• Nenhum resultado encontrado

de alto fluxo nasal em paciente com fibrose pulmonar idiopática sob cuidados paliativos: relato de um caso

N/A
N/A
Protected

Academic year: 2018

Share "de alto fluxo nasal em paciente com fibrose pulmonar idiopática sob cuidados paliativos: relato de um caso"

Copied!
4
0
0

Texto

(1)

TO O

KdžŝŐĞŶŽƚĞƌĂƉŝĂ ĚĞ ĂůƚŽ ŇƵdžŽ ŶĂƐĂů Ğŵ ƉĂĐŝĞŶƚĞ ĐŽŵ ĮďƌŽƐĞ

ƉƵůŵŽŶĂƌŝĚŝŽƉĄƟĐĂƐŽďĐƵŝĚĂĚŽƐƉĂůŝĂƟǀŽƐ͗ƌĞůĂƚŽĚĞƵŵĐĂƐŽ

KdžLJŐĞŶŚŝŐŚŇŽǁŶĂƐĂůŝŶƉĂƟĞŶƚǁŝƚŚƉƵůŵŽŶĂƌLJĮďƌŽƐŝƐŝĚŝŽƉĂƚŚŝĐ

ŝŶƉĂůůŝĂƟǀĞĐĂƌĞ͗ƌĞƉŽƌƚŽĨĂĐĂƐĞ

F ! "#! S $ % L"& S "'( 1

. P ) "! " * H* +, "-* # B *)$ 1

.0* ) +$# S ) $# +* V#! $ ! *' $# 3

. 0 45* '

P " )$S ' * # 6

.A + 7+N ób*-r " " $N$-5* " 8

.9!* ' $A '! )H $' + :

.

;<= >= ?@ CDE pCG@E I JC>= KMQU= E CW XC DE p= E YQ @ CQ>= ZE Q ? [ ?> p= @Ei\Q= Z CD>= @] D= ? ^E i @ C D_EQ @` K= ? a[\^_cI \Q= Z CD>= KEK C < CK CDEi

K ? _ CE D] a\ < _cI <?D @E i CfE I _ CED] I g DE >=i h j <= >= ?@ CDEpCG@EI k?G@ ?DE QKE CW U= MQU =E > WmK=U E> pCi E \Q= Z C D>= KEK C < CK CDEi K ?

_ CE D] a\ < _cIU??DK CQE K ?DEKE>\ XYl>K ?[ ?> p= @Ei\Q= Z CD>= @] D= ?^E i @ CD_EQ @` K= ?a [\^ _ cI<?D @E i CfE I_ CED]Ig DE>= i hnoC> @ DC

CWU =M QU= E>W mK=U E>pCi E\Q= Z CD>= KEK C<CK CDEiK ?_ CE D]a \ <_ cI<= >= ?@ C DE pC G@EKEqWpD C>Eg DE >=i C= DEK CsC DZ=t?>[ ?> p= @Ei E DC>

aqgsqJ[ cI <?D @E i CfE I _CE D] I gDE>= i h u<= >= ?@C DE pC G@E Ik?G@ ?DEQKE CW _= M QU= E> W mK= UE > pCi E\Q= Z CD>= KE K C<CK CDE i K ? _CE D]

8)& FRRUGHQDGRUD GD 5HVLGrQFLD ,QWHJUDGD 0XOWLSUR¿VVLRQDO HP$WHQomR +RVSLWDODU GD 8)& )RUWDOH]D &HDUi %UDVLO 0pGLFR'RXWRUHP3QHXPRORJLDSHOD8QLYHUVLGDGH)HGHUDOGH6mR3DXOR81,)(63SURIHVVRUDVVRFLDGRGH7HUDSLD,QWHQVLYDH

vQ CGW ?i ?w= EK ?k CpE D @EWCQ @ ?K CoCK= U= QE_i ` Q=U EKE\ Q=Z C D>= KEK C< CK C DEiK ?_ CE D]a\ < _ cI< ?D @Ei CfE I_CE D]Ig DE>= i h

xyz{|}

~ €‚ƒ „…†EZEi= ED?G>?KE@ CDE p=EKC‡i @ ?<i Gˆ?‰E>Eia ‡<‰ cCWGWEpEU= CQ @CU ?W<= ŠD?> CvGi W ?QE DYK= ?p] @=UEa <vY c>?ŠU G=KEK?>

pEi =E @=Z ?> h‹Œ‚ …Ž …†WGi ‘CDK C’“EQ ?>IEKW= @=KECWGWE\Q=KEK CK CXCDEp=EYQ @CQ>=ZEa\ XY cSRULQVX¿FLrQFLDUHVSLUDWyULD

KLSR[rPLFDJUDYHSRU)3,HPHVWiJLRDYDQoDGRVHPLQGLFDomRGHLQWXEDomRWUDTXHDO,QLFLDOPHQWHWUDWDGDFRP9HQWLODomR1mR

YQZE>=ZE a ”‰Y c =Q@ CDUEiEQK? U ?WW]>UE DE DC>CDZE @•D= ?K C ?ˆ=wMQ= ?a– —

cI p?DmWU ?WŠE= ˆE @?i CDâQU=E hoC> W?U ?WE W]>UE DE

DC>CDZE @•D= ?KC–

—DSUHVHQWRXIUHTXrQFLDUHVSLUDWyULDIGHUSPVDWXUDomRSHULIpULFDGH2— asp–

—GHIUHTXrQFLDFDUGtDFD

)&GHESPSUHVVmRDUWHULDO3$[PP+J$JDVRPHWULDDUWHULDOUHYHORX3D2—

KCn˜WW[wCsE – —

KC’j™h–p@?Gš>C

SRUXVDUR$)1SHORVLVWHPD2SWLÀRZŒ)LVKHU 3D\NHO®FRPÀX[RGHOPLQGH2 —

C@CWpCDE@ GDEKCn’°_h‡p•>n“W= QG@?>

KRXYHUHVSRVWDFOtQLFDLPHGLDWDDSUHVHQWRXI USP)& ESP3$ [PP+J6S2— 3D2— PP+JH6D2—

$SyVKRUDVDSUHVHQWRX3D2— PP+JH6D2— VHPDOWHUDomRGHS+

›…œŒã…†R$)1IRLLPSRUWDQWHSDUD

RPHOKRUDGDR[LJHQDomRHFRQIRUWRGDSDFLHQWHGRFDVRUHODWDGRJDUDQWLQGRDOpPGDPHOKRUDFOtQLFDXPDPRUWHWUDQTXLODFRPD UHGXomRGRVVLQWRPDVUHVSLUDWyULRV

žŒ „Ÿ ¡„†–ˆ=wCQ ?@ CDEp= E h<= Š D?> CpGi W ?QEDh_ G= KE K ?>pEi = E @= Z ?> h

¢£z¤x¢¥¤

~ € ‚ ƒ „†WRHYDOXDWHWKHXVHRIWKH+LJKWKHUDS\1DVDO)ORZ$)1LQDSDWLHQWZLWK,GLRSDWKLF3XOPRQDU\)LEURVLV,3)LQ pEi i = E @= Z CU E DC h›Ÿ¦ …Ÿ‚†D\HDUROGDGPLWWHGWRWKH,&8IRUVHYHUHK\SR[LFUHVSLUDWRU\IDLOXUHE\)3,LQDQDGYDQFHGVWDJH

ZLWKQRLQGLFDWLRQRIWUDFKHDOLQWXEDWLRQ,QLWLDOO\WUHDWHGZLWK1RQ,QYDVLYH9HQWLODWLRQ1,9LQWHUVSHUVHGZLWKPDVNR[\JHQ WDQN2—EXWZLWKORZWROHUDQFH(YHQZLWKWKHPDVN2—UHVHUYRLUSUHVHQWHGUHVSLUDWRU\IUHTXHQF\IRIUSPSHULSKHUDO2—

>E @ GDE@= ?Qasp–

—RIKHDUWUDWH+5RIESPEORRGSUHVVXUH%3[PP+J$UWHULDOEORRGJDVDQDO\VLVVKRZHG vE –

—

n˜W W[wE QKsE–

—RI:HFKRVHWRXVHWKH$)1E\2SWLÀRZŒ)LVKHU 3D\NH

®V\VWHPZLWKOPLQ2 —

EQKn’°_ h

$IWHUPLQXWHVWKHUHZDVLPPHGLDWHFOLQLFDOUHVSRQVHVKRZHGI USP+5 ESP%3 [PP+J6S2— vE –

— PP+JDQG6D2— $IWHUKRXUVVKRZHG3D2— PP+JDQG6D2— QRFKDQJHRIS+

›…œŒƒ …œ†@‘ C

$)1ZDVLPSRUWDQWIRUWKHLPSURYHGR[\JHQDWLRQDQGFRPIRUWRIWKHFDVHUHSRUWHGJXDUDQWHHLQJEH\RQGFOLQLFDOLPSURYHPHQWD SHDFHIXOGHDWKZLWKWKHUHGXFWLRQLQUHVSLUDWRU\V\PSWRPV

§¨©…ŸŽ †2[LJHQLQKDODWLRQWKHUDS\3XOPRQDU\¿EURVLV3DOOLDWLYHFDUH

ª «¬ ­¯± ­¯ ¯ ²³´ ­µ¶ ²µ ¬ ²·¸¹ º » º¹¼ d¸¹½¹¾ ¿¹¼À ¹ ÁR ¹ Áà Áà ¸ d¸ e dÁd  Ŀ Ád¸ ŹÀ eƹ Áe¹ ¸ ÇÈÉ 2 ÊeÀ eËd eÌ Í Í 2 È¿¹À »d¸¹ ½¹ À ¿¹ Î Ï¿¹À ºd¿

&RQÀLWRGHLQWHUHVVHV1mRKiTXDOTXHUFRQÀLWRGHLQWHUHVVHVSRUSDUWHGHTXDOTXHUXPGRVDXWRUHV

(2)

