Comportamento da mecânica ventilatória durante a realização de um atendimento de fisioterapia respiratória

Question: Can Respiratory therapy alter the lung mechanics in patients with invasive mechanical ventilation? The data available in the literature remain controversial. This study aims to assess the changes of pulmonary mechanics in patients with invasive mechanical ventilation, comparing hemodynamic and ventilatory parameters one hour prior to application of the service, immediately after and one hour after the service. Design: Participants: Patients on mechanical ventilation for at least 48 hours with oro-tracheal tube. Intervention: Patients underwent a protocol of respiratory therapy and hemodynamic variables were recorded at different times. Outcome measures: The following variables were measured one hour before, immediately after and one hour after application of the protocol of respiratory therapy. Dynamic lung compliance (Cdyn), respiratory system resistance (Rsr), Tidal Volume (Vt), Positive End Expiratory Pressure (PEEP), Peak inspiratory pressure (PIP), Heart Rate (HR), Respiratory frequency (RF), and Saturation peripheral oxygen (SpO2). Results: The variables obtained the following mean and standard deviation: HR 88.9 ± 18.7 an hour before the service, presented an increase to 93.7 ± 19.2 immediately after the service, which fell one hour after the service, 88.5 ± 17.1. So we can conclude that heart rate showed an increase after treatment of respiratory therapy and one hour after this variable had a value less than the obtained in the beginning. SpO2 96.5 ± 2.29 one hour before the service, with an increase to 98.2 ± 1.62 immediately after the service, and a slight decrease to 97.8 ± 1.79 one hour after the service. We can conclude that the oxygen saturation showed a significant improvement one hour after the service, not returning to the value obtained one hour before the service. RF 20.8 ± 5.40 one hour before the service, increasing to 21.9 ± 5.89 immediately after the service and presenting a decrease of 19.4 ± 1.79 one hour after the service, when compared to one hour before the service. Rsr 14.2 ± 4.63 one hour before the service, down immediately after the service 11.0 ± 3.43 and a small increase one hour after the service, but did not return to baseline. Vt 550± 134 one hour before the service, increasing significantly to 698 ± 155 and presenting a decrease 672 ± 146, although it remained higher than the value obtained one hour before the service. PIP 22.2 ± 5.54 one hour before the service, with a slowdown that does not differ from the Bonferroni test with the value immediately after the service, and decreased to 21.5 ± 5.24, when compared with the previous two times . Cdyn 52.3 ± 16.1 one hour before the service, increased significantly immediately after the service 65.1 ± 19.1 and decreased to 64.7 ± 20.2 one hour after the service, with no significant difference if compared to the second time, and significant difference if compared with the first time. Peep 5.93 ± 1.80 one hour before the service, 5.89 ± 1.71 immediately after the service and 5.91 ± 1.70 one hour after the service. This was the only variable that showed no significant difference in any of the times compared. In Conclusion: The variables HR, SpO2, RF, Rsr, Vt and Cdyn obtained significance p < 0,01.Variable PIP gained significance with p <0, 013

Qualidade de vida do paciente DPOC após alta da UTI baseado na classificação Gold : coorte prospectiva

Objetivos: Avaliