Bakgrund: Att arbeta som specialistsjuksköterska inom intensivvård innebär att du kommer möta patienter som vårdas i respirator. En respiratorbehandling är många gånger livräddande, men lång respiratorbehandling associeras även med flera komplikationer och ett stort lidande för den enskilde patienten. Fundamentals of Care (FoC) kan användas som ett stöd för att tillhandahålla en personcentrerad grundläggande omvårdnad. På grund av de komplexa kraven på urträning är det särskilt viktigt att identifiera och tillgodose patienters grundläggande vårdbehov under urträningsprocessen. Syfte: Syftet är att beskriva intensivvårdssjuksköterskors erfarenheter av omvårdnadsåtgärder som underlättar patientens urträning ur respirator utifrån FoC. Metod: En kvalitativ intervjustudie med deduktiv ansats. Totalt rekryterades åtta informanter från två intensivvårdsavdelningar på ett universitetssjukhus i Mellansverige. Insamlad data analyserades med en kvalitativ innehållsanalys enligt Graneheim och Lundman (2004). Resultat: Tre kategorier presenteras i resultatet med utgångspunkt i FoC: etablerad vårdrelation, grundläggande vårdbehov och vårdkontext. Resultatet visade att intensivvårdssjuksköterskorna upplevde att närvaro bidrog till trygghet för patienten, och att kontinuitet i vårdandet kunde underlätta urträningsprocessen. Intensivvårdssjuksköterskorna belyste även vikten av en personcentrerad vård och individanpassad information som viktiga omvårdnadsåtgärder i urträningsprocessen. Slutsats: Genom att tillämpa delarna i FoC kan ramverket fungera som en vägledning för att tillhandahålla en personcentrerad omvårdnad i takt med urträningsprocessen. Att beskriva omvårdnadsåtgärder som kan underlätta urträning ur respirator kan bidra till att göra urträningsprocessen skonsammare för den enskilde patienten. / Background: Working as a critical care nurse means encountering patients undergoing mechanical ventilation. Mechanical ventilation is often life-saving, however prolonged mechanical ventilation is also associated with several complications and patient suffering. Fundamentals of Care (FoC) can be used as a guidance to provide person-centered care. Given the complex demands of weaning, it is important to identify and address patients' basic care needs during the weaning process. Aim: The aim is to describe critical care nurses’ experiences of nursing interventions facilitating the patient's weaning from mechanical ventilation based on FoC. Method: A qualitative interview study with a deductive approach. A total of eight informants were recruited from two critical care units at a university hospital in central Sweden. Collected data were analyzed using qualitative content analysis following Graneheim and Lundman (2004). Result: Three categories are presented in the results based on FoC: relationship, integration of care and context of care. The results showed that critical care nurses experienced that presence contributed to providing a sense of security for the patient, and that continuity in care could facilitate the weaning process. Critical care nurses also highlighted the importance of person-centered care and information as important nursing interventions in the weaning process. Conclusion: By applying the components of FoC, the framework can serve as guidance for providing person-centered care during the weaning process. Describing nursing interventions that can facilitate weaning can contribute to making the weaning process gentler for the patient.

Tesis por compendio / [EN] The aim of this thesis was to evaluate the productive performance of a rabbit line (OR-LS) selected by ovulation rate during first 6 generations (period 1), and later by ovulation rate (OR) and litter size (LS) during 11 generations using independent culling levels (Period 2). Genetic parameters, direct response for OR and LS and the correlated response for embryo (ES), foetal (FS) and prenatal survival (PS) were estimated. Also, the correlated response on growth rates (GR), weaning (WW) and marketing weight (MW) were estimated. The objective of chapter 3 was to estimate the genetic parameters of the productive traits and the response to selection by OR and LS of OR-LS line. For traits analysis, Bayesian methods were used. Heritability values of litter size traits were low, 0.10, 0.07, 0.07 and 0.07 for litter size, number of born alive (NBA), number of kits at weaning (NW) and marketing (NM), respectively. Heritability for OR was moderate (0.25), while it was low (0.13 and 0.14) for number of implanted embryos (IE) and number of live foetuses at 12 days of gestation (LF12), respectively. Low heritability values for survival traits were found, 0.09 for embryo survival (ES), 0.16 for foetal survival (FS) and 0.14 for prenatal survival (PS). In the second period, after 11 generations of selection by OR and LS, a genetic response of 0.17 kits per generation for LS was achieved. This response was higher than the obtained in period 1 (0.07 kits per generation), in which just selection by OR was performed. The opposite effect was found for OR; the highest response for OR appeared in the first period (0.24 ova per generation) versus the second period (0.17 ova per generation). This reduction in OR response can be due to the decrease in selection differential during the second period of selection. Since high genetic correlations were obtained for LS and other litter size traits, a positive correlated response was observed for NBA, NW and NM (0.12, 0.12 and 0.11 kits per generation, respectively) in the second period. In the first period, no