Renata dos Santos Vasconcelos

Influences of Duration of Inspiratory Effort, Respiratory Mechanics, and Ventilator Type on Asynchrony With Pressure Support and Proportional Assist Ventilation

BACKGROUND: Pressure support ventilation (PSV) is often associated with patient-ventilator asynchrony. Proportional assist ventilation (PAV) offers inspiratory assistance proportional to patient effort, minimizing patient-ventilator asynchrony. The objective of this study was to evaluate the influence of respiratory mechanics and patient effort on patient-ventilator asynchrony during PSV and PAV plus (PAV+). METHODS: We used a mechanical lung simulator and studied 3 respiratory mechanics profiles (normal, obstructive, and restrictive), with variations in the duration of inspiratory effort: 0.5, 1.0, 1.5, and 2.0 s. The Auto-Trak system was studied in ventilators when available. Outcome measures included inspiratory trigger delay, expiratory trigger asynchrony, and tidal volume (VT). RESULTS: Inspiratory trigger delay was greater in the obstructive respiratory mechanics profile and greatest with a effort of 2.0 s (160 ms); cycling asynchrony, particularly delayed cycling, was common in the obstructive profile, whereas the restrictive profile was associated with premature cycling. In comparison with PSV, PAV+ improved patient-ventilator synchrony, with a shorter triggering delay (28 ms vs 116 ms) and no cycling asynchrony in the restrictive profile. VT was lower with PAV+ than with PSV (630 mL vs 837 mL), as it was with the single-limb circuit ventilator (570 mL vs 837 mL). PAV+ mode was associated with longer cycling delays than were the other ventilation modes, especially for the obstructive profile and higher effort values. Auto-Trak eliminated automatic triggering. CONCLUSIONS: Mechanical ventilation asynchrony was influenced by effort, respiratory mechanics, ventilator type, and ventilation mode. In PSV mode, delayed cycling was associated with shorter effort in obstructive respiratory mechanics profiles, whereas premature cycling was more common with longer effort and a restrictive profile. PAV+ prevented premature cycling but not delayed cycling, especially in obstructive respiratory mechanics profiles, and it was associated with a lower VT.

Avaliação neurofuncional em pacientes com hanseníase

Objective: To investigate neurofunctional alterations in patients affected by leprosy, also searching to identify their socioeconomic and clinical profile. Methods: Cross-sectional study with 51 adult patients diagnosed with leprosy, regardless of gender, conducted in a reference center in 2010, in which the simplified neurofunctional evaluation form and a questionnaire (socioeconomic and clinical data) were applied. Findings were presented in a descriptive approach. Results: The study found a mean age of 46.4 ± 14.9 years, 32 (62.7%) patients of male sex, 32 (62.7%) with incomplete elementary school and 37 (72.5%) with family income between 1 and 3 minimum wages. The mean time of treatment was 14.4 ± 15.63 months. The multibacillary type of leprosy predominated (n=18/35.3%) with tuberculoid form (n=11/21.6%). The interphalangeal joints of upper and lower limbs were compromised in 5 (9.8%) and 6 (11.7%) patients, respectively. The most affected nerves were the posterior tibial in 19 (37.3%), the ulnar in 17 (33.3%), and the common fibular in 13 (25.5%) patients. The muscles with deficit were the extensor hallucis (n=8/15.7%), the toe extensors (n=6/11.8%) and the 5o finger abductor (n=6/11.8%). It was observed that 35 patients (68.6%) presented sensitive alterations in lower limbs and 14 (27.5%) presented functional incapacity degree 1. Conclusion: The study highlighted the socioeconomic profile of leprosy patients as men, low educational level and income, with multibacillary operational classification showing tuberculoid clinical form. In the neurofunctional assessment, there were sensory changes with higher incidence than the motor alterations, as well as discreet presence of deformities and high degree of functional disability. doi:10.5020/18061230.2014.p247

Estratégia dE Educação continuada na árEa dE rEabilitação cardíaca

O programa de reabilitacao cardiovascular consiste nas atividades multiprofissionais necessarias para garantir aos cardiopatas melhores condicoes biopsicossociais. O presente estudo trata-se de um relato de experiencia da pratica assistencial desenvolvido entre marco a maio de 2011, com 12 profissionais em um hospital escola de nivel terciario na cidade de Fortaleza-Ce e que descreve a estrategia utilizada para realizacao de acoes de educacao continuada. Foram realizadas 6 atividades para delinear protocolos de atendimento e revisao dos temas especificos. Baseou-se nas experiencias do cotidiano das equipes. Alguns temas foram organizados por categoria profissional e outros em conjuntas. Implantar processos de Educacao Permanente e fundamental para qualificacao do servico.

