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Souza JA, Pasqualoto AS, Cielo CA, Andriollo DB, Moraes DAO. Can We Use the Maximum Phonation Time as a Screening of Pulmonary Forced Vital Capacity in Post-COVID-19 Syndrome Patients? J Voice 2024:S0892-1997(24)00118-8. [PMID: 38649315 DOI: 10.1016/j.jvoice.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/30/2024] [Accepted: 04/01/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To verify the accuracy of the maximum phonation time of the vowel /a/ (MPT/a/), fricative /s/ (MPT/s/), number counting (MPTC), and number reached in this count (CN) to estimate forced vital capacity (FVC) in patients with post-COVID-19 syndrome. METHOD Cross-sectional study involving adult patients, who were admitted to the intensive care unit and referred to the Post-COVID-19 Rehabilitation Outpatient Clinic. Voice function was assessed using a Vocal Handicap Index (VHI) self-assessment questionnaire and MPT tests. To perform the phonatory tests, the patients remained in a standing posture and were instructed to inhale as much air as possible and, during a single exhalation, at usual pitch and loudness, sustain the emission of /a/ and /s/; and in another breath, to perform the ascending numerical count, starting from the number one up to the highest number they could reach. Pulmonary function was assessed by spirometry. The receiver operating characteristic (ROC) curve was plotted, and FVC values lower than the normal limit by Z-score (fifth percentile) were classified as impaired lung function. The predictive values and likelihood ratios were calculated. RESULTS A total of 70 patients participated, with 20-30% having a high VHI. Approximately 24% had an FVC impairment and significantly low values of MPT/a/, MPT/s/, MPTC, and CN. The test results showed overall accuracy of 70% and the cutoff points of 9.69, 6.78, 10.60, and 13, respectively, with high sensitivity, predictive negative value and low specificity, predictive positive value, and positive likelihood ratio. CONCLUSIONS Our results suggest that the MPT has moderate discriminatory power for FVC impairment, indicating that it is not a reliable indicator of pulmonary function in the population studied. Therefore, in patients with an MPT of less than 10.60 seconds, or a CN lower than 13, other criteria should be added to improve the diagnostic accuracy and support the decision to perform more complex investigations.
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Affiliation(s)
- Juliana Alves Souza
- Department of Speech, Hearing and Language Sciences and Postgraduate Program in Human Communication Disorders, Voice Laboratory of he Universidade Federal de Santa Maria (UFSM), Santa Maria, Brazil.
| | - Adriane Schmidt Pasqualoto
- Department of Speech, Hearing and Language Sciences and Postgraduate Program in Human Communication Disorders, Voice Laboratory of he Universidade Federal de Santa Maria (UFSM), Santa Maria, Brazil; Department of Physiotherapy and Postgraduate Program in Human Communication Disorders at Universidade Federal de Santa Maria (UFSM), Santa Maria, Brazil
| | - Carla Aparecida Cielo
- Department of Speech, Hearing and Language Sciences and Postgraduate Program in Human Communication Disorders, Voice Laboratory of he Universidade Federal de Santa Maria (UFSM), Santa Maria, Brazil
| | - Débora Bonesso Andriollo
- Department of Speech, Hearing and Language Sciences and Postgraduate Program in Human Communication Disorders, Voice Laboratory of he Universidade Federal de Santa Maria (UFSM), Santa Maria, Brazil
| | - Denis Altieri Oliveira Moraes
- Department of Speech, Hearing and Language Sciences and Postgraduate Program in Human Communication Disorders, Voice Laboratory of he Universidade Federal de Santa Maria (UFSM), Santa Maria, Brazil; Departament of Statistics and Postgraduate Program in Human Communication Disorders at Universidade Federal de Santa Maria (UFSM), Santa Maria, Brazil
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Delmondes GMB, Couto NFS, Correia Junior MGA, Bonifácio ABDS, Freitas Dias RD, Bezerra J, Santos MADM, Gomes de Barros MV, Costa EC, Correia Junior MADV. Single breath counting technique to assess pulmonary function: a systematic review and meta-analysis. J Breath Res 2023; 18:014001. [PMID: 37875103 DOI: 10.1088/1752-7163/ad0647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/24/2023] [Indexed: 10/26/2023]
Abstract
Pulmonary function is usually assessed by measuring Vital Capacity (VC) using equipment such as a spirometer or ventilometer, but these are not always available to the population, as they are relatively expensive tests, difficult to transport and require trained professionals. However, the single breath counting technique (SBCT) appears as a possible alternative to respiratory function tests, to help in the pathophysiological understanding of lung diseases. The objective is to verify the applicability of the SBCT as a parameter for evaluating VC. This is a systematic review registered in the International Prospective Register of Systematic Reviews (CRD42023383706) and used for PubMed®, Scientific Electronic Library Online, LILACS, EMBASE, and Web of Science databases of articles published until January 2023. Methodological quality regarding the risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 and National Institutes of Health tools. Eleven of a total of 574 studies were included, of these, nine showed a correlation between VC and SBCT (weak in healthy, moderate in neuromuscular and strong in hospitalized patients). One study of hospitalized patients accurately identified a count value of 21 for a VC of 20 ml kg-1(Sensitivity = 94% and Specificity = 77%), and another estimated a count lower than 41 for a VC below 80% of predicted in patients with neuromuscular dystrophy (Sensitivity = 89% and Specificity = 62%), and another showed good intra and inter-examiner reproducibility in young, adult, and elderly populations. A meta-analysis of three studies showed a moderate correlation in subjects with neuromuscular diseases (r= 0.62, 95% CI = 0.52-0.71,p< 0.01). A high risk of bias was identified regarding the justification of the sample size and blinding of the evaluators. SBCT has been presented as an alternative to assess VC in the absence of specific equipment. There is a clear relationship between SBCT and VC, especially in neuromuscular and hospitalized individuals. New validation studies conducted with greater control of potential bias risks are necessary.
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Affiliation(s)
| | - Nathália Ferreira Santos Couto
- Universidade de Pernambuco-UPE/Universidade Federal da Paraíba-UFPB, Associate Graduate Program in Physical Education, Recife, Pernambuco, Brazil
| | | | | | | | - Jorge Bezerra
- Universidade de Pernambuco-UPE, Graduate Program in Hebiatrics, Recife, Pernambuco, Brazil
- Universidade de Pernambuco-UPE/Universidade Federal da Paraíba-UFPB, Associate Graduate Program in Physical Education, Recife, Pernambuco, Brazil
| | - Marcos André de Moura Santos
- Universidade de Pernambuco-UPE, Graduate Program in Hebiatrics, Recife, Pernambuco, Brazil
- Universidade de Pernambuco-UPE/Universidade Federal da Paraíba-UFPB, Associate Graduate Program in Physical Education, Recife, Pernambuco, Brazil
| | - Mauro Virgílio Gomes de Barros
- Universidade de Pernambuco-UPE, Graduate Program in Hebiatrics, Recife, Pernambuco, Brazil
- Universidade de Pernambuco-UPE/Universidade Federal da Paraíba-UFPB, Associate Graduate Program in Physical Education, Recife, Pernambuco, Brazil
| | - Emília Chagas Costa
- Centro Acadêmico de Vitória da Universidade Federal de Pernambuco, Vitoria de Santo Antao, Pernambuco, Brazil
| | - Marco Aurélio de Valois Correia Junior
- Universidade de Pernambuco-UPE, Graduate Program in Hebiatrics, Recife, Pernambuco, Brazil
- Universidade de Pernambuco-UPE/Universidade Federal da Paraíba-UFPB, Associate Graduate Program in Physical Education, Recife, Pernambuco, Brazil
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Cahalin LP, Formiga MF, Owens J, Osman BM. A Meta-Analysis of Remote Ischemic Preconditioning in Lung Surgery and Its Potential Role in COVID-19. Physiother Can 2023; 75:30-41. [PMID: 37250733 PMCID: PMC10211375 DOI: 10.3138/ptc-2021-0031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 08/17/2021] [Accepted: 09/06/2021] [Indexed: 08/08/2023]
Abstract
Purpose: To determine the effects of remote ischemic preconditioning (RIPC) on pulmonary gas exchange in people undergoing pulmonary surgery and discuss a potential role of RIPC in COVID-19. Method: A search for studies examining the effects of RIPC after pulmonary surgery was performed. RevMan was used for statistical analyses examining measures of A-ado2, Pao2/Fio2, respiratory index (RI), a/A ratio and Paco2 obtained earlier after surgery (i.e., 6-8 hours) and later after surgery (i.e., 18-24 hours). Results: Four trials were included (N = 369 participants). Significant (p < 0.05) overall effects of RIPC were observed early after surgery on A-ado2 and RI (SMD -0.84 and SMD -1.23, respectively), and later after surgery on RI, Pao2/Fio2, and a/A ratio (SMD -0.39, 0.72, and 1.15, respectively) with the A-ado2 approaching significance (p = 0.05; SMD -0.45). Significant improvements in inflammatory markers and oxidative stress after RIPC were also observed. Conclusions: RIPC has the potential to improve pulmonary gas exchange, inflammatory markers, and oxidative stress in people with lung disease undergoing lung surgery and receiving mechanical ventilation. These potential improvements may be beneficial for people with COVID-19, but further investigation is warranted.