correlated response on ES was observed and a decrease in FS (-0.04) was found. Nevertheless, in the second period a correlated response on PS appeared due to an improvement in both ES (0.04) and FS (0.03). Summarizing, the improvement in litter size in the second period is due to an increase in ovulation rate as well as an increase in prenatal survival. The objective of chapter 4 was to study the correlated response on growth traits in the OR-LS line in both periods of selection, the selection by OR during six generations and the selection by independent levels by OR and LS during 11 generations. The heritability estimates were low for weaning weight (WW), marketing weight (MW) and growth rate (GR), 0.09, 0.13 and 0.14, respectively. The estimated genetic correlations of WW, GR and MW with LS were around zero and with OR were positive and from low (0.19) to moderate (0.38). The positive moderate genetic correlation estimated between OR and MW could explain the correlated response found in MW. Correlated response on WW could be explained by positive and high genetic correlation between MW and WW. The aim of chapter 5 was to investigate magnitude and timing of embryo and early foetal survival in females with high OR using hormonal treatment as a model for selection by OR. Two groups of females (treated and untreated) were used. Treated females were injected with 50 IU eCG 48 hours before mating. Females were slaughtered at day 18 of gestation. OR, IE, LF12 and LF18 were recorded. Besides, ES (IE/OR), FSLF18 (LF18/IE), FSLF18/LF12 (LF18/LF12) and PSLF18 (LF18/OR) were estimated. Treated females had a higher OR than untreated females. According to the previous results for OR and LF18, treated females showed a lower survival rate from ovulation to 18 d of gestation. Treated females also had lower embryo and foetal survival. Main difference in foetal survival appeared from day 12 to 18 of gestation. / [ES] El objetivo de esta tesis fue evaluar el tamaño de camada de una línea de conejo seleccionada por tasa de ovulación durante las primeras seis generaciones (periodo 1) y después por tasa de ovulación (OR) y tamaño de camada (LS) durante 11 generaciones mediante el método de niveles independientes (periodo 2). Se estimaron los parámetros genéticos, así como la respuesta en OR y LS y la respuesta correlacionada en los caracteres reproductivos (capítulo 3). Además, se evaluó la respuesta correlacionada en los caracteres de crecimiento (capítulo 4); peso al destete (WW), peso al sacrificio (MW) y ganancia de peso entre el destete y el sacrificio (GR). Para el análisis de los caracteres se utilizaron métodos bayesianos. El objetivo del capítulo 3 fue estimar los parámetros genéticos de los caracteres reproductivos y la respuesta a la selección. Los valores de heredabilidad de los caracteres del tamaño de camada fueron bajos (alrededor de 0.10). La heredabilidad estimada para OR fue moderada (0.25), mientras que fue baja para el número de embriones implantados (IE) y el número de fetos vivos a los 12 días de gestación (LF12). Se obtuvieron valores bajos de heredabilidad; 0.09 para la supervivencia embrionaria (ES), 0.16 para la supervivencia fetal (FS) y 0.14 para la supervivencia prenatal (PS). En el periodo 2, se obtuvo una respuesta genética de 0.17 gazapos por generación para LS. Esta respuesta fue mayor que la obtenida en el periodo 1. En el caso de la tasa de ovulación, la mayor respuesta en OR se obtuvo en el periodo 1 (0.24 óvulos por generación) versus (0.17 óvulos por generación) en el periodo 2. Esta reducción en la respuesta de OR se puede atribuir a la disminución del diferencial de selección durante el período 2 de selección. De acuerdo con la alta correlación genética entre LS y otros caracteres del tamaño de camada, también se observó una respuesta correlacionada positiva en el número de nacidos vivos (NBA), destetados (NW) y comercializados (NM); 0.12, 0.12 y 0.11 gazapos por generación, respectivamente, en el segundo periodo. En el primer periodo no se observa respuesta correlacionada en la SE y se produce una disminución de la SF (-0.04). Sin embargo, en el segundo periodo se produce una respuesta correlacionada positiva en la SP que se debe a una mejora de la SE (0.04) y SF (0.03). En resumen, la mejora del tamaño de camada en el segundo periodo se debe tanto a un aumento de la tasa de ovulación como a un aumento de la supervivencia prenatal. El objetivo del capítulo 4 fue estudiar la respuesta correlacionada en los caracteres de crecimiento en esta línea. Las estimas de heredabilidad fueron bajas para los caracteres WW (0.09), MW (0.13) y GR (0.14). Las correlaciones genéticas estimadas de LS con WW, MW y GR fueron cercanas a cero; con la tasa de ovulación, las correlaciones fueron positivas y variaban de bajas a moderadas (de 0.19 a 0.38). La correlación genética moderada entre OR y MW podría explicar la respuesta correlacionada observada en MW. La alta correlación entre MW y WW podría explicar la respuesta correlacionada obtenida para WW. Finalmente, el objetivo de capítulo 5 fue estudiar en hembras con alta tasa de ovulación en qué momento se producen las mayores pérdidas fetales y cómo se ve afectado el desarrollo fetal. Para ello, de un total de 51 hembras, 24 hembras fueron pinchadas con 50 UI de eCG 48 horas antes de la cubrición para aumentar la tasa de ovulación. Las hembras fueron sacrificadas a los 18 días de gestación. Se registró OR, IE y el número de fetos vivos a los 12 y 18 días de gestación (LF18). Las hembras tratadas tuvieron una tasa de ovulación mayor que