Analysis of physical function, muscle strength, and pulmonary function in surgical cancer patients: a prospective cohort study

The aim of this study was to investigate mobility, physical functioning, peripheral muscle strength, inspiratory muscle strength and pulmonary function in surgical cancer patients admitted to an intensive care unit (ICU). We conducted a prospective cohort study with 85 patients. Mobility, physical functioning, peripheral muscle strength, inspiratory muscle strength, and pulmonary function were assessed using the following tests: ICU Mobility Scale (IMS); Chelsea Critical Care Physical Assessment (CPAx); handgrip strength and Medical Research Council Sum-Score (MRC-SS); maximal inspiratory pressure (MIP) and S-Index; and peak inspiratory flow, respectively. The assessments were undertaken at ICU admission and discharge. The data were analyzed using the Shapiro-Wilk and Wilcoxon tests and Spearman's correlation coefficient. Significant differences in inspiratory muscle strength, CPAx, grip strength, MRC-SS, MIP, S-Index, and peak inspiratory flow scores were observed between ICU admission and discharge. Grip strength showed a moderate correlation with MIP at admission and discharge. The findings also show a moderate correlation between S-Index scores and both MIP and peak inspiratory flow scores at admission and a strong correlation at discharge. Patients showed a gradual improvement in mobility, physical functioning, peripheral and inspiratory muscle strength, and inspiratory flow during their stay in the ICU.

Physiotherapeutic approach and profile of patients treated in the emergency room surgical unit of a tertiary care hospital in the Federal District

Abstract Introduction The emergency room (ER) is the main entry door for the care of critically ill patients. The inclusion of physiotherapists in these sectors is being consolidated in Brazil. Objective To characterize the physiotherapeutic approach and the clinical-functional profile of patients in the ER surgical unit of a tertiary hospital. Methods This was a retrospective cross-sectional study conducted from August to December of 2020. Clinical and functional data, and the main physiotherapeutic procedures performed, were collected. Analyses were conducted by means of the Friedman and Pearson Correlation tests, using SPSS software v.23. Results The sample included 98 patients, 68% male, mean age of 52 ± 19 years. The most common (64%) physiotherapeutic diagnosis was central nervous system (CNS) deficiency with mechanical ventilation (MV) dependence. The mean time of MV use was 4 ± 5 days. Association (p < 0.05) between MV time and admission in the emergency department (r = 0.972) and between MV time and age (r = 0.330) was identified. The most used physiotherapeutic actions were: suction (69%), lung re-expansion therapy (51%), and bed kinesiotherapy (37%). Conclusion Adult men with CNS-related disabilities were the principal patient profile. The physiotherapeutic action in the surgical emergency unit was diverse, with application of motor and respiratory techniques, and the predominant activity was the management and maintenance of MV.

Abordagem fisioterapêutica e perfil dos pacientes assistidos na unidade cirúrgica do pronto-socorro de um hospital terciário do Distrito Federal

Resumo Introdução O pronto-socorro (PS) tornou-se a principal porta para o início da assistência a pacientes graves. A inserção do fisioterapeuta nesses setores está em processo de consolidação no Brasil. Objetivo Carac-terizar a abordagem fisioterapêutica e o perfil clínico-funcional dos pacientes na unidade cirúrgica PS de um hospital terciário. Métodos Trata-se de um estudo transversal retrospectivo realizado no período de agosto a dezembro de 2020. Coletaram-se dados clínicos, funcionais e as principais condutas fisioterapêuticas utilizadas. As análises foram conduzidas por meio dos testes de Friedman e Correlação de Pearson, utilizando o software Statistical Package for the Social Sciences v.23. Resultados Ao todo, a amostra foi de 98 pacientes, dos quais 68% eram homens, com idade média de 52 ± 19 anos. O principal (64%) diagnóstico fisioterapêutico foi deficiência do sistema nervoso central (SNC) com dependência de ventilação mecânica (VM). O tempo médio de uso de VM foi de 4 ± 5 dias. Houve associação (p < 0,05) entre tempo de VM e internação no PS (r = 0,972) e entre tempo de VM e idade (r = 0,330). As condutas fisioterapêuticas mais utilizadas foram a aspiração (69%), terapia de reexpansão pulmonar (51%) e cinesioterapia no leito (37%). Conclusão Os homens em faixa etária adulta e com deficiências relacionadas ao SNC constituíram o principal perfil dos usuários. A atuação fisioterapêutica na unidade de emergência cirúrgica foi ampla, com emprego de técnicas motoras e respiratórias, das quais a atuação predominante ocorreu no manejo e condução da VM.