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Affiliation(s)
- Lawrence P. Cahalin
- University of Miami, Department of Physical Therapy, Coral Gables, Florida, United States
| | - Magno F. Formiga
- Universidade Federal do Ceará, Departamento de Fisioterapia, Fortaleza, Ceará, Brazil
| | - Johnny Owens
- Owens Recovery Science, San Antonio, Texas, United States
| | - Brian M. Osman
- of Miami, Department of Anesthesiology, Perioperative Medicine, and Pain Management, Miami, Florida, United States
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de Alencar Martins AR, Rodrigues Junior LF, de Oliveira JR. Benefits of early mobilization in patients with deep venous thrombosis: a scope review. HEART, VESSELS AND TRANSPLANTATION 2023. [DOI: 10.24969/hvt.2023.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objective: Deep venous thrombosis (DVT) is a blood flow obstruction caused by the formation of a thrombus in deep system veins, with higher prevalence in lower limbs. Bed restriction has been indicated in patients with DVT in order to avoid pulmonary embolism caused by displacement of the thrombus. However, immobility has recently been considered a risk factor for DVT, not only due to blood flow stasis, but also by secondary complications as muscle atrophy and weakness. Objective was to review the possible benefits of early mobilization in patients with DVT in the intensive care unit.
Methods: A scope review of literature was conducted. The following keywords were used: deep venous thrombosis, early mobilization and physical therapy. The search was made on Pubmed and Scielo databases. Results: 20 studies were found and 7 articles were included in the review using the exclusion criteria.
Conclusion: Early mobilization association with anticoagulation and compression was described as essential in the treatment of DVT, reducing deleterious effects of immobility, pain, edema, and promoting quality of life improvement.
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Morais CCA, Campos SL, Andrade ADD. Hospital physiotherapy practice in times of COVID-19-lessons to advance. JORNAL BRASILEIRO DE PNEUMOLOGIA : PUBLICACAO OFICIAL DA SOCIEDADE BRASILEIRA DE PNEUMOLOGIA E TISILOGIA 2022; 48:e20220300. [PMID: 36074413 PMCID: PMC9496263 DOI: 10.36416/1806-3756/e20220300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Caio C A Morais
- . Departamento de Fisioterapia, Universidade Federal de Pernambuco, Recife (PE) Brasil.,. Laboratório de Investigação Médica em Pneumologia (LIM 09), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Shirley L Campos
- . Departamento de Fisioterapia, Universidade Federal de Pernambuco, Recife (PE) Brasil
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Raposo AB, Moliterno AH, Silva JPLN, Fabri RV, Freire APCF, Pacagnelli FL. Comparison of hemodynamic responses between conventional and virtual reality therapies in patients with heart failure admitted to an emergency room. FISIOTERAPIA E PESQUISA 2022. [DOI: 10.1590/1809-2950/21008729012022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT This study aimed to evaluate and to compare the acute response, due to semi-immersive virtual reality (VR) and conventional therapies (CT), of hemodynamic parameters in hospitalized individuals admitted to an emergency unity for heart failure (HF). This is a viability study with 11 individuals subjected to sessions with and without VR. At CT, stretching, active or active-assisted exercises, and fractional inspiration were performed. In VR therapy (VRT), VR box glasses were used to promote VR relaxation associated with CT. The hemodynamic parameters evaluated were heart rate, systolic and diastolic blood pressure, oxygen saturation, and double product. To analyze them, Student’s t- and Mann Whitney tests were used (p<0.05). Comparing baseline and final evaluations showed no significant differences in the hemodynamic parameters of both groups (p>0.05). Comparing absolute variations between CT and VRT also produced no significant differences between hemodynamic responses (p>0.05). Results showed that administering VRT and CT promoted physiological changes in the responses of hemodynamic parameters in individuals with HF hospitalized in an emergency unit without significant differences between the two interventions. This study suggests that VRT is a hemodynamically safe method for treating patients in emergency units.
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Raposo AB, Moliterno AH, Silva JPLN, Fabri RV, Freire APCF, Pacagnelli FL. Comparação da resposta hemodinâmica entre terapia convencional e realidade virtual em pacientes com insuficiência cardíaca internados na unidade de emergência. FISIOTERAPIA E PESQUISA 2022. [DOI: 10.1590/1809-2950/21008729012022pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO O objetivo deste estudo foi avaliar e comparar a resposta aguda de parâmetros hemodinâmicos de acordo com o uso de realidade virtual (RV) semi-imersiva e terapia convencional (TC) em indivíduos internados no serviço hospitalar de emergência por insuficiência cardíaca (IC). Trata-se de estudo de viabilidade com 11 indivíduos submetidos a sessões de terapia com e sem o uso da RV. Na TC, os participantes realizaram alongamentos, exercícios ativos ou ativo-assistidos e inspiração fracionada. Já na terapia com realidade virtual (TRV) utilizou-se os óculos VR box - virtual reality glasses aplicando VR relax associado à TC. Os parâmetros hemodinâmicos avaliados foram: frequência cardíaca, pressão arterial sistólica e diastólica e saturação de oxigênio. Para análise, foram utilizados os testes t de Student e de Mann-Whitney (p<0,05). Ao avaliar os parâmetros hemodinâmicos basal e final em ambos os grupos, não foi verificada diferença significativa entre os momentos (p>0,05). Com relação à comparação das variações absolutas entre a TC e a TRV, não foi observada diferença significativa entre as respostas hemodinâmicas (p>0,05). Os resultados demonstraram que a implementação da TRV e da TC promoveram alterações fisiológicas nas respostas dos parâmetros hemodinâmicos em indivíduos com IC hospitalizados em uma unidade de emergência, não havendo diferenças significativas entre as duas intervenções. O estudo sugere que a RV é um método hemodinamicamente seguro para aplicação em unidade de emergência.