Ñ Ò$OWRÀX[RQDVDOHPFXLGDGRVSDOLDWLYRV

è éê ëì íî ïðì

$ ¿EURVH SXOPRQDU LGLRSiWLFD )3, p D PDLV FRPXP GDV

ñòô õö ÷ñø ù úø û úò ùô üûù úý úø ú û úþ ú÷ñ ÿ ù úý ø û ô ý ø üüôcø ÷ ñ ú ÷ü

ñ ü÷còpûù úý ÷t Sõø ñ üôrøòý úø ô ûù ú öø þø ôö ù ÷üò ÷ þô 3

ýøû÷û ñ ÷ü 1t ñôûû÷øû øõöôò ùø rô ü ùúc úò ÷ûø öôò ùô

FRP D LGDGH DIHWDQGR PDLV GH LQGLYtGXRV SRU

ñô ûû÷ø ûý ÷öúþø þô úc õø ÷õûõñôüú ÷üø7ø ò ÷ûtOûûúò ù ÷öø û

LQFOXHPWRVVHVHFDHIDOWDGHDUSURJUHVVLYD8PDVREUHYLGD

þôøñ ü ÷úöø þø öôò ùôù üûøò ÷ûøñøüù úüþ÷þ úøcòpûù úý ÷ñ ÷þô

ûô üôûñô üø þøt

$LQFLGrQFLDGHLQVX¿FLrQFLDUHVSLUDWyULDHP¿EURVHSXOPRQDU

é ø

ùø ôôûùø

é

øýøõûøöø ú ûý÷ö õöþôö ÷üùôòôûûôû

ñø ý úôò ùô ût

2 PDX SURJQyVWLFR H D UHGXomR GD TXDOLGDGH GH YLGD VmR

üôûõùøþ ÷ûþôòôýôûûúþø þôþôýõúþø þ ÷ûñøúøù úr÷ût 2

Oû ñø ý úôò ùô û ñ ÷ü ùø þ ÷üô û þô þ ÷ôòdø û ûô ö ñ ÷ûûúbúúþøþôû þô

ý ÷ò ù úò õúþøþô þø rúþø ÷õ þô ý õüø ý ÷ö ÷ ø û þ ÷ô òdø û c üørô û

ñ ü÷c üôûûúrøûôúòý õü ÿrô ú ûþôrô öûô üøb÷üþø þ ÷ûý÷öý õúþøþ ÷û

SDOLDWLYRV'HQWUHRVSULQFtSLRVGHVVDDERUGDJHPHVWmRRDOtYLR

þøþ ÷üôþô÷õù ü÷ûûúò ù÷öø ûþô ûø c üøþ ÿrô ú ûòmRDFHOHUDUQHP øþ úø üøö ÷üùôFXLGDGRPXOWLSUR¿VVLRQDODRVSDFLHQWHVHVHXV

IDPLOLDUHVFRQWURODUVLWXDo}HVFOtQLFDVHVWUHVVDQWHVHPHOKRUDU

øaõøúþø þôþôrúþøt

Dô òù üô ÷û ûúò ù÷öø û ñ üôûô ò ùô û ò ÷û úòþúriþ õ÷û ôö ý õúþø þ ÷û

ñøúø ù úr÷ûøþú ûñòô úøùôööø ú ÷üúòý úþòýúøûô òþ ÷ôûùøþôûý üú ùø

FRPR XPD VHQVDomR VXEMHWLYD GH GHVFRQIRUWR UHVSLUDWyULR

ù üø ùø òþ ÷ûô þô õö ûúò ù÷öø þô ûø c üøþ ÿrô ô ôûùüô ûûøò ùô aõô

LQWHUIHUHGLUHWDPHQWHQDTXDOLGDGHGHYLGD4

2 R[LJrQLR HVWi HQWUH DERUGDJHQV XWLOL]DGDV SDUD D UHGXomR

þøþ ú ûñòôúøò ÷ûý õúþøþ ÷ûñø úøù úr÷ût

Iòþ úýøþ ÷ò ÷û

úòþ úriþ õ÷û

FRP KLSR[HPLD JUDYH D R[LJHQRWHUDSLD IDYRUHFH D UHGXomR

þøúò ùô ò ûúþø þôþøþ úûñòôúøüô þ õomRþ ÷ùüøbø ÷üô ûñ ú üøùpü ú÷ ÷ù ú öú oøomRGDIXQomRFDUGLRYDVFXODUPHOKRUDGRGHVFRQIRUWR üôûñ ú üø ùpüú ÷ôþ ÷aõøþ ü ÷ýiò úý÷t

5

Oõû÷ ý ÷ò ùiò õ÷þô ÷úcò ú÷ñ ÷þô üô ûõùøü ôöüôûûô ýø öô ò ù÷

GDUHJLmRQDVDORUDOHUHGXomRGDLQWHUDomRGRLQGLYtGXRFRP VHXVIDPLOLDUHVHHTXLSHSUHMXGLFDQGRDVRFLDOL]DomR'LDQWH GLVVRDR[LJHQRWHUDSLDFRPXVRGHFkQXODVQDVDLVFRPÀX[RV XPLGL¿FDGRV H DTXHFLGRV YHP GHPRQVWUDQGR UHVXOWDGRV SRVLWLYRVQDUHGXomRGDIUHTXrQFLDUHVSLUDWyULDHDXPHQWRGD VDWXUDomRWUD]HQGREHQHItFLRVDRVSDFLHQWHVTXHDSUHVHQWDP