Profile of adult intensive care units in Brazil: systematic review of observational studies

OBJECTIVE

To identify the clinical and epidemiological profile of adult intensive care units in Brazil.

METHODS

A systematic review was performed using a comprehensive strategy to search PubMed®, Embase, SciELO, and the Biblioteca Virtual em Saúde. The eligibility criteria for this review were observational studies that described the epidemiological and/or clinical profile of critically ill patients admitted to Brazilian intensive care units and were published between 2007 and 2020.

RESULTS

From the 4,457 identified studies, 27 were eligible for this review, constituting an analysis of 113 intensive care units and a final sample of 75,280 individuals. There was a predominance of male and elderly patients. Cardiovascular diseases were the main cause of admission to the intensive care unit. The Acute Physiology and Chronic Health Evaluation II score was the most widely used disease severity assessment system. The length of stay and mortality in the intensive care unit varied widely between institutions.

CONCLUSION

These results can help guide the planning and organization of intensive care units, providing support for decision-making and the implementation of interventions that ensure better quality patient care.Registration PROSPERO: CRD4201911808.

Analysis of functional status and muscle strength in adults and older adults in an intensive care unit: a prospective cohort study

The aim of this study was to analyze and assess the association between functional status (FS) and muscle strength (MS) in young adults, adults and older adults in an intensive care unit (ICU). We conducted a prospective cohort study with 48 patients. FS was assessed using the Functional Status Score for the Intensive Care Unit (FSS-ICU) and MS was measured using the Medical Research Council Sum-Score (MRC-SS) and by testing handgrip strength (HS). The assessments were performed on awakening and ICU discharge. The data were analyzed using the Kruskall-Wallis, chi-squared, Wilcoxon and Spearman's correlation tests. FS and MRC-SS scores were higher on ICU discharge in all groups. Gains were lowest in the older adult group. HS was greater in both hands on ICU discharge in all groups except the adults. FSS-ICU on both awakening and ICU discharge was highest in the adults; HS-R was lowest in the older adults. There was a strong association between FS and MS in the young adults and adults. FS and MS showed progressive improvement during ICU stay. Gains in FS and MS on awakening and ICU discharge were lowest among the older adults. Important associations were found between these variables in all groups except the older adults. This can be explained by the multifactorial nature of illness and incapacity in this group.

The impact of sarcopenic obesity on inflammation, lean body mass, and muscle strength in elderly women

Objective

The objective of this study was to apply the newly standardized definition for sarcopenia from the Foundation for the National Institutes of Health (FNIH) and the current definition for obesity to 1) determine the prevalence of sarcopenic obesity (SO) in obese elderly women; 2) compare the muscle strength, lean body mass, and markers of inflammation between obese elderly women with SO and nonsarcopenic obesity (NSO), and 3) elucidate the relationship between appendicular lean mass adjusted for body mass index (aLM/BMI) with muscle strength, lean body mass, and obesity indices.

Methods

A total of 64 elderly obese women (age: 68.35±6.04 years) underwent body composition analysis by dual-energy X-ray absorptiometry. Participants were classified into two groups according to the definition of SO and NSO. Blood samples were collected for total cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, uric acid, urea, interleukin-6 (IL-6), glucose, and creatine kinase (CK) measurements.

