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

High levels of B-type natriuretic peptide predict weaning failure from mechanical ventilation in adult patients after cardiac surgery

OBJECTIVE: The failure to wean from mechanical ventilation is related to worse outcomes after cardiac surgery. The aim of this study was to evaluate whether the serum level of B-type natriuretic peptide is a predictor of weaning failure from mechanical ventilation after cardiac surgery. METHODS: We conducted a prospective, observational cohort study of 101 patients who underwent on-pump coronary artery bypass grafting. B-type natriuretic peptide was measured postoperatively after intensive care unit admission and at the end of a 60-min spontaneous breathing test. The demographic data, hemodynamic and respiratory parameters, fluid balance, need for vasopressor or inotropic support, and length of the intensive care unit and hospital stays were recorded. Weaning failure was considered as either the inability to sustain spontaneous breathing after 60 min or the need for reintubation within 48 h. RESULTS: Of the 101 patients studied, 12 patients failed the weaning trial. There were no differences between the groups in the baseline or intraoperative characteristics, including left ventricular function, EuroSCORE and lengths of the cardiac procedure and cardiopulmonary bypass. The B-type natriuretic peptide levels were significantly higher at intensive care unit admission and at the end of the breathing test in the patients with weaning failure compared with the patients who were successfully weaned. In a multivariate model, a high B-type natriuretic peptide level at the end of a spontaneous breathing trial was the only independent predictor of weaning failure from mechanical ventilation. CONCLUSIONS: A high B-type natriuretic peptide level is a predictive factor for the failure to wean from mechanical ventilation after cardiac surgery. These findings suggest that optimizing ventricular function should be a goal during the perioperative period

Myocardial infarction scar plication in the rat: Cardiac mechanics in an animal model for surgical procedures

Background. the immediate effects of surgical reduction of left ventricle cavity on cardiac mechanics have not been well defined.Methods. Cardiac mechanics were analyzed before and after myocardial infarction scar plication in 11 isolated infarcted rat hearts.Results. Despite a decrease in myocardial stiffness, an increase in chamber stiffness was noted after myocardial infarction scar plication. Systolic function was favored in more than one way. for the same diastolic pressures, maximal developed pressures were higher after myocardial infarction scar plication, and the slope of the systolic pressure-volume relationship was steeper afterwards as compared with before; this means that Frank-Starling recruitment is accentuated in smaller cavities. in addition, the developed net forces needed to generate these pressures were clearly lower afterward than before, indicating reduced ventricular afterload.Conclusions. the study results show that diastolic function is harmed and systolic function is favored by myocardial infarction scar plication. We suggest that preoperative evaluation of the degree of diastolic dysfunction and impairment of the Frank-Starling mechanism may help to identify patients who may have a poor postoperative outcome due to diastolic or systolic dysfunction.Universidade Federal de São Paulo, Dept Physiol, BR-04022000 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Surg, BR-04022000 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Internal Med, BR-04022000 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Physiol, BR-04022000 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Surg, BR-04022000 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Internal Med, BR-04022000 São Paulo, BrazilWeb of Scienc

Randomized and comparative study between two intra-hospital exercise programs for heart transplant patients

OBJECTIVE: To compare the effects of two physical therapy exercise in-hospital programs in pulmonary function and functional capacity of patients in the postoperative period of heart transplantation. METHODS: Twenty-two heart transplanted patients were randomized to the control group (CG, n=11) and training group (TG, n=11). The control group conducted the exercise program adopted as routine in the institution and the training group has had a protocol consisting of 10 stages, with incremental exercises: breathing exercises, resistance training, stretching and walking. The programs began on the first day after extubation and stretched until hospital discharge. Assessed pulmonary function, distance walked in six minutes walk test (6MWT) and peripheral muscle strength by one repetition maximum test (1RM). RESULTS: Similar behavior was observed between the two groups treated, with statistically significant increases between the first and second test of the following variables: FVC (59% in CG and 35.2% in TG); MIP (8.6% in CG and 53.5% in TG), MEP (28.8% in CG and 40.7% in TG) and 6MWT (44.5% in CG and 31.4% in TG). There was an increase of peripheral strength by 1RM test, over time, to the muscle groups of the elbow flexors, shoulder flexors, hip abductors and knee flexors. CONCLUSION: Heart transplant patients benefit from exercise programs in hospital, regardless of the program type applied. A new training proposal did not result in superiority compared to routine programme applied. Exercise protocols provided improves in ventilatory variables and functional capacity of this population

Alveolar recruitment maneuver in refractory hypoxemia and lobar atelectasis after cardiac surgery: A case report

<p>Abstract</p> <p>Objective</p> <p>This case report describes an unusual presentation of right upper lobe atelectasis associated with refractory hypoxemia to conventional alveolar recruitment maneuvers in a patient soon after coronary artery bypass grafting surgery.</p> <p>Method</p> <p>Case-report.</p> <p>Results</p> <p>The alveolar recruitment with PEEP = 40cmH₂O improved the patient’s atelectasis and hypoxemia.</p> <p>Conclusion</p> <p>In the present report, the unusual alveolar recruitment maneuver with PEEP 40cmH₂O showed to be safe and efficient to reverse refractory hypoxemia and uncommon atelectasis in a patient after cardiac surgery.</p

Autophagy in inflammation, infection, neurodegeneration and cancer

In its classical form, autophagy is an essential, homeostatic process by which cytoplasmic components are degraded in a double-membrane-bound autophagosome in response to starvation. Paradoxically, although autophagy is primarily a protective process for the cell, it can also play a role in cell death. The roles of autophagy bridge both the innate and adaptive immune systems and autophagic dysfunction is associated with inflammation, infection, neurodegeneration and cancer. In this review, we discuss the contribution of autophagy to inflammatory, infectious and neurodegenerative diseases, as well as cancer