þ ú ûñòô úøô öüô ñ ÷õû÷ô úñ ÷ô ö úøt 6

1D R[LJHQRWHUDSLD GH DOWR ÀX[R SRU FkQXOD QDVDO R JiV IRUQHFLGRXPLGL¿FDGRHDTXHFLGRSURSRUFLRQDPDLRUFRQIRUWR H DFHLWDomR GH DOWRV ÀX[RV GH R[LJrQLR SRGHQGR HVWH VHU RIHUWDGRHPDWp PLQFRP)UDomR,QVSLUDGDGH2[LJrQLR

( úO 2

)þôø ùé1tEûûøùô üø ñ úørô öø ñ üô ûô ò ùø òþ ÷üôûõùøþ ÷û

VDWLVIDWyULRV QD PHOKRUD GDV GL¿FXOGDGHV UHVSLUDWyULDV UHGX]LQGRDQHFHVVLGDGHGHLQWXEDomRHQGRWUDTXHDOHLQWHUQDomR

òø ûõò úþø þô ûþôùô üøñ úø û

úò ùôò ûúrø û( I û)ébô ö

ù ÷ô üøþøô

ûôc õüøôöñøý úô ò ùôûý ÷òþ õo úþ ÷ûô öý õúþø þ ÷ûñøúø ù úr÷ûñ ÷úû

SURSRUFLRQDUHGXomRGRGHVFRQIRUWRUHVSLUDWyULR

Dúøò ùô þ ÷ ôñ ÷ûù ÷ ørøúø ö ÷û ÷ õû÷ þø ùô üø ñ úø þô Aù ÷

)OX[R1DVDO$)1HPXPDSDFLHQWHFRP¿EURVHSXOPRQDU

úþ ú ÷ñ ÿù úýøû÷bý õúþøþ ÷ûñøúø ù úr÷ût

ëR êìíR ì

(VWH HVWXGR IRL DSURYDGR SHOR FRPLWr GH pWLFD HP SHVTXLVD VHJXQGRSDUHFHUQ~PHUR

7UDWDVHGHXPDSDFLHQWHGHDQRVVH[RIHPLQLQRSURFHGHQWH

þø ýúþø þô þô ÷ü ùøô oøF E øþ ö ú ù úþø ô ö õöø õò úþø þô

KRVSLWDODUSULYDGDDSUHVHQWDQGRGHVFRQIRUWRUHVSLUDWyULRSRU ,QVX¿FLrQFLD5HVSLUDWyULD$JXGD,5S$KLSR[rPLFDGHYLGR

àIô öô ûù ÿc ú ÷ørøòdø þ ÷( úc õüø1)tF÷ö ÷aõô úøñ üúòý úñø

UHODWDYDGLVSQHLDHFRQVWLSDomR'HYLGRDRHVWiJLRDYDQoDGR GD ¿EURVH SXOPRQDU D SDFLHQWH SDVVRX D UHFHEHU FXLGDGRV SDOLDWLYRVFRPRULHQWDomRSDUDQmRLQWXEiODHQmRUHDQLPiOD

,PDJHP UDGLROyJLFD GR WyUD[ QD DGPLVVmR 5HGXomR !" ##$%v$& "' %* "&'$ u%$'$ * + # #u!+ "&$ - $ #"& u% ELODWHUDLVDODUJDPHQWRHGLVWRUomRGDWUDTXHLD

$ FRQGXWD DGRWDGD SDUD GLPLQXLU R GHVFRQIRUWR UHVSLUDWyULR H D KLSR[HPLD IRL D 9HQWLODomR 0HFkQLFD 1mR ,QYDVLYD 91, LQWHUPLWHQWH FRP PiVFDUD IDFLDO WRWDO 3HUIRUPD[

,ôûñ ú ü÷ò úýû ®

) úò ùô üýøøòþ ÷ ý ÷ö ö ÿûýøüø üô ûôürø ùpüú ÷ þô

O

2$ SDFLHQWH QmR VH DGDSWRX D WDLV GLVSRVLWLYRV UHODWDQGR

LQFRPRGRSULQFLSDOPHQWHHPUHODomRj91,&RPRREMHWLYR GH GLPLQXLU HVVH LQFRPRGR IRUDP WHVWDGRV RXWURV WLSRV LQWHUIDFHVSRUpPQmRKRXYHDGHVmR