las no tratadas. De acuerdo con los resultados obtenidos para OR y LF18, las hembras tratadas mostraron una supervivencia más baja desde la ovulación hasta los 18 días de gestación y tuvieron una menor supervivencia embrionaria y fetal. Las principales diferencias en l / [CA] L'objectiu d'esta tesi va ser avaluar la millora de la grandària de ventrada d'una línia de conill seleccionada per tasa d'ovulació durant les primeres sis generacions (període 1) i després per tasa d'ovulació (OR) i la grandària de ventrada (LS) durant 11 generacions per mitjà del mètode de nivells independents (període 2). Es van estimar els paràmetres genètics, així com la resposta en OR i LS i la resposta correlacionada en caràcters reproductius (capítol 3). A més, es va estudiar la resposta correlacionada en els caràcters de creixement (capítol 4); pes al deslletament (WW), pes al sacrifici (MW) i guany de pes entre el deslletament y el sacrifici (GR). Per a l'anàlisi dels caràcters es van utilitzar mètodes bayesians. L'objectiu del capítol 3 va ser estimar els paràmetres genètics dels caràcters reproductius i la resposta a la selecció. Els valors d'heretabilitat dels caràcters de la grandària de ventrada van ser baixos (al voltant de 0.10). L'heretabilitat estimada per a OR va ser moderada (0.25), mentres que va ser baixa per al nombre d'embrions implantats (IE) i el nombre de fetus vius als 12 dies de gestació (LF12). Es van obtindre valors baixos d'heretabilitat; 0.09 per a ES, 0.16 per a FS i 0.14 per a PS. En el període 2, es va obtindre una resposta genètica de 0.17 llorigons per generació per a LS. Esta resposta va ser major que l'obtinguda en el període 1. En el cas de la tasa d'ovulació, la major resposta per a OR va ser en el primer període (0.24 òvuls per generació) versus (0.17 òvuls per generació) en el període 2. Esta reducció en la resposta d'OR es pot atribuir a la disminució del diferencial de selecció durant el període 2 de selecció. Donada l'alta correlació genètica entre LS i altres caràcters de la grandària de ventrada, també es va observar una resposta correlacionada positiva en el nombre de nascuts vius (NBA), deslletats (NW) i comercialitzats (NM); 0.12, 0.12 i 0.11 llorigons per generació, respectivament, en el segon període. En el primer període no s'observa resposta correlacionada en la SE i es produeix una disminució de la SF (-0.04). No obstant això, en el segon període es produeix una resposta correlacionada en la SP que es deu a una millora de la SE (0.04) i SF (0.03). En resum, la millora de la grandària de ventrada en el segon període es deu tant a un augment de la tasa d'ovulació com a un augment de la supervivència prenatal. L'objectiu del capítol 4 va ser estudiar la resposta correlacionada en els caràcters de creixement en aquesta línia. Les estimes d'heretabilitat van ser baixes per als caràcters WW (0.09), MW (0.13) i GR (0.14). Les correlacions genètiques estimades de LS amb WW, MW i GR van ser pròximes a zero; amb la tasa d'ovulació, les correlacions van ser positives i variaven de baixes a moderades (de 0.19 a 0.38). La correlació genètica moderada entre OR i MW podria explicar la resposta correlacionada trobada per a MW. D'altra banda, l'alta correlació entre MW i WW podria explicar la resposta correlacionada obtinguda per a WW. Finalment. l'objectiu del capítol 5 va ser estudiar en femelles amb alta tasa d'ovulació en quin moment es van produir les majors pèrdues fetals i com es veu afectat el desenvolupament fetal. Per a això, d'un total de 51 femelles, 24 femelles van ser punxades amb 50 UI d'eCG 48 hores abans del cobriment per a augmentar la tasa d'ovulació. Les femelles van ser sacrificades al 18 dies de gestació. Es va registrar OR, IE i el nombre de fetus vius al 12 i 18 dies de gestació (LF18). Les femelles tractades van tindre una tasa d'ovulació major que les no tractades. D¿acord als resultats obtinguts per OR i LF18, les femelles tractades van mostrar una supervivència més baixa des de l'ovulació fins als 18 dies de gestació i van tindre una menor supervivència embrionària i fetal. Les principals diferències en la supervivència fetal van aparèixer entre els dies 12 i 18 de gestaci / Yehia Badawy Elmoghazy, A. (2016). SELECTION FOR OVULATION RATE AND LITTER SIZE IN RABBITS [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/73265 / Compendio

This study investigated stable-isotope ratio evidence of weaning for the late Anglo-Saxon population of Raunds Furnells, Northamptonshire, UK. delta(15)N and delta(13)C values in rib collagen were obtained for individuals of different ages to assess the weaning age of infants within the population. A peak in delta(15) N values at about 2-year-old, followed by a decline in delta(15) N values until age three, indicates a change in diet at that age. This change in nitrogen isotope ratios corresponds with the mortality profile from the site, as well as with archaeological and documentary evidence on attitudes towards juveniles in the Anglo-Saxon period. The pattern of delta(13) C values was less clear. Comparison of the predicted age of weaning to published data from sites dating from the Iron Age to the 19th century in Britain reveals a pattern of changing weaning practices over time, with increasingly earlier commencement and shorter periods of complementary feeding in more recent periods. Such a change has implications for the interpretation of socioeconomic changes during this period of British history, since earlier weaning is associated with decreased birth spacing, and could thus have contributed to population growth.

