Perspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumologia e Tisiologia - SBPT), represented by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members. The document was based on the available evidence regarding 29 subtopics selected as the most relevant for the subject of interest. The project was developed in several stages, during which the selected topics were distributed among experts recommended by both societies with recent publications on the subject of interest and/or significant teaching and research activity in the field of mechanical ventilation in Brazil. The experts were divided into pairs that were charged with performing a thorough review of the international literature on each topic. All the experts met at the Forum on Mechanical Ventilation, which was held at the headquarters of AMIB in São Paulo on August 3 and 4, 2013, to collaboratively draft the final text corresponding to each sub-topic, which was presented to, appraised, discussed and approved in a plenary session that included all 58 participants and aimed to create the final document.

Management of Sepsis would greatly benefit from the incorporation of simple and informative new biomarkers in clinical practice. Ideally, a sepsis biomarker should segregate infected from non-infected patients, provide information about prognosis and organ-specific damage, and be accessible to most healthcare services. The immature platelet fraction (IPF) and immature reticulocyte fraction (IRF) are new analytical parameters of the complete blood count, that have been studied as biomarkers of several inflammatory conditions. Recently, a study performed in critically-ill patients suggested that IPF could be a more accurate sepsis biomarker than C-reactive protein (CRP) and procalcitonin. In this retrospective study we evaluated the performance of IPF and IRF as biomarkers of sepsis diagnosis and severity. 41 patients admitted to two intensive care units were evaluated, 12 of which with severe sepsis or septic shock, and 11 with non-complicated sepsis. Significantly higher IPF levels were observed in patients with severe sepsis/ septic shock. IPF correlated with sepsis severity scores and presented the highest diagnostic accuracy for the presence of sepsis of all studied clinical and laboratory parameters. No significant differences were observed in IRF levels. Our results suggest that IPF levels could be used as a biomarker of sepsis diagnosis and severity.

Factors associated with increased mortality and prolonged length of stay in an adult intensive care unit Fatores associados à maior mortalidade e tempo de internação prolongado em uma unidade de terapia intensiva de adultos

Treinamento muscular melhora o volume corrente e a capacidade vital no pós-operatório de revascularização do miocárdioInspiratory muscle training improves tidal volume and vital capacity after CABG surgery 6. PhD in surgery at FCM Unicamp, cardiac surgeon, Campinas, SP, Brazil.This study was carried out at Hospital e Maternidade Celso Pierro, Pontifical Catholic University of Campinas (PUC Campinas), Campinas, SP, Brazil. 363Matheus GB, et al. -Inspiratory muscle training improves tidal volume and vital capacity after CABG surgery Bras Cir Cardiovasc 2012;27(3):362-9 Rev

Perspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumologia e Tisiologia - SBPT), represented by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members. The document was based on the available evidence regarding 29 subtopics selected as the most relevant for the subject of interest. The project was developed in several stages, during which the selected topics were distributed among experts recommended by both societies with recent publications on the subject of interest and/or significant teaching and research activity in the field of mechanical ventilation in Brazil. The experts were divided into pairs that were charged with performing a thorough review of the international literature on each topic. All the experts met at the Forum on Mechanical Ventilation, which was held at the headquarters of AMIB in São Paulo on August 3 and 4, 2013, to collaboratively draft the final text corresponding to each sub-topic, which was presented to, appraised, discussed and approved in a plenary session that included all 58 participants and aimed to create the final document.

BackgroundThe early postoperative period is critical for surgical patients. SOFA, SAPS 3 and APACHE II are prognostic scores widely used to predict mortality in ICU patients. This study aimed to evaluate these index tests for their prognostic accuracy for intra-ICU and in-hospital mortalities as target conditions in patients admitted to ICU after urgent or elective surgeries and to test whether they aid in decision-making. The process comprised the assessment of discrimination through analysis of the areas under the receiver operating characteristic curves and calibration of the prognostic models for the target conditions. After, the clinical relevance of applying them was evaluated through the measurement of the net benefit of their use in the clinical decision.ResultsIndex tests were found to discriminate regular for both target conditions with a poor calibration (C statistics—intra-ICU mortality AUROCs: APACHE II 0.808, SAPS 3 0.821 and SOFA 0.797/in-hospital mortality AUROCs: APACHE II 0.772, SAPS 3 0.790 and SOFA 0.742). Calibration assessment revealed a weak correlation between the observed and expected number of cases in several thresholds of risk, calculated by each model, for both tested outcomes. The net benefit analysis showed that all score’s aggregate value in the clinical decision when the calculated probabilities of death ranged between 10 and 40%.ConclusionsIn this study, we observed that the tested ICU prognostic scores are fair tools for intra-ICU and in-hospital mortality prediction in a cohort of postoperative surgical patients. Also, they may have some potential to be used as ancillary data to support decision-making by physicians and families regarding the level of therapeutic investment and palliative care.Electronic supplementary materialThe online version of this article (10.1186/s13613-019-0488-9) contains supplementary material, which is available to authorized users.

The fragmentation of neutron-rich 132 Sn nuclei produced in the fission of 238 U projectiles at 950 MeV/u has been investigated at the FRagment Separator (FRS) at GSI. This work represents the first investigation of fragmentation of medium-mass radioactive projectiles with a large neutron excess. The measured production cross sections of the residual nuclei are relevant for the possible use of a two-stage reaction scheme (fission+fragmentation) for the production of extremely neutron-rich medium-mass nuclei in future rare-ion-beam facilities. Moreover, the new data will provide a better understanding of the "memory" effect in fragmentation reactions.

RESUMO -O b j e t i v o:Estudar a influência das manobras de fisioterapia respiratória na pressão intracraniana (PIC) dos pacientes com trauma craniencefálico grave. Método: Trinta e cinco pacientes com trauma craniencefálico grave foram incluídos no estudo, sendo divididos em três grupos: com PIC < 10, 11-20 e 21-30 mmHg. As variáveis monitorizadas foram: PIC e pressão arterial média. A pressão de perfusão cerebral foi calculada pela diferença de pressão arterial média e PIC. Resultados: A manobra de aspiração traqueal causou aumento de PIC em todos os grupos. A pressão arterial média não teve alterações e a pressão de perfusão cerebral diminuiu pouco, porém mantendo valores normais. Conclusão: As manobras de fisioterapia respiratória podem ser usadas com segurança em pacientes com traumatismo craniencefálico grave, com PIC abaixo de 30 mmHg.Certo cuidado deve ser tomado durante a aspiração traqueal.PALAVRAS-CHAVE: traumatismo craniencefálico, fisioterapia respiratória, pressão intracraniana, pressão de perfusão cerebral.Influence of the respiratory physioterapy on intracranial pre s s u re in severe head trauma patients ABSTRACT -O b j e c t i v e:To evaluate influence of the respiratory physiotherapy on intracranial pressure (ICP) in patients with severe head trauma. M e t h o d: Thirty five patients with severe head trauma were included in the study.The patients were divided into three groups: ICP 0-10, 11-20 and 21-30 mmHg. The following variables were measured: ICP and mean arterial pressure. Cerebral perfusion pressure was calculated as the difference between mean arterial and intracranial pressure. R e s u l t s: Endotracheal aspiration increased ICP in all patients. The mean arterial pressure didn't change and cerebral perfusion pressure decreased, but remaning normal value. Conclusion: Respiratory physiotherapy maneuvers can be safely applied in patients with severe head trauma with ICP below 30 mmHg. More attention should be taken during endotracheal aspiration .KEY WORDS: head injury, respiratory physioterapy, intracranial pressure, cerebral perfusion pressure.Os pacientes com traumatismo craniencefálico (TCE) grave, com escala de coma de Glasgow igual ou menor que 8, são geralmente submetidos à monitorização da pressão intracraniana (PIC), e da pressão arterial média (PAM) e tratados de acordo c o m um protocolo rígido de assistência, que inclui sedação, elevação de cabeceira do leito, ventilação mecânica otimizada, fisioterapia respiratória e motora, entre outras 1 , 2 . A aplicação das manobras cinéticas de fisioterapia respiratória promove aumento momentâneo da pressão intratorácica, diminuindo o retorno venoso cerebral e elevando a PIC nesses p acientes [3][4][5][6] .Sabe-se que as alterações da PIC influenciam diretamente a pressão de perfusão cerebral (PPC), que é calculada como diferença entre a PAM e a PIC. Portanto, aumentos da PIC poderiam acarretar diminuição da PPC, se não houver aumento conco-