The Learning Incubator: an innovative teaching and learning technology in nursing.

OBJECTIVE: To understand the meaning of the Learning Incubator as a teaching and learning technology in the nursing area. METHOD: Qualitative research, supported by grounded theory. Data was collected from March to November 2019, through interviews with guiding questions and hypotheses directed at two different groups. The analysis was done by comparative data analysis and included open, axial and integrated coding, as proposed by the method. The theoretical sample included 23 participants, which were nurses, technicians, and nursing students. RESULTS: The delimitation of the categories converged in the phenomenon (Re)signifying knowledge and practices in the Learning Incubator. Guided by the paradigmatic model, the categories were named according to the three following components: Condition: Recognizing that the being and the professional practice are inextricable; Action/interaction: Revisiting professional practices that are repetitive and mechanic; Consequence: Referring to the reflections and knowledge constructed in the Learning Incubator. CONCLUSION: The Learning Incubator, as seen by the study participants, is not limited to the Incubator meetings or the themes addressed in it. Beyond a welcoming physical space, the Incubator expands itself and becomes a tool that promotes self-reflection and self-assessment of professional behaviors and attitudes.

Maternal ingestion of cocoa causes constriction of fetal ductus arteriosus in rats.

Maternal consumption of polyphenol-rich foods has been associated with fetal ductus arteriosus constriction (DAC), but safety of chocolate exposure in fetal life has not been studied. This experimental study tested the hypothesis that maternal cocoa consumption in late pregnancy causes fetal DAC, with possible associated antioxidant effects. Pregnant Wistar rats, at the 21st gestational day, received by orogastric tube cocoa (720 mg/Kg) for 12 h, indomethacin (10 mg/Kg), for 8 h, or only water, before cesaren section. Immediately after withdrawal, every thorax was obtained and tissues were fixed and stained for histological analysis. The ratio of the narrowest part of the pulmonary artery to the fetal ductus inner diameter and increased ductal inner wall thickness characterized ductal constriction. Substances reactive to thiobarbituric acid were quantified. Statistical analysis used ANOVA and Tukey test. Cocoa (n = 33) and indomethacin (n = 7) reduced fetal internal ductus diameter when compared to control (water, n = 25) (p < 0.001) and cocoa alone increased ductus wall thickness (p < 0.001), but no change was noted in enzymes activity. This pharmacological study shows supporting evidences that there is a cause and effect relationship between maternal consumption of cocoa and fetal ductus arteriosus constriction. Habitual widespread use of chocolate during gestation could account for undetected ductus constriction and its potentially severe consequences, such as perinatal pulmonary hypertension, cardiac failure and even death. For this reason, dietary guidance in late pregnancy to avoid high chocolate intake, to prevent fetal ductal constriction, may represent the main translational aspect of this study.

The Learning Incubator: an innovative teaching and learning technology in nursing / Incubadora de Aprendizaje: tecnología innovadora de enseñanza y aprendizaje en la enfermería / Incubadora de Aprendizagem: tecnologia inovadora de ensino e aprendizagem na enfermagem

ABSTRACT Objective: To understand the meaning of the Learning Incubator as a teaching and learning technology in the nursing area. Method: Qualitative research, supported by grounded theory. Data was collected from March to November 2019, through interviews with guiding questions and hypotheses directed at two different groups. The analysis was done by comparative data analysis and included open, axial and integrated coding, as proposed by the method. The theoretical sample included 23 participants, which were nurses, technicians, and nursing students. Results: The delimitation of the categories converged in the phenomenon (Re)signifying knowledge and practices in the Learning Incubator. Guided by the paradigmatic model, the categories were named according to the three following components: Condition: Recognizing that the being and the professional practice are inextricable; Action/interaction: Revisiting professional practices that are repetitive and mechanic; Consequence: Referring to the reflections and knowledge constructed in the Learning Incubator. Conclusion: The Learning Incubator, as seen by the study participants, is not limited to the Incubator meetings or the themes addressed in it. Beyond a welcoming physical space, the Incubator expands itself and becomes a tool that promotes self-reflection and self-assessment of professional behaviors and attitudes.

