 12 horas (Fisio-12), sobre o tempo de VMI, tempo de internação na UTI, frequência de complicações respiratórias relacionadas a VMI e custos indiretos de pacientes pós-operatórios. Este estudo observacional, prospectivo, de coorte incluiu 114 pacientes de UTIs com Fisio-12 e 152 pacientes de UTIs com Fisio-24 em condição pós-operatória, idade 18 anos, submetidos a VMI por 24 horas e admitidos na UTI para rotina pós-operatória. Foram coletados dados demográficos e cirúrgicos. Os desfechos primários deste estudo foram tempo de VMI, tempo de internação na UTI, complicações respiratórias relacionadas a VMI e custos indiretos. O desfecho secundário foi o dia-livre de ventilação (VFD). Os custos foram avaliados através do Omega French Score que compreende três categorias (Omega 1, 2 e 3). Um modelo de regressão linear múltipla (MRL) foi construído para verificar a associação entre o turno diário de assistência fisioterapêutica na UTI e o tempo de VMI. A despeito dos pacientes Fisio-24 serem mais velhos (p=0,002), possuírem maior número de comorbidades (p=0,001), maior frequência de risco cirúrgico moderado a alto (p=0,003), maior frequência de complicações intra operatórias (p=0,012) e insuficiência renal aguda dialítica (p<0,001), comparados aos pacientes Fisio-12, apresentaram melhores desfechos clínicos, tais quais, menor mediana de tempo de VMI (4 dias versus 6 dias; p=0,002), maior mediana de VFD (24 dias versus 21 dias; p=0,004) e menor mediana de tempo de internação na UTI (10 dias versus 15 dias; p=0,015). Não foi encontrada diferença na frequência de complicações respiratórias relacionadas à VMI entre os dois grupos (p=0,704), embora pacientes Fisio-24 tenham recebido mais sessões de fisioterapia respiratória durante a internação na UTI (25 versus 20 sessões; p=0,014). Pacientes Fisio-24 apresentaram menor pontuação do Omega 2 (p=0,007). O MRL manteve como variáveis explicativas o número de sessões de fisioterapia respiratória, APACHE II, realização de Neurocirurgia e o turno diário de assistência fisioterapêutica na UTI. Mantidas constantes as outras variáveis explicativas, a presença de Fisio-24 na UTI reduziu o tempo de VMI em 2,80 unidades. Concluí-se que pacientes pós-operatórios admitidos em UTIs com Fisio-24 apresentaram menores tempo de VMI e tempo de internação na UTI, maior VFD, contudo, não foi encontrada diferença na frequência de complicações respiratórias relacionadas à VMI entre Fisio-12 e Fisio-24. A redução da pontuação de Omega 2 nos pacientes Fisio-24 não foi suficiente para promover diferenças no custo indireto entre os grupos / According to studies based on physiologic parameters, physiotherapy plays an imperative role on pre and postoperative patients. The effects of physiotherapy assistance (PTA) in the intensive care unit (ICU) on length of invasive mechanical ventilation (IMV), length of ICU stay, frequency of ventilator-associated pneumonia and mortality remain unclear. Moreover, studies about impact of PTA shifts have not been conducted. Despite this fact, and possibly based on clinical experiences, Brazilian ICUs are going to adopt 18 hours of PTA shifts in order to attend a governmental regulation. The objective of this study was to compare the effects of 24-hour PTA (Physio-24) to 12-hour PTA (Physio-12) daily shifts in the ICU on length of IMV, length of ICU stay, frequency of respiratory complications related to IMV and indirect costs of postoperative patients. This observational, prospective and cohort study included 114 patients from ICUs with Physio-12 and 152 patients from ICU with Physio-24. Patients presented postoperative conditions, were aged 18 years, who underwent IMV 24 hours and were admitted on ICU for postoperative routine. We collected demographical and surgical data. Our primaries end-points were duration of IMV, length of ICU stay, frequency of respiratory complications related to IMV and indirect costs. The secondary end-point was ventilator-free days (VFD). Indirect costs were assessed by Omega French Score which comprises three categories (Omega 1, 2 and 3). In addition, a multiple linear regression model (MLR) was constructed to verify the association between daily shifts of PTA in ICU and length of IMV. Despite of the fact that Physio-24 patients were older (p=0.002), with more severe conditions such as higher number of co morbidities (p<0.001), higher presence of moderate to severe surgical risk (p=0.003), higher frequency of intraoperative complications (p=0.012) and dialytic acute renal failure in ICU (p<0.001), compared to Physio-12 patients, they presented better clinical outcomes such as fewer median days spent in IMV (4 versus 6 days; p=0.002), higher median of VFD (24 versus 21 days; p=0.004) and shorter median of ICU stay (10 versus 15 days; p=0.015). No differences were found concerning respiratory complications related to IMV between groups (p=0.704), although Physio-24 patients had received more sessions of chest physiotherapy during ICU stay (25 versus 20 sessions; p=0.014). Physio-24 patients presented lower scores of Omega 2 (p=0.007). The number of chest physiotherapy sessions, APACHE II, Neurosurgery, and daily shifts of PTA in ICU remained as independent variables to length of IMV in the MLR model. According to this model, Physio-24 may reduce 2.80 units from length of IMV if the other independent variables are constant. We concluded that postoperative patients admitted in ICUs with daily shifts of 24-hour PTA showed shorter length of IMV and length of ICU stay and increased VFD; however, no reduction in frequency of respiratory complications related to IMV was found between groups. Despite the fact that Physio-24 patients had lower score of Omega 2, it was not enough to provoke a difference on indirect costs between Physio-12 and Physio-24 patients

No description available.

<p>The principal aim was to study selected aspects of indoor environment in dwellings and their association with symptoms compatible with the sick building syndrome (SBS). A validated questionnaire was developed specifically for residential indoor investigations, using sociological principles and test procedures. The questionnaire was mailed to 14,243 multi-family dwellings in Stockholm, selected by stratified random sampling. Females, subjects with a history of atopy, those above 65 y, and those in new buildings reported more symptoms. Subjects owning their own dwelling had less symptoms. A multiple regression model was developed, to identify residential buildings with a higher than expected occurrence of SBS. In total, 28.5% reported at least one sign of building dampness in their home (condensation on windows, humidity in the bathroom, mouldy odour, water leakage). All indicators of dampness were related to symptoms, even when adjusting for demographic data, and other building characteristics (OR=2.9-6.0). Associations between symptoms and other building data was evaluated in older houses, built before 1961. Subjects in older buildings with a mechanical ventilation system had fewer symptoms. Heating by electric radiators, and wood heating was associated with an increase of most types of symptoms (OR=1.2-5.0). Multiple sealing measures (OR=1.3), and major reconstruction (OR=1.1-1.9), was associated with an increase of symptoms. The effect of seasonal adapted ventilation (SAV) was studied in a small experimental study. A 20% reduction of ventilation flow from 0.5-0.8 ac/h to 0.4-0.5 ACH during the heating season increased the perception of poor indoor air quality in the dwelling in general, and in the bedroom. In conclusion, low building age, and building dampness in the dwelling are associated with SBS. In older houses, mechanical ventilation is beneficial. The thesis did not support the view that energy saving measures in general is an important risk factor for SBS, but major reconstruction and multiple sealing measures can be risk factor for symptoms. Reducing the outdoor ventilation flow below the current Swedish ventilation standard (0.5 ACH) may increase the perception of impaired air quality. </p>

The principal aim was to study selected aspects of indoor environment in dwellings and their association with symptoms compatible with the sick building syndrome (SBS). A validated questionnaire was developed specifically for residential indoor investigations, using sociological principles and test procedures. The questionnaire was mailed to 14,243 multi-family dwellings in Stockholm, selected by stratified random sampling. Females, subjects with a history of atopy, those above 65 y, and those in new buildings reported more symptoms. Subjects owning their own dwelling had less symptoms. A multiple regression model was developed, to identify residential buildings with a higher than expected occurrence of SBS. In total, 28.5% reported at least one sign of building dampness in their home (condensation on windows, humidity in the bathroom, mouldy odour, water leakage). All indicators of dampness were related to symptoms, even when adjusting for demographic data, and other building characteristics (OR=2.9-6.0). Associations between symptoms and other building data was evaluated in older houses, built before 1961. Subjects in older buildings with a mechanical ventilation system had fewer symptoms. Heating by electric radiators, and wood heating was associated with an increase of most types of symptoms (OR=1.2-5.0). Multiple sealing measures (OR=1.3), and major reconstruction (OR=1.1-1.9), was associated with an increase of symptoms. The effect of seasonal adapted ventilation (SAV) was studied in a small experimental study. A 20% reduction of ventilation flow from 0.5-0.8 ac/h to 0.4-0.5 ACH during the heating season increased the perception of poor indoor air quality in the dwelling in general, and in the bedroom. In conclusion, low building age, and building dampness in the dwelling are associated with SBS. In older houses, mechanical ventilation is beneficial. The thesis did not support the view that energy saving measures in general is an important risk factor for SBS, but major reconstruction and multiple sealing measures can be risk factor for symptoms. Reducing the outdoor ventilation flow below the current Swedish ventilation standard (0.5 ACH) may increase the perception of impaired air quality.

No description available.

Estudos baseados em parâmetros fisiológicos tem mostrado que a fisioterapia tem papel imperativo na assistência de pacientes pré e pós-operatórios. Os efeitos da assistência fisioterapêutica na unidade de terapia intensiva (UTI) sobre o tempo de ventilação mecânica invasiva (VMI), tempo de internação e mortalidade do paciente crítico não foram elucidados. Tampouco, estudos sobre o impacto do turno diário da assistência fisioterapêutica nestes desfechos tem sido realizados. A despeito disto, e, possivelmente, baseadas na experiência clínica, as UTIs brasileiras adotarão turnos de 18 horas de assistência fisioterapêutica na UTI para atender a uma regulamentação governamental. O objetivo deste estudo foi comparar o efeito da assistência fisioterapêutica na UTI em turno diário de 24 horas (Fisio-24) ao turno diário de 12 horas (Fisio-12), sobre o tempo de VMI, tempo de internação na UTI, frequência de complicações respiratórias relacionadas a VMI e custos indiretos de pacientes pós-operatórios. Este estudo observacional, prospectivo, de coorte incluiu 114 pacientes de UTIs com Fisio-12 e 152 pacientes de UTIs com Fisio-24 em condição pós-operatória, idade 18 anos, submetidos a VMI por 24 horas e admitidos na UTI para rotina pós-operatória. Foram coletados dados demográficos e cirúrgicos. Os desfechos primários deste estudo foram tempo de VMI, tempo de internação na UTI, complicações respiratórias relacionadas a VMI e custos indiretos. O desfecho secundário foi o dia-livre de ventilação (VFD). Os custos foram avaliados através do Omega French Score que compreende três categorias (Omega 1, 2 e 3). Um modelo de regressão linear múltipla (MRL) foi construído para verificar a associação entre o turno diário de assistência fisioterapêutica na UTI e o tempo de VMI. A despeito dos pacientes Fisio-24 serem mais velhos (p=0,002), possuírem maior número de comorbidades (p=0,001), maior frequência de risco cirúrgico moderado a alto (p=0,003), maior frequência de complicações intra operatórias (p=0,012) e insuficiência renal aguda dialítica (p<0,001), comparados aos pacientes Fisio-12, apresentaram melhores desfechos clínicos, tais quais, menor mediana de tempo de VMI (4 dias versus 6 dias; p=0,002), maior mediana de VFD (24 dias versus 21 dias; p=0,004) e menor mediana de tempo de internação na UTI (10 dias versus 15 dias; p=0,015). Não foi encontrada diferença na frequência de complicações respiratórias relacionadas à VMI entre os dois grupos (p=0,704), embora pacientes Fisio-24 tenham recebido mais sessões de fisioterapia respiratória durante a internação na UTI (25 versus 20 sessões; p=0,014). Pacientes Fisio-24 apresentaram menor pontuação do Omega 2 (p=0,007). O MRL manteve como variáveis explicativas o número de sessões de fisioterapia respiratória, APACHE II, realização de Neurocirurgia e o turno diário de assistência fisioterapêutica na UTI. Mantidas constantes as outras variáveis explicativas, a presença de Fisio-24 na UTI reduziu o tempo de VMI em 2,80 unidades. Concluí-se que pacientes pós-operatórios admitidos em UTIs com Fisio-24 apresentaram menores tempo de VMI e tempo de internação na UTI, maior VFD, contudo, não foi encontrada diferença na frequência de complicações respiratórias relacionadas à VMI entre Fisio-12 e Fisio-24. A redução da pontuação de Omega 2 nos pacientes Fisio-24 não foi suficiente para promover diferenças no custo indireto entre os grupos / According to studies based on physiologic parameters, physiotherapy plays an imperative role on pre and postoperative patients. The effects of physiotherapy assistance (PTA) in the intensive care unit (ICU) on length of invasive mechanical ventilation (IMV), length of ICU stay, frequency of ventilator-associated pneumonia and mortality remain unclear. Moreover, studies about impact of PTA shifts have not been conducted. Despite this fact, and possibly based on clinical experiences, Brazilian ICUs are going to adopt 18 hours of PTA shifts in order to attend a governmental regulation. The objective of this study was to compare the effects of 24-hour PTA (Physio-24) to 12-hour PTA (Physio-12) daily shifts in the ICU on length of IMV, length of ICU stay, frequency of respiratory complications related to IMV and indirect costs of postoperative patients. This observational, prospective and cohort study included 114 patients from ICUs with Physio-12 and 152 patients from ICU with Physio-24. Patients presented postoperative conditions, were aged 18 years, who underwent IMV 24 hours and were admitted on ICU for postoperative routine. We collected demographical and surgical data. Our primaries end-points were duration of IMV, length of ICU stay, frequency of respiratory complications related to IMV and indirect costs. The secondary end-point was ventilator-free days (VFD). Indirect costs were assessed by Omega French Score which comprises three categories (Omega 1, 2 and 3). In addition, a multiple linear regression model (MLR) was constructed to verify the association between daily shifts of PTA in ICU and length of IMV. Despite of the fact that Physio-24 patients were older (p=0.002), with more severe conditions such as higher number of co morbidities (p<0.001), higher presence of moderate to severe surgical risk (p=0.003), higher frequency of intraoperative complications (p=0.012) and dialytic acute renal failure in ICU (p<0.001), compared to Physio-12 patients, they presented better clinical outcomes such as fewer median days spent in IMV (4 versus 6 days; p=0.002), higher median of VFD (24 versus 21 days; p=0.004) and shorter median of ICU stay (10 versus 15 days; p=0.015). No differences were found concerning respiratory complications related to IMV between groups (p=0.704), although Physio-24 patients had received more sessions of chest physiotherapy during ICU stay (25 versus 20 sessions; p=0.014). Physio-24 patients presented lower scores of Omega 2 (p=0.007). The number of chest physiotherapy sessions, APACHE II, Neurosurgery, and daily shifts of PTA in ICU remained as independent variables to length of IMV in the MLR model. According to this model, Physio-24 may reduce 2.80 units from length of IMV if the other independent variables are constant. We concluded that postoperative patients admitted in ICUs with daily shifts of 24-hour PTA showed shorter length of IMV and length of ICU stay and increased VFD; however, no reduction in frequency of respiratory complications related to IMV was found between groups. Despite the fact that Physio-24 patients had lower score of Omega 2, it was not enough to provoke a difference on indirect costs between Physio-12 and Physio-24 patients