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Silveira BO, de Melo JL, Neri GPDO, Gregório ML, de Godoy MF, Accioly MF. Influence of an Early Mobilization Protocol on the Autonomic Behavior of Patients Undergoing Percutaneous Transluminal Coronary Angioplasty. Arq Bras Cardiol 2021; 117:1161-1169. [PMID: 35613173 PMCID: PMC8757161 DOI: 10.36660/abc.20200296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 12/06/2020] [Accepted: 01/27/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Recurrence Plots (RP) enable a nonlinear analysis of Heart Rate Variability (HRV) and provide information on the Autonomic Nervous System (ANS). OBJECTIVES To evaluate whether early ambulation in patients undergoing Percutaneous Transluminal Coronary Angioplasty (PTCA) influences the quantitative and qualitative components of RP. METHODS A total of 32 participants who underwent PTCA were divided into a Control Group (CG - no physical exercises) and an Early Ambulation Group (EAG - with physical exercises). Beat-to-beat heart rate was recorded using a heart rate monitor in both groups upon admission and discharge. The linear indices in the time and frequency domains were analyzed, and nonlinear indices were obtained through RP. The Early Ambulation Physical Therapy Protocol began 12-18 hours after PTCA. A two-tailed unpaired t-test was used for comparisons, and p-values < 0.05 were accepted as significant. RESULTS When comparing both groups, upon discharge, EAG showed an increase in SDNN (23.55 ± 12.05 to 37.29 ± 16.25; p=0.042), Triangular Index (8.99 ± 3.03 to 9.66 ± 3.07; p=0.014), and VLF (694.20 ± 468.20 to 848.37 ± 526.51; p=0.004), but without significant changes in the nonlinear evaluation. In addition, in the qualitative analysis of RP, a more diffuse and less geometric pattern was observed in EAG, indicating greater variability, while in CG, an altered and more geometric pattern was noted. CONCLUSION The Early Ambulation Protocol promotes an improvement in autonomic behavior as evaluated by HRV and by RP, which can thus be considered a useful procedure for better recovery of patients undergoing PTCA.
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Affiliation(s)
- Bárbara Oliveira Silveira
- Universidade Federal do Triângulo MineiroUberabaMGBrasilUniversidade Federal do Triângulo Mineiro, Uberaba, MG – Brasil
| | - Jade Lara de Melo
- Universidade Federal do Triângulo MineiroUberabaMGBrasilUniversidade Federal do Triângulo Mineiro, Uberaba, MG – Brasil
| | | | - Michele Lima Gregório
- Faculdade de Medicina de São José do Rio PretoSão Jose do Rio PretoSPBrasilFaculdade de Medicina de São José do Rio Preto (FAMERP) - Pós Graduação Enfermagem, São Jose do Rio Preto, SP – Brasil
| | - Moacir Fernandes de Godoy
- Faculdade de Medicina de São José do Rio PretoSão Jose do Rio PretoSPBrasilFaculdade de Medicina de São José do Rio Preto (FAMERP) - Cardiologia e Cirurgia Cardiovascular, São Jose do Rio Preto, SP – Brasil
| | - Marilita Falangola Accioly
- Universidade Federal do Triângulo MineiroUberabaMGBrasilUniversidade Federal do Triângulo Mineiro, Uberaba, MG – Brasil
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Checklist de Mobilização Precoce: construção de uma ferramenta para facilitar sua aplicação na Unidade de Terapia Intensiva. CONSCIENTIAE SAÚDE 2021. [DOI: 10.5585/20.2021.19500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introdução: Um extenso período imóvel no leito, ocasionalmente, leva à síndrome do imobilismo, comum em Unidades de Terapia Intensiva. Contrapondo-se as complicações, a mobilização precoce proporciona melhora ventilatória, circulatória e metabólica. Objetivo: Construir um instrumento (checklist) que aponte os principais achados clínicos para nortear a atuação fisioterapêutica no combate ao imobilismo prolongado. Métodos: Elaborar Checklist com achados particulares e na literatura, aperfeiçoando escolhas no protocolo cinesioterapêutico em pacientes críticos admitidos no Mario Palmério Hospital Universitário, em Uberaba-MG. Mediante Revisão Integrativa para fundamentação do instrumento Checklist para Mobilização Precoce, somada à Pesquisa Experimental para adequações no referido serviço hospitalar. Resultados: 24 pacientes, coleta beira-leito e prontuários eletrônicos, idade média de 66anos (±25) distribuído igualmente em ambos os gêneros. Discussão: A ferramenta promoveu apoio na atuação da equipe de fisioterapia, não havendo divergência nos parâmetros cardiorrespiratórios entre beira-leito e prontuário eletrônico. Conclusão: A utilização de uma ferramenta avaliativa é fundamental ao tratamento, favorecendo a conduta individualizada ao paciente crítico.
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Sousa MLDA, Coimbra VRDM, Takei MT, Melo CCDA, Feltrim MIZ, Nozawa E. Physiological abnormalities and adverse events during physical therapy in the intensive care unit after cardiac surgery: A prospective observational study. Braz J Phys Ther 2021; 25:623-631. [PMID: 34045123 DOI: 10.1016/j.bjpt.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/16/2021] [Accepted: 04/01/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND After cardiac surgery, physiological abnormalities or adverse events might occur in patients in the intensive care unit (ICU) during physical therapy care. Identifying these events may help improve patient safety and care. OBJECTIVES To estimate the incidence and the degree of severity of physiological abnormalities or adverse events during physical therapy interventions provided in the ICU after cardiac surgery. To explore the relationship between these events and patients' characteristics and clinical outcomes. METHODS Prospective observational study of adult patients in the postoperative period of cardiac surgery admitted to the ICU of a referenced university hospital. Physical therapy interventions were observed by a team trained to evaluate and register the occurrence of physiological abnormalities or adverse events and grading their consequences. We compared baseline characteristics and outcomes of patients with versus without these events. RESULTS We observed 935 physical therapy interventions in 323 patients, of which 189 (20%, 95% confidence interval: 18, 23%) resulted in physiological abnormalities or adverse events. The highest incidences of these events were observed during endotracheal suctioning (44%), walking (40%), and noninvasive ventilation (37%). Hemodynamic changes were the most frequent events accounting for 74% of all events. Only 2% of interventions resulted in mild harm and 0.2% in moderate harm. The presence of comorbidities was associated (p = 0.03) with the occurrence of these events. CONCLUSION Physiological abnormalities or adverse events occurred in 20% of physical therapy interventions in patients in the ICU after cardiac surgery, with 10% of those resulting in negative effects. Only the presence of comorbidities was associated with the occurrence of these events.
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Affiliation(s)
- Mayson Laércio de Araújo Sousa
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil; Department of Physical Therapy, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil.
| | - Vera Regina de Moraes Coimbra
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil; Department of Physical Therapy, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Mauro Tadashi Takei
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil; Department of Physical Therapy, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Cyalmê Cristina de Almeida Melo
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil; Department of Physical Therapy, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Maria Ignêz Zaneti Feltrim
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil; Department of Physical Therapy, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Emilia Nozawa
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil; Department of Physical Therapy, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
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Mendes RMG, Nunes ML, Sousa MCBC, Gonçalves RBR, Fernandes PN, Gomes AJO. Validation of the ICU Mobility Scale for Nursing Use: Portuguese Multicentric Observational Study. J Nurs Meas 2020; 29:80-93. [PMID: 33334844 DOI: 10.1891/jnm-d-19-00062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Mobilization of critical patients should be precocious and the inclusion of nursing in this task can be decisive in paradigm shift. The purpose of this study was to validate the Portuguese version of the intensive care unit Mobility Scale for nursing use. METHODS Prospective multicenter observational study. Patients' mobility was evaluated by rehabilitation nurses in order to determine interobserver agreement. The validation criteria was tested by determining the correlation between the evaluation results of mobility, strength, and functionality levels at discharge. RESULTS Good interobserver agreement (R = 0.98; K = 0.76). Positive correlation with muscle strength (R = 0.77) and functionality (R = 0.85) levels at discharge. CONCLUSIONS Based on the correlations observed the scale is a valid instrument for nurses and could be a useful tool for routine use. More research is recommended to make the results more robust.
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Yuenyongchaiwat K, Kulchanarat C, Satdhabudha O. Sarcopenia in open heart surgery patients: A cohort study. Heliyon 2020; 6:e05759. [PMID: 33364510 PMCID: PMC7753126 DOI: 10.1016/j.heliyon.2020.e05759] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/27/2020] [Accepted: 12/14/2020] [Indexed: 12/13/2022] Open
Abstract
Background Sarcopenia is a condition characterized by loss of muscle mass, muscle strength, or physical performance. It has been reported that cardiac surgery causes systemic inflammatory response, which leads to sarcopenia. In addition, open-heart surgery (OHS) has been associated with length of hospital stay, prolonged mechanical ventilation, and postoperative pulmonary complications. However, very few studies have explored the association of sarcopenia with OHS. Thus, this study explores the prevalence of sarcopenia in OHS patients as well as their relationship. Methods This cohort study included 160 patients; it was designed to assess sarcopenia during preoperative OHS and before patient discharge from the hospital. Sarcopenia was defined according to Asian Working Group for Sarcopenia (AWGS) criteria as low muscle mass plus low muscle strength and/or slow gait speed. Participants were requested to perform exercises to test their handgrip strength, gait speed, and bioelectrical impedance. In addition, their medical history (e.g., duration of hospitalization and mechanical ventilation) was recorded. Results The prevalence of sarcopenia during preoperative OHS was 26.9%, with affected men comprising 11.9% and affected women comprising 15% of the total sample. Participants with sarcopenia had a significantly lower body mass index (BMI) than those without. Further, patients who had longer stays in the hospital and prolonged mechanical ventilation time showed significantly higher rates of developing sarcopenia. During postoperative OHS, the incidence of sarcopenia rose by 20.92%, increasing the total prevalence of sarcopenia to 46.41%. Moreover, advanced age emerged as one of the most significant risk factors of sarcopenia. Participants in the age group >55 years had an increased risk of sarcopenia (odds ratio [OR]: 3.90). It was also found that patients with a low BMI (<23 kg∗m−2) and a history of diabetes mellitus (DM) had an increased risk of sarcopenia (ORs: 2.11 and 1.47, respectively). Moreover, longer hospital stays and mechanical ventilation times were important risk factors (ORs: 1.58 and 2.07, respectively). Conclusion The prevalence of sarcopenia was observed to be high during postoperative OHS. Participants with sarcopenia who underwent OHS had a history of DM, longer length of hospital stays, and prolonged mechanical ventilation times, compared with patients without sarcopenia. Clinical trial registration number TCTR20190509003.
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Affiliation(s)
- Kornanong Yuenyongchaiwat
- Physiotherapy Department, Faculty of Allied Health Sciences, Thammasat University, Thailand.,Thammasat University Research Unit in Physical Therapy in Respiratory and Cardiovascular Systems, Thailand
| | - Chitima Kulchanarat
- Physiotherapy Department, Faculty of Allied Health Sciences, Thammasat University, Thailand
| | - Opas Satdhabudha
- Division of Cardiovascular Thoracic Surgery, Department of Surgery, Thammasat University Hospital, Thailand
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Guzel S, Umay E, Gundogdu I, Bahtiyarca ZT, Cankurtaran D. Effects of diaphragm thickness on rehabilitation outcomes in post-ICU patients with spinal cord and brain injury. Eur J Trauma Emerg Surg 2020; 48:559-565. [PMID: 32601716 PMCID: PMC7322389 DOI: 10.1007/s00068-020-01426-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 06/19/2020] [Indexed: 10/26/2022]
Abstract
BACKGROUND Intensive care unit (ICU) complications affect outcomes but it remains unknown if the diaphragm thickness affects rehabilitation outcomes after ICU. We conducted a pilot study to evaluate the effect of diaphragm thickness on rehabilitation outcomes of post-ICU patients with spinal cord injury (SCI) and traumatic brain injury (TBI) and to evaluate factors that may be associated with diaphragm atrophy. MATERIALS AND METHODS Fifty-one patients (26 SCI, 25 TBI) who admitted to the rehabilitation clinic from the ICU included in this study. All demographic data were recorded. All participants underwent diaphragmatic ultrasonography evaluation before and after 12 weeks of neurologic rehabilitation program. The diaphragm thickness and outcome parameters were compared in all patient groups and in each patient subgroups. Evaluation parameters of patients before and after treatment were compared in patient subgroups. RESULTS Diaphragm atrophy was found in 14 patients (64%) in TBI group and 12 patients (46%) in SCI group. The diaphragm thickness negatively correlated with the ICU length of stay and positively correlated with the before/after rehabilitation functional scores and the change in functional independence measure scores (p < 0.05). According to the regression analysis; the change in functional independence measure scores was found to be affected by the diaphragm thickness (p < 0.05). CONCLUSIONS The diaphragm thickness may be an effective factor on the rehabilitation process.
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Affiliation(s)
- Sukran Guzel
- Faculty of Medicine, Physical Medicine and Rehabilitation Clinic, Ankara Hospital, Baskent University, Ankara, Turkey.
| | - Ebru Umay
- Physical Medicine and Rehabilitation Clinic, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Ibrahım Gundogdu
- Physical Medicine and Rehabilitation Clinic, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Zeynep Tuba Bahtiyarca
- Physical Medicine and Rehabilitation Clinic, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Damla Cankurtaran
- Physical Medicine and Rehabilitation Clinic, Ankara Diskapi Yildirim Beyazit Education and Research Hospital, University of Health Sciences, Ankara, Turkey
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Gonçalves JDSPDR, Shimoya-Bittencourt W, Santos VM, Belmonte M. Impacts in the Respiratory Mechanics of the Ventilator Hyperinsuflation in the Flow Bias Concept: a Narrative Review. JOURNAL OF HEALTH SCIENCES 2019. [DOI: 10.17921/2447-8938.2019v21n3p250-254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
AbstractPatients who require invasive ventilatory support are subject to the deleterious effects of this, mainly ventilator-associated pneumonia (VAP). The physiotherapist, a member of the multiprofessional team, assists the patient with the purpose of promoting the recovery and preservation of the functionality, being able to minimize / avoid secondary complications. This study aims to identify the repercussions of mechanical ventilation hyperinflation (MVH) in the flow bias concept in respiratory mechanics. This study is a narrative review. MVH is an important resource commonly used in clinical practice that involves the manipulation of mechanical ventilator configurations to provide larger pulmonary volumes, and the generated airflow gradient may play a relevant role in mucus transport, with the concept of flow bias the main factor responsible for its direction. For the mobilization of the mucus towards the cephalic direction to occur, there must be a predominant expiratory flow, guaranteeing the peak ratio of expiratory flow / inspiratory flow peak (EFP / IFP) greater than 1.11. Maintenance of mechanical ventilation assures the patient to maintain the positive end expiratory pressure (PEEP) and the oxygen inspired fraction, avoiding the deleterious effects of the mechanical ventilator disconnection. MVH is able to improve lung compliance without, however, increasing airway resistance. MVH in the cephalic flow bias concept is effective for the mucus mobilization in the central direction, being able to improve pulmonary compliance and peripheral oxygen saturation.Keywords: Respiration, Artificial. Intensive Care Units. Physical Therapy Department, Hospital.ResumoOs pacientes internados que necessitam de suporte ventilatório invasivo estão sujeitos aos efeitos deletérios deste, principalmente a pneumonia associada à ventilação mecânica (PAV). O fisioterapeuta, integrante da equipe multiprofissional, assiste o paciente com a finalidade de promover a recuperação e preservação da funcionalidade, podendo minimizar/evitar complicações secundárias. Este estudo consiste em identificar as repercussões da hiperinsuflação com ventilador mecânico (HVM) no conceito flow bias na mecânica respiratória. O presente estudo trata-se de uma revisão narrativa. A HVM é um importante recurso comumente utilizado na prática clínica que envolve a manipulação das configurações do ventilador mecânico para fornecer maiores volumes pulmonares, e o gradiente de fluxo de ar gerado pode desempenhar um papel relevante no transporte do muco, sendo o conceito de flow bias cefálico o principal fator responsável pelo direcionamento deste. Para que a mobilização do muco em direção cefálica ocorra, deve existir um fluxo expiratório predominante, garantindo a razão pico de fluxo expiratório/pico de fluxo inspiratório (PFE/PFI) maior do que 1,11. A manutenção da assistência ventilatória mecânica assegura ao paciente a manutenção da pressão positiva ao final da expiração (PEEP) e a fração inspirada de oxigênio (FiO2), evitando os efeitos deletérios da desconexão do ventilador mecânico. A HVM é capaz de melhorar a complacência pulmonar sem, no entanto, aumentar a resistência das vias aéreas. A HVM no conceito flow bias cefálico é eficaz para a mobilização do muco em direção central, sendo capaz de melhorar a complacência pulmonar e saturação periférica de oxigênio (SpO2).Palavras-chave: Respiração Artificial. Unidades de Terapia Intensiva. Serviço Hospitalar de Fisioterapia.
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de Farias CAC, Gualdi LP, da Silva SB, Parreira VF, Montemezzo D, Resqueti VR, Fregonezi GAF. Effects of different modalities of inspiratory muscle training as an add-on to conventional treatment of patients with chronic obstructive pulmonary disease (COPD): study protocol for a randomized controlled trial. Trials 2019; 20:231. [PMID: 31014365 PMCID: PMC6480485 DOI: 10.1186/s13063-019-3271-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 03/01/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) leads to peripheral and respiratory muscle dysfunctions. Nowadays, inspiratory muscle training can be geared toward strength or endurance gains. This study aims to investigate the effects of an inspiratory muscle training (IMT) protocol using different therapeutic modalities to be implemented in pulmonary rehabilitation programs. The effects of IMT on exercise capacity were considered as the primary endpoint, and the effects of IMT on inspiratory muscle function, health-related quality of life, and daily physical activity level were considered as the secondary outcomes. METHODS This study is a blinded-investigator randomized controlled clinical trial. Sixty subjects will be randomly allocated into three groups: (1) pulmonary rehabilitation (PR) associated with inspiratory muscle training without any load (PRWIMT), (2) PR associated with inspiratory muscle training with a linear load (PRIMTLL), and (3) PR associated with inspiratory muscle training with isocapnic voluntary hyperpnea (PRIMTIVH). The protocol will be performed 5 days a week (3 days with supervision) for 10 weeks. The study will assess anthropometric data, lung function, respiratory muscle strength, and functional capacity by the Incremental Shuttle Walking Test and the Six-Minute Walk Test, lung volumes during the submaximal endurance test, peripheral muscle strength of the upper and lower limbs, dyspnea, and quality of life related to health, before and after the training protocol. Normality will be tested using the Kolmogorov-Smirnov test, and variables will be compared by two-way analysis of variance. The significance level was set at p < 0.05. Ethics approval was obtained from the Institutional Ethics Committee in Research (1.663.411). The study results will be disseminated through presentation at specific scientific conferences and publication in peer-reviewed journals. DISCUSSION The different IMT protocols used in our study will be able to guide respiratory therapists to understand and to include in conventional PR programs the most effective respiratory muscle training type in subjects with COPD. TRIAL REGISTRATION Brazilian Clinical Trials Registry, RBR-94v6kd . Registered on 11 March 2017.
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Affiliation(s)
- Catharinne Angélica Carvalho de Farias
- Laboratório de Desempenho PneumoCardioVascular e Músculos Respiratórios, Departamento de Fisioterapia, Universidade Federal do Rio Grande Do Norte (UFRN), Natal, Rio Grande do Norte Brazil
- PneumoCardioVascular Lab/HUOL, Empresa Brasileira de Serviços Hospitalares - EBSERH), Universidade Federal do Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte Brazil
| | - Lucien Peroni Gualdi
- Laboratório de Desempenho PneumoCardioVascular e Músculos Respiratórios, Departamento de Fisioterapia, Universidade Federal do Rio Grande Do Norte (UFRN), Natal, Rio Grande do Norte Brazil
- PneumoCardioVascular Lab/HUOL, Empresa Brasileira de Serviços Hospitalares - EBSERH), Universidade Federal do Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte Brazil
- Faculdade de Ciências da Saúde do Trairi, Universidade Federal do Rio Grande do Norte (UFRN), Santa Cruz, Rio Grande do Norte Brazil
| | - Selma Bruno da Silva
- Centro de Reabilitação Cardíaca e Metabólica, Empresa Brasileira de Serviços Hospitalares (EBSERH), Universidade Federal do Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte Brazil
| | - Verônica Franco Parreira
- Departamento de Fisioterapia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais Brazil
| | - Dayane Montemezzo
- Centro de Ciências da Saúde e do Esporte, Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Santa Catarina Brazil
| | - Vanessa R. Resqueti
- Laboratório de Desempenho PneumoCardioVascular e Músculos Respiratórios, Departamento de Fisioterapia, Universidade Federal do Rio Grande Do Norte (UFRN), Natal, Rio Grande do Norte Brazil
- PneumoCardioVascular Lab/HUOL, Empresa Brasileira de Serviços Hospitalares - EBSERH), Universidade Federal do Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte Brazil
| | - Guilherme A. F. Fregonezi
- Laboratório de Desempenho PneumoCardioVascular e Músculos Respiratórios, Departamento de Fisioterapia, Universidade Federal do Rio Grande Do Norte (UFRN), Natal, Rio Grande do Norte Brazil
- PneumoCardioVascular Lab/HUOL, Empresa Brasileira de Serviços Hospitalares - EBSERH), Universidade Federal do Rio Grande do Norte (UFRN), Natal, Rio Grande do Norte Brazil
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Rocha MRSD, Souza S, Costa CMD, Merino DFB, Montebelo MIDL, Rasera-Júnior I, Pazzianotto-Forti EM. AIRWAY POSITIVE PRESSURE VS. EXERCISES WITH INSPIRATORY LOADING FOCUSED ON PULMONARY AND RESPIRATORY MUSCULAR FUNCTIONS IN THE POSTOPERATIVE PERIOD OF BARIATRIC SURGERY. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2018; 31:e1363. [PMID: 29972391 PMCID: PMC6031315 DOI: 10.1590/0102-672020180001e1363] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/06/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Bariatric surgery can trigger postoperative pulmonary complications due to factors inherent to the procedure, mainly due to diaphragmatic dysfunction. AIM To evaluate and compare the effects of two levels of positive pressure and exercises with inspiratory load on lung function, inspiratory muscle strength and respiratory muscle resistance, and the prevalence of atelectasis after gastroplasty. METHODS Clinical, randomized and blind trial, with subjects submitted to bariatric surgery, allocated to two groups: positive pressure group, who received positive pressure at two levels during one hour and conventional respiratory physiotherapy and inspiratory load group, who performed exercises with load linear inspiratory pressure, six sets of 15 repetitions, in addition to conventional respiratory physiotherapy, both of which were applied twice in the immediate postoperative period and three times a day on the first postoperative day. Spirometry was performed for pulmonary function analysis, nasal inspiratory pressure for inspiratory muscle strength and incremental test of respiratory muscle resistance for sustained maximal inspiratory pressure, both preoperatively and on hospital discharge on the second postoperative day. RESULTS There was no significant difference (p> 0.05) in the expiratory reserve volume and in the tidal volume in the pre and postoperative periods when compared intra and intergroup. There was no significant difference (p>0.05) in the nasal inspiratory pressure and the maximal inspiratory pressure maintained in the inspiratory load group in the intragroup evaluation, but with a significant difference (p<0.05) compared to the positive pressure group. The prevalence of atelectasis was 5% in both groups with no significant difference (p>0.05) between them. CONCLUSION Both groups, associated with conventional respiratory physiotherapy, preserved expiratory reserve volume and tidal volume and had a low atelectasis rate. The inspiratory loading group still maintained inspiratory muscle strength and resistance of respiratory muscles.