RESUMEN Objetivo: Comprender el significado de la Incubadora de Aprendizaje como tecnología de enseñanza e instrucción en enfermería. Método: Es una investigación cualitativa basada en la teoría fundamentada en los datos, los cuales se recopilaron entre marzo y noviembre de 2019 mediante entrevistas compuestas por preguntas orientadoras e hipótesis dirigidas a dos grupos diferentes. Se consideró la técnica del análisis comparativo de los datos, a partir de la codificación abierta, axial e integral, propuesta por el método, llegando al muestreo teórico con 23 participantes enfermeros, técnicos y estudiantes de enfermería. Resultados: La delimitación de las categorías convergió en el fenómeno, (Re)significar el conocimiento y las prácticas a través de la Incubadora de Aprendizaje. A partir del modelo paradigmático, las categorías se denominaron en función de tres componentes: Condición: Reconocer la inseparabilidad entre el ser y el hacer profesional; Acción/interacción: Revisar las posturas profesionales rutinarias y mecanicistas; Consecuencia: Remitirse a las reflexiones y conocimientos construidos en la Incubadora de Aprendizaje. Conclusión: La Incubadora de Aprendizaje, tal y como la entienden los participantes del estudio, no se reduce al momento de la Incubación ni a los temas tratados. Además de ser un espacio acogedor, la incubadora se expande y se traduce en una herramienta que induce a la autorreflexión y a la autoevaluación de actitudes y posturas profesionales.

RESUMO Objetivo: Compreender o significado da Incubadora de Aprendizagem como tecnologia de ensino e aprendizagem na área de enfermagem. Método: Pesquisa qualitativa, apoiada na teoria fundamentada nos dados. A coleta de dados ocorreu entre março e novembro de 2019, por meio de entrevistas com questões norteadoras e hipóteses direcionadas a dois diferentes grupos. Considerou-se a técnica de análise comparativa dos dados, a partir da codificação aberta, axial e integralizada, conforme proposto pelo método, atingindo-se amostragem teórica com 23 participantes, os quais eram enfermeiros, técnicos e alunos de enfermagem. Resultados: A delimitação das categorias confluiu para o fenômeno, (Re)significando saberes e práticas por meio da Incubadora de Aprendizagem. Norteadas pelo modelo paradigmático, as categorias foram denominadas com base nos três componentes: Condição: Reconhecendo a indissociabilidade entre o ser e fazer profissional; Ação/interação: Revisitando posturas profissionais rotineiras e mecanicistas; Consequência: Remetendo-se às reflexões e aos saberes construídos na Incubadora de Aprendizagem. Conclusão: A Incubadora de Aprendizagem, conforme significado pelos participantes do estudo, não se reduz ao momento da Incubação ou às temáticas abordadas. Para além de espaço acolhedor, a incubadora amplia e traduz-se em ferramenta indutora de autorreflexão e autoavaliação de atitudes e posturas profissionais.

Contribuições da Estratégia Mãe-Bebê São-Borjense para a qualificação da rede de atenção à saúde materno-infantil / Contribuciones de la Estrategia Madre-Bebé São-Borjense a la calificación de la red de atención maternoinfantil / Contributions of the São-Borjense Mother-Baby Strategy to qualify the maternal and child health care network

Objetivo: descrever as contribuições da Estratégia Mãe-Bebê São-Borjense para a qualificação da rede de atenção à saúde materno-infantil local. Método: trata-se de pesquisa-ação desenvolvida no Município de São Borja, Rio Grande do Sul, entre março/2018 e outubro/2019, após um ano de implementação da Estratégia no referido local. Dados coletados por meio de dez grupos focais e categorizados pela Análise Focal Estratégica, com a participação de gestores locais, profissionais de saúde e gestantes, totalizando 55 participantes. Resultados: os dados, organizados e categorizados, resultaram em duas categorias: Contribuições que transcendem o fazer técnico-profissional e Contribuições com vistas à qualificação da Estratégia Mãe-Bebê São-Borjense. Conclusão: a Estratégia Mãe-Bebê São-Borjense contribuiu, de forma afirmativa e prospectiva, para a qualificação da rede de atenção à saúde materno-infantil local, especialmente no que se refere às relações e interações entre profissionais e gestantes e a (re)organização dos fluxos e processos de intervenção na rede.