Results

The SO group presented a significantly greater BMI, fat (%), glucose, a marginal trend toward significance for uric acid, and IL-6 compared to the NSO group. In addition, the SO group displayed lower values for muscle strength and lean body mass. From a correlation standpoint, a higher aLM/BMI was positively associated with lean body mass and muscle strength and negatively associated with a lower BMI and percentage body fat.

Conclusion

The definition criteria from FNIH and obesity permit the ability to illustrate the prevalence and identify SO in elderly women with low muscle mass, low muscle strength, and impaired markers of inflammation.

Blood pressure response to resistance training in hypertensive and normotensive older women

PURPOSE

The purpose of the present study was to identify the variability of blood pressure response to a 10-week resistance training (RT) program in hypertensive and normotensive elderly women.

PARTICIPANTS AND METHODS

Twenty-seven untrained hypertensive and 12 normotensive elderly women participated in the present study. A whole-body RT program was performed on two nonconsecutive days per week for 10 weeks. The responsiveness of resting systolic blood pressure (SBP) was determined based on the percent decline between the pre- and post-training time points T1 and T4. The term responders were used to describe subjects who exhibited a percent SBP decline ≥-2.58% and the term nonresponders for subjects who exhibited a percent SBP decline <-2.58%, respectively.

RESULTS

Both the responders and nonresponders in the hypertensive group presented significant changes in SBP (-7.83 ± 5.70 mmHg vs 3.78 ± 7.42 mmHg), respectively. Moreover, the responders and nonresponders in the normotensive group presented significant changes in SBP as well (-8.58 ± 5.52 mmHg vs 5.71 ± 3.84 mmHg).

CONCLUSION

SBP presents a heterogeneous response to a controlled RT program in hypertensive and normotensive elderly women. A different modality of training and additional therapies should be used for nonresponders in order to decrease resting SBP.

Elderly women with metabolic syndrome present higher cardiovascular risk and lower relative muscle strength

Objective:

To compare the metabolic, anthropometric, arterial blood pressure, and muscle strength parameters of elderly women with and without metabolic syndrome.

Methods:

A case-control study with 27 (67.3±4.8 years of age, 31.0±5.0kg/m²) elderly women with metabolic syndrome and 33 (68.8±5.6 years of age, 27.2±5.3kg/m²) sedentary control elderly women. They were submitted to an evaluation of body composition by means of dual-energy X-ray absorptiometry and muscle strength testing with 10 maximal repetitions of knee extension.

Results:

When compared to the elderly women without metabolic syndrome, those with the metabolic syndrome had higher levels for body mass (72.2±13.5 versus 63.4±14.6kg, p=0.03), body mass index (31.0±5.0 versus 27.2±5.3kg/m^2, p=0.007), fat mass (30.9±9.9 versus 24.4±8.5kg, p=0.01), systolic arterial pressure (125.1±8.2 versus 119.3±8.7mmHg, p=0.01), diastolic arterial pressure (75.5±6.9 versus 71.4±6.7mmHg, p=0.03), mean arterial pressure (92.5±6.2 versus 87.1±6.7mmHg, p=0.004), blood glucose (103.8±19.1 versus 91.1±5.9mg/dL, p=0.001), triglycerides (187.1±70.2 versus 116.3±36.7mg/dL, p=0.001), and creatine kinase (122.6±58.6 versus 89.8±32.5U/L, p=0.01); lower levels were found for fat-free mass (55.9±5.8 versus 59.3±6.7%; p=0.05), HDL-C (40.7±5.0 versus 50.5±10.1mg/dL, p=0.001), and relative muscle strength (0.53±0.14 versus 0.62±0.12, p=0.01).

Conclusion:

Elderly women with metabolic syndrome have a higher cardiovascular risk and less relative muscle strength when compared to those without metabolic syndrome. Relative muscle strength may be related to the cardiovascularr risk factors of the metabolic syndrome.