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Stein C, Fernandes RO, Miozzo AP, Coronel CC, Baroni BM, Belló-Klein A, Plentz RDM. Acute Effects of Low-Level Laser Therapy on Patients' Functional Capacity in the Postoperative Period of Coronary Artery Bypass Graft Surgery: A Randomized, Crossover, Placebo-Controlled Trial. Photomed Laser Surg 2018; 36:122-129. [PMID: 29466116 DOI: 10.1089/pho.2017.4270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the acute effects of low-level laser therapy (LLLT) on the functional capacity to exercise tested by incremental shuttle walking test (ISWT) after coronary artery bypass graft (CABG) surgery. METHODS Fifteen male patients (60 ± 9 years) were crossed over during the experiment, to compare the outcomes after active LLLT and placebo LLLT treatments. LLLT (850 nm, 200 mW, 30 J to each point, resulting in a total of 240 J per quadriceps muscle), using a multidiode cluster (five spots; 6 J/spot) in eight points per leg was performed 3 min before the ISWT. We analyzed distance walked, Borg scale of perceived exertion, heart rate, and brachial arterial blood pressure. Markers of tissue damage [lactate dehydrogenase (LDH)] and oxidative stress [lipid peroxidation, total thiol levels, and antioxidant enzyme activity of superoxide dismutase (SOD) and catalase (CAT)] were also measured in peripheral blood. RESULTS Comparison of the distances walked revealed no significant differences between the LLLT and placebo LLLT groups (p = 0.779). Regarding the Borg scale (p = 0.567), heart rate (p = 0.506) as well as systolic and diastolic blood pressure (p = 0.164 and p = 0.140, respectively), no differences were observed between LLLT and placebo LLLT groups. Application of LLLT was not able to change levels of LDH (p = 0.214), oxidative lipid damage (p = 0.733), total thiol levels (p = 0.925), SOD (p = 0.202), and CAT (p = 0.825) enzyme activities. CONCLUSIONS Acute LLLT improved neither functional capacity to exercise nor the markers of oxidation after CABG. TRIAL REGISTRATION Registered as a clinical trial (NCT02688426).
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Affiliation(s)
- Cinara Stein
- 1 Physical Therapy Department, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) , Porto Alegre, RS, Brazil .,2 Instituto de Cardiologia do Rio Grande do Sul (IC), Fundação Universidade de Cardiologia (FUC) , Porto Alegre, RS, Brazil
| | - Rafael Oliveira Fernandes
- 3 Laboratory of Cardiovascular Physiology, Institute of Basic Sciences of Health (ICBS), Universidade Federal do Rio Grande do Sul (UFRGS) , Porto Alegre, Rio Grande do Sul, Brazil
| | - Aline Paula Miozzo
- 1 Physical Therapy Department, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) , Porto Alegre, RS, Brazil .,2 Instituto de Cardiologia do Rio Grande do Sul (IC), Fundação Universidade de Cardiologia (FUC) , Porto Alegre, RS, Brazil
| | - Christian Correa Coronel
- 1 Physical Therapy Department, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) , Porto Alegre, RS, Brazil .,2 Instituto de Cardiologia do Rio Grande do Sul (IC), Fundação Universidade de Cardiologia (FUC) , Porto Alegre, RS, Brazil
| | - Bruno Manfredini Baroni
- 1 Physical Therapy Department, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) , Porto Alegre, RS, Brazil
| | - Adriane Belló-Klein
- 3 Laboratory of Cardiovascular Physiology, Institute of Basic Sciences of Health (ICBS), Universidade Federal do Rio Grande do Sul (UFRGS) , Porto Alegre, Rio Grande do Sul, Brazil
| | - Rodrigo Della Méa Plentz
- 1 Physical Therapy Department, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) , Porto Alegre, RS, Brazil
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Chacon PFS, Schon CF, Furtado VHLA, Signoretti GLAM, Oliveira JPP, Ribeiro AG, Wanderley CDV, Diniz AAR, Soares HB. Support and rehabilitation of patients with pulmonary expansion deficit by using game therapy. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:5632-5635. [PMID: 28269532 DOI: 10.1109/embc.2016.7592004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Patients suffering from hypoventilation and pulmonary expansion deficit are at increased risk of developing pulmonary complications such as atelectasis, pneumonia or pleural effusion. These complications can increase the length of stay and spending on health, and generate long-term functional impairment. This study aims to produce a therapeutic alternative to the traditional method of lung re-expansion through incentive spirometry (IS) using the game therapy to build an innovative system. This system makes use of infrared and Bluetooth communication technology to associate the game therapy to EI. At the end of the system implementation, we expect to obtain good adhesion of the patient and the physiotherapists.
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Faria LM, Barbosa SDFF. Assessment of functional status in the ICU: instruments used in Brazilian settings. FISIOTERAPIA EM MOVIMENTO 2017. [DOI: 10.1590/1980-5918.030.001.ar02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: Physical function impairment is a significant concern for patients who survive their intensive care unit (ICU) stay, due to its impact on the patient’s independence and functional status. In this context, the choice of a suitable instrument for the assessing functional status is important, because an inappropriate assessment could lead to incorrect conclusions regarding patient prognosis, treatment benefits, and condition. Objective: To identify which functional assessment tools are used in Brazil to assess patients who are in ICU. Additionally, we investigated the translation, adaptation, and validation of these instruments for use in this population. Methods: We searched Pubmed, SCIELO, Lilacs, and Scopus in November 2015. No language or date restrictions were applied to the search. Results: Ten studies and seven instruments were identified. The most commonly used instruments were the Karnofsky Performance Status Scale Scores and the Functional Independence Measure. Conclusion: The instruments found in the review were neither specifically developed to assess the functional status of ICU patients, nor were they validated for use in this population in Brazil. Transcultural development or adaptation studies should be conducted, followed by a validation process.
