MOBILIZAÇÃO ARTICULAR DE MAITLAND COMO TRATAMENTO DA CERVICALGIA CRÔNICA: REVISÃO NARRATIVA DA LITERATURA

Introduction: Chronic neck pain is a common multifactorial musculoskeletal disorder that can cause disability. The limitations generated by neck pain compromise the individual's biopsychosocial well-being. Among the therapeutic approaches, joint mobilization stands out through the Maitland technique. Objective: To verify the effects of the Maitland technique as a treatment of chronic neck pain. Methodology: This is a narrative review of the literature. The data were taken from studies published in English and Portuguese in the period from 2013 to 2023, in the Pubmed, Pedro, Lilacs, Scielo databases, using the following descriptors in Portuguese: neck pain, neck pain, manual therapy and Maitland, as well as in English: neck pain, neck ache, manual therapy and Maitland. A total of 990 articles were pre-selected and after applying the eligibility criteria, 5 were included. Results and Discussion: The Maitland technique alone or associated with other therapies promotes pain reduction, gains in ROM and improvements in neck disability. Conclusion: Maitland is effective in treating chronic neck pain in adults, promoting symptom improvement.Introducción: El dolor crónico de cuello es un trastorno musculoesquelético multifactorial común que puede causar incapacidad. Las limitaciones que genera el dolor de cuello comprometen el bienestar biopsicosocial del individuo. Entre los abordajes terapéuticos destaca la movilización articular de Maitland. Objetivo: Verificar los efectos de la técnica Maitland como tratamiento para dolor crónico de cuello. Metodología: Esta es una revisión narrativa de la literatura. Los datos fueron tomados de estudios publicados en inglés y portugués en el período de 2013 a 2023, en las bases de datos Pubmed, Pedro, Lilacs, Scielo, utilizando los siguientes descriptores en portugués: dolor de cuello, dolor de cuello, terapia manual y Maitland, además como en inglés: dolor de cuello, dolor de cuello, terapia manual y Maitland. Se preseleccionaron un total de 990 artículos y tras aplicar los criterios de elegibilidad se incluyeron 5. Resultados y Discusión: La técnica de Maitland sola o asociada con otras terapias promueve la reducción del dolor, ganancias en el ROM y mejoras en la discapacidad del cuello. Conclusión: Maitland es eficaz en el tratamiento del dolor crónico de cuello en adultos, promoviendo la mejora de los sintomas.Introdução: A cervicalgia crônica é um distúrbio musculoesquelético multifatorial comum que pode gerar incapacidade. As limitações geradas pela dor no pescoço comprometem o bem-estar biopsicossocial do indivíduo. Dentre as condutas terapêuticas destaca-se a mobilização articular por meio da técnica de Maitland. Objetivo: Verificar os efeitos da técnica de Maitland como tratamento da cervicalgia crônica. Metodologia: Trata-se de uma revisão narrativa da literatura.  Os dados foram retirados de estudos publicados nos idiomas inglês e português no período de 2013 a 2023, nas bases de dados Pubmed, Pedro, Lilacs, Scielo, por meio dos seguintes descritores em português: cervicalgia, dor no pescoço, terapia manual e Maitland, bem como em inglês: neck pain, neck ache, manual therapy e Maitland. Um total de 990 artigos foram pré selecionados e após a aplicação dos critérios de elegibilidade, 5 foram incluídos. Resultados e Discussão: A técnica de Maitland isolada ou associada a outras terapêuticas promove diminuição da dor, ganho de ADM e melhora da incapacidade do pescoço. Conclusão: Maitland é eficaz no tratamento da cervicalgia crônica em adultos, promovendo melhora dos sintomas

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.13Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt