Guilherme Silva Mendonça

Arterial stiffness in elderly patients with normotension and hypertension in Brazil

Data on arterial stiffness in older populations, according to blood pressure (BP) levels, are scarce in Brazil. The objective of this study was to establish reference values for core measures of arterial stiffness, including carotid‐femoral pulse wave velocity (cf‐PWV) and aortic augmentation index (AIx), in a cohort of older individuals with normotension (NT) and hypertension. Cross‐sectional analysis was performed with applanation tonometry data from 1192 patients aged 60 years or older. The authors classified patients according to their BP levels as having NT, controlled hypertension (CH), and uncontrolled hypertension (UH). The cf‐PWV values were 9.11 ± 0.16 m/s (NT), 9.12 ± 0.18 m/s (CH), and 9.42 ± 2.2 m/s (UH) (P < 0.005; UH vs NT and CH). The AIx was 33.3% for the entire cohort and similar across all groups. The cf‐PWV increased with age but reached a ceiling at 75 years. Compared with men, women had a higher AIx but similar cf‐PWV levels. In conclusion, the markers of arterial stiffness were similar among individuals with NT/CH and higher among individuals with UH.

Breakdown of complications related to the use of central venous catheters in intensive therapy units

The ICU is a highly complex sector, and among the wide range of interventions performed in the intensive care patient, we highlight the use of the central venous catheter (CVC). Maintaining the CVC requires knowledge and ability to ensure safe and long-lasting vascular access. However, during the permanence time of the device, some complications related to the catheter material, caliber, puncture site, dressing used, type of medication administered and length of stay may occur. Knowing the possible complications that occur with the catheter during its stay and the outcome of these complications favors the health professional in the elaboration of prevention strategies. Therefore, this research aims to elucidate the occurrence of non-elective removal, the main complications and outcomes related to the use of CVC in clients hospitalized in the ICU. This is a descriptive, observational, prospective study with a quantitative approach. The study was carried out in a teaching hospital in Uberaba-MG, from March to August 2016. The population of the study consisted of CVCs inserted in clients hospitalized in the ICUs. As a result, 75 (38.3%) catheters presented complications, being the outcome of 55 (73.3%) non-elective removal when the complication was discovered. The other 121 (61.7%) catheters had the outcome of removal on discharge from the client to the ward 59 (48.7%), death of the client 25 (20.6%), discharge from the client to the ward with the device (Risk benefit) 27 (22.3%) and removal at the physician’s discretion 10 (8.2%). The permanence time of the device was 7.65. The greater the number of complications the catheter presented, the greater the chances of catheter loss (63.4). This study emphasizes the importance of conducting other studies that may contribute to the reduction of complications resulting from the use of CVC, and emphasize that complications demand higher expenses for the health system and increase the risk of infection of clients hospitalized in the ICU.

PS 08-77 AGREEMENT AMONG SEQUENTIAL CAROTID-FEMORAL PULSE WAVE VELOCITY (CF-PWV) MEASUREMENTS IN ELDERLY HYPERTENSIVE PATIENTS(*)

Objective: Measurement of cf-PWV using aplanation tonometry requires that patients remain in the supine position for a considerable amount of time to allow multiple measurements that can be averaged. This may pose a problem to elderly patients with difficulty lying supine for prolonged periods. We assessed the agreement among repeated sequential cf-PWV measurements to evaluate the necessity of more than one measurement in clinical practice. Design and Method: We performed cf-PWV in 3 sequential measurements made by the same trained observer in 38 elderly hypertensive patients using the SphygmoCor device (AtCor Medical, Sydney, Australia). Subjects were in the supine position for at least 10 minutes and we performed cf-PWV measurements in 10-minute intervals. Results: Subjects averaged 67± 5.8 years, with average BP 131/75 ± 21/11 mmHg, heart rate 72 ± 11 bpm., and cf-PWV 7.8 ± 2.0 m/s. Three successful measurements were obtained in all subjects. We quantified the limits of agreement among measurements using Bland-Altman plots. The average difference (SD) was 0.09 (1.98) m/s, 0.14 (2.01) m/s and 0.06 (1.98) m/s between the first and second, first and third, and second and third measurements, respectively. Therefore, the 95% limits of agreement were 3.88 m/s, 3.94 m/s and 3.88 m/s, respectively. The range of measurements within individual subjects was 0.39 m/s (range 0 to 1.7 m/s). Only 3 subjects had a range of variation >1 m/s, and 26 subjects had a range < 0.5 m/s. Lin concordance coefficients for the 38 sets of triplicate measurements (114 comparisons) was 0.978 (95% limits 0.968–0.985), indicating “substantial” agreement among measurements (figure). Conclusions: Sequential measurements of cf-PWV showed almost perfect agreement (arbitrarily defined when Lins coefficient is > 0.99) and most measurements were within 0.5–1 m/s of each other. We conclude that a single measurement of cf-PWV provides enough precision in elderly hypertensive patients. This has particular relevance to the practicability of its implementation in clinical practice. *: supported by FAPEMIG

Development of the First Brazilian Project on Superconducting Power Cable

The SUPERCABO Project is in development in Brazil, and its primary objective is to achieve knowledge on designing, construction, tests, and economic feasibility of high-temperature superconducting power cable (HTS cable) technology for Brazil. Such knowledge is shared with four major Brazilian power utilities and with Brazils National Electric Energy Agency. The method employed was to exchange knowledge and information with those power utilities to guide the project in giving results that allow for actual use of HTS cable technology in Brazil. The procedures were to evaluate the best geometry of HTS cable according to the operating voltage level, to search for an auxiliary solution for fault current protection, and to improve the terminations of the cable. The main outcomes and results presented here are the complete design of the first Brazilian HTS cable, the proposed termination for use in an HTS cable, and computational models for the superconducting core. As a conclusion, the SUPERCABO Project is in development, with results to improve the feasibility of HTS cable technology in Brazil, using cryocooled aluminum power cables to fault current protection and a proposal of inductive linking for power flow in terminations. Some details are not shown because they are patent pending.