Graziella França Bernardelli

Short-term transcutaneous electrical nerve stimulation after cardiac surgery: effect on pain, pulmonary function and electrical muscle activity

This study aimed to evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) for treatment of postoperative pain in patients who underwent cardiac surgery. In addition, we sought to determine whether TENS would be related to improved pulmonary function and muscle electrical activity in this patient population. Forty-five patients, 32 males and 13 females, aged 41-74 years were randomly allocated to receive TENS (n=23) or sham treatment (n=22) during 4 h on the third postoperative day. A 0-10 visual analogic scale was used to assess pain; lung function was evaluated by spirometry and surface electromyography (n=10 in each group) was used to quantify electrically-induced muscle activity (trapezius and pectoralis major). TENS was associated with significant reductions on spontaneous and cough-induced postoperative pain as compared to sham (P<0.05). There was also improvement in chest wall-pulmonary mechanics after TENS with proportional increases in tidal volume and vital capacity (P<0.05). In addition, electrical activity of both muscle groups was enhanced after TENS, but not post sham (P<0.05). TENS is a valuable strategy to alleviate postoperative pain following cardiac surgery with positive effects on pulmonary ventilatory function and electrical activity of thoracic and girdle muscles.

Estimulação elétrica nervosa transcutânea de curta duração no pós-operatório de cirurgia cardíaca

BACKGROUND: Respiratory muscle strength has been related to the postoperative outcome of cardiac surgeries. The main documented therapeutic purpose of transcutaneous electrical nerve stimulation (TENS) is the reduction of pain, which could bring secondary benefits to the respiratory muscles and, consequently, to lung capacities and volumes. OBJECTIVES: The objective of the present study was to evaluate the effectiveness of short-duration transcutaneous electrical nerve stimulation (TENS) in the reduction of pain and its possible influence on respiratory muscle strength and lung capacity and volumes of patients in the postoperative period of cardiac surgery. METHODS: Twenty five patients with mean age of 59.9 ± 10.3 years, of whom 72% were men, and homogeneous as regards weight and height, were randomly assigned to two groups. One group received therapeutic TENS (n = 13) and the other, placebo TENS (n = 12), for four hours on the third postoperative day of cardiac surgery. Pain was analyzed by means of a visual analogue scale, and of respiratory muscle strength as measured by maximum respiratory pressures and lung capacity and volumes before and after application of TENS. RESULTS: Short-duration TENS significantly reduced pain of patients in the postoperative period (p < 0.001). Respiratory muscle strength (p < 0.001), tidal volume (p < 0.001) and vital capacity (p < 0.05) significantly improved after therapeutic TENS, unlike in the placebo group. CONCLUSION: Short-duration TENS proved effective for the reduction of pain and improvement of respiratory muscle strength, as well as of lung volumes and capacity. (Arq Bras Cardiol 2010; 94(3):325-331)

Avaliação da segurança do teste de caminhada dos 6 minutos em pacientes no pré-transplante cardíaco

