Fabricio Olinda de S. Mesquita

Ruídos na unidade de terapia intensiva: quantificação e percepção dos profissionais de saúde

OBJETIVO: Em uma unidade de terapia intensiva, a circulacao de pessoas da equipe multidisciplinar e o numero consideravel de equipamentos e alarmes sonoros deixam o ambiente ruidoso. O objetivo desta pesquisa foi mensurar os niveis de ruidos de uma unidade de terapia intensiva da cidade de Recife e avaliar sua percepcao pelos profissionais da unidade. METODOS: Durante uma semana, 24 horas por dia, foi utilizado um decibelimetro para realizar mensuracoes a cada cinco segundos. Apos as afericoes, foi aplicado um questionario aos profissionais sobre sua percepcao e incomodo causados pelo ruido, e se eles achavam possivel reduzir o barulho. RESULTADOS: A media de ruido verificada foi de 58,21 ± 5,93 dB. O periodo diurno apresentou maiores niveis de ruidos que o noturno (60,86 ± 4,90 vs 55,60 ± 5,98 dB; p < 0,001), assim como os dias uteis quando comparados ao final de semana (58,77 ± 6,05 vs 56,83 ± 5,90 dB; p < 0,001) e a passagem de plantao noturna quando comparada a diurna (62,31 ± 4,70 vs 61,35 ± 5,08 dB; p < 0,001). Dos 73 profissionais que responderam o questionario, 97,3% acham que a unidade de terapia intensiva tem ruido de moderado a intenso, 50,7% se sentem prejudicados pelo barulho e 98,6% acham que e possivel reduzir o nivel de ruidos. CONCLUSAO: Os niveis de ruidos encontrados estavam acima dos recomendados. Programas preventivos e educativos conscientizando da importância da reducao do nivel de ruido devem ser estimulados, envolvendo todos os profissionais que compoem a equipe da unidade de terapia intensiva.

Correlação entre a capacidade vital lenta e o tempo máximo de fonação em adultos saudáveis

Purpose to correlate the value of slow vital capacity (SVC) with the maximum phonation time (TMF) in order to estimate the vital capacity. Methods the study is a cross-sectional crossover and participated in this research one hundred one (101) healthy subjects 71 women and 30 men. The slow vital capacity (SVC) was measured using a spirometer and TMF was evaluated by vowel “a”;, the phoneme “s”; and “z”; and the manner of counting numbers. Results there was significant correlation between the SVC (ml) and TMF (a, s, z) and technique of counting with r * respectively (0.420, 0.442, 0.399, 0.279) with a p-value <0.05 in total population. There was a positive correlation between the slow vital capacity and the variables /a /, /s /, /z / and technique of counting for females, according to values of r * (0.296, 0.334, 0.326, 0.320) respectively and p-value < 0.05 . Conclusion in this study was possible to observe a positive correlation between the SVC and TMF in total population and females, this correlation was not observed among males.

Scintigraphic assessment of radio-aerosol pulmonary deposition with the acapella positive expiratory pressure device and various nebulizer configurations.

BACKGROUND: The Acapella device produces high-frequency oscillations and positive expiratory pressure to promote bronchial secretion clearance. Its performance during aerosol delivery has not been described. We evaluated the effect of nebulizer and Acapella configuration on pulmonary deposition of radio-tagged aerosol in healthy subjects. METHODS: Ten healthy male subjects (mean age 24.4 ± 2.2 y) participated in a crossover study that compared pulmonary delivery of 4 mL of technetium-99m-labeled diethylene triamine penta-acetic acid (25 mCi) and 0.9% saline solution via jet nebulizer. We tested 3 configurations: nebulizer attached to the distal end of the Acapella; nebulizer placed between the mouthpiece and the Acapella; and nebulizer alone (control). With scintigraphy we measured radio-aerosol deposition in 6 lung regions: upper, middle, lower, central, intermediate, and peripheral. RESULTS: Deposition was similar between the right and left lungs, with no significant differences between device configurations. Lung deposition was less with the nebulizer attached to the Acapella than with nebulizer between the mouthpiece and the Acapella (P = .001, for both lungs) or without the Acapella (P = .003 and P = .001 for the right and left lungs, respectively). There was no significant difference between the setup without Acapella and the setup with the nebulizer between the mouthpiece and the Acapella (P = .001, for both lungs). On the vertical axis, deposition was lower with the nebulizer attached to the distal end of the Acapella than with the nebulizer between the mouthpiece and the Acapella (upper region P < .001, middle region P = .001, lower region P = .003), and lower with the nebulizer attached to the distal end of the Acapella than with the setup without Acapella (upper and middle region both P = .001, lower region P = .002), with up to a 3-fold difference in the middle and lower regions. On the central-peripheral axis, deposition was lower with the nebulizer attached to the distal end of the Acapella than with the nebulizer between the mouthpiece and the Acapella (central region P < .001, peripheral region P < .001), and lower with the nebulizer attached to the distal end of the Acapella than with the setup without Acapella (central and peripheral regions both P = .002), with differences of 3–4-fold between the central and peripheral regions. CONCLUSIONS: Placing the nebulizer distal to the Acapella, as recommended by the manufacturer, decreased intrapulmonary deposition, compared to placing the nebulizer between the Acapella and the patient airway, or delivering aerosol without the Acapella in the circuit. (ClinicalTrials.gov NCT01102166)