Objective: to describe the contributions of the São-Borjense Mother-Baby Strategy to qualify the local maternal and child health care network. Method: this is an action research carried out in the municipality of São Borja, Rio Grande do Sul, between March/2018 and October/2019, after one year of implementation of the Strategy in that location. Data collected through ten focus groups and categorized by Strategic Focal Analysis, with the participation of local managers, health professionals and pregnant women, totaling 55 participants. Results: the data, organized and categorized, resulted in two categories: Contributions that transcend technical and professional practice and Contributions aimed at qualifying the São-Borjense Mother-Baby Strategy. Conclusion: the São-Borjense Mother-Baby Strategy contributed, in an affirmative and prospective way, to qualify the local maternal and child health care network, especially with regard to the relationships and interactions between professionals and pregnant women and (re)organization of flows and intervention processes in the network.

Objetivo: describir los aportes de la Estrategia Madre-Bebé São-Borjense a la calificación de la red local de atención maternoinfantil. Método: se trata de una investigación-acción realizada en el municipio de São Borja, Rio Grande do Sul, entre marzo/2018 y octubre/2019, luego de un año de implementación de la Estrategia en ese lugar. Datos recolectados a través de diez grupos focales y categorizados por Análisis Focal Estratégico, con la participación de gerentes locales, profesionales de la salud y embarazadas, totalizando 55 participantes. Resultados: los datos, organizados y categorizados, resultaron en dos categorías: Aportes que trascienden la práctica técnica y profesional y Aportes orientados a calificar la Estrategia Madre-Bebé São-Borjense. Conclusión: la Estrategia Madre-Bebé São-Borjense contribuyó, de manera afirmativa y prospectiva, a la calificación de la red local de atención maternoinfantil, especialmente en lo que se refiere a las relaciones e interacciones entre profesionales y gestantes y (re)organización de flujos y procesos de intervención en la red.

Corrigendum to "Behaviour of the Foramen Ovale Flow in Fetuses with Intrauterine Growth Restriction".

[This corrects the article DOI: 10.1155/2018/1496903.].

Behaviour of the Foramen Ovale Flow in Fetuses with Intrauterine Growth Restriction.

Background: Foramen ovale (FO) flow may be altered in IUGR. This study was designed to test this hypothesis. Methods: Forty pregnant women (24-38 weeks) were divided into 3 groups: group I (IUGR), group II (adequate growth and maternal hypertension), and group III (normal controls). Impedance across the FO was assessed by the FO pulsatility index (FOPI): (systolic velocity - presystolic velocity)/mean velocity. Statistical analysis utilized ANOVA, Tukey test, and ROC curves. Results: Mean FOPI in IUGR fetuses (n = 15) was 3.70 ± 0.99 (3.15-4.26); in the group II (n = 12), it was 2.84 ± 0.69 (2.40-3.28), and in the group III (n = 13), it was 2.77 ± 0.44 (2.50-3.04) (p=0.004). FOPI and UtA RI were correlated (r = 0.375, p=0.017), as well as FOPI and UA RI (r = 0.356, p=0.024) and, inversely, FOPI and MCA RI (r = -0.359, p=0.023). Conclusions: The FO flow pulsatility index is increased in fetuses with IUGR, probably as a result of impaired left ventricular diastolic function.

Myocardial velocities, dynamics of the septum primum, and placental dysfunction in fetuses with growth restriction.

INTRODUCTION: Diastolic dysfunction may occur in fetuses with intrauterine growth restriction (IUGR) and may be assessed by myocardial tissue Doppler (MTD). We previously have shown that excursion index of the septum primum (EISP) is reduced in IUGR fetuses over 30 weeks because of a higher left atrial pressure. PATIENTS, SETTING, AND DESIGN: The sample was made up of 14 fetuses with IUGR. MTD examination was carried out with the sample volume placed at the basal lateral wall of the left ventricle (LV), interventricular septum (IVS), and free wall of the right ventricle (RV) to determine E'/A' ratios. EISP was calculated as the ratio between the maximal excursion of the septum primum into the left atrium during diastole and the maximal diastolic diameter of the left atrium. Mitral and tricuspid flows were assessed by the conventional Doppler method. OUTCOME MEASURES: Pearson's correlation test was used to analyze the correlations between the parameters. RESULTS: A positive correlation was observed between UARI and E'/A' ratios for RV (r = 0.63, P = .02), IVS (r = 0.59, P = .03), and LV (r = 0.41, P = .15). There was a negative correlation between EISP and IVS E'/A' ratios (r = -0.58, P = .03), and a positive correlation for LV (r = 0.49, P = .08). At the RV position, a weak negative correlation was observed (r = -0.32, P = .26). CONCLUSIONS: A higher left atrial pressure in fetuses with IUGR, indicated by the lower mobility of the septum primum, is accompanied by higher ratios between early and late diastolic myocardial velocities. Placental dysfunction was correlated to septal E'/A' ratios. Fetal MTD can be a useful method to assess severity of placental dysfunction and fetal distress.

