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Introdução: A Síndrome do Desconforto Respiratório Agudo (SDRA) é uma doença aguda caracterizada por hipoxemia e infiltrados na radiografia de tórax que não são totalmente explicadas por sobrecarga hídrica ou insuficiência cardíaca. Este estudo analisa o uso dos critérios de diagnóstico para SDRA por profissionais da área da saúde, trabalhadores de UTIs de três hospitais do Vale do Itajaí/ Santa Catarina. Métodos: A coleta de dados foi realizada por entrevistas gravadas com os profissionais enfermeiros, fisioterapeutas e médicos das referidas unidades. As entrevistas foram gravadas e transcritas posteriormente. A análise das entrevistas foi realizada através da técnica de Análise de Conteúdo Temática de Bardin. Seis Enfermeiros, seis Fisioterapeutas e quatro Médicos se dispuseram a responder e a participar do estudo. As categorias que emergiram das entrevistas foram: a) Diagnóstico centrado em exames clínicos, laboratorial e em imagem e b) diagnóstico médico centrado. Resultados: Apesar da divulgação mundial, mas por ser uma doença complexa, o diagnóstico da SDRA permanece um grande desafio para os profissionais. O desconhecimento, a falta de adequada formação profissional, o tempo de atuação, o ambiente de trabalho ainda hegemônico e com pouca participação dos componentes da equipe corroboram para o subdiagnóstico ou o superdiagnóstico da SDRA. Conclusão: Sugerem-se novos estudos para investigar se essa realidade acontece nas demais UTIs da região, estado e país, e se intervenções pontuais podem melhorar a formação profissional e suas relações no ambiente de trabalho e se isso influencia no diagnóstico da SDRA.

Introduction: Acute Respiratory Distress Syndrome (ARDS) is an acute disease characterized by hypoxemia and infiltrates on chest radiography that are not fully explained by fluid overload or heart failure. This study analyzes the use of diagnostic criteria for ARDS by health professionals, ICU workers from three hospitals in Vale do Itajaí, Santa Catarina. Methods: Data collection was performed through recorded interviews with nurses, physical therapists and physicians from the aforementioned units. The interviews were recorded and later transcribed. The analysis of the interviews was carried out using Bardin's Thematic Content Analysis technique. Six Nurses, 6 Physiotherapists and 4 Physicians were willing to respond and participate in the study. The categories that emerged from the interviews were: a) Diagnosis centered on clinical, laboratory and imaging exams and b) physician-based diagnosis. Results: Despite the worldwide dissemination, the diagnosis of ARDS remains a great challenge for professionals because it is a complex disease. Lack of knowledge, lack of adequate professional training, length of experience, the still hegemonic work environment and with little participation of the team members all contribute to underdiagnosis or overdiagnosis of ARDS. Conclusion: Further studies should be carried out to determine if this reality occurs in other ICUs in the region, state and country, and if specific interventions can improve professional training and relationships in the work environment and whether this influences the diagnosis of ARDS.

RESUMO

Crop production in the Brazilian Cerrado is limited by soil phosphorus (P) supply without large inputs of inorganic P fertilizer, which may become more costly and scarce in the future. Reducing dependency on fertilizer P requires a greater understanding of soil P supply in the highly weathered soils in this important agricultural region. We investigated the impact of no tillage (NT) and conventional tillage (CT) agriculture on accumulated (legacy) soil P and P forms in four long-term sites. Compared to the native savanna soils, tilled soils receiving regular annual P fertilizer inputs (30-50 kg P ha(-1)) increased all forms of inorganic and organic P, except highly recalcitrant P associated with the background lithology. However, 70-85% of the net added P was bound in moderately labile and non-labile forms associated with Fe/Al oxyhydroxides rather than in plant available forms. Under NT agriculture, organic P forms and labile and non-labile inorganic P forms were all significantly (P<0.05) increased in the surface soil, except for one site with maize residues where labile inorganic P was increased more under CT agriculture. The contribution of organic P cycling in these tropical soils increased after conversion to agriculture and was proportionally greater under NT. The results highlight the large amounts of unutilized legacy P present in Brazil's Cerrado soils that could be better exploited to reduce dependency on imports of finite phosphate rock. No tillage agriculture confers a positive albeit relatively small benefit for soil P availability and overall soil function.