La diarrhée colibacillaire post-sevrage (DCPS) est une infection intestinale endémique dans les fermes porcines à l’échelle mondiale. Cette maladie est causée principalement par la présence et la multiplication au niveau de l’intestin des porcelets d’un pathotype d’Escherchia coli, nommé E. coli entérotoxinogène (ETEC) et en particulier celui qui exprime l’adhésine F4 (K88) (ETEC: F4). Le sérogroupe ETEC: O149 a été le plus isolé à partir des cas de DCPS à travers le monde. Plusieurs études ont rapporté un taux de résistance important des souches O149: F4 contre les antibiotiques qui sont classiquement utilisés pour traiter cette infection et en particulier les aminoglycosides. Ainsi, pour remédier aux échecs thérapeutiques observés dans les fermes porcines au Canada, les vétérinaires ont commencé à utiliser, sous leurs responsabilités, un antibiotique, la colistine sulfate (CS), qui n’est pas homologué en production animale au Canada. Cette étude avait pour buts d’étudier la pharmacocinétique de la CS in vitro et in vivo, de développer une technique sensible pour une quantification plasmatique de la CS, de déterminer son efficacité thérapeutique in vivo dans un modèle d’infection expérimentale de DCPS et de caractériser la résistance d’E. coli consécutive à l’utilisation thérapeutique de la CS chez le porc. Une simulation du liquide gastrique (SLG) a été préparée, et après l’ajout de la CS et de la pepsine à cette solution, les concentrations de la CS ont été mesurées par chromatographie liquide à haute performance couplée à la spectrométrie de masse en tandem (HPLC-MS/MS). Une dégradation rapide de CS a été constatée dans la SLG et a été accompagnée par la formation de produits de dégradation qui ont démontré une activité microbienne plus importante par comparaison avec la molécule mère (CS). Dans un volet in vivo, l’infection expérimentale des porcelets sevrés par une souche ETEC: F4 n’a pas augmenté l’absorption digestive de la CS dans un modèle subclinique de DCPS chez le porc. L’administration orale de la CS à la dose thérapeutique de 50,000 UI/kg à raison de 2 fois par jour pendant 5 jours pour traiter la DCPS dans des conditions expérimentales a entraîné une réduction significative de l’excrétion fécale de la souche infectieuse (ETEC : F4), de la population totale d’E. coli et des scores de diarrhée, uniquement pendant la période du traitement. Cependant, ces résultats ont été accompagnés par une légère augmentation dans l’excrétion fécale des E. coli résistants à la colistine, et le traitement n'a pas empêché la perte de poids des porcs infectés. En revanche, l’infection expérimentale des porcelets par ETEC: F4 a augmenté l’absorption digestive de la CS dans un modèle clinique de diarrhée colibacillaire chez le porc. Cette étude a permis de générer pour la première fois des données scientifiques concernant l’efficacité thérapeutique, la pharmacocinétique et la résistance à la colistine dans un modèle de DCPS chez le porc. Elle a également remis en doute la pertinence économique d’augmenter la dose de CS pour accélérer le rétablissement clinique des porcs. Finalement, elle a indiqué que des conditions d’élevage optimales, sans autres facteurs prédisposants, étaient aussi efficaces que la CS dans l’amélioration des symptômes cliniques de la DCPS. / Post-weaning diarrhea (PWD) caused by Escherichia coli is an endemic intestinal infection in pig farms worldwide. This disease is mostly the consequence of the presence and the multiplication in piglet’s gut of an Escherchia pathotype, named enterotoxigenic E. coli (ETEC) and in particular those that express the F4 (K88) fimbrial adhesin (ETEC: F4). The predominant serogroup of E. coli isolated from piglets with PWD worldwide is O149. Several studies have reported a significant resistance rate of O149 ETEC strains against commonly used antibiotics for the treatment of PWD, particularly, aminoglycosides. Thereby, to address therapeutic failures observed in pig farms during PWD treatment, veterinarians in Canada started using, under their responsibilities, the colistin sulfate (CS), an antibiotic not approved for farm animals in Canada. The objectives of this thesis were: to study the pharmacokinetics of CS in vitro and in vivo, to develop a sensitive method for the quantification of CS plasma concentrations in pigs, to determine the therapeutic efficacy of CS in an experimental model of PWD, and to characterize the resistance of E. coli to colistin consecutive to its therapeutic use in pigs. Simulated gastric fluid (SGF) was prepared, and after the addition of CS and pepsin to this solution, the concentrations of CS were followed by liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS). A rapid degradation of CS in the SGF was observed, and the degradation products showed a greater antimicrobial activity compared to the native CS. On the other hand, the experimental challenge of piglets with an ETEC: F4 strain has not increased the CS intestinal absorption in a subclinical model of PWD in pigs. The oral administration of a therapeutic dose of CS at 50,000 IU/kg twice a day for 5 successive days to treat an experimental PWD in pigs, resulted in a significant reduction of fecal ETEC: F4 and total E. coli shedding, and in diarrhea scores but only during the treatment period. However, CS treatment resulted in a slight increase in fecal shedding of CS resistant E. coli and did not prevent weight loss in challenged pigs. In addition, challenge with ETEC: F4 resulted in an increase of CS intestinal absorption in a clinical model of PWD. This study has generated, for the first time, scientific data regarding CS therapeutic efficacy, its pharmacokinetic and the selection of E. coli colistin resistant in an experimental model of PWD in pigs. It also challenged the economic relevance of increasing CS oral doses to accelerate the clinical recovery of pigs. Finally, it indicated that optimal housing conditions were without other predisposing factors, effective as CS in improving clinical symptoms of experimental PWD in pigs.

