Respiratory pattern, thoracoabdominal motion and ventilation in chronic airway obstruction

Background. Patients with chronic obstructive pulmonary disease (COPD) present abnormal respiratory mechanics, but its relation to ventilation variables at rest is not fully understood. Methods. We evaluated breathing pattern, thoracoabdominal motion, and ventilation in moderate and severe COPD patients by means of respiratory inductive plethysmograph and analysis of respiratory metabolism in semirecumbent position at rest. Diaphragmatic movement was measured using radiographs. Results. COPD patients showed an increase in mean inspiratory flow, minute ventilation, dead space ventilation, oxygen and carbon dioxide ventilatory equivalents and reduction of respiratory times and pulse oxymetry. These findings were more pronounced in severe COPD. Changes in ventilatory efficiency were correlated with decreased respiratory times, reduced diaphragmatic movement, and lower oxygen uptake. Conclusions. Rapid shallow breathing and reduced diaphragmatic movement have led to ventilatory inefficiency without changes in thoracoabdominal motion

Perfil de fisioterapeutas brasileiros que atuam em unidades de terapia intensiva

The purpose of this study was to outline a profile of physical therapists who work in intensive care units (ICU) in Brazil, focusing on service management, techniques used, and the degree of therapists' autonomy regarding invasive and non-invasive mechanical ventilation. Questionnaires were sent to the heads of physical therapy (PT) services of 1,192 hospitals registered at the Brazilian Intensive Care Medicine Association and 461 (39%) ICUs replied. In 88% of these, PT services are headed by physical therapists and up to eight therapists work in 78% of the ICUs. Therapists work 30 hours a week in 44.4% of the units; 46.1% are formally hired. PT 24-hour assistance is available in 32.8% of the ICUs and on weekends, in 88%. Concerning PT techniques, all therapists perform mobilization, positioning, and aspiration; 91.5% play an active role in non-invasive ventilation, with 42.5% working with full autonomy. As to invasive mechanical ventilation, 80% perform extubation, 79.2% adjusting and weaning; however, only 22% have full autonomy (the others requiring physicians' protocol). Brazilian physical therapists work mostly in private institution ICUs, in services headed by physiotherapists, and have relative autonomy in handling PT techniques and non-invasive mechanical ventilation; as to invasive mechanical ventilation, most depend on protocols or discussions with a physician.Este estudo visou investigar o perfil dos fisioterapeutas que atuam nas unidades de terapia intensiva (UTIs) no Brasil, focalizando a direção do serviço, técnicas fisioterapêuticas empregadas e nível de autonomia em relação à ventilação mecânica invasiva e não-invasiva. Questionários foram enviados aos chefes dos serviços de fisioterapia de 1.192 hospitais registrados na Associação Médica de Terapia Intensiva, com retorno de 461 (39%) UTIs. Em 88% destas, os serviços são chefiados por fisioterapeutas; em 78%, compostos por até oito fisioterapeutas; 44,4% dos fisioterapeutas trabalham em regime de 30 horas semanais e 46,1% têm contrato de trabalho. Há assistência fisioterapêutica durante 24 horas em 33,6% das UTIs; 88% delas mantêm assistência nos finais de semana. Quanto às técnicas fisioterapêuticas, todos realizam mobilização, posicionamento e aspiração; 91,5% atuam na ventilação não-invasiva, sendo que 43% trabalham com total autonomia. Em relação à ventilação mecânica invasiva, 80% realizam extubação; 79,2% realizam regulagem e desmame do ventilador; entretanto, só 22% têm total autonomia (78% necessitam de protocolo ou opinião da equipe médica). Os fisioterapeutas brasileiros atuam, em sua maioria, em instituições privadas e assistenciais, cujos serviços são chefiados por fisioterapeutas. Têm relativa autonomia quanto às técnicas fisioterapêuticas e o manuseio da ventilação mecânica não-invasiva mas, no caso da invasiva, atuam sob diretiva da equipe médica