Bruno Prata Martinez

Pre- and postoperative inspiratory muscle training in patients undergoing cardiac surgery: systematic review and meta-analysis:

Objective: To determine the effects of pre- and postoperative inspiratory muscle training on length of postoperative hospital stay and pulmonary function in patients undergoing cardiac surgery. Design and methods: We conducted a systematic search using databases (MEDLINE, CINAHL, EMBASE, PEDro and the Cochrane) to find controlled trials evaluating the effects of pre- and postoperative inspiratory muscle training. Results: Eight studies fulfilled the inclusion criteria. Four were about preoperative inspiratory muscle training (416 patients), three about postoperative inspiratory muscle training (115 patients) and one study about pre- and postoperative inspiratory muscle training (43 patients). Preoperative inspiratory muscle training resulted in improvement in: Reduction in length of postoperative hospital stay of −2 days (95% CI −3.4, −0.7, N = 302), inspiratory pressure of 16.7 cm H2O (95% CI 13.8, 19.5, N = 386), forced expiratory volume in one second of 3% predicted (95% CI 0.1, 6, N = 140), forced vital capacity of 4.6% predicted (95% CI 1.9, 7.4, N = 140). Patients that received preoperative training had an inspiratory muscle training reduced risk of postoperative pulmonary complications, (RR = 0.6; 95% CI 0.5 to 0.8; P = 0.0004, N = 386). Postoperative inspiratory muscle training resulted in improvement in inspiratory pressure of 16.5 cm H2O (95% CI 4.9, 27.8, N = 115), and tidal volume of 185 ml (95% CI 19.7, 349.8, N = 85). Conclusion: Pre- and postoperative inspiratory muscle training showed to be a beneficial intervention in the treatment of patients undergoing cardiac surgery.

Accuracy of the Timed Up and Go test for predicting sarcopenia in elderly hospitalized patients

OBJECTIVES: The ability of the Timed Up and Go test to predict sarcopenia has not been evaluated previously. The objective of this study was to evaluate the accuracy of the Timed Up and Go test for predicting sarcopenia in elderly hospitalized patients. METHODS: This cross-sectional study analyzed 68 elderly patients (≥60 years of age) in a private hospital in the city of Salvador-BA, Brazil, between the 1st and 5th day of hospitalization. The predictive variable was the Timed Up and Go test score, and the outcome of interest was the presence of sarcopenia (reduced muscle mass associated with a reduction in handgrip strength and/or weak physical performance in a 6-m gait-speed test). After the descriptive data analyses, the sensitivity, specificity and accuracy of a test using the predictive variable to predict the presence of sarcopenia were calculated. RESULTS: In total, 68 elderly individuals, with a mean age 70.4±7.7 years, were evaluated. The subjects had a Charlson Comorbidity Index score of 5.35±1.97. Most (64.7%) of the subjects had a clinical admission profile; the main reasons for hospitalization were cardiovascular disorders (22.1%), pneumonia (19.1%) and abdominal disorders (10.2%). The frequency of sarcopenia in the sample was 22.1%, and the mean length of time spent performing the Timed Up and Go test was 10.02±5.38 s. A time longer than or equal to a cutoff of 10.85 s on the Timed Up and Go test predicted sarcopenia with a sensitivity of 67% and a specificity of 88.7%. The accuracy of this cutoff for the Timed Up and Go test was good (0.80; IC=0.66-0.94; p=0.002). CONCLUSION: The Timed Up and Go test was shown to be a predictor of sarcopenia in elderly hospitalized patients.

High-intensity interval training versus moderate-intensity continuous training on exercise capacity and quality of life in patients with coronary artery disease: A systematic review and meta-analysis:

Background Exercise is an effective strategy for reducing total and cardiovascular mortality in patients with coronary artery disease. However, it is not clear which modality is best. We performed a meta-analysis to investigate the effects of high-intensity interval versus moderate-intensity continuous training of coronary artery disease patients. Methods We searched MEDLINE, PEDro, LILACS, SciELO and the Cochrane Library (from the earliest date available to November 2016) for controlled trials that evaluated the effects of high-intensity interval versus moderate-intensity continuous training for coronary artery disease patients. Weighted mean differences and 95% confidence intervals were calculated, and heterogeneity was assessed using the I2 test. Results Twelve studies met the study criteria, including 609 patients. High-intensity interval training resulted in improvement in peak oxygen uptake weighted mean difference (1.3 ml/kg/min, 95% confidence interval: 0.6–1.9, n = 594) compared with moderate-intensity continuous training. No significant difference in physical, emotional, and social domain of quality of life was found for participants for participants in the high-intensity interval training group compared with the moderate-intensity continuous training group. Sub-analysis of three studies with isocaloric exercise training showed no significant difference in peak oxygen uptake weighted mean difference (0.4 ml/kg/min, 95% confidence interval: –0.1–0.9, n = 137) for participants in the high-intensity interval training group compared with moderate-intensity continuous training group. Conclusions High-intensity interval training may improve peak oxygen uptake and should be considered as a component of care of coronary artery disease patients. However, this superiority disappeared when isocaloric protocol is compared.