Dõüøò ùô ÷ õû÷þø ö ÿûýøüø üôûôürø ùpüú ÷þô O

2FRP ÀX[R GH 1 PLQDSUHVHQWRXWDTXLSQHLDFRP)UHTXrQFLD5HVSLUDWyULD

I LJXDO D USP KLSRVVDWXUDomR FRP 6DWXUDomR 3HULIpULFD

þô Oúcò ú ÷ (SñO 2

) þô . ùøaõúýø üþ úø ý ÷ö üôaõòýúø

&DUGtDFD )& GH ESP SLFR KLSHUWHQVLYR FRP 3UHVVmR

A üùô üúø (A) 17.öö mctAcø û÷öô ù üúø øüùô üúø üôrô÷õ

KLSR[HPLD JUDYH H 6DWXUDomR DUWHULDO GH 2[LJrQLR 6D22 )

DEDL[RGRVQtYHLVGHQRUPDOLGDGH7DEHOD$HTXLSHHQWmR

(3)

/ 0$OWRÀX[RQDVDOHPFXLGDGRVSDOLDWLYRV

2SWLÀRZŒGDPDUFD)LVKHU 3D\NHOQREMHWLYDQGRSURPRYHU

PDLRUFRQIRUWRjSDFLHQWH

)RL XWLOL]DGR ÀX[R GH lPLQ GH 2 T

sUV VW sX YZ[ \U [Z

] ^V_ZW VW \ ^] ^V`W f T

\ UghhjUX U V_UZ[X YZ[\ Ukn°qwx_ó s

PLQXWRVGHXWLOL]DomRDYDOLRXVHRVVLQDLVYLWDLVREWHQGRVH RVVHJXLQWHVUHVXOWDGRVI USP)& ESP3$ [

V Vyz{|_f

T DXPHQWRGD6D2TUHGXomRGDKLSR[HPLD

HGRXVRGHPXVFXODWXUDDFHVVyULDHDSDFLHQWHUHIHULXPDLRU FRQIRUWR7DEHOD7DPEpPIRLSRVVtYHOREVHUYDUPHOKRUHV

ZUsYlX [\ ^sz[s^V}X ZW] ^s] ^V~€^Z[s\UYs^\ [X UZ[_W [‚[ƒUl [

g„wfs…í†UW s\ U|_f

THVWmRPHOKRUUHSUHVHQWDGRVQRJUi¿FR

RQGHpSRVVtYHOYLVXDOL]DUDFXUYDDVFHQGHQWHGDVDWXUDomR DSyVRXVRGDWHUDSLDFRP$)1*Ui¿FR

*Ui¿FR1tYHLVGH6DWXUDomR3HULIpULFDGH2[LJrQLR6S2FRP

‡ˆ‰Š‹Œ‹Œ ‰ ŒŽ‹Œ‘’“”•–

S+ 3RWHQFLDO GH +LGURJrQLR 3D&2 3UHVVmR DUWHULDO GH JiV FDUE{QLFR3D23UHVVmRDUWHULDOGHR[LJrQLR+&2%LFDUERQDWR 6D26DWXUDomRDUWHULDOGHR[LJrQLR%(%DVH([FHVV

—˜™š›˜œž‹Ÿ’‰ ‹‰’‡ ¡Œ‘Š’‰Š’‡‡ˆ‰Š‹Œ‹Œ ‰ ŒŽ‹Œ‘’“ ”•–

$SyVVHWHGLDVGHXVRDSDFLHQWHIRLDyELWR2$)1WURX[H FRQIRUWRSDUDDPHVPDHPVHXV~OWLPRVPRPHQWRVSHUPLWLQGR TXHKRXYHVVHLQWHUDomRFRPDIDPtOLDHUHDOL]DomRGHDWLYLGDGHV

sW V _l Us ]^V^ \ ^ZVW Z U sU [l W V U…X [ Z{ _Z ^_^Z]W ^…[…\ ^ [ssW V

YV [V^ZX U€YV[…W¢[\ [UX Z[…£YW l [w

¤¥ ¦§¨ ¦¦Ã©

f s ZUsYl X [\ ^s U…]^…X Z [\ ^s …UsX U ZUl [X ^ \ U ] [ s^ sYzU ZUV ^

EHQHItFLR GR XVR GR $)1 HP XPD SDFLHQWH FRP )3, HP

ªˆ‰Š‹Œ‹ Š’‡

Œ ‰ ŒŽ‹Œ‘’