Les E. coli entérotoxinogènes (ETEC) sont souvent la cause de diarrhée post-sevrage chez le porc. Deux types d’entérotoxines sont retrouvées chez les ETEC, soit les thermolabiles, comme la toxine LT, et les thermostables, comme EAST-1, STa et STb. Cette dernière est composée de 48 acides aminés et est impliquée dans la pathologie causée par les ETEC. Pour la première fois un variant de la toxine STb fut découvert dans une étude. Nous avons alors émis l’hypothèse qu’il y a présence de variants dans la population de souches ETEC du Québec. Dans les 100 souches STb+ analysées, 23 possédaient le gène de la toxine avec une variation dans la séquence génétique : l’asparagine était présente en position 12 remplaçant ainsi l’histidine. Une corrélation entre la présence du variant et la présence de facteurs de virulence retrouvés dans ces 100 souches ETEC étudiées a été effectuée. Ce variant semble fortement associé à la toxine STa puisque toutes les souches variantes ont hybridé avec le gène codant pour cette dernière. Étant donné sa présence répandue dans la population de souches ETEC du Québec, nous avons de plus émis l’hypothèse que ce variant a des caractéristiques biologiques altérées par rapport à la toxine sauvage. L’analyse par dichroïsme circulaire a montré que le variant et la toxine sauvage ont une structure secondaire ainsi qu’une stabilité similaires. Par la suite, l’attachement au récepteur de la toxine, le sulfatide, a été étudié par résonnance plasmonique de surface (biacore). Le variant a une affinité au sulfatide légèrement réduite comparativement à la toxine sauvage. Puisque l’internalisation de la toxine fut observée dans une étude précédente et qu’elle semble liée à la toxicité, nous avons comparé l’internalisation du variant et de la toxine sauvage à l’intérieur des cellules IPEC-J2. L’internalisation du variant dans les cellules est légèrement supérieure à l’internalisation de la toxine sauvage. Ces résultats suggèrent que le variant est biochimiquement et structurellement comparable à la toxine sauvage. / Enterotoxigenic Escherichia coli (ETEC) are a major cause of post-weaning diarrhea. STb is one of two heat-stable toxins produced by ETEC and is mostly associated with pathogenic porcine isolates. For the first time, a variant of the toxin was observed in a study in 2003. Our hypothesis is that STb variants are present in ETEC strains from Quebec. To screen for alterations at the gene level, a collection of 100 STb+ ETEC strains isolated from diseased pigs was randomly selected and analyzed. A total of 23 strains had a change from His12 to Asn. An association between the presence of the variant and virulence factors present in those strains was done. These strains were also positive for STa. Since this variant seems to be widely distributed in Quebec, we hypothesize that the variant has different biological properties compared to the wild-type STb. First, the secondary structure of the variant and wild-type toxin and their thermal stability was determined by circular dichroism. Both show similar structures and thermal stability. In addition, the binding affinity with the toxin receptor, the sulfatide, was determined by surface plasmon resonance. The affinity of the wild-type for the sulfatide is slightly superior to the variant. Finally, the internalization inside IPEC-J2 cells of the variant was compared to the wild-type. The variant is able to internalize more cells than the wild-type. Altogether, these results suggest that both the variant and the wild-type toxin are biochemically and structurally similar.

Les objectifs de la thèse sont l'a nalyse approfondie d'un système de supervision automatique de la ventilation artificielle des patients hospitalisés en soins intensifs et l'élaboration de solutions pour améliorer et étendre son fonctionnement. Ce système adapte l'assistance en pression de la ventilation spontanée avec aide inspiratoire (AI) par un rétrocontrôle basé sur la fréquence respiratoire du patient et, comme variables de "sécurité", le volume courant et le CO2 de fin d'expiration (etCO2). Il établit ainsi une classification ventilatoire et règle un niveau de pression d'AI.Sur la base d'études publiées rapportant des limitations, d'analyses d'une base de données rétrospectives acquises sur patient, d'études sur banc-test et d'études observationnelles prospectives réalisées chez les patients, nous avons étudié précisément le fonctionnement du système. Pour la plupart des limitations, une solution a été proposée et évaluée sur banc. A partir d'une étude clinique, nous avons proposé une amélioration de la procédure de traitement du signal etCO2 par le système. En nous basant sur les observations de la base de données, nous avons décrit une procédure automatisée de sevrage de la PEP dont un niveau supérieur à 5 mbar entrave le sevrage par le système. Sur le même principe, nous avons souhaité, en amont de l'AI, tenter d'automatiser un changement de mode depuis la ventilation assistée contrôlée. Au travers d'une étude clinique, nous avons déterminé des critères ventilatoires qui pourraient permettre d'automatiser cette procédure. L'ensemble a permis la définition d'une méthodologie d'évaluation et d'amélioration d'un système automatisé de ventilation artificielle / The objectives of the thesis are the detailed analysis of an automated system of management of artificial ventilation for patients in intensive care unit and the elaboration of solutions to improve and upgrade its functioning. This system automatically adapts the level of pressure support ventilation (PSV) through a feedback based on the respiratory rate of the patient and, as “safety” variables, the tidal volume and the end tidal of expired CO2 (etCO2). The system, called “SmartCare”, establishes a ventilatory classification and sets a level of inspiratory pressure.We precisely studied the system functioning on the basis of published studies reporting limitations, on a database analysis compound with retrospective data acquired on patients, of bench-test studies and observational prospective studies performed in patients. For most of the limitations, a solution was proposed and evaluated on bench. Using the results of a clinical study, we proposed an improvement of etCO2 signal processing. From observations of the database, we described a procedure of automated weaning of positive end expiratory pressure level which hinders pressure support weaning if above 5 mbar. On the same principle, upstream to PSV, we wished to automate a change of ventilation mode from assist control ventilation. Through a clinical study, we determined ventilatory criteria which could allow automation of this procedure. The whole project allowed to define a methodology of evaluation and improvement of an automated mechanical ventilation system

No description available.