OCORRÊNCIA DE DOR NA COLUNA VERTEBRAL E SUA RELAÇÃO COM A QUALIDADE DE VIDA DE MANICURES E PEDICURES

Objective: To analyze the occurrence of spine column pain in manicures/pedicures and verify its relationship with quality of life. Methods: A quantitative and descriptive crosssectional research conducted from February to June 2010 with 30 professionals aged between 18 and 45 years and with at least one year of work experience. After selection, two questionnaires were applied: the SF-36 and another developed by the researchers with questions related to occupation (working hours and length of service), occurrence of pain and its characteristics (location, type, frequency and intensity). Results: Of the 30 participants, 76.7% (n=23) reported pain, with 63.3% (n=19) occurrence in the lumbar spine and 46.7% (n=14) occurrence of chronic type (lasting more than 6 months). A total of 36.7% (n=11) of interviewees reported daily pain with an average intensity of 6.1+2.24. Age and length of service rates were higher in the group of people who felt pain (34.2+6.80 and 12.3+6.39 years respectively). Regarding the quality of life in the group of people who did not feel pain, the domains “functional capacity”, “pain” and “general health status” had higher scores when compared to the group of people who felt pain (p<0.05). Conclusion: It was detected a high occurrence of spinal column pain among manicures / pedicures, especially in the lumbar spine, leading to functional limitations, and a consequent change in quality of life. doi:10.5020/18061230.2013.p318

Programa de fisioterapia geriátrica como promotor de saúde e qualidade de vida

OBJETIVO: Identificar os beneficios de um programa de fisioterapia geriatrica na promocao de saude e na qualidade de vida de idosos. METODOS: Trata-se de um estudo de carater descritivo, exploratorio e longitudinal. A amostra do estudo foi composta por 12 idosos participantes de um programa de reabilitacao em um periodo superior a tres meses. Utilizou-se um questionario de avaliacao elaborado pelo pesquisador e a escala de Atividade da Vida Diaria (AVD) aplicado de forma individual, constando de perguntas objetivas e subjetivas a cerca de identificacao, aspectos gerais, atividades da vida diaria e do programa de fisioterapia. As variaveis analisadas foram: perfil epidemiologico, qualidade de vida, patologias, nivel de saude, relacao entre o uso de farmacos e o tempo no programa. RESULTADOS: O perfil epidemiologico apontou que a populacao investigada e composta em sua maioria de idosos (66,6% - n=8) do sexo feminino, 50% (n=6) eram casados e que 100% (n=12) faziam uso de mais de um tipo de medicamento e apresentaram patologias associadas ao envelhecimento, alem de algumas limitacoes nas atividades de vida diaria. Apos a entrada no programa de fisioterapia geriatrica, 41,6% (n=5) da amostra deixaram de fazer uso de medicamentos. CONCLUSOES: Apos a entrada no programa, observou-se melhora nas funcoes vitais, maior adesao na realizacao de exercicios fisicos regulares e diminuicao no uso de medicamentos, com repercussao direta na autoestima e na qualidade de vida. Portanto, pode-se observar a importância da fisioterapia para a prevencao e manutencao das AVDs, bem como para a melhoria da qualidade de vida.

Qualidade de vida (QV) e aspectos clínicos de pacientes com síndrome da apneia obstrutiva do sono (SAOS) em tratamento com pressão positiva contínua nas vias aéreas (CPAP)

OBJETIVO: Analisar a qualidade de vida (QV) e a escala de sonolencia dos pacientes com sindrome da apneia obstrutiva do sono (SAOS) em tratamento com pressao positiva continua nas vias aereas (CPAP). METODOS: Realizou-se um estudo transversal, no Centro do Estudo do Sono de Fortaleza (CESF), de agosto de 2011 a abril de 2012. Participaram 33 usuarios de CPAP com SAOS, independentes do sexo, e adultos ou idosos. Aplicaram-se tres instrumentos de coleta: questionario sobre a QV; dados demograficos e clinicos e a escala de sonolencia de Epworth (ESE). RESULTADOS: Os participantes tinham idade media de 58,03 ± 11,83 anos, dos quais 19 (69,21%) acima de 60 anos; 25 (75,8%) do sexo masculino; e 27 (81,8%) com alguma comorbidade. Sobre o CPAP, 19 (57,6%) utilizaram por mais de 12 meses; 31 (93,9%) faziam uso do automatico; e com media de pressao de 11,40 ± 3,48 cmH 2 O. Na QV, todos os dominios tiveram pontuacoes acima de 70, com maiores escores para aspecto social e a limitacao por aspecto fisico. Na ESE foi encontrado pontuacao de 7,64 ± 3,81. O sexo masculino e a faixa etaria abaixo de 60 anos apresentaram maiores pontuacoes da QV e menor pontuacao na sonolencia diurna (ESE), porem nao se constatou influencia do tempo de uso do CPAP. CONCLUSOES: Diante desses achados, ressalta-se a importância da prescricao e aplicacao do CPAP para melhoria das condicoes clinicas da SAOS, como a sonolencia diurna, e as repercussoes beneficas na QV desses pacientes.