Combined Exercise and Inspiratory Muscle Training in Patients With Heart Failure: A SYSTEMATIC REVIEW AND META-ANALYSIS.

PURPOSE: Studies have reported the benefits of exercise and inspiratory muscle training (IMT) in patients with heart failure (HF); however, there is no meta-analysis on the effects of the combination of exercise and IMT in patients with HF. The objective of this study was to determine whether combined exercise/IMT was more effective than conventional exercise on exercise capacity, respiratory muscle strength, and quality of life in patients with HF. METHODS: This is a systematic review and meta-analysis. We searched MEDLINE, LILACS, CINAHL, EMBASE, PEDro, and the Cochrane Central Register of Controlled Trials (from the earliest date available to April 2015) for randomized controlled trials, examining effects of combined exercise/IMT versus conventional exercise on exercise capacity, respiratory muscle strength, and quality of life measurements in patients with HF. Two reviewers selected studies independently. Weighted mean differences and 95% CIs were calculated. RESULTS: Three studies met the study criteria. Combined exercise/IMT resulted in improvement in maximal inspiratory pressure weighted mean differences (20.89 cm H2O; 95% CI, 14.0-27.78) and Minnesota Living with Heart Failure Questionnaire weighted mean differences (4.43; 95% CI, 0.72-8.14). Nonsignificant difference was observed in peak O2 for participants in the combined exercise/IMT group compared with the conventional exercise group. No serious adverse events were reported. CONCLUSIONS: Combined exercise/IMT may improve maximal inspiratory pressure and quality of life in patients with HF and should be considered for inclusion in cardiac rehabilitation programs.

SEGURANÇA E REPRODUTIBILIDADE DO TESTE TIMED UP AND GO EM IDOSOS HOSPITALIZADOS

Introducao: Testes fisicos seguros e confiaveis sao importantes para rastrear risco de queda em idosos, entretanto, nao existem estudos que tenham avaliado a seguranca e a confiabilidade do teste Timed Up and Go (TUG) em idosos hospitalizados. Objetivos: Avaliar a seguranca e reprodutibilidade do TUG em idosos hospitalizados. Metodos: Trata-se de um estudo transversal no qual foram coletadas tres afericoes do TUG para cada idoso, sendo considerado o melhor desempenho em segundos (s). Outras variaveis coletadas foram funcao cognitiva (MEEM), indice de comorbidades de Charlson, perfil admissional (clinico ou cirurgico), relato de quedas no ultimo ano e IMC. Para avaliar a confiabilidade relativa utilizou-se o coeficiente de correlacao intraclasse (CCI) e para a confiabilidade absoluta, a analise de Bland-Altman. Resultados: Foram incluidos 68 idosos com media de idade de 70,4 ± 7,7 anos, indice de Charlson 5,4 ± 2,0 e predominio do perfil clinico (64,7%). Nenhum dos 204 testes foi interrompido pelos criterios estabelecidos. Houve reducao gradativa entre a primeira e a terceira afericao (1a = 11,6 ± 6,54; 2a = 10,7 ± 6,22 e 3a = 10,3 ± 5,54; p = 0,001) e elevado CCI (1a e 2a: CCI = 0,98; 1a e 3a: CCI = 0,98; 2a e 3a: CCI = 0,98; p = 0,001), sendo que a maior correlacao com o melhor desempenho foi associada a 3a afericao (CCI = 0,99; p = 0,001). Identificou-se que os menores vies (0,29 s) e limites de concordância (-1,1 a 1,68 s) ocorreram tambem entre a terceira afericao e a de melhor desempenho. A medida de erro do metodo para avaliacao da variabilidade foi 0,5 s e a alteracao clinicamente significante 3,4 s. Conclusao: O TUG foi um instrumento seguro e com boa reprodutibilidade para mensuracao do desempenho fisico em idosos hospitalizados.