«¬­Š’‡“¯’”¯ ±²’ 1DVDOOPLQ

“³‰´µ¶’Œ‹‰Š’‡

“¯’”¯ ±²’•‹‰‹¯

« ¬OPLQ

·³¸¹º»µµ ³¸¹º»µµ ³¸¹º»µ«

·¼‹½¾ ¿

¹µº‡‡¸  ¼‹½¾ ¿

¹µÀ‡‡¸  ¼‹½¾ ¿

¹µ«‡‡¸ 

·¼‹¾ ¿

¹«À‡‡¸  ¼‹¾ ¿

¹µÀ‡‡¸  ¼‹¾ ¿

¹Á À‡‡¸ 

·¸½¾

ÂPPRO/ ¸½¾

ÂPPRO/ ¸½¾

ÂPPRO/

·Ä‹¾ ¿

¹º´Å Ä ‹¾

¿

¹Æ« Šċ¾

¿

%(PPRO/ %(PPRO/ %(PPRO/

FXLGDGRVSDOLDWLYRVRQGHIRLSRVVtYHOREVHUYDUXPDUHGXomR GRGHVFRQIRUWRUHVSLUDWyULRU\ [€W _^Ç UVW [{[l}V\ U_UZVW X W Z

LQWHUDomRFRPDIDPtOLDHDUHDOL]DomRGHDWLYLGDGHVGLiULDV SURSRUFLRQDQGRFRQIRUWRHWUDQTXLOLGDGHQR¿PGDYLGD

q^ZZ ^ƒ^Z[…\ ^ ] ^V ^ _Z UsU…X U UsX Y\ ^{ q[l†[…^ U q^l s UV

SXEOLFDUDP XP UHODWR GH FDVR GH XPD PXOKHU GH

[…^s UV ] YW \ [\ ^s _[lW [XW†^s ]^V \ UVȅ] W [ U _…UYV ^…W [

PXOWLOREDUDPHVPDHUDLQFDSD]GHWROHUDUPiVFDUDVIDFLDLVH

…[s[W sYX W l W¢[\ [sUVÉÊË{[_ZU sU…X […\ ^€W _^Ç UVW [UVYs^\ U

PiVFDUDGH9HQWXUL8WLOL]RXVHR$)1FRPOPLQH FRPRUHVXOWDGRVYHUL¿FRXVHUHGXomRGDIGHSDUDUSP

`q\ UghÌ_[Z[Íhƒ_V{|_ f

TDXPHQWRXGHSDUDH Î [f

TGHSDUDPP+J$SDFLHQWHWRUQRXVHPDLVUHOD[DGD U ] ^^_UZ [X W†[{ W…W ] W ^Y \W UX [ ZUzYl [ Z{ VUl€^Z^Y [ \W s_…UW [{

R[LJHQDomRHWROHUkQFLDDR[LJHQRWHUDSLDSURPRYHQGRPDLRU FRQIRUWRQR¿PGDYLGDÏ

$GL¿FXOGDGHGHWROHUDUPiVFDUDVIDFLDLVGH91,IRLREVHUYDGD QDSDFLHQWHGHVWHUHODWRDOpPGLVVRQmRIRLSRVVtYHOPDQWHU XPD R[LJHQDomR DGHTXDGD FRP RXWURV GLVSRVLWLYRV GH

^ÇWzU…^X U Z[_W [w

8PHVWXGRSXEOLFDGRHPFRPSDURXWHUDSLDSDGUmRFRP

^ÇWzȅW ^{x`ÊUÉÊË U V _[]W U…X Us] ^VË Ð_x€W _^ÇÈVW ] [{

PRVWURX TXH D GLVSQHLD IRL PHQRU FRP R XVR GR $)1 UHVXOWDQGR DVVLP QD UHGXomR GD PRUWDOLGDGH QD 87, HP

\W [ s…^s_[] W U…X Us£YUYX W lW¢[Z[ Vx`Ê£Y[…\ ^] ^V _[ Z[\ ^[ ^s

JUXSRVGHWHUDSLDSDGUmRH91,

2 $)1 WDPEpP VH PRVWURX H¿FD] HP XP HVWXGR SLORWR

ZU[lW¢[\ ^ U V ~h gk{ [ YVU…X […\ ^ ^ †^l YV U ] ^ZZ U…X U UV

_ []W U…X U s]^VÑ ^U…Ò [Î Yl V ^…[ZfƒsX ZYX W†[q ZӅW ] [ÑÎfq„{

DOpP GH UHGX]LU D IUHTXrQFLD UHVSLUDWyULD H YROXPH PLQXWR

…UssUs _[]W U…X Us{ UV _[] W U…X Us ]^V `ÎË U UV †^l Y…X Ô ZW ^s

VDXGiYHLV1HVVHHVWXGRD3UHVVmR$UWHULDOGH*iV&DUE{QLFR

Î [ qf T

„\W VW…YW Y…^s_[]W U…X Us]^V`ÎËUÑÎfq{Z UsYl X […\ ^

HP HIHLWRV VLJQL¿FDWLYRV VREUH SDUkPHWURV UHVSLUDWyULRV

UV _[]W U…X Us ] ^V \ ^U…Ò[ _Yl V^…[ Z ^ƒsX Z YXW†[ U ZUsX ZW X W†[

FRQWULEXLQGR SDUD R DXPHQWR GD H¿FiFLD GH YHQWLODomR H UHGXomRGRWUDEDOKRGHUHVSLUDWyULRÕÖ

$ LQWHUDomR GD SDFLHQWH FRP D IDPtOLD WDPEpP IRL XP IDWRU LPSRUWDQWH SDUD R FRQIRUWR GD PHVPD SHUPLWLQGR D FRPXQLFDomR H H[SUHVVmR GH VHXV VHQWLPHQWRV DWp RV VHXV ~OWLPRV PRPHQWRV $FKDGRV VHPHOKDQWHV IRUDP GHVFULWRV

