Flávio Maciel D. Andrade

Influência da mobilização precoce na força muscular periférica e respiratória em pacientes críticos

OBJECTIVE:To evaluate the effects of an early mobilization protocol on respiratory and peripheral muscles in critically ill patients. METHODS: A randomized controlled clinical trial was conducted with 59 male and female patients on mechanical ventilation. The patients were divided into a conventional physical therapy group (control group, n=14) that received the sectors standard physical therapy program and an early mobilization group (n=14) that received a systematic early mobilization protocol. Peripheral muscle strength was assessed with the Medical Research Council score, and respiratory muscle strength (determined by the maximal inspiratory and expiratory pressures) was measured using a vacuum manometer with a unidirectional valve. Systematic early mobilization was performed on five levels. RESULTS: Significant increases were observed for values for maximal inspiratory pressure and the Medical Research Council score in the early mobilization group. However, no statistically significant improvement was observed for maximal expiratory pressure or MV duration (days), length of stay in the intensive care unit (days), and length of hospital stay (days). CONCLUSION: The early mobilization group showed gains in inspiratory and peripheral muscle strength.

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.

Influência da força da musculatura periférica no sucesso da decanulação

INTRODUCTION Tracheostomy is probably the most common surgical procedure in critically ill patients and is generally performed to facilitate mechanical ventilation weaning. Evidence-based guidelines have confirmed the benefits of tracheostomy weaning protocols and of the physiotherapists engagement in this process; however, no consensus decannulation criteria are currently available. Therefore, this study aimed to evaluate the influence of peripheral muscle strength and other indicators on decannulation success. METHODS This was an observational retrospective study that analyzed the medical records of patients admitted to the medical and surgical intensive care unit of Hospital Agamenon Magalhães between March 2007 and August 2009. Respiratory and peripheral muscle strengths were evaluated in decannulated patients. RESULTS Overall, 1,541 patients were evaluated, 143 of which had been tracheostomized, and only 57 of which had been decannulated. Forty-six patients had a satisfactory decannulation outcome, while 11 had decannulation failure, requiring the return to an artificial airway within 2 weeks. The calculated Medical Research Council peripheral muscle strength score was significantly lower for the failure group than for the successful decannulation group (28.33 ± 15.31 vs. 41.11 ± 11.52; P = 0.04). Scores above or equal 26 had 94.4% sensitivity and 50.0% specificity for the decannulation outcome, with an area under the ROC curve of 0.7593. In addition, white blood cell counts were higher in decannulation failure group patients (14,070 ± 3,073 vs. 10,520 ± 3,402 cells/μL; P = 0.00). CONCLUSION This study has shown that peripheral muscle strength and blood leucocyte counts evaluated on the day of decannulation may influence the tracheostomy decannulation success rate.

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.

Effects of electrical muscle stimulation early in the quadriceps and tibialis anterior muscle of critically ill patients

Abstract Background: Electrical muscle stimulation (EMS) is applied to critically ill patients in order to improve their muscle strength, thereby preventing hypotrophy and promoting functional recovery. Objective: To assess the effects of early EMS on the range of movement of the ankle joint, and on thigh and leg circumference in critically ill patients. Methods: This is a prospective randomized clinical trial comprising 11 patients undergoing mechanical ventilation. Before and after EMS the thigh and leg circumference in both lower limbs and the goniometry of the tibiotarsal joint were measured. The angle of 90° on the goniometer was taken as the standard neutral position (NP), with the arm fixed on the lateral malleolus of the ankle joint. Other measurements, namely dorsiflexion and plantar flexion, referred to as mobile arm, were taken from the NP. These recordings were obtained following an active contraction of the patients’ muscles. Results: Compared with the electrostimulated limb, a difference in dorsiflexion of the control limb was observed (96.2 ± 24.9 versus 119.9 ± 14.1°; p = 0.01). A girth of 10 cm of the leg was found in limb reduction when compared to the electrostimulated one (24.7 ± 3.1 versus 26.4 ± 4.0 cm; p = 0.03). Conclusions: EMS used at low current intensity and for a short duration failed to prevent muscle atrophy in critically ill patients. However, we did find a significant improvement in active dorsiflexion of the ankle joint suggesting that it could help to prevent against stance plantar flexion in these patients.