Introduction: La pneumonie associée à la ventilation mécanique (VM) est fréquente chez les patients ventilés. L’étirement cyclique (EC) induit par la VM pourrait amorcer le poumon vers une réponse inflammatoire en cas d'exposition à des bactéries. Les Toll-like Receptors (TLR) reconnaissent les bactéries et déclenchent l'immunité. La VM pourrait moduler l'expression des TLR et leur réactivité aux agonistes. Le décubitus ventral (DV) réduit l’étirement du poumon. Méthodes: Les niveaux de TLR2 et la réponse à ses agonistes ont été mesures dans des cellules pulmonaires soumises à un EC, et dans un modèle de lapin ventilé. Une stimulation ex vivo du sang total prélevé sur lapins ventilés a été réalisée. Une pneumonie a été induite chez des lapins soumis à VM et maintenus en décubitus dorsal ou tournés en DV. Résultats: L’EC des cellules ainsi que des poumons de lapins augmente les niveaux de TLR2 et la réponse inflammatoire à ses agonistes. La VM et l’exposition du poumon à des agonistes TLR2 induisent synergiquement des lésions. Chez des lapins avec pneumonie sous VM la clairance bactérienne pulmonaire est réduite, la probabilité de bactériémie et le taux des cytokines circulantes augmentés. Le sang total provenant d'animaux sous VM libère de grandes quantités de cytokines après stimulation. Le DV est associe à des niveaux plus faibles de concentrations bactériennes et d'inflammation. Conclusions: La VM sensibilise le poumon aux ligands bactériens de TLR2, modifie la clairance bactérienne pulmonaire, favorise les lésions pulmonaires et de l'inflammation. La surexpression de TLR2 induite par l’EC pourrait expliquer ces différences. Le DV pourrait avoir un effet protecteur. / Introduction: Ventilator-associated pneumonia is common in patients subjected to mechanical ventilation (MV). Cyclic stretch subsequent to MV could prime the lung toward an inflammatory response if exposed to bacteria. Toll-like receptors (TLRs) recognize pathogens thus triggering immunity. MV could modulate TLRs expression and responsiveness to agonists. The prone position (PP) reduces lung stretch.Methods:TLR2 levels and response to the TLR2 ligands were measured in human pulmonary cells submitted to cyclic stretch, and either spontaneously breathing (SB) or MV rabbits. Ex vivo stimulation of whole blood taken from SB or MV rabbits was performed.Enterobacter aerogenes pneumonia was induced in rabbits subjected to MV and kept supine or turned to the PP. Results: Cyclic stretch of human cells as well as rabbitsÕ lung increased both TLR2 levels and inflammatory response to its agonist. MV and airways exposure to TLR2 ligands acted synergistically in causing lung injury.A decrease of lung bacterial clearance and a greater likelihood of bacteremia were observed in MV rabbits with S. aureus pneumonia. Circulating cytokines rose significantly only in these animals. MV induced TLR2 spleen overexpression. Whole blood obtained from MV animals released larger amounts of cytokines after stimulation. PP was associated with lower levels of bacterial concentrations and inflammation. Conclusions: MV sensitizes the lung to bacterial TLR2 ligands, alters lung bacterial clearance, promotes lung injury and inflammation. Both pulmonary and peripheral blood stretch-induced TLR2 overexpression could account at least in part for such differences. The PP could be protective.