SAFETY AND REPRODUCIBILITY OF THE TIMED UP AND GO TEST IN HOSPITALIZED ELDERLY

Introducao: Testes fisicos seguros e confiaveis sao importantes para rastrear risco de queda em idosos, entretanto, nao existem estudos que tenham avaliado a seguranca e a confiabilidade do teste Timed Up and Go (TUG) em idosos hospitalizados. Objetivos: Avaliar a seguranca e reprodutibilidade do TUG em idosos hospitalizados. Metodos: Trata-se de um estudo transversal no qual foram coletadas tres afericoes do TUG para cada idoso, sendo considerado o melhor desempenho em segundos (s). Outras variaveis coletadas foram funcao cognitiva (MEEM), indice de comorbidades de Charlson, perfil admissional (clinico ou cirurgico), relato de quedas no ultimo ano e IMC. Para avaliar a confiabilidade relativa utilizou-se o coeficiente de correlacao intraclasse (CCI) e para a confiabilidade absoluta, a analise de Bland-Altman. Resultados: Foram incluidos 68 idosos com media de idade de 70,4 ± 7,7 anos, indice de Charlson 5,4 ± 2,0 e predominio do perfil clinico (64,7%). Nenhum dos 204 testes foi interrompido pelos criterios estabelecidos. Houve reducao gradativa entre a primeira e a terceira afericao (1a = 11,6 ± 6,54; 2a = 10,7 ± 6,22 e 3a = 10,3 ± 5,54; p = 0,001) e elevado CCI (1a e 2a: CCI = 0,98; 1a e 3a: CCI = 0,98; 2a e 3a: CCI = 0,98; p = 0,001), sendo que a maior correlacao com o melhor desempenho foi associada a 3a afericao (CCI = 0,99; p = 0,001). Identificou-se que os menores vies (0,29 s) e limites de concordância (-1,1 a 1,68 s) ocorreram tambem entre a terceira afericao e a de melhor desempenho. A medida de erro do metodo para avaliacao da variabilidade foi 0,5 s e a alteracao clinicamente significante 3,4 s. Conclusao: O TUG foi um instrumento seguro e com boa reprodutibilidade para mensuracao do desempenho fisico em idosos hospitalizados.

Viability of gait speed test in hospitalized elderly patients

ABSTRACT Objective: The gait speed test (GST) is a physical test that can predict falls and aid in the diagnosis of sarcopenia in the elderly. However, to our knowledge, there have been no studies evaluating its reproducibility in hospitalized elderly patients. The objective of this study was to evaluate the safety and reproducibility of the six-meter GST (6GST) in hospitalized elderly patients. Methods: This repeated measures study involved hospitalized elderly patients (≥ 60 years of age) who underwent the 6GST by the fifth day of hospitalization, were able to walk without assistance, and presented no signs of dyspnea or pain that would prevent them from performing the test. The 6GST was performed three times in sequence, with a rest period between each test, in a level corridor. Gait speed was measured in meters/second. Reproducibility was assessed by comparing the means, intraclass correlation coefficients (ICCs) and Bland-Altman plots. Results: We evaluated 110 elderly patients in a total of 330 tests. All participants completed all of the tests. The comparisons between the speeds obtained during the three tests showed high ICCs and a low mean bias (Bland-Altman plots). The correlation and accuracy were greatest when the mean maximum speed was compared with that obtained in the third test (1.26 ± 0.44 m/s vs. 1.22 ± 0.44 m/s; ICC = 0.99; p = 0.001; mean bias = 0.04; and limits of agreement = −0.27 to 0.15). Conclusions: The 6GST was proven to be safe and to have good reproducibility in this sample of hospitalized elderly patients. The third measurement seems to correspond to the maximum speed, since the first two measurements underestimated the actual performance.

Influence of different degrees of head elevation on respiratory mechanics in mechanically ventilated patients.

