Marco Aurélio de V. Correia Junior

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.

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.

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.

Exercise-Induced Bronchospasm in Soccer Athletes Living in a Tropical Humid Region

Background: Exercise-induced bronchospasm (EIB) is frequent in asthmatic athletes and, although less prevalent, also occurs in non-asthmatic ones. Breathing warm-humid air reduces this phenomenon.Objective: To evaluate EIB prevalence in semi-professional soccer athletes from a tropical humid region.Methods: We included athletes from a soccer team from the city of Recife-Brazil. A history of asthma or respiratory symptoms after exercise, demographic data and baseline FEV1 measurements were obtained. Thereafter, each athlete performed a standardized free field running to achieve 85% to 95% of the maximum calculated heart rate for the last 6 minutes of a total running time of 8 to 10 minutes. FEV1 was measured again at 5, 10, 15 and 30 minutes after exercise and EIB was defined as a reduction ≥ 10% from basal values in two consecutive time points. Results: Fifty-four male athletes aged between 13 and 21 years were evaluated. All denied exercise associated respiratory symptoms. Mean temperature and air humidity were 30.2°C ± 2.7°C and 82.1% ± 2.9%, respectively. EIB was found in two (7%) athletes (with a fall in FEV1 from baseline of 23.3% and 22.6%), none with history of asthma symptoms. Two other athletes had a history of asthma symptoms in childhood but no decrease in FEV1. Conclusion: The studied population of semi-professional soccer athletes with no exercise associated respiratory complaints showed a low BIE prevalence (7%). It may be necessary to perform the challenge with the athlete breathing dry air in those that also play in more dry and cold climates.

Acute Effect of Neuromuscular Electrical Stimulation on Oxidative Stress and Hematological Parameters in Critical Patients

Aims: To analyze oxidative cellular stress and monitor the evolution of hematological parameters before and after of neuromuscular electrical stimulation (NMES) in critically ill patients. Methods: A controlled and randomized clinical trial, composed of a sample of 19 patients, admitted to the Agamenon Magalhaes Hospital intensive care unit. The patients were divided into two groups: NMES group (n=9), patients that underwent only one NMES in the quadriceps muscle for 20 min, and the other, control group (n=10) that did undergo any therapeutic intervention. Results: In relation to the demographic and clinical variables, the groups were homogeneous at the beginning of the study. For the nitric oxide (NO) analysis, we perceived a reduction, when comparing the before and after analyses, in NO in the stimulated cell (p=0.0188) and non-stimulated cell (p=0.0258) in the NMES group. Also in relation to NO, when comparing the two groups, we observed a significant reduction in the NMES group compared to the control one. For the hematological parameters we did not observe any difference when comparing before and after in the two groups studied. Conclusion: We can conclude that the use of NMES causes a reduction in cellular NO levels, showing the beneficial effects in reducing oxidative stress. With relation to complete blood count, we observed that its application was not able to causes any alterations.

Oxidative stress and immune system analysis after cycle ergometer use in critical patients

OBJECTIVE: The passive cycle ergometer aims to prevent hypotrophy and improve muscle strength, with a consequent reduction in hospitalization time in the intensive care unit and functional improvement. However, its effects on oxidative stress and immune system parameters remain unknown. The aim of this study is to analyze the effects of a passive cycle ergometer on the immune system and oxidative stress in critical patients. METHODS: This paper describes a randomized controlled trial in a sample of 19 patients of both genders who were on mechanical ventilation and hospitalized in the intensive care unit of the Hospital Agamenom Magalhães. The patients were divided into two groups: one group underwent cycle ergometer passive exercise for 30 cycles/min on the lower limbs for 20 minutes; the other group did not undergo any therapeutic intervention during the study and served as the control group. A total of 20 ml of blood was analysed, in which nitric oxide levels and some specific inflammatory cytokines (tumour necrosis factor alpha (TNF-α), interferon gamma (IFN-γ) and interleukins 6 (IL-6) and 10 (IL-10)) were evaluated before and after the study protocol. RESULTS: Regarding the demographic and clinical variables, the groups were homogeneous in the early phases of the study. The nitric oxide analysis revealed a reduction in nitric oxide variation in stimulated cells (p=0.0021) and those stimulated (p=0.0076) after passive cycle ergometer use compared to the control group. No differences in the evaluated inflammatory cytokines were observed between the two groups. CONCLUSION: We can conclude that the passive cycle ergometer promoted reduced levels of nitric oxide, showing beneficial effects on oxidative stress reduction. As assessed by inflammatory cytokines, the treatment was not associated with changes in the immune system. However, further research in a larger population is necessary for more conclusive results.

Overweight effect on spirometric parameters in adolescents undergoing exercise

ABSTRACT Objective To evaluate effects of overweight on spirometric parameters in adolescents who underwent bronchial provocation test for exercise. Methods We included 71 male adolescents. The diagnosis of asthma was done based on participants’ clinical history and on the International Study Questionnaire Asthma and Allergies in Childhood, and the diagnosis of obesity was based on body mass index above 95th percentile. The bronchospasm induced by exercise was assessed using the run-walk test on a treadmill for eight minutes. The decrease in forced expiratory volume in one second > or equal to 10% before exercise was considered positive, and to calculate the intensity in exercise-induced bronchospasm we measured the maximum percentage of forced expiratory volume in one second and above the curve area. Data analysis was carried out using the Mann-Whitney U test and Friedman test (ANOVA), followed by Wilcoxon test (p<0.05). In addition, we used Fisher’s exact test to analyze the exercise-induced bronchospasm frequency. Results Significant differences were observed among obese adolescents in exercise-induced bronchospasm frequency (p=0,013) and in relation to time required for recovery after exercise (p=0,007). Conclusion Overweight can influence the increase in the exercise-induced bronchospasm frequency in non-asthmatic adolescents compared with eutrophic adolescents.

Descrição da atividade física e da jornada de trabalho na qualidade de vida de profissionais de terapia intensiva: Comparação entre um grande centro urbano e uma cidade do interior brasileiro

O objetivo deste estudo foi comparar a qualidade de vida dos diversos profissionais que trabalham em terapia intensiva considerando o nivel de atividade fisica, a jornada de trabalho e o local de residencia. Trata-se de um estudo transversal realizado em quatro Unidades de Terapia Intensiva de uma capital brasileira e em tres de uma regiao interiorana do sertao brasileiro. O nivel de atividade fisica foi avaliado pelo IPAQ versao curta e a qualidade de vida foi analisada mediante o questionario SF-36, ambos aplicados em forma de entrevista. Participaram do estudo 280 profissionais medicos, enfermeiros, fisioterapeutas e tecnicos de enfermagem. Embora tenha sido observado que a maior parte dos profissionais apresentou elevada jornada de trabalho, este fator nao influenciou na qualidade de vida. Os individuos ativos apresentaram melhores escores nos dominios referentes a limitacao por aspectos fisicos (p = 0,010); aspecto social (p = 0,043) e saude mental (p = 0,014). Profissionais com elevada jornada de trabalho e que se mantinham ativos apresentaram melhor escore do dominio capacidade vital em relacao aos individuos inativos (p = 0,028). Os profissionais residentes no interior apresentaram maior escore para o dominio saude mental (p = 0,034). O nivel de atividade fisica foi a variavel que mais influenciou nos escores de qualidade de vida e garantiu aos profissionais que trabalham em regime elevado melhor escore no dominio capacidade vital.