Proposta de utilização da técnica de contagem como preditor da capacidade vital lenta em indivíduos hospitalizados

PURPOSE:to evaluate if there is a correlation between the slow vital capacity and the maximum phonation time by technique of counting numbers and if it is possible from the maximum phonation time estimate the slow vital capacity in hospitalized individuals.METHODS:it is a cross-sectional study, crossover and choice of techniques (technique of numerical count and spirometry) were performed randomly (simple draw). The slow vital capacity was measured by spirometry and maximum phonation time was assessed using the technique of counting numbers.RESULTS:participated in the research 221 hospitalized patients. A positive correlation was observed between the Slow vital capacity and maximum phonation time evaluated on an absolute (r = 0.75; p <0.001) and relative (r = 0.76; p <0.001). From the simple linear regression of the data, were verified equations of the lines analyzed absolutely, Slow vital capacity = 55 Technique of numerical count + 735 (r2= 0,56; p < 0,0001) and relative Slow vital capacity = 0,84 Technique of numerical count + 14 (r2= 0,57; p < 0,0001).CONCLUSIONS:the results obtained in this study showed a good correlation between the techniques evaluated, possible to estimate the Slow vital capacity from the technique of counting numbers in hospitalized individuals.

Quality of life and physical activity in intensive care professionals from middle São Francisco

OBJECTIVE The objective was to assess the level of physical activity (LPA) and the quality of life QL of the professionals who work in ICU. METHOD This was a cross-sectional study carried out in Adult ICUs. LPA was assessed by the International Questionnarie of Physical Activity--short form (IQPA-SF) and the QL by the Medical Outcomes Study 36 (SF-36) questionnaire. RESULTS It was classified active 50.89% out of a total of 59 professionals. Nursing technicians were considered the most active with 60.6%. The QL of the professionals who were considered active were better when compared to inactives, with statistical differences to the category of physical aspects limitation, social aspects and mental health. The working hours were higher than recommend, the physicians were higher than the physical therapist, nurses and technicians nurses (p = 0.046). CONCLUSION Physically active professionals who work in ICU had higher quality of life probably why have lower hours of work and consequently more free time to engage in physical activity.

Hemodynamic effects of noninvasive ventilation with facial mask in premature infants

Correspondence to: Andrezza de Lemos Bezerra – Rua do Espinheiro, 685, apto. 1602 – CEP: 52020-020 – Recife (PE) – E-mail: alemos4@gmail.com Presentation: apr. 2013 – Accepted for publication: nov. 2013 – Financial source: none – Conflict of interest: nothing to declare – Presentation at scientific event: 2 Brazilian Congress of Perinatology, November 2012 – Approval at the Ethics Committee n. 0199.0.236.000-10. ABSTRACT | Premature infants present inspiratory muscles disadvantage of their biomechanics, which predisposes to muscular fatigue and airway collapse, therefore noninvasive ventilation (NIV) is the choice expansion therapy for this population. Despite this, studies concerning the risk and beneficial effects of its application by facial mask in neonates are not available. The aim of this study was to evaluate hemodynamic variables in premature infants (PTI) submitted to NIV by facial mask, as a therapeutic resource. It is a case series study, in which 14 PTI were evaluated, with gestational age (GA) <37 weeks, both genders, according to indication of lung expansion therapy. The PTI were evaluated before, during, immediately after, 30 and 60 minutes after application of NIV, and a heart rate (HR), blood pressure (BP) and peripheral oxygen saturation (PO 2 S) were collected. It was observed a significant increase in PO 2 S when compared the moment during to the moment before the application of NIV (96.95 [94.98; 99.48] versus 99.15 [97.98; 100.00], p<0.05). Non-significant variations of HR and mean BP resulting from NIV by facial mask were observed. With the present results, it is suggested that NIV by facial mask is beneficial for the PTI, without adding hemodynamic instability.Recien nacidos prematuros presentan desventaja mecanica de los musculos inspiratorios, predisposicion a la fatiga muscular y colapso de las vias aereas. La ventilacion no invasiva (VNI) es la terapia de expansion de eleccion para esa poblacion. Mientras tanto, no existen estudios sobre la evaluacion del riesgo-beneficio de su aplicacion por mascara facial en neonatos durante la fisioterapia respiratoria. El objetivo de este estudio fue evaluar variables hemodinamicas en recien nacidos prematuros (RNPT) sometidos a la utilizacion de la VNI por mascara facial para terapia de expansion pulmonar. Se trata de un estudio casi experimental del tipo antes y despues, en que fueron evaluados 14 RNPT, con edad gestacional (IG) <37 semanas, de ambos sexos, con indicacion de terapia de expansion pulmonar. Los RNPT fueron evaluados antes, durante, inmediatamente despues de 30 e 60 minutos de la aplicacion de la VNI, habiendo sido colectados frecuencia cardiaca (FC), presion arterial (PA), presion arterial media (PAM) y saturacion periferica de oxigeno (SpO2). Fue observado un aumento significativo de la SpO2 cuando fueron comparados los momentos antes y durante la aplicacion de la VNI (96,95 [94,98; 99,48] versus 99,15 [97,98; 100,0], p<0,05). No fueron observadas variaciones significativas de la FC e PAM resultantes de la VNI por mascara facial. Con los presentes resultados, se sugiere que la VNI por mascara facial es benefica para el RN, sin promover inestabilidad hemodinamica.

Pico de fluxo expiratório e resistência do sistema respiratório de pacientes sob ventilação mecânica submetidos a duas formas de tosse manualmente assistida

OBJECTIVE Mechanical ventilation is associated with retained airway secretions. Manually assisted cough contributes to the displacement of bronchial mucus, whereas positive end-expiratory pressure increases collateral ventilation and maintains airway patency. This study aimed to assess the effects of manually assisted cough, either alone or added to increased positive end-expiratory pressure and inspiratory time (optimized manually assisted cough), on the expiratory peak flow and respiratory system mechanics in mechanically ventilated patients. METHODS In this controlled and randomized clinical trial, respiratory mechanics and expiratory peak flow were assessed in male and female patients undergoing either tracheal suctioning alone, manually assisted cough followed by tracheal suctioning or optimized manually assisted cough followed by tracheal suctioning. RESULTS Thirty-five patients completed the trial. Respiratory system resistance was significantly reduced after optimized manually assisted cough (16.0 ± 3.6 versus 12.4 ± 3.1 cmH2O/L/s; p = 0.04). The expiratory peak flow during optimized manually assisted cough was significantly higher in comparison with the values observed during manually assisted cough (112.3 ± 15.6 versus 95.8 ± 18.3 Lpm; p < 0.05). Both values were significantly higher than the values observed in the group undergoing tracheal suctioning alone (52.0 ± 7.6 Lpm; p < 0.001). CONCLUSION Optimized manually assisted cough increases the expiratory peak flow in comparison with manually assisted cough; in addition, this procedure reduces respiratory system resistance.

Qualidade de vida e atividade física em profi ssionais de terapia intensiva do sub médio São Francisco

OBJECTIVE The objective was to assess the level of physical activity (LPA) and the quality of life QL of the professionals who work in ICU. METHOD This was a cross-sectional study carried out in Adult ICUs. LPA was assessed by the International Questionnarie of Physical Activity--short form (IQPA-SF) and the QL by the Medical Outcomes Study 36 (SF-36) questionnaire. RESULTS It was classified active 50.89% out of a total of 59 professionals. Nursing technicians were considered the most active with 60.6%. The QL of the professionals who were considered active were better when compared to inactives, with statistical differences to the category of physical aspects limitation, social aspects and mental health. The working hours were higher than recommend, the physicians were higher than the physical therapist, nurses and technicians nurses (p = 0.046). CONCLUSION Physically active professionals who work in ICU had higher quality of life probably why have lower hours of work and consequently more free time to engage in physical activity.