Significados e vivências mediante a indicação cirúrgica para pacientes cardíacos / Meanings and experiences following the surgical indication for cardiac patients / Significación y vivencias por medio de la indicación quirúrgica para pacientes cardíacos

Este é um estudo qualitativo, de cunho exploratório e descritivo, cujo objetivo consistiu em compreender os significados atribuídos à cirurgia cardíaca por pacientes pré-cirúrgicos. Para sua realização participaram quinze usuários de ambulatório de cardiologia de um hospital universitário. A coleta de dados aconteceu através de entrevistas semiestruturadas. A análise dos dados foi realizada através da análise de conteúdo, da qual emergiram quatro categorias: A ansiedade da espera; A cirurgia e o medo; Expectativas de futuro após a cirurgia; e Religiosidade e introspecção. Os resultados mostram as repercussões emocionais decorrentes do caráter de imprevisibilidade atribuído à cirurgia, evidenciando um cenário de vulnerabilidade e de fragilização emocional. Constata-se a necessidade de refletir sobre aspectos da cirurgia que estão além do adoecimento físico, abarcando as mais diversas áreas profissionais e de conhecimento no âmbito da atenção à saúde.(AU)

This is a qualitative study, characterized as exploratory and descriptive. Its aim consisted on understanding the meanings attributed to the cardiac surgery by presurgical patients. Fifteen users of a cardiology outpatient clinic of a university hospital participated on the study. Data collection was carried out through semi-structured interviews. Data analysis was carried out through content analysis, emerging four categories: Anxiety of waiting; Surgery and fear; Expectations about the future after the surgery; and Religiosity and introspection. Results emphasize the emotional repercussions due to the unpredictable character attributed to surgery, evidencing a context of vulnerability and emotional fragility. Such results highlight the need for reflection concerning aspects of the surgery that are beyond the physical body, covering the several fields of knowledge and professionals who are involved on health care.(AU)

Este es un estudio cualitativo, de carácter exploratorio y descriptivo, cuyo objetivo consistió en comprender los significados atribuidos a la cirugía cardíaca por pacientes prequirúrgicos. Participaron 15 usuarios de ambulatorio de cardiología de un hospital universitario. La colecta de datos ocurrió a través de entrevistas semi-estructuradas. El análisis de datos fue realizado a través de análisis de contenido, emergiendo cuatro categorías: La ansiedad de espera; La cirugía y el miedo; Expectativas de futuro después de la cirugía; y Religiosidad e introspección. Los resultados enfatizan las repercusiones emocionales mediante al carácter de imprevisión atribuido a la cirugía, evidenciando un escenario de vulnerabilidad y de fragilidad emocional. Se constata la necesidad de reflexión sobre aspectos de la cirugía que están más allá de la enfermedad física, abarcando las más distintas áreas profesionales y de conocimiento en el ámbito de atención a la salud.(AU)

Significados e vivências mediante a indicação cirúrgica para pacientes cardíacos / Meanings and experiences following the surgical indication for cardiac patients / Significación y vivencias por medio de la indicación quirúrgica para pacientes cardíacos

Este é um estudo qualitativo, de cunho exploratório e descritivo, cujo objetivo consistiu em compreender os significados atribuídos à cirurgia cardíaca por pacientes pré-cirúrgicos. Para sua realização participaram quinze usuários de ambulatório de cardiologia de um hospital universitário. A coleta de dados aconteceu através de entrevistas semi estruturadas. A análise dos dados foi realizada através da análise de conteúdo, da qual emergiram quatro categorias: A ansiedade da espera; A cirurgia e o medo; Expectativas de futuro após a cirurgia; e Religiosidade e introspecção. Os resultados mostram as repercussões emocionais decorrentes do caráter de imprevisibilidade atribuído à cirurgia, evidenciando um cenário de vulnerabilidade e de fragilização emocional. Constata-se a necessidade de refletir sobre aspectos da cirurgia que estão além do adoecimento físico, abarcando as mais diversas áreas profissionais e de conhecimento no âmbito da atenção à saúde.