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Mondadori AG, Zeni EDM, Oliveira AD, Silva CCD, Wolf VLW, Taglietti M. Humanização da fisioterapia em Unidade de Terapia Intensiva Adulto: estudo transversal. FISIOTERAPIA E PESQUISA 2016. [DOI: 10.1590/1809-2950/16003123032016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Para promover qualidade de vida aos pacientes internados na unidade de terapia intensiva (UTI), há a necessidade e obrigação de humanizar o atendimento, em que somos comprometidos a prevenir, cuidar, proteger e recuperar, ou seja, promover saúde. O fisioterapeuta exerce um papel fundamental na reabilitação dos pacientes internados em UTI, e, além de qualidade técnica, deve prezar pela qualidade relacional de sua assistência, a fim de transmitir confiança e de estar atento às necessidades dos pacientes. O objetivo do estudo foi verificar se a assistência fisioterapêutica em unidade de terapia intensiva é realizada de forma humanizada. Trata-se de um estudo de corte transversal, mediante entrevistas com questionário avaliativo no quarto dos pacientes, incluindo 60 indivíduos maiores de 18 anos que receberam alta da UTI adulta. Os pacientes entrevistados aprovaram as condutas utilizadas pelos fisioterapeutas, destacando o cuidado destes ao realizar os procedimentos, a modo de evitar maior desconforto dos pacientes. Eles também apresentaram satisfação nas dimensões de atendimento, sendo que dignidade, comunicação, confiabilidade, aspectos interpessoais e receptividade alcançaram 100% de respostas positivas, garantia 98,3%, empatia 96,7%, os aspectos autonomia e eficácia emplacaram 95% das respostas favoráveis à humanização. Os pacientes demonstraram alto grau de aprazimento nos vários aspectos analisados quanto à assistência oferecida pelos fisioterapeutas, que devem prezar pela humanização em sua conduta profissional. Chegou-se à conclusão de que o atendimento fisioterapêutico disponibilizado na UTI foi caracterizado como humanizado pelos pacientes. Os fisioterapeutas demonstraram sua assistência com respeito e ética, possibilitando uma assistência de qualidade.
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Fernandes SCDS, Santos RSD, Giovanetti EA, Taniguchi C, Silva CSDM, Eid RAC, Timenetsky KT, Carnieli-Cazati D. Impact of respiratory therapy in vital capacity and functionality of patients undergoing abdominal surgery. EINSTEIN-SAO PAULO 2016; 14:202-7. [PMID: 27462894 PMCID: PMC4943354 DOI: 10.1590/s1679-45082016ao3398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 05/06/2016] [Indexed: 01/09/2023] Open
Abstract
Objective To evaluate the vital capacity after two chest therapy techniques in patients undergoing abdominal surgical. Methods A prospective randomized study carried out with patients admitted to the Intensive Care Unit after abdominal surgery. We checked vital capacity, muscular strength using the Medical Research Council scale, and functionality with the Functional Independence Measure the first time the patient was breathing spontaneously (D1), and also upon discharge from the Intensive Care Unit (Ddis). Between D1 and Ddis, respiratory therapy was carried out according to the randomized group. Results We included 38 patients, 20 randomized to Positive Intermittent Pressure Group and 18 to Volumetric Incentive Spirometer Group. There was no significant gain related to vital capacity of D1 and Ddis of Positive Intermittent Pressure Group (mean 1,410mL±547.2 versus 1,809mL±692.3; p=0.979), as in the Volumetric Incentive Spirometer Group (1,408.3mL±419.1 versus 1,838.8mL±621.3; p=0.889). We observed a significant improvement in vital capacity in D1 (p<0.001) and Ddis (p<0.001) and in the Functional Independence Measure (p<0.001) after respiratory therapy. The vital capacity improvement was not associated with gain of muscle strength. Conclusion Chest therapy, with positive pressure and volumetric incentive spirometer, was effective in improving vital capacity of patients submitted to abdominal surgery.
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Gomes RHS, Santos RS. Avaliação da capacidade e comprometimento funcional em pacientes traqueotomizados de um hospital público de Curitiba. REVISTA CEFAC 2016. [DOI: 10.1590/1982-021620161813715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivos: avaliar e descrever os graus de capacidade e comprometimento funcionais em pacientes traqueotomizados de um hospital público e suas inter-relações. Métodos: estudo caso-controle, quantitativo, descritivo e transversal, realizado em um hospital terciário, vinculado ao Sistema Único de Saúde. A capacidade e comprometimento funcional foram avaliados por meio do Índice de Barthel e da Escala de Desempenho de Karnofsky, em pacientes traqueotomizados e não traqueotomizados em quatro unidades de internação. O grupo de estudo foi pareado com o grupo controle levando-se em conta a idade, o sexo e a doença que ocasionou a internação. Resultados: a amostra foi composta por 52 pacientes, 30 do sexo masculino e 22 do sexo feminino. A média de idade entre o grupo de estudo foi de 55,4 anos e no grupo controle de 55,1 anos. A análise estatística do Índice de Barthel no grupo de estudo classificou 84,62% dos pacientes como totalmente dependentes para a realização dos dez domínios do instrumento, ao contrário do grupo controle no qual somente 15,38% dos pacientes apresentaram este grau de dependência física e 53,85% mostravam total independência às mesmas atividades. O levantamento da escala Karnofsky evidenciou que 57,69% do grupo estudo apresentava escore de 40%, diferentemente do grupo controle no qual 42,31% obteve escore de 90%. Conclusão: houve implicação da capacidade e comprometimento funcional nos pacientes traqueotomizados, fato que demanda novo olhar da equipe multidisciplinar frente às incapacidades e demonstra que independente da traqueotomia facilitar o desmame da ventilação mecânica e consequentemente o período de internação, causa importante impacto na qualidade de vida.
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dos Santos LJ, de Aguiar Lemos F, Bianchi T, Sachetti A, Dall' Acqua AM, da Silva Naue W, Dias AS, Vieira SRR. Early rehabilitation using a passive cycle ergometer on muscle morphology in mechanically ventilated critically ill patients in the Intensive Care Unit (MoVe-ICU study): study protocol for a randomized controlled trial. Trials 2015; 16:383. [PMID: 26314881 PMCID: PMC4552342 DOI: 10.1186/s13063-015-0914-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 08/17/2015] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Patients in Intensive Care Units (ICU) are often exposed to prolonged immobilization which, in turn, plays an important role in neuromuscular complications. Exercise with a cycle ergometer is a treatment option that can be used to improve the rehabilitation of patients on mechanical ventilation (MV) in order to minimize the harmful effects of immobility. METHODS/DESIGN A single-blind randomized controlled trial (the MoVe ICU study) will be conducted to evaluate and compare the effects of early rehabilitation using a bedside cycle ergometer with conventional physical therapy on the muscle morphology of the knee extensors and diaphragm in critical ill patients receiving MV. A total of 28 adult patients will be recruited for this study from among those admitted to the intensive care department at the Hospital de Clínicas de Porto Alegre. Eligible patients will be treated with MV from a period of 24 to 48 h, will have spent maximum of 1 week in hospital and will not exhibit any characteristics restricting lower extremity mobility. These subjects will be randomized to receive either conventional physiotherapy or conventional physiotherapy with an additional cycle ergometer intervention. The intervention will be administered passively for 20 min, at 20 revolutions per minute (rpm), once per day, 7 days a week, throughout the time the patients remain on MV. Outcomes will be cross-sectional quadriceps thickness, length of fascicle, pennation angle of fascicles, thickness of vastus lateralis muscle, diaphragm thickness and excursion of critical ICU patients on MV measured with ultrasound. DISCUSSION The MoVe-ICU study will be the first randomized controlled trial to test the hypothesis that early rehabilitation with a passive cycle ergometer can preserve the morphology of knee extensors and diaphragm in critical patients on MV in ICUs. TRIAL REGISTRATION NCT02300662 (25 November 2014).