Objective The positioning of a patient in bed may directly affect their respiratory mechanics. The objective of this study was to evaluate the respiratory mechanics of mechanically ventilated patients positioned with different head angles hospitalized in an intensive care unit. Methods This was a prospective physiological study in which static and dynamic compliance, resistive airway pressure, and peripheral oxygen saturation were measured with the head at four different positions (0° = P1, 30° = P2, 45° = P3, and 60° = P4). Repeated-measures analysis of variance (ANOVA) with a Bonferroni post-test and Friedman analysis were used to compare the values obtained at the different positions. Results A comparison of the 35 evaluated patients revealed that the resistive airway pressure values in the 0° position were higher than those obtained when patients were positioned at greater angles. The elastic pressure analysis revealed that the 60° position produced the highest value relative to the other positions. Regarding static compliance, a reduction in values was observed from the 0° position to the 60° position. The dynamic compliance analysis revealed that the 30° angle produced the greatest value compared to the other positions. The peripheral oxygen saturation showed little variation, with the highest value obtained at the 0° position. Conclusion The highest dynamic compliance value was observed at the 30° position, and the highest oxygenation value was observed at the 0° position.

Influence of different body positions in vital capacity in patients on postoperative upper abdominal

RATIONALE The changes in body position can cause changes in lung function, and it is necessary to understand them, especially in the postoperative upper abdominal surgery, since these patients are susceptible to postoperative pulmonary complications. OBJECTIVE To assess the vital capacity in the supine position (head at 0° and 45°), sitting and standing positions in patients in the postoperative upper abdominal surgery. METHODS A cross-sectional study conducted between August 2008 and January 2009 in a hospital in Salvador/BA. The instrument used to measure vital capacity was analogic spirometer, the choice of the sequence of positions followed a random order obtained from the draw of the four positions. Secondary data were collected from the medical records of each patient. RESULTS The sample consisted of 30 subjects with a mean age of 45.2 ± 11.2 years, BMI 20.2 ± 1.0 kg/m(2). The position on orthostasis showed higher values of vital capacity regarding standing (mean change: 0.15 ± 0.03 L; p=0.001), the supine to 45 (average difference: 0.32 ± 0.04 L; p = 0.001) and 0° (0.50 ± 0.05 L; p = 0.001). There was a positive trend between the values of forced vital capacity supine to upright posture (1.68 ± 0.47; 1.86 ± 0.48; 2.02 ± 0.48 and 2.18 ± 0.52 L; respectively). CONCLUSION Body position affects the values of vital capacity in patients in the postoperative upper abdominal surgery, increasing in postures where the chest is vertical.

Impacto do internamento em unidade de cuidados intensivos na amplitude de movimento de pacientes graves: estudo piloto

Objective To evaluate the joint range of motion of critically ill patients during hospitalization in the intensive care unit. Methods This work was a prospective longitudinal study conducted in a critical care unit of a public hospital in the city of Salvador (BA) from September to November 2010. The main variable evaluated was the passive joint range of motion. A goniometer was used to measure the elbows, knees and ankles at the time of admission and at discharge. All patients admitted in the period were included other than patients with length of stay <72 hours and patients with reduced joint range of motion on admission. Results The sample consisted of 22 subjects with a mean age of 53.5±17.6 years, duration of stay in the intensive care unit of 13.0±6.0 days and time on mechanical ventilation of 12.0±6.3 days. The APACHE II score was 28.5±7.3, and the majority of patients had functional independence at admission with a prior Barthel index of 88.8±19. The losses of joint range of motion were 11.1±2.1°, 11.0±2.2°, 8.4±1.7°, 9.2±1.6°, 5.8±0.9° and 5.1±1.0°, for the right and left elbows, knees and ankles, respectively (p<0.001). Conclusion There was a tendency towards decreased range of motion of large joints such as the ankle, knee and elbow during hospitalization in the intensive care unit.Objective: To evaluate the joint range of motion of critically ill patients during hospitalization in the intensive care unit. Methods: This work was a prospective longitudinal study conducted in a critical care unit of a public hospital in the city of Salvador (BA) from September to November 2010. The main variable evaluated was the passive joint range of motion. A goniometer was used to measure the elbows, knees and ankles at the time of admission and at discharge. All patients admitted in the period were included other than patients with length of stay <72 hours and patients with reduced joint range of motion on admission. Results: The sample consisted of 22 subjects with a mean age of 53.5±17.6 years, duration of stay in the intensive care unit of 13.0±6.0 days and time on mechanical ventilation of 12.0±6.3 days. The APACHE II score was 28.5±7.3, and the majority of patients had functional independence at admission with a prior Barthel index of 88.8±19. The losses of joint range of motion were 11.1±2.1°, 11.0±2.2°, 8.4±1.7°, 9.2±1.6°, 5.8±0.9° and 5.1±1.0°, for the right and left elbows, knees and ankles, respectively (p<0.001). Conclusion: There was a tendency towards decreased range of motion of large joints such as the ankle, knee and elbow during hospitalization in the intensive care unit.