This is a qualitative study, characterized as exploratory and descriptive. Its aim consisted on understanding the meanings attributed to the cardiac surgery by presurgical patients. Fifteen users of a cardiology outpatient clinic of a university hospital participated on the study. Data collection was carried out through semi-structured interviews. Data analysis was carried out through content analysis, emerging four categories: Anxiety of waiting; Surgery and fear; Expectations about the future after the surgery; and Religiosity and introspection. Results emphasize the emotional repercussions due to the unpredictable character attributed to surgery, evidencing a context of vulnerability and emotional fragility. Such results highlight the need for reflection concerning aspects of the surgery that are beyond the physical body, covering the several fields of knowledge and professionals who are involved on health care.

Este es un estudio cualitativo, de carácter exploratorio y descriptivo, cuyo objetivo consistió en comprender los significados atribuidos a la cirugía cardíaca por pacientes prequirúrgicos. Participaron 15 usuarios de ambulatorio de cardiología de un hospital universitario. La colecta de datos ocurrió a través de entrevistas semi-estructuradas. El análisis de datos fue realizado a través de análisis de contenido, emergiendo cuatro categorías: La ansiedad de espera; La cirugía y el miedo; Expectativas de futuro después de la cirugía; y Religiosidad e introspección. Los resultados enfatizan las repercusiones emocionales mediante al carácter de imprevisión atribuido a la cirugía, evidenciando un escenario de vulnerabilidad y de fragilidad emocional. Se constata la necesidad de reflexión sobre aspectos de la cirugía que están más allá de la enfermedad física, abarcando las más distintas áreas profesionales y de conocimiento en el ámbito de atención a la salud.

Restrição materna de polifenóis e dinâmica ductal fetal na gestação normal: um ensaio clínico aberto / Maternal restriction of polyphenols and fetal ductal dynamics in normal pregnancy: an open clinical trial

FUNDAMENTOS: Recentemente demonstramos reversão da constrição ductal fetal após redução da ingesta materna de alimentos ricos em polifenóis (ARP), por sua ação inibidora da síntese das prostaglandinas. OBJETIVOS: Testar a hipótese de que fetos normais no 3º trimestre também melhoram a dinâmica ductal após restrição materna de polifenóis. MÉTODOS: Ensaio clínico aberto com 46 fetos com idade gestacional (IG) > 28 semanas submetidos a dois estudos Dopplerecocardiográficos com intervalo de duas semanas, sendo os examinadores cegados para os hábitos alimentares maternos. Um questionário de frequência alimentar validado para esse objetivo foi aplicado e uma dieta com alimentos pobres em polifenóis (< 30 mg/100 mg) foi orientada. Um grupo controle de 26 fetos no 3º trimestre foi submetido ao mesmo protocolo. Utilizou-se o teste-t para amostras independentes. RESULTADOS: A IG média foi 33 ± 2 semanas. A média do consumo materno diário de polifenóis (CMDP) foi 1277 mg, caindo para 126 mg após orientação (p = 0,0001). Ocorreu diminuição significativa nas Velocidades Ductais Sistólica (VSD) e Diastólica (VDD) e na relação dos diâmetros ventriculares (VD/VE), assim como aumento do índice de pulsatilidade (IP) [VSD = 1,2 ± 0,4 m/s (0,7-1,6) para 0,9 ± 0,3 m/s (0,6-1,3) (p = 0,018);VDD = 0,21 ± 0,09 m/s (0,15-0,32) para 0,18 ± 0,06 m/s (0,11-0,25) (p = 0,016); relação VD/VE = 1,3 ± 0,2 (0,9-1,4) para 1,1 ± 0,2 (0,8 - 1,3) (p = 0,004); IP do ducto = 2,2 ± 0,03 (2,0-2,7) para 2,4 ± 0,4 (2,2-2,9) (p = 0,04)]. A IG média dos controles foi de 32 ± 4 semanas, não ocorrendo diferenças significativas no CMDP, nas velocidades ductais, no IP do ducto e na relação VD/VE. CONCLUSÃO: A restrição da ingesta de alimentos ricos em polifenóis no 3º trimestre por duas semanas melhora a dinâmica do fluxo no ducto arterioso fetal e as dimensões do VD.

