Claudia Kümpel

Análise comparativa da complacência do sistema respiratório em três diferentes posições no leito (lateral, sentada e dorsal) em pacientes submetidos à ventilação mecânica invasiva prolongada

OBJECTIVES: This study is justified by the fact that in clinical practice, changes occur in patients positioning in the bed during hospitalization in intensive care unity, its necessary better understanding about possible adverse effects that such changes might cause mainly on the respiratory system condition. The objective this study was to evaluate if the patients positioning in bed can to alter the pulmonary complacency. METHODS: All included patients were submitted to mechanical ventilation and were sedated and curarized respiratory system compliance was assessed in three different positioning: lateral, dorsal and sitting. After an alveolar recruitment maneuver, patients were placed to a position throughout two hours, and in the last five minutes the data was collected from the mechanical ventilator display. RESULTS: twenty eight patients were prospectively assessed. Values of respiratory system compliance in the lateral position were 37,07 ± 12,9 in the dorsal were 39,2 ± 10,5 and in the sitting 43,4 ± 9,6 mL/cmH2O. There were a statistical difference when we compared to the sitting and dorsal with lateral positioning for respiratory system compliance (p = 0.0052) and tidal volume (p < 0.001). There was a negative correlation between mean values of positive end expiratory pressure a respiratory system compliance (r = 0.59, p = 0.002). The FIO2 administered was 0.6 for the lateral positioning and 0.5 for the dorsal and sitting positioning (p = 0.049). CONCLUSIONS: That body positioning in patients restrained to a bed and submitted to invasive mechanical ventilation leads to pulmonary compliance, tidal volume and SpO2 oscillations. In the sitting position the pulmonary compliance is higher than in others positions.

Análise comparativa entre a manobra de recrutamento alveolar e a técnica de breath stacking em pacientes com lesão pulmonar aguda

Objective To compare the effectiveness of the alveolar recruitment maneuver and the breath stacking technique with respect to lung mechanics and gas exchange in patients with acute lung injury. Methods Thirty patients were distributed into two groups: Group 1 - breath stacking; and Group 2 - alveolar recruitment maneuver. After undergoing conventional physical therapy, all patients received both treatments with an interval of 1 day between them. In the first group, the breath stacking technique was used initially, and subsequently, the alveolar recruitment maneuver was applied. Group 2 patients were initially subjected to alveolar recruitment, followed by the breath stacking technique. Measurements of lung compliance and airway resistance were evaluated before and after the use of both techniques. Gas analyses were collected before and after the techniques were used to evaluate oxygenation and gas exchange. Results Both groups had a significant increase in static compliance after breath stacking (p=0.021) and alveolar recruitment (p=0.03), but with no significant differences between the groups (p=0.95). The dynamic compliance did not increase for the breath stacking (p=0.22) and alveolar recruitment (p=0.074) groups, with no significant difference between the groups (p=0.11). The airway resistance did not decrease for either groups, i.e., breath stacking (p=0.91) and alveolar recruitment (p=0.82), with no significant difference between the groups (p=0.39). The partial pressure of oxygen increased significantly after breath stacking (p=0.013) and alveolar recruitment (p=0.04), but there was no significant difference between the groups (p=0.073). The alveolar-arterial O2 difference decreased for both groups after the breath stacking (p=0.025) and alveolar recruitment (p=0.03) interventions, and there was no significant difference between the groups (p=0.81). Conclusion Our data suggest that the breath stacking and alveolar recruitment techniques are effective in improving the lung mechanics and gas exchange in patients with acute lung injury.

Evaluación de la musculatura respiratoria en la predicción del resultado de la extubación de pacientes con ictus

BACKGROUND Patients with cerebral infarction often present impaired consciousness and unsatisfactory extubation. We aimed to assess the respiratory mechanics components that might be associated with the success of extubation in stroke patients. METHODS Twenty consecutive patients with stroke who needed mechanical ventilation support were enrolled. The maximal inspiratory pressure, gastric and the esophageal pressure (Pdi/Pdimax), minute volume, respiratory rate, static compliance, airway resistance, rapid and superficial respiration index (RSRI), inspiratory time/total respiratory cycle (Ti/Ttot), and PaO(2)/FiO(2) were measured. RESULTS The group who presented success to the extubation process presented 12.5±2.2=days in mechanical ventilation and the group who failed presented 13.1±2=days. The mean Ti/Ttot and Pdi/Pdimax for the failure group was 0.4±0.08 (0.36-0.44) and 0.5±0.7 (0.43-0.56), respectively. The Ti/Ttot ratio was 0.37±0.05 (0.34-0.41; p=0.0008) and the Pdi/Pdimax was 0.25±0.05 for the success group (0.21-0.28; p<0.0001). A correlation was found between Pdi/Pdimax ratio and the RSRI (r=0.55; p=0.009) and PaO(2)/FiO(2) (r=-0.59; p=0.005). Patients who presented a high RSRI (OR, 3.66; p=0.004) and Pdi (OR, 7.3; p=0.002), and low PaO(2)/FIO(2) (OR, 4.09; p=0.007), Pdi/Pdimax (OR, 4.12; p=0.002) and RAW (OR, 3.0; p=0.02) developed mechanical ventilation extubation failure. CONCLUSION Muscular fatigue index is an important predicting variable to the extubation process in prolonged mechanical ventilation of stroke patients.

Hospitalização e mortalidade em idosos institucionalizados

The objective was to evaluate the causes of hospitalization and mortality in institutionalized elderly. Retrospective study carried out with records of institutionalized elderly individuals from January 1, 2013 to December 1, 2016. The death certificate, data related to the personal anthropometric profile, health history, diagnosis, medication in use, clinical manifestations, history Of falls, fractures, hospitalizations. Participated 25 records, distributed in two groups, G1 composed of 19 living patients, G2 six individuals who died. 100% female. The mean time of institutionalization was 4.8 ± 3.9 years, G2 age was significantly higher (p=0.028), proportion of dependents (p=0.04) and hospitalizations (p =0.028). G1 had a higher proportion of independent individuals, who performed the ADLs (p=0.002). He concluded that the factors that predispose hospitalization and the mortality of institutionalized elderly people are old age, dependence to perform activities of daily living and loss of locomotion.

Associação entre jornadas de trabalho e estilo de vida

Estilo de vida corresponde aos habitos, que refletem atitudes, valores e oportunidades das pessoas. As horas de trabalho diariamente podem interferir no estilo de vida saudavel. Avaliou-se, transversalmente, o estilo de vida de 82 jovens estudantes, do periodo noturno, moradores da Zona Sul da cidade de Sao Paulo, correlacionando com a jornada de trabalho. Aplicaram-se os questionarios: Estilo de Vida Fantastico e Calculo da Idade Biologica e Cronologica. Calculados a media e o desvio padrao, utilizados os testes: normalidade de Kolmogorov-Smirnov e de Pearson, e analisada a variância, considerou-se p<0,05 estatisticamente signifi cante. Os estudantes declararam ter a idade de 26 ± 5,6 anos, 16 eram casados, 65%, 25% e 10% declaram ter tripla, dupla e uma unica jornada de trabalho, respectivamente. A media diaria de sono foi de 5,5 horas nos de tripla, 6,8 horas (p=0,004) para os de dupla e 7,1 horas (p=0,0012) nos de unica jornada de trabalho. Os de dupla ou tripla jornada de trabalho apresentaram pior estilo de vida (p=0,0021) (p<0,0001), quando comparados aos de uma unica jornada.

Benefício do Método Pilates em mulheres com fibromialgia

Introduction - Fibromyalgia Syndrome (FMS) is a chronic disease with diffuse pain. Objective - To assess the effectiveness of Pilates for pain relief in patients with fibromyalgia. Method - This study is a prospective self-control, patients were evaluated before and after treatment by algometry and Visual Analogue Scale. The quality of life through the Fibromyalgia Impact Questionnaire (FIQ), and sleep by Pittsburgh Sleep Quality Index. The Pilates exercise program on the ground had 15 sessions, twice a week, during 60 minutes. Results - Composed these study 20 women with SDF, diagnosis time of 6 ± 4 years, as QIF patients improved in all areas. Correlation was found among the impact of fibromyalgia on the quality of sleep. Conclusion - The effects of Pilates are positive for reducing pain.

Impacto de um programa estruturado de hidrocinesioterapia em pacientes com osteoartrite de joelho

51 ABSTRACT Osteoarthritis is a pervasive, chronic rheumatic, multifactorial, degenerative joint disease, afflicting 10% of the population over 65 years of age. It affects both genders, and in women the incidence is higher after menopause. This disease comprises 65% of the causes of disability, exceeded only by cardiovascular and mental disorders. The rehabilitation of patients with osteoarthritis is a complex process that involves specialized procedures Objective: To evaluate the effects of a hydrotherapy program on the ability to perform activities of daily living in patients with osteoarthritis. Method: This is a prospective study where twenty-six patients with knee osteoarthritis history underwent a treatment program in aquatic therapy, often twice a week lasting 50 minutes each session. The program consisted of four phases, namely: warming up, stretching, strengthening, and relaxation. These patients were evaluated before and after treatment. Assessments were done with the goniometer, EVA pain scale, and Six Minute Walk Test. Results: There was significant improvement in range of motion when performing flexion of the affected knees, as well as a significant decrease in pain and a significant improvement in the ability to perform the activities of daily living, assessed by the distance walked in the six-minute walk test. Conclusion: There was an improved ability to perform ADLs and inn physical capacity, as well as reduced pain and increased range of motion.Osteoarthritis is a pervasive, chronic rheumatic, multifactorial, degenerative joint disease, afflicting 10% of the population over 65 years of age. It affects both genders, and in women the incidence is higher after menopause. This disease comprises 65% of the causes of disability, exceeded only by cardiovascular and mental disorders. The rehabilitation of patients with osteoarthritis is a complex process that involves specialized procedures Objective: To evaluate the effects of a hydrotherapy program on the ability to perform activities of daily living in patients with osteoarthritis. Method: This is a prospective study where twenty-six patients with knee osteoarthritis history underwent a treatment program in aquatic therapy, often twice a week lasting 50 minutes each session. The program consisted of four phases, namely: warming up, stretching, strengthening, and relaxation. These patients were evaluated before and after treatment. Assessments were done with the goniometer, EVA pain scale, and Six Minute Walk Test. Results: There was significant improvement in range of motion when performing flexion of the affected knees, as well as a significant decrease in pain and a significant improvement in the ability to perform the activities of daily living, assessed by the distance walked in the six-minute walk test. Conclusion: There was an improved ability to perform ADLs and inn physical capacity, as well as reduced pain and increased range of motion