The diploma thesis deals with the problems of the indoor environment of swimming pool halls. Firstly, it describes issues and principles of designing HVAC system in the areas with high humidity production. Thesis then focuses on various approaches to calculations of evaporation from the water surface and different possibilities of dehumidification including different types of HVAC units. This knowledge was applied to the design of HVAC system for particular assigned building, for which are proposed two different solutions. Thesis includes experimental part, its aim is to analyse one specific critical part of the hall. Based on local surveying and long-term measurements a few possibilities of improvement are suggested.

The aim of this master´s thesis is the elaboration of project documentation for kindergarten with almost zero energy consumption. The project consists of three main parts. The first part is devoted to the civil engineering design of the building. The building is designed regarding to architectural expression, quality of made and type of use. The kindergarten is designed with capacity of 48 children split into two departments. The second part is devoted to the design of HVAC systems. The building uses mechanical ventilation with heat recovery, heating is provided by two gas boilers and the need of electricity is provided by a photovoltaic system. Captured rainwater is used effectively. The third part values the building regarding the method of multi–criteria analysis. For this evaluation uses national method SBToolCZ.

This diploma thesis deals with the processing of project documentation for construction of a health centre in Šlapanice. The proposed building is situated on parcels no. 1906/1, 1906/11 and 1906/13. The parcels are part of the cadastral city Šlapanice. The terrain is flat. There are all necessary underground utilities nearby. The object is functionally divided into two parts and has a rectangular plan. The first part consists of a medical centre with a capacity of 19 specialized surgeries. The second part consists of a pharmacy for the general public. The building is designed of the brick construction system with a monolithic reinforced concrete columns and a reinforced concrete continuous slab. The largest footprint building is 66.75 x 18.75 meters. The cladding is designed in aluminium and glass facades with a total thickness of 250 mm. Roofing of the building's entire surface of a flat roof with a waterproofing layer at a gradient of 3% with multiple height levels. The structure of flat roofs is designed as a flat roof with a stabilizing layer of washed river gravel or vegetation roof. Foundation of a building is a combination of foundation footings and foundation passports. The pharmacy part is designed as a single-storey building and the health centre is designed as a partial basement building with three floors.