Falha de extubação em unidade de terapia intensiva pediátrica: estudo de coorte retrospectivo

Na unidade de terapia intensiva (UTI) pediátrica, a falha de extubação pode aumentar o risco de mortalidade. Este estudo objetivou: (1) verificar a taxa de falha de extubação na UTI pediátrica de um hospital público do município de Bauru (São Paulo, Brasil); (2) identificar a principal causa atribuída à falha de extubação; (3) avaliar se características como a idade e o tempo de ventilação mecânica invasiva (VMI) estão associadas à falha de extubação; (4) avaliar se o tempo de permanência na UTI e hospital é maior entre os pacientes que apresentaram falha de extubação. Foi realizado estudo de coorte retrospectivo com 89 pacientes internados de maio de 2017 até julho de 2018. Os resultados mostraram taxa de falha de extubação correspondente a 16%. A principal causa atribuída à falha de extubação foi o estridor laríngeo, totalizando 57% dos casos. A comparação intergrupos (sucesso vs. falha de extubação) não mostrou diferenças em relação à idade (p=0,294) e ao tempo de VMI (p=0,228). No entanto, observamos que o grupo falha de extubação apresentou maior tempo de UTI (p=0,000) e hospital (p=0,010). Desta forma, concluímos que a taxa de extubação está de acordo com a observada em outros estudos. O estridor laríngeo foi responsável por mais da metade dos casos de falha de extubação. Embora a idade e o tempo de VMI não tenham sido características associadas à falha de extubação, esta contribuiu para o maior período de permanência na UTI e no hospital.En la unidad de cuidados intensivos (UCI) pediátrica, el fracaso de la extubación puede aumentar el riesgo de mortalidad. Este estudio tuvo el objetivo de: (1) verificar el índice de fracaso de la extubación en la UCI pediátrica de un hospital público en el municipio de Bauru (São Paulo, Brasil); (2) identificar la causa principal atribuida al fracaso de la extubación; (3) evaluar si las características edad y tiempo de ventilación mecánica invasiva (VMI) están asociadas al fracaso de la extubación; (4) evaluar si la duración en la UCI y el hospital es mayor entre los pacientes que experimentaron este fracaso. Se realizó un estudio de cohorte retrospectivo con 89 pacientes hospitalizados desde mayo de 2017 hasta julio de 2018. Los índices del fracaso de la extubación fueron del 16%. El estridor laríngeo fue la causa principal atribuida al fracaso de la extubación, lo que totaliza el 57% de los casos. La comparación intergrupal (éxito versus fracaso de la extubación) no presentó diferencias en relación con la edad (p=0,294) y el tiempo VMI (p=0,228). Se observó que el grupo fracaso de la extubación estuvo más tiempo en la UCI (p=0,000) y el hospital (p=0,010). Se concluye que el índice de extubación está en consonancia con lo observado en otros estudios. El estridor laríngeo fue el responsable de más de la mitad de los casos de fracaso de la extubación. Las características edad y el tiempo de VMI no estuvieron asociadas al fracaso de la extubación, pero esta contribuyó a un período más prolongado en la UCI y en el hospital.In the pediatric intensive care unit (ICU), extubation failure may increase mortality risk. This study aimed: (1) to verify the rate of extubation failure in the pediatric ICU of a public hospital located in the city of Bauru (São Paulo, Brazil); (2) to identify the main cause attributed to extubation failure; (3) to evaluate whether age and time of invasive mechanical ventilation (IMV) are characteristics associated to extubation failure; (4) to evaluate whether the length of stay in the ICU/hospital is longer among patients who presented extubation failure. A retrospective study was performed with 89 hospitalized patients from May 2017 to July 2018. Results showed an extubation failure rate corresponding to 16%. The main cause attributed to extubation failure was laryngeal stridor, totaling 57% of the cases. Intergroup comparison (success vs. failure of extubation) showed no differences in relation to age (p=0.294) and IMV time (p=0.228). However, we observed that the extubation failure group had longer ICU (p=0.000) and hospital time (p=0.010). In this way, we conclude that the rate of extubation failure is in agreement with other studies. Laryngeal stridor was responsible for more than half of cases of extubation failure. Although IMV time and age were not associated with the extubation failure, they contributed to a longer stay in the ICU and in the hospital