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Affiliation(s)
- Laura Jurema dos Santos
- Graduate Program in Health Sciences: Cardiology and Cardiovascular Science, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Dr Pereira Neto, 725 torre 1 ap 902, Tristeza-Porto Alegre, RS, CEP 91920530, Brazil. .,Department of Physical Therapy, Universidade Luterana do Brasil (ULBRA), Canoas, RS, Brazil.
| | - Fernando de Aguiar Lemos
- Graduate Program in Human Movement Science, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
| | - Tanara Bianchi
- Graduate Program in Respiratory Science, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
| | - Amanda Sachetti
- Graduate Program in Respiratory Science, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
| | - Ana Maria Dall' Acqua
- Graduate Program in Health Sciences: Cardiology and Cardiovascular Science, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Dr Pereira Neto, 725 torre 1 ap 902, Tristeza-Porto Alegre, RS, CEP 91920530, Brazil.
| | - Wagner da Silva Naue
- Physical Therapy Service-Intensive Care Unit, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.
| | - Alexandre Simões Dias
- Graduate Program in Human Movement Science, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil. .,Graduate Program in Respiratory Science, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil. .,Department of Physical Therapy, Universidade Federal do Rio Grande do Sul (UFRGS); Physical Therapy Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.
| | - Silvia Regina Rios Vieira
- Graduate Program in Health Sciences: Cardiology and Cardiovascular Science, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Dr Pereira Neto, 725 torre 1 ap 902, Tristeza-Porto Alegre, RS, CEP 91920530, Brazil. .,School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS); Intensive Care Unit, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.
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Influence of different body positions in vital capacity in patients on postoperative upper abdominal. Braz J Anesthesiol 2015; 65:217-21. [PMID: 25925035 DOI: 10.1016/j.bjane.2014.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 06/02/2014] [Indexed: 11/21/2022] Open
Abstract
RATIONALE The changes in body position can cause changes in lung function, and it is necessary to understand them, especially in the postoperative upper abdominal surgery, since these patients are susceptible to postoperative pulmonary complications. OBJECTIVE To assess the vital capacity in the supine position (head at 0° and 45°), sitting and standing positions in patients in the postoperative upper abdominal surgery. METHODS A cross-sectional study conducted between August 2008 and January 2009 in a hospital in Salvador/BA. The instrument used to measure vital capacity was analogic spirometer, the choice of the sequence of positions followed a random order obtained from the draw of the four positions. Secondary data were collected from the medical records of each patient. RESULTS The sample consisted of 30 subjects with a mean age of 45.2 ± 11.2 years, BMI 20.2 ± 1.0 kg/m(2). The position on orthostasis showed higher values of vital capacity regarding standing (mean change: 0.15 ± 0.03 L; p=0.001), the supine to 45 (average difference: 0.32 ± 0.04 L; p = 0.001) and 0° (0.50 ± 0.05 L; p = 0.001). There was a positive trend between the values of forced vital capacity supine to upright posture (1.68 ± 0.47; 1.86 ± 0.48; 2.02 ± 0.48 and 2.18 ± 0.52 L; respectively). CONCLUSION Body position affects the values of vital capacity in patients in the postoperative upper abdominal surgery, increasing in postures where the chest is vertical.
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Martinez BP, Silva JR, Silva VS, Neto MG, Forgiarini Júnior LA. [Influence of different body positions in vital capacity in patients on postoperative upper abdominal]. Rev Bras Anestesiol 2014; 65:217-21. [PMID: 25990497 DOI: 10.1016/j.bjan.2014.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 06/02/2014] [Indexed: 11/26/2022] Open
Abstract
RATIONALE The changes in body position can cause changes in lung function, it is necessary to understand them, especially in the postoperative upper abdominal surgery, since these patients are susceptible to postoperative pulmonary complications. OBJECTIVE To assess the vital capacity in the supine position (head at 0° and 45°), sitting and standing positions in patients in the postoperative upper abdominal surgery. METHODS A cross-sectional study conducted between August 2008 and January 2009 in a hospital in Salvador/BA. The instrument used to measure vital capacity (VC) was analogic spirometer, the choice of the sequence of positions followed a random order obtained from the draw of the four positions. Secondary data were collected from the medical records of each patient. RESULTS The sample consisted of 30 subjects with a mean age of 45.2±11.2 years, BMI 20.2±1.0 kg/m(2). The position on orthostasis showed higher values of CV regarding standing (mean change: 0.15±0.03 liters; p=0.001), the supine to 45 (average difference: 0.32±0.04 liters; p=0.001) and 0° (0.50±0.05 liters; p=0.001). There was a positive trend between the values of FVC supine to upright posture (1.68±0.47; 1.86±0.48; 2.02±0.48 and 2.18±0.52 liters; respectively). CONCLUSION Body position affects the values of CV in patients in the postoperative upper abdominal surgery, increasing in postures where the chest is vertical.
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Affiliation(s)
- Bruno Prata Martinez
- Hospital Aliança, Salvador, BA, Brasil; Escola Baiana de Medicina e Saúde Pública (EBMSP), Salvador, BA, Brasil; Faculdade Social da Bahia (FSBA), Salvador, BA, Brasil
| | | | - Vanessa Salgado Silva
- Faculdade Social da Bahia (FSBA), Salvador, BA, Brasil; Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil
| | | | - Luiz Alberto Forgiarini Júnior
- Centro Universitário Metodista (IPA), Programa de Pós-graduação em Reabilitação e Inclusão, e, Biociências e Reabilitação, Porto Alegre, RS, Brasil; Laboratório de Vias Aéreas e Pulmão do Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil.
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Falavigna LF, Silva MG, Freitas ALDA, Silva PFDS, Paiva Júnior MDS, de Castro CMMB, Andrade MDA, Gallindo MAC, Ribeiro LC, Ramos FF, de Andrade FMD, de França EET. Effects of electrical muscle stimulation early in the quadriceps and tibialis anterior muscle of critically ill patients. Physiother Theory Pract 2013; 30:223-8. [PMID: 24377663 DOI: 10.3109/09593985.2013.869773] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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.
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Affiliation(s)
- Letícia Ferreira Falavigna
- Department of Physiotherapy, Institute of Biology and Health, Universidade Catœlica de Pernambuco -- UNICAP , Recife, PE , Brazil
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Taquary SADS, Ataíde DS, Vitorino PVDO. Perfil clínico e atuação fisioterapêutica em pacientes atendidos na emergência pediátrica de um hospital público de Goiás. FISIOTERAPIA E PESQUISA 2013. [DOI: 10.1590/s1809-29502013000300011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Nos últimos anos, tem-se ampliado a atuação fisioterapêutica no setor de urgência e emergência, visando reduzir complicações e tempo de internação hospitalar. Os objetivos deste estudo foram traçar o perfil dos pacientes admitidos na sala de reanimação do Serviço de Referência em Urgência Pediátrica (SERUPE) do Hospital das Clínicas da Universidade Federal de Goiás (HC/UFG) e descrever a atuação fisioterapêutica nesse setor. Trata-se de um estudo observacional, prospectivo, realizado entre fevereiro e junho de 2012, para o qual foram acompanhados todos os pacientes admitidos na sala de reanimação do SERUPE. Foram avaliados 47 pacientes, 53,2% (n=25) do sexo masculino, idade média de 5,2±4,1 anos e 74,5% (n=35) apresentavam doenças prévias. A queixa principal mais frequente foi dispneia em 26,1% (n=29) dos casos e as hipóteses diagnósticas mais identificadas foram doenças respiratórias em 69,4% (n=43). Do total de pacientes, 76,6% (n=36) necessitaram de oxigenoterapia, 21,3% (n=10), de assistência ventilatória e 31,9% (n=15) tiveram acompanhamento fisioterapêutico, 86,7% (n=13) com abordagem respiratória e motora. O tempo médio de permanência na sala de reanimação foi de 1,9±1,5 dias; subsequentemente, 63,8% (n=30) dos pacientes foram internados em enfermaria. Portanto, verifica-se que, no setor de emergência, existe uma grande demanda de pacientes com desordens respiratórias que podem se beneficiar com a presença de um fisioterapeuta.
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