O estudo avaliou o efeito do nível de consumo e do método de desaleitamento sobre o desempenho, metabolismo e fisiologia de bezerros leiteiros. Em delineamento fatorial 2x2, utilizando-se 36 bezerros leiteiros, os animais foram classificados em grupos com alto (>350 g/d) ou baixo (<350 g/d) consumo de concentrado na quinta semana de e alocados a dois métodos de desaleitamento: abrupto ou gradual. Os animais foram alojados em abrigos individuais, receberam 4L/d de dieta líquida, água e concentrado inicial à vontade (até 2 kg/dia). O desaleitamento abrupto foi realizado na oitava semana de vida. Animais desaleitados de forma gradual, receberam 4L/dia até a sexta semana, 3 L/dia da sexta até a sétima semana, 2L/dia da sétima semana até dois dias antes de completarem 8 semanas e 1L/dia até a 8a semana, quando foram desaleitados. O consumo de concentrado foi avaliado diariamente. Semanalmente foram realizadas pesagens, medidas corporais e coletadas amostras de sangue para análise de glicose, ?-hidroxibutirato (BHBA) e proteína total sérica (PT), até a 10a semana de vida, quando se encerrou o período experimental. Foram realizadas observações de comportamento dos animais nos dias -14, -7, -2, 0, 2, 7 relativos ao desaleitamento. Nestes dias foram colhida amostras de sangue para determinação de cortisol e glicoproteínas solúveis em ácido (GSA). Não houve interação entre os dois fatores estudados para nenhuma das variáveis analisadas. O consumo de concentrado não diferiu (P<0,05) entre os métodos de desaleitamento, havendo efeito da idade (P<0,001) de acordo com o nível de consumo . Animais com alto consumo de concentrado consumiram mais feno na nona semana de vida (P<0,05). O método de desaleitamento não afetou as variáveis: ganho de peso, peso vivo e medidas corporais (P<0,05), porém, houve diferença significativa para estas variáveis em função dos níveis de consumo (P<0,05). Não houve interação entre os fatores estudados para parâmetros sanguíneos; os valores de BHBA para os animais de alto consumo de concentrado foram maiores durante praticamente todo período; os valores de PT e de cortisol não diferiram entre os tratamentos ou com a idade dos animais (P<0,05). Não houve efeito do método de desaleitamento sobre as medidas fisiológicas dos animais. Os níveis de consumo tiverem efeito (P>0,05) sobre as frequências cardíacas as 6:00, 12:00, 18:00; e temperatura retal as 18:00. Animais desaleitados gradualmente passaram mais tempo consumindo concentrado (P>0,05) e o tempo ruminando e o tempo consumindo concentrado aumentaram conforme a idade do animal (P>0,05). O número de vocalizações foi maior (P>0,05) no dia do desaleitamento e no segundo dia subseqüente, normalizando após uma semana. O método de desaleitamento afetou o número de vocalizações no segundo dia pós desaleitamento (P>0,05), de forma que bezerros desaleitados de forma gradual vocalizaram menos que os demais. O método de desaleitamento não teve influência no desempenho, metabolismo ou bem estar dos animais. No entanto, o nível de consumo teve influência no desempenho e parâmetros sanguíneos dos bezerros. O consumo de concentrado é mais importante que o método de desaleitamento no que diz respeito ao desempenho, metabolismo e nível de estresse. / The study evaluated the effect of the level of concentrate intake at the 5th week of age and the weaning method on the performance, metabolism and physiology of dairy calves. In a 2x2 factorial design, using 36 dairy calves, animals were classified as presenting high (>350g/d) or low (<350 g/d) concentrate intake at the 5th week of life, and distributed in two weaning methods: abrupt or gradual. Animals were individually housed in hutches, had free access to water and concentrate (up to 2kg/d) and were fed 4L of milk-replacer. The abrupt weaning was done at the 8th week of age. Animals weaned gradually received milk-replacer at the rate of 4l/d until the 6th week of age, 3L/d from the 6th until the 7th week, 2L/d from the 7th until 2 days before weaning, and 1L/d until weaning at the 8th week of age. Concentrate intake was monitored daily. Animals were weighted and corporal measures, as well as, blood samples were taken weekly for glucose, ?-hydroxybutyrate (BHBA) and serum total protein (TP), until the 10th week of age when the experimental period ended. Animal behavior was monitored on days -14, -7, -2, 0, 2, 7 relative to weaning. On those days blood samples were drawn for cortisol and acid soluble glycoprotein (ASG) levels determination. There was no significant interaction of the studied factors for all the analyzed variables. Average concentrate intake was not affected by the weaning method (P>0.05), however there was an significant age effect (P<0.001) according to the level of intake at the 5th week of age. Animals at the high intake level group presented higher hay intake at the 9th week of age (P<0.05). Weaning method had no effect on: live weight, daily gain or corporal measures (P>0.05); however, there was a significant difference for those variables according to the level of intake (P<0.05). There was no significant interaction of the intake level at the 5th week and the weaning method for blood parameters. BHBA concentrations were higher for animals at the higher concentrate intake level for almost the whole period. Cortisol and TP were not affected by the studied factors or by the animals age (P>0.05). Weaning methods had no effect on physiological measures. Concentrate intake level affected (P<0.05) heart rate at 6:00, 12:00, 18:00; and rectal temperature at 18:00. Animals gradually weaned spent more time consuming concentrate (P<0.05); and time ruminating and consuming concentrate were increased as animals aged (P<0.05). The number of vocalizations were higher (P<0.05) at the weaning day and the second day after that, getting back to normal a week after. The weaning method affected the number of vocalizations at the second day after weaning (P<0.05), with animals weaned gradually presenting lower numbers. The weaning method had no effect on performance, metabolism or well-being of dairy calves. However, the intake level had impact on performance and blood parameters. In spite of performance, metabolism and stress level of the animals the concentrate intake level is more important than the method of weaning.