Intradialytic exercise and postural control in patients with chronic kidney disease undergoing hemodialysis

Abstract Introduction: Exercise promotes physiological improvements that reflect better quality of life and survival among chronic kidney disease patients. However, little is known about the effect of exercise on postural control of hemodialysis patients. Objective: To evaluate the effect of intradialytic aerobic exercise on postural balance in patients on hemodialysis. Methods: a pilot study with seven individuals was conducted at the Hemodialysis Center of Bauru State Hospital. The Berg Balance Scale evaluated balance and postural balance was evaluated by the force platform Advance Mechanical Technology Inc. (AMTI - AccuGait). Trunk mean sway amplitude in the anterior-posterior (AP) and medial-lateral (ML) directions and mean velocity in the AP and ML directions were assessed. Secondary outcomes about functional capacity and body composition (DEXA) were evaluated. The aerobic exercise was performed with a ergometric bicycle during the first two hours of hemodialysis session for 50-60 minutes (BORG >12), three times a week for 12-weeks. Results: Four men and three women, 52.86 ± 11.08 years, participated in the study. There was no difference between pre and post-test of postural balance outcomes. Although the results were not statistically significant, except for the lean body mass and leg lean mass, the presented pilot study suggests improved functional balance and lower limb strength. Conclusion: The 12-weeks of aerobic exercise protocol during hemodialysis despite inducing gains in lean body mass and leg lean mass, was not able to promote improvements in postural control of chronic renal failure patients on hemodialysis

Supplementary_data.. – Supplemental material for Effect of continuous progressive resistance training during hemodialysis on body composition, physical function and quality of life in end-stage renal disease patients: a randomized controlled trial

<p>Supplemental material, Supplementary_data.. for Effect of continuous progressive resistance training during hemodialysis on body composition, physical function and quality of life in end-stage renal disease patients: a randomized controlled trial by Clara Suemi da Costa Rosa, Danilo Yuzo Nishimoto, Giovana Damasceno e Souza, Ariane Pereira Ramirez, Carla Oliveira Carletti, Célio Guilherme Lombardi Daibem, Giorgos K Sakkas and Henrique Luiz Monteiro in Clinical Rehabilitation</p

A new tuning fork with different vibration frequencies as an aid to bronchopulmonary hygiene physiotherapy

Background: The main function of the mucociliary system is the removal of particles or substances that are potentially harmful to the respiratory tract. The tuning fork therapeutic for the purpose of bronchial hygiene has still not been described in the literature. The optimal vibration frequency to mobilize secretions is widely debated and varies between 3 and 25 Hz. It is expected that a tuning fork is able to generate vibrations in the thorax, facilitating bronchial hygiene. The aim of the present study is to develop tuning forks with different frequencies, for use in bronchopulmonary hygiene therapy. Methods: The first tuning fork was made with a fixed frequency of 25 Hz and it was recorded in the Brazilian institution of patent registration. This device generated a frequency of 25 Hz and had a weight of 521 g, with dimensions of 600 mm in total length. The device is characterized by a bottom end containing a transducer with a diameter of 62 mm and a thickness of 5/16 mm (8''), a rod removable 148 mm, fork length of 362 mm and an extension at the upper end of sinuous shape bilaterally.The tuning forks must be applied at an angle of 90° directly on the chest wall of the patient after pulmonary auscultation for location of secretions. The tuning fork is activated by squeezing the tips of the extensions together and releasing them in a sudden movement. Results: This study shows the result of the development of others three tuning forks of different dimensions to generate different frequencies. Each equipment reaches a fixed frequency preset of 12, 15 and 20 Hz measured by digital oscilloscope. Conclusions: The tuning fork models developed in this study generated different frequencies proposed by the scientific literature as effective in the mobilization of pulmonary secretions