_^Z×[€l U ZU] ^l s{^…\ U^ƒsU Z†[Z[ V£YU[X UZ [_W [] ^Vx`Ê

SHUPLWLXXPDPHOKRULQWHUDomRFRPDVIDPtOLDVSRLVPHOKRURX VLJQL¿FDWLYDPHQWHDR[LJHQDomRHUHGX]LXDWRVVHGHSDFLHQWHV HPIDVHWHUPLQDOFRPKLSR[HPLDJUDYHGHFRUUHQWHGHGRHQoDV

_Yl V ^…[Z Us W…X UZ sXW ]W [W s{ £Y[…\ ^ ] ^V _[Z[\ [ Øs VÔs] [Z [s\ U

R[LJrQLRVHPUHLQDODomRÕÕ

fs ZU sYlX [\ ^s \ ^ _Z UsU…X U UsX Y\ ^ V ^sX Z[Z [V V Ul€^Z[

FRQVLGHUiYHOQDR[LJHQDomRDSyVR$)16]WU\PIHFROVDSyV

^Ys^\ ^x `ÊU^ÇWzU…^X UZ [_W []^…†U…]W ^…[lU V~h_[] W U…X Us

] ^V Ë Ð_x_UZ sW sX U…X U[^Ys^\ U ^ÇWzȅW ^^ƒsU Z†[Z[ V£YU [

R[LJHQRWHUDSLDSRU$)1SHUPLWLXXPDUHGXomRGDISDUD USPDXPHQWRVLJQL¿FDWLYRGD3D2T

Í{nk[gÙ{ ~n„U\[

|_f

TSDUD

(4)

Ú Û$OWRÀX[RQDVDOHPFXLGDGRVSDOLDWLYRV

òô õô òö ÷øù úû

üýþÿATSA EpARAp SA ýT

MRLQW VWDWHPHQW RI WKH$PHULFDQ 7KRUDFLF 6RFLHW\ $76 DQG WKH

EpARAp SA (ER Swap AabAþTSba RIGLUHFWRUV-XQHDQGE\WKH(56([HFXWLYH&RPPLWWHH-XQH $P-5HVSLU&ULW&DUH0HG(UUDWXPLQ $P-5HVSLU&ULW&DUH0HG

6SUXLW0$-DQVVHQ'-)UDQVVHQ)0:RXWHUV()5HKDELOLWDWLRQ DQGSDOOLDWLYHFDUHLQOXQJ¿EURVLV5HVSLURORJ\

/DQNHQ 31 7HUU\ 3% 'HOLVVHU +0 )DK\ %) +DQVHQ)ODVFKHQ -+HIIQHU-(HWDO$QRI¿FLDO$PHULFDQ7KRUDFLF6RFLHW\FOLQLFDO SROLF\VWDWHPHQWSDOOLDWLYHFDUHIRUSDWLHQWVZLWKUHVSLUDWRU\GLVHDVHV DQGFULWLFDOLOOQHVVHV$P-5HVSLU&ULW&DUH0HG

4ýC RT, P Hþ(ga A ýM aAaa

SDOLDWLYRV $1&3 5LR GH -DQHLUR 'LDJUDSKLF Cp í 2, 'LVSQpLDWRVVHHKLSHUVHFUHomRGHYLDVDpUHDV pýü .4 ü ý

%DUWKROR73*RPHV001RURQKD$-)LOKR'32&RLPSDFWRGD

R[LJHQRWHUDSLDGRPLFLOLDUQRWUDWDPHQWR3XOPmR5-84ý

&DFKLD($KPHG]DL6+%UHDWKOHVVQHVVLQFDQFHUSDWLHQWV(XU-CAý2 ..8 44 (8 üüü12ý

*RWHUD&'tD]/REDWR63LQWR7:LQFN-&&OLQLFDOHYLGHQFHRQ KLJKÀRZR[\JHQWKHUDS\DQGDFWLYHKXPLGL¿FDWLRQLQDGXOWV5HY 3RUW3QHXPRO

&DOYDQR736LOO-0.HPS.5&KXQJ..8VHRIDKLJKÀRZ

ogA aA A Aÿ p A w aAÿA ý

5HVSLU&DUH

)UDW -37KLOOH$: 0HUFDW$ *LUDXOW & 5DJRW 6 3HUEHW 6 HW DO +LJKÀRZ R[\JHQ WKURXJK QDVDO FDQQXOD LQ DFXWH K\SR[HPLF UHVSLUDWRU\IDLOXUH1(QJO-0HG

%UlXQOLFK-%H\HU'0DL'+DPPHUVFKPLGW66H\IDUWK+-:LUW] + (IIHFWV RI QDVDO KLJK ÀRZ RQ YHQWLODWLRQ LQ YROXQWHHUV &23' DQG LGLRSDWKLF SXOPRQDU\ ¿EURVLV SDWLHQWV 5HVSLUDWLRQ