BACKGROUND:We have recently demonstrated reversal of fetal ductal constriction after dietary maternal restriction of polyphenol-rich foods (PRF), due to its inhibitory action on prostaglandin synthesis. OBJECTIVE: To test the hyphotesis that normal third trimester fetuses also improve ductus arteriosus dynamics after maternal restriction of polyphenols. METHODS: Open clinical trial with 46 fetuses with gestational age (GA) > 28 weeks submitted to 2 Doppler echocardiographic studies with an interval of at least 2 weeks, being the examiners blinded to maternal dietary habits. A validated food frequency questionnaire was applied and a diet based on polyphenol-poor foods (<30mg/100mg) was recommended. A control group of 26 third trimester fetuses was submitted to the same protocol. Statistics used t test for independent samples. RESULTS: Mean GA was 33±2 weeks. Mean daily maternal estimated polyphenol intake (DMPI) was 1277mg, decreasing to 126mg after dietary orientation (p=0.0001). Significant decreases in systolic (SDV) and diastolic (DDV) ductal velocities, and RV/LV diameters ratio, as well as increase in ductal PI were observed [DSV=1.2±0.4m/s (0.7-1.6) to 0.9±0.3m/s (0.6-1.3) (p=0.018); DDV=0.21±0.09m/s (0.15-0.32) to 0.18±0.06m/s (0.11-0.25) (p=0.016); RV/LV ratio =1.3±0.2 (0.9-1.4) to 1.1±0.2 (0.8-1.3) (p=0.004); ductal PI=2.2±0.03 (2.0-2.7) to 2.4±0.4(2.2-2.9) (p=0.04)]. In the control group, with GA of 32±4 weeks, there were no significant differences in DMPI, mean SDV, DDV, PI and RV/LV ratio. CONCLUSION: The oriented restriction of third trimester maternal ingestion of polyphenol-rich foods for a period of 2 weeks or more improve fetal ductus arteriosus flow dynamics and right ventricular dimensions.

Maternal restriction of polyphenols and fetal ductal dynamics in normal pregnancy: an open clinical trial.

BACKGROUND: We have recently demonstrated reversal of fetal ductal constriction after dietary maternal restriction of polyphenol-rich foods (PRF), due to its inhibitory action on prostaglandin synthesis. OBJECTIVE: To test the hyphotesis that normal third trimester fetuses also improve ductus arteriosus dynamics after maternal restriction of polyphenols. METHODS: Open clinical trial with 46 fetuses with gestational age (GA) > 28 weeks submitted to 2 Doppler echocardiographic studies with an interval of at least 2 weeks, being the examiners blinded to maternal dietary habits. A validated food frequency questionnaire was applied and a diet based on polyphenol-poor foods (<30 mg/100 mg) was recommended. A control group of 26 third trimester fetuses was submitted to the same protocol. Statistics used t test for independent samples. RESULTS: Mean GA was 33 ± 2 weeks. Mean daily maternal estimated polyphenol intake (DMPI) was 1277 mg, decreasing to 126 mg after dietary orientation (p=0.0001). Significant decreases in systolic (SDV) and diastolic (DDV) ductal velocities, and RV/LV diameters ratio, as well as increase in ductal PI were observed [DSV = 1.2 ± 0.4 m/s (0.7-1.6) to 0.9 ± 0.3 m/s (0.6-1.3) (p = 0.018); DDV = 0.21 ± 0.09 m/s (0.15-0.32) to 0.18 ± 0.06 m/s (0.11-0.25) (p = 0.016); RV/LV ratio = 1.3 ± 0.2 (0.9-1.4) to 1.1 ± 0.2 (0.8-1.3) (p=0.004); ductal PI = 2.2 ± 0.03 (2.0-2.7) to 2.4 ± 0.4(2.2-2.9) (p = 0.04)]. In the control group, with GA of 32 ± 4 weeks, there were no significant differences in DMPI, mean SDV, DDV, PI and RV/LV ratio. CONCLUSION: The oriented restriction of third trimester maternal ingestion of polyphenol-rich foods for a period of 2 weeks or more improve fetal ductus arteriosus flow dynamics and right ventricular dimensions.

Influence of fetal respiratory movements on left atrial functional status.