FUNDAMENTO: El test de marcha de 6 minutos (TM6m) ha sido utilizado como forma de evaluacion de la capacidad funcional, del estadiamiento clinico y el pronostico cardiovascular. La seguridad y el impacto metabolico son poco descritos en la literatura, principalmente en pacientes con insuficiencia cardiaca severa e indicacion clinica para transplante cardiovascular Objetivo: Evaluar la ocurrencia de arritmias y alteraciones cardiovasculares durante el TM6m. Correlacionar el desempeno en el TM6m con el estadiamiento clinico y el pronostico cardiovascular. METODOS: Un total de 12 pacientes, 10 varones, con edad de 52 ± 8 anos, fueron sometidos a evaluacion inicial. Realizaron el TM6m con monitoreo electrocardiografico por telemetria, senales vitales y lactato. Se siguieron a los individuos por 12 meses. RESULTADOS: Los pacientes recorrieron 399,4 ± 122,5 (D, m), alcanzando un esfuerzo percibido (EP) de 14,3 ± 1,5 y variacion del 34% en la frecuencia cardiaca basal. Dos pacientes presentaron arritmia de mayor severidad pre-TM6m y no mostraron empeoramiento ante el esfuerzo; cuatro tuvieron elevacion significativa en los niveles de lactato sanguineo (>5 mmol/dl), y tres interrumpieron el examen. La distancia recorrida evidencio correlacion con la fraccion de eyeccion (%) y la clasificacion funcional (NYHA). Tras 12 meses de seguimiento, tres pacientes murieron, y siete se reinternaron por descompensacion cardiaca. La relacion (D/EP) y frecuencia cardiaca de recuperacion en el segundo minuto (FCR2, lpm) fueron inferiores en el grupo obito. CONCLUSION: El comportamiento clinico y electrocardiografico sugiere que el metodo es seguro, pero se puede considerarlo de alta intensidad para algunos pacientes con insuficiencia cardiaca severa. Variables relacionadas al desempeno en el TM6m pueden estar asociadas con la mortalidad en el seguimiento de un ano.BACKGROUND The 6-minute walk test (6WT) has been used as a means of assessment of the functional capacity, clinical staging and cardiovascular prognosis. Its safety and metabolic impact have not been frequently described in the literature, especially in patients with severe heart failure with clinical indication for cardiovascular transplantation. OBJECTIVE To evaluate the occurrence of arrhythmias and cardiovascular changes during 6WT. To correlate 6WT performance with clinical staging and cardiovascular prognosis. METHODS Twelve patients, 10 of whom males, aged 52 +/- 8 years were evaluated at baseline. 6WT was performed with telemetry electrocardiography, vital signs and lactate monitoring. The patients were followed-up for 12 months. RESULTS The patients walked 399.4+/-122.5 (D, m), reaching a perceived exertion (PE) of 14.3+/-1.5 and a 34% baseline heart rate variation. Two patients presented more severe pre-6WT arrhythmia which did not worsen with the exercise, four patients presented a significant increase of blood lactate levels (>5 mmol/dl), and three interrupted the test. The distance walked correlated with the ejection fraction (%) and functional class (NYHA). After 12-month follow-up, three patients died and seven were rehospitalized for cardiac decompensation. The D/PE ratio and 2-minute heart rate recovery (HRR2, bpm) were lower in the death group. CONCLUSION The clinical and electrocardiographic behaviors suggest that the method is safe, but it may be considered too strenuous for some patients with severe heart failure. Variables related to 6WT performance may be associated with the one-year follow-up mortality.

Analysis of 6-minute walk test safety in pre-heart transplantation patients

FUNDAMENTO: El test de marcha de 6 minutos (TM6m) ha sido utilizado como forma de evaluacion de la capacidad funcional, del estadiamiento clinico y el pronostico cardiovascular. La seguridad y el impacto metabolico son poco descritos en la literatura, principalmente en pacientes con insuficiencia cardiaca severa e indicacion clinica para transplante cardiovascular Objetivo: Evaluar la ocurrencia de arritmias y alteraciones cardiovasculares durante el TM6m. Correlacionar el desempeno en el TM6m con el estadiamiento clinico y el pronostico cardiovascular. METODOS: Un total de 12 pacientes, 10 varones, con edad de 52 ± 8 anos, fueron sometidos a evaluacion inicial. Realizaron el TM6m con monitoreo electrocardiografico por telemetria, senales vitales y lactato. Se siguieron a los individuos por 12 meses. RESULTADOS: Los pacientes recorrieron 399,4 ± 122,5 (D, m), alcanzando un esfuerzo percibido (EP) de 14,3 ± 1,5 y variacion del 34% en la frecuencia cardiaca basal. Dos pacientes presentaron arritmia de mayor severidad pre-TM6m y no mostraron empeoramiento ante el esfuerzo; cuatro tuvieron elevacion significativa en los niveles de lactato sanguineo (>5 mmol/dl), y tres interrumpieron el examen. La distancia recorrida evidencio correlacion con la fraccion de eyeccion (%) y la clasificacion funcional (NYHA). Tras 12 meses de seguimiento, tres pacientes murieron, y siete se reinternaron por descompensacion cardiaca. La relacion (D/EP) y frecuencia cardiaca de recuperacion en el segundo minuto (FCR2, lpm) fueron inferiores en el grupo obito. CONCLUSION: El comportamiento clinico y electrocardiografico sugiere que el metodo es seguro, pero se puede considerarlo de alta intensidad para algunos pacientes con insuficiencia cardiaca severa. Variables relacionadas al desempeno en el TM6m pueden estar asociadas con la mortalidad en el seguimiento de un ano.BACKGROUND The 6-minute walk test (6WT) has been used as a means of assessment of the functional capacity, clinical staging and cardiovascular prognosis. Its safety and metabolic impact have not been frequently described in the literature, especially in patients with severe heart failure with clinical indication for cardiovascular transplantation. OBJECTIVE To evaluate the occurrence of arrhythmias and cardiovascular changes during 6WT. To correlate 6WT performance with clinical staging and cardiovascular prognosis. METHODS Twelve patients, 10 of whom males, aged 52 +/- 8 years were evaluated at baseline. 6WT was performed with telemetry electrocardiography, vital signs and lactate monitoring. The patients were followed-up for 12 months. RESULTS The patients walked 399.4+/-122.5 (D, m), reaching a perceived exertion (PE) of 14.3+/-1.5 and a 34% baseline heart rate variation. Two patients presented more severe pre-6WT arrhythmia which did not worsen with the exercise, four patients presented a significant increase of blood lactate levels (>5 mmol/dl), and three interrupted the test. The distance walked correlated with the ejection fraction (%) and functional class (NYHA). After 12-month follow-up, three patients died and seven were rehospitalized for cardiac decompensation. The D/PE ratio and 2-minute heart rate recovery (HRR2, bpm) were lower in the death group. CONCLUSION The clinical and electrocardiographic behaviors suggest that the method is safe, but it may be considered too strenuous for some patients with severe heart failure. Variables related to 6WT performance may be associated with the one-year follow-up mortality.