0DKOHU '$ 6HOHFN\ 3$ +DUURG &* %HQGLWW -2 &DUULHUL .RKOPDQ9&XUWLV-5HWDO$PHULFDQ&ROOHJHRI&KHVW3K\VLFLDQV FRQVHQVXVVWDWHPHQWRQWKHPDQDJHPHQWRIG\VSQHDLQSDWLHQWVZLWK DGYDQFHGOXQJRUKHDUWGLVHDVH&KHVW

6]WU\PI%0HVVLND-0D\RW7/HQJOHW+'UH\IXVV'5LFDUG -',PSDFWRIKLJKÀRZQDVDOFDQQXODR[\JHQWKHUDS\RQLQWHQVLYH FDUH XQLW SDWLHQWV ZLWK DFXWH UHVSLUDWRU\ IDLOXUH D SURVSHFWLYH REVHUYDWLRQDOVWXG\-&ULW&DUHH

/HQJOHW+6]WU\PI%/HUR\&%UXQ3'UH\IXVV'5LFDUG -' +XPLGL¿HG KLJK ÀRZ QDVDO R[\JHQ GXULQJ UHVSLUDWRU\ IDLOXUH LQWKHHPHUJHQF\GHSDUWPHQWIHDVLELOLW\DQGHI¿FDF\5HVSLU&DUH 2 .ü2 5(üü ü88ý

&XTXHPHOOH(3KDP73DSRQ-)/RXLV%'DQLQ3(%URFKDUG / +HDWHG DQG KXPLGL¿HG KLJKÀRZ R[\JHQ WKHUDS\ UHGXFHV GLVFRPIRUW GXULQJ K\SR[HPLF UHVSLUDWRU\ IDLOXUH 5HVSLU &DUH 2 .ü2 5(ü .ü5ü ý

6LOYD)6%DUUHWR3+9DVFRQFHORV566DOHV531RJXHLUD$1+RODQGD0$2[LJHQRWHUDSLDGHDOWRÀX[RQDVDOHPSDFLHQWHFRP¿EURVH SXOPRQDULGLRSiWLFDVREFXLGDGRVSDOLDWLYRVUHODWRGHXPFDVR5HY0HG8)&MDQDEU

! " e# $%& e"' e)&#I*$+$e- ) )' e"' e/e )' 0% ))& %3 %

jPHOKRUDVLJQL¿FDWLYDHVXVWHQWDGDGRVSDUkPHWURVFOtQLFRV

e6 i7 & )9 :;

N% e# e - !"& % 3 e u# < )$ ' % i U"=e- ) ' 0 - F-% "&! )/

&# $%- %-%# %&c"ui %3 e+FN e% # 0)& % -% -e )e-=% '7 -e#

$%& e "' e)&#I*$+9O)- e)ui ' %3 )# )' -% -%#q ue%' e -%$ %

FRP$)1UHVXOWRXQDUHGXomRGDISHGRVVLQDLVGH GHVFRQIRUWRUHVSLUDWyULRSDXPHQWRGD6S2;S

# eim -% -0$ 3 % e )u)' e"' %3 % 3 % 3 )$"e % / %i># 3 e )e - 6e#

WROHUDGR H PDLV FRQIRUWiYHO GR TXH WHUDSLD FRQYHQFLRQDO GH

! " 9 :?

2 FRQIRUWR GHVWD WHUDSLD RFRUUH SULQFLSDOPHQWH GHYLGR D XPLGL¿FDomRRIHUHFLGDVHQGRHVWHDYDOLDGRHPSDFLHQWH)

FRP ,5S$ KLSR[rPLFD DWUDYpV GD FRPSDUDomR GD WHUDSLD GH R[LJrQLR SDGUmR FRP R$)1 DTXHFLGR H XPLGL¿FDGR 2 UHVVHFDPHQWR QDVDO IRL VLJQL¿FDWLYDPHQWH PHQRU QR JUXSR $)1HPKVS HKVS DOpPGLVVRREWHYH PDLRUSUHIHUrQFLDGHQWUHRVSDUWLFLSDQWHVS VREUHWXGR DTXHOHVTXHQHFHVVLWDUDPGHÀX[RVPDLVDOWRVGHR[LJ!" "

PRPHQWRGDLQWHUQDomRS : @

øB ÷øDGûÃB

2$)1IRLXPIDWRULPSRUWDQWHSDUDDPHOKRUDGDR[LJHQDomR H FRQIRUWR GD SDFLHQWH GR FDVR UHODWDGR JDUDQWLQGR DOpP

3 % # e im - %& iJQLFDXPDPRUWHWUDQTXLODFRPDUHGXomRGRV

Referências

Documentos relacionados

[r]

[r]

Dissertação (Mestrado em Educação) – Setor de Educação da Universidade Federal do Paraná. Programa Nacional do Livro Didático

[r]

[r]

Os compostos selecionados foram o eugenol (Figura 18a), por ser o majoritário do óleo de canela (69,84%); a mistura dos isômeros (E) e (Z) do isoeugenol (Figura 18b), para se

Em B, paciente com achados tomográficos mais consistentes com um diagnóstico de não fibrose pulmonar idiopática, compatível com pneumonia intersticial não

[r]