OBJECTIVE: Because fetal respiratory movements increase left ventricular compliance, we hypothesized that the left atrial shortening fraction increases during fetal respiratory motions. METHODS: A group of 26 normal fetuses with gestational ages between 28 and 38 weeks were assessed in a prospective cross-sectional study. Left atrial telesystolic and presystolic diameters were measured during apnea and after five consecutive respiratory movements. Left atrial shortening fraction was obtained by the ratio: [maximal left atrium diameter (telesystolic) - minimal left atrium diameter (presystolic)]/maximal left atrium diameter (telesystolic). The mean of three measurements were considered. Two-tailed Student's t-test was used. RESULTS: Mean gestational age was (mean ± SD) 30.7 ± 2.8 weeks. Mean left atrial telesystolic diameter in apnea was 10.6 ± 0.7 mm and during respiratory movements it was 10.5 ± 1.1 mm (p = 0.98). Presystolic left atrial diameter was 5.2 ± 0.1 mm in apnea and 4.4 ± 1.3 mm during respiratory movements (p < 0.001). Left atrial shortening fraction was 0.50 ± 0.05 in apnea and 0.58 ± 0.13 during respiratory movements (p < 0.001). CONCLUSION: Left atrial shortening fraction is higher during respiratory movements as a result of increased left ventricular compliance and consequent optimization of left atrial functional status.

Echocardiographic evaluation during weaning from mechanical ventilation.

INTRODUCTION: Echocardiographic, electrocardiographic and other cardiorespiratory variables can change during weaning from mechanical ventilation. OBJECTIVES: To analyze changes in cardiac function, using Doppler echocardiogram, in critical patients during weaning from mechanical ventilation, using two different weaning methods: pressure support ventilation and T-tube; and comparing patient subgroups: success vs. failure in weaning. METHODS: Randomized crossover clinical trial including patients under mechanical ventilation for more than 48 h and considered ready for weaning. Cardiorespiratory variables, oxygenation, electrocardiogram and Doppler echocardiogram findings were analyzed at baseline and after 30 min in pressure support ventilation and T-tube. Pressure support ventilation vs. T-tube and weaning success vs. failure were compared using ANOVA and Student's t-test. The level of significance was p<0.05. RESULTS: Twenty-four adult patients were evaluated. Seven patients failed at the first weaning attempt. No echocardiographic or electrocardiographic differences were observed between pressure support ventilation and T-tube. Weaning failure patients presented increases in left atrium, intraventricular septum thickness, posterior wall thickness and diameter of left ventricle and shorter isovolumetric relaxation time. Successfully weaned patients had higher levels of oxygenation. CONCLUSION: No differences were observed between Doppler echocardiographic variables and electrocardiographic and other cardiorespiratory variables during pressure support ventilation and T-tube. However cardiac structures were smaller, isovolumetric relaxation time was larger, and oxygenation level was greater in successfully weaned patients.

Echocardiographic evaluation during weaning from mechanical ventilation

INTRODUCTION: Echocardiographic, electrocardiographic and other cardiorespiratory variables can change during weaning from mechanical ventilation. OBJECTIVES: To analyze changes in cardiac function, using Doppler echocardiogram, in critical patients during weaning from mechanical ventilation, using two different weaning methods: pressure support ventilation and T-tube; and comparing patient subgroups: success vs. failure in weaning. METHODS: Randomized crossover clinical trial including patients under mechanical ventilation for more than 48 h and considered ready for weaning. Cardiorespiratory variables, oxygenation, electrocardiogram and Doppler echocardiogram findings were analyzed at baseline and after 30 min in pressure support ventilation and T-tube. Pressure support ventilation vs. T-tube and weaning success vs. failure were compared using ANOVA and Student's t-test. The level of significance was p<0.05. RESULTS: Twenty-four adult patients were evaluated. Seven patients failed at the first weaning attempt. No echocardiographic or electrocardiographic differences were observed between pressure support ventilation and T-tube. Weaning failure patients presented increases in left atrium, intraventricular septum thickness, posterior wall thickness and diameter of left ventricle and shorter isovolumetric relaxation time. Successfully weaned patients had higher levels of oxygenation. CONCLUSION: No differences were observed between Doppler echocardiographic variables and electrocardiographic and other cardiorespiratory variables during pressure support ventilation and T-tube. However cardiac structures were smaller, isovolumetric relaxation time was larger, and oxygenation level was greater in successfully weaned patients.