Evaluación de la seguridad de la test de marcha de 6 minutos en pacientes en el pre-transplante cardiaco

FUNDAMENTO: El test de marcha de 6 minutos (TM6m) ha sido utilizado como forma de evaluacion de la capacidad funcional, del estadiamiento clinico y el pronostico cardiovascular. La seguridad y el impacto metabolico son poco descritos en la literatura, principalmente en pacientes con insuficiencia cardiaca severa e indicacion clinica para transplante cardiovascular Objetivo: Evaluar la ocurrencia de arritmias y alteraciones cardiovasculares durante el TM6m. Correlacionar el desempeno en el TM6m con el estadiamiento clinico y el pronostico cardiovascular. METODOS: Un total de 12 pacientes, 10 varones, con edad de 52 ± 8 anos, fueron sometidos a evaluacion inicial. Realizaron el TM6m con monitoreo electrocardiografico por telemetria, senales vitales y lactato. Se siguieron a los individuos por 12 meses. RESULTADOS: Los pacientes recorrieron 399,4 ± 122,5 (D, m), alcanzando un esfuerzo percibido (EP) de 14,3 ± 1,5 y variacion del 34% en la frecuencia cardiaca basal. Dos pacientes presentaron arritmia de mayor severidad pre-TM6m y no mostraron empeoramiento ante el esfuerzo; cuatro tuvieron elevacion significativa en los niveles de lactato sanguineo (>5 mmol/dl), y tres interrumpieron el examen. La distancia recorrida evidencio correlacion con la fraccion de eyeccion (%) y la clasificacion funcional (NYHA). Tras 12 meses de seguimiento, tres pacientes murieron, y siete se reinternaron por descompensacion cardiaca. La relacion (D/EP) y frecuencia cardiaca de recuperacion en el segundo minuto (FCR2, lpm) fueron inferiores en el grupo obito. CONCLUSION: El comportamiento clinico y electrocardiografico sugiere que el metodo es seguro, pero se puede considerarlo de alta intensidad para algunos pacientes con insuficiencia cardiaca severa. Variables relacionadas al desempeno en el TM6m pueden estar asociadas con la mortalidad en el seguimiento de un ano.BACKGROUND The 6-minute walk test (6WT) has been used as a means of assessment of the functional capacity, clinical staging and cardiovascular prognosis. Its safety and metabolic impact have not been frequently described in the literature, especially in patients with severe heart failure with clinical indication for cardiovascular transplantation. OBJECTIVE To evaluate the occurrence of arrhythmias and cardiovascular changes during 6WT. To correlate 6WT performance with clinical staging and cardiovascular prognosis. METHODS Twelve patients, 10 of whom males, aged 52 +/- 8 years were evaluated at baseline. 6WT was performed with telemetry electrocardiography, vital signs and lactate monitoring. The patients were followed-up for 12 months. RESULTS The patients walked 399.4+/-122.5 (D, m), reaching a perceived exertion (PE) of 14.3+/-1.5 and a 34% baseline heart rate variation. Two patients presented more severe pre-6WT arrhythmia which did not worsen with the exercise, four patients presented a significant increase of blood lactate levels (>5 mmol/dl), and three interrupted the test. The distance walked correlated with the ejection fraction (%) and functional class (NYHA). After 12-month follow-up, three patients died and seven were rehospitalized for cardiac decompensation. The D/PE ratio and 2-minute heart rate recovery (HRR2, bpm) were lower in the death group. CONCLUSION The clinical and electrocardiographic behaviors suggest that the method is safe, but it may be considered too strenuous for some patients with severe heart failure. Variables related to 6WT performance may be associated with the one-year follow-up mortality.