Dois experimentos foram conduzidos com o objetivo de avaliar o efeito da inclusão de butirato de sódio, monensina sódica ou propionato de cálcio no concentrado inicial, sobre o desempenho, parâmetros sanguíneos e desenvolvimento ruminal de bezerros leiteiros. No primeiro experimento, 24 bezerras recém-nascidas da raça Holandesa foram alojadas em abrigos individuais até a 10a semana de vida, com livre acesso à água, sendo alimentadas com 4 litros de leite/dia e concentrado ad libitum, enquanto feno de capim-coast-cross foi fornecido após o desaleitamento. Os animais foram distribuídos em blocos de acordo com peso ao nascer e data de nascimento e alocados em um dos tratamentos, de acordo com o aditivo no concentrado: 1)Butirato de sódio (0,15%); 2)Monensina sódica (30 ppm); e 3)Propionato de cálcio (0,15%). Os animais foram pesados e avaliados quanto à altura na cernelha, largura do traseiro e perímetro torácico semanalmente. A partir da 4a semana foram realizadas colheitas semanais de amostras de sangue para determinação de glicose, ácidos graxos livres (AGL) e ?-hidroxibutirato (BHBA). Não foram observadas diferenças significativas entre os tratamentos para o consumo de concentrado ou de feno e para o peso e ganho de peso dos animais (P>0,05). As avaliações quanto à altura na cernelha e perímetro torácico também não apresentaram diferenças entre os tratamentos (P>0,05), entretanto as medidas de largura de traseiro foram menores para os animais do tratamento com adição de propionato de cálcio (P<0,05). As concentrações plasmáticas de glicose, AGL e BHBA não foram afetadas pelos tratamentos (P>0,05). Houve efeito significativo da idade (P<0,0001) para a concentração plasmática de glicose, sendo esta reduzida com a idade dos animais. No segundo experimento, 15 bezerros recémnascidos da raça Holandesa, recebendo o mesmo manejo nutricional, foram fistulados no rúmen e alojados em baias individuais até a 10ª semana de vida. A partir da 4ª semana, foram realizadas colheitas semanais de fluído ruminal para determinação de pH, ácidos graxos de cadeia curta (AGCC) e N-amoniacal; e de sangue para determinação de glicose. Ao completar dez semanas os animais foram abatidos para avaliação do desenvolvimento do trato digestório superior e de papilas ruminais. Não foram observadas diferenças significativas entre tratamentos para o consumo de concentrado e para o desempenho dos animais (P>0,05). Houve efeito significativo (P<0,05) de tratamento e horário de colheita para o pH ruminal. As concentrações de AGCC totais, bem como de cada ácido, não foram afetadas pelos tratamentos. As concentrações plasmáticas de glicose foram afetadas pelos tratamentos (P<0,05). O peso total do trato digestório superior, os pesos médios de cada compartimento e a capacidade máxima do retículo-rúmen não foram afetados pelos tratamentos, assim como os parâmetros de desenvolvimento do epitélio ruminal. Os aditivos incluídos no concentrado inicial se mostraram igualmente eficazes no que diz respeito aos seus efeitos no desempenho e desenvolvimento ruminal de bezerros em aleitamento. / Two trials were conducted in order to evaluate the effects of the addition of sodium butyrate, sodium monensin or calcium propionate in the starter feed on the performance, blood parameters and ruminal development of dairy calves. In the first experiment, 24 newborn Holstein calves were housed in individual hutches during ten weeks of life, with free access to water, being fed 4 liters of milk per day and starter ad libitum, with coast-cross hay offered only after weaning. The animals were blocked according to weight and date of birth and allocated in one of the treatments, according to the additive included in the starter feed: 1) sodium butyrate (0.15%); 2) sodium monensin (30 ppm); and 3) calcium propionate (0.15%). Animals were weighed and evaluated for whiter height, hearth girth and hip width weekly. From the fourth week of age blood samples were taken for glucose, free fatty acids and ?-hydroxybutyrate concentration determination. No significant differences were observed among treatments for starter or hay intake, and weight gain or live weight (P>0.05). Measurements of whiter height and hearth girth were also not affected by treatments (P> 0.05); however, measures of hip width of the animals were smaller for treatment with addition of calcium propionate (P<0.05). Plasma concentrations of glucose, free fatty acids and ?-hydroxybutyrate were not affected by treatment (P>0.05). There was significant effect of age (P<0.0001) for the plasma concentration of glucose, with reduction as animals aged. In the second experiment, 15 male newborns Holstein calves, receiving the same nutritional management, were ruminally fistulated and housed in individual pens during ten weeks of life. From the fourth week of age ruminal samples were taken weekly for the determination of pH, short-chain fatty acids (SCFA) and ammonia-N concentration. Blood samples were also taken weekly for glucose determination. By completing ten weeks of age, animals were slaughtered for forestomach growth and papillae development evaluation. No significant differences were observed among treatments for starter intake as well as for animal performance (P>0.05). The ruminal pH was significantly affected (P<0.05) by treatments and by sampling time. Concentrations of total SCFA and individual SCFA were not affected by treatments (P<0.05). Plasma concentrations of glucose were affected by treatments (P<0.05). The total forestomach weight, the average weight of each compartment and the maximum capacity of reticulum-rumen were not affected by treatments, as well as the parameters for ruminal epithelium development. The additives included in the starter feed were equally effective as regard to its effects on animal performance and rumen development of milk-fed dairy calves.

Objetivo: avaliar a eficácia da aplicação do teste de respiração espontânea (TRE) em predizer o sucesso da extubação em crianças com cardiopatia congênita no pósoperatório de cirurgia cardíaca, comparando-se com a aplicação do protocolo de desmame atualmente utilizado em centro de terapia intensiva pediátrico de hospital terciário. Desenho do estudo: ensaio clínico prospectivo randomizado controlado Pacientes: Foram elegíveis para o estudo pacientes de 0 a 18 anos de idade, no pósoperatório de cirurgia cardíaca para correção de cardiopatias congênitas, submetidos à ventilação mecânica (VM) pós-operatória por > 12 horas. Métodos: Os pacientes foram avaliados por um médico da equipe e os considerados aptos ao desmame foram selecionados para o estudo. Os pacientes randomizados ao grupo intervenção foram submetidos ao TRE (com PS de 10 cm H2O, PEEP de 5 cm H2O e FiO2 <= 50%, durante duas horas). Este teste foi realizado com ventilação em CPAP+PS. Os pacientes do grupo controle seguiram o desmame ventilatório de acordo com o protocolo vigente no CTIP do HCFMRP/USP. O desfecho primário foi considerado o sucesso da extubação, avaliado pela necessidade ou não de reintubação nas primeiras 48 horas após a extubação. Os desfechos secundários foram a duração da internação na UTI e no hospital, a incidência de pneumonia associada à ventilação e a mortalidade. Resultados: Foram alocadas no estudo 110 crianças (54 no grupo controle e 56 no grupo intervenção). Os dados demográficos, clínicos, as características cirúrgicas e os escores de gravidade, complexidade cirúrgica e de disfunção orgânica foram semelhantes nos dois grupos. Os pacientes submetidos ao TRE comparados ao grupo controle apresentaram maior sucesso de extubação (83% vs. 68.5%, p=0,02) e menor tempo de internação no CTIP (mediana 85 h vs. 367 h, p< 0,0001), respectivamente. Não houve diferença significativa entre os grupos no tempo de internação hospitalar, incidência de pneumonia associada à ventilação e mortalidade. Conclusões: O estudo mostra que o TRE é uma importante ferramenta de avaliação de prontidão à extubação. Os pacientes que foram alocados ao grupo de intervenção apresentaram maior sucesso de extubação e menor tempo de internação na UTI. / Objective: To evaluate the efficacy of the spontaneous breathing test (SBT) in predicting the success of extubation in children with congenital heart disease in the postoperative period of cardiac surgery compared with the application of the weaning protocol currently used in a pediatric intensive care unit. Study design: randomized controlled trial. Patients: Patients 0 to 18 years of age in the postoperative period following congenital heart surgery and on, mechanical ventilation (MV) for> 12 hours were eligible for the study. Methods: Patients were evaluated by a staff physician and those considered ready for weaning were selected for the study. Patients randomized to the intervention group underwent the SBT (with PS of 10 cm H2O, PEEP of 5 cm H2O and FiO2 <= 50% for two hours). This test was performed with CPAP + PS ventilation. The patients in the control group underwent ventilator weaning according to the current protocol in the PICU. The primary endpoint was success of extubation, defined as no need for reintubation in the first 48 hours following extubation. Secondary outcomes were duration of PICU and hospital stay, incidence of ventilator-associated pneumonia, and mortality. Results: 110 children (54 in the control group and 56 in the intervention group) were included in the study. Demographic, clinical, surgical, and severity scores, surgical complexity, and organ dysfunction were similar in both groups. Patients submitted to SBT compared to the control group had greater extubation success (83% vs. 68.5%, p = 0.02) and shorter length of stay in the PICU (median 85 h vs. 367 h, p <0.0001), respectively. There was no significant difference between the groups in length of hospital stay, incidence of ventilator-associated pneumonia and mortality. Conclusions: The study shows that the SBT is an important tool for assessment of extubation readiness. Patients who were allocated to the intervention group had greater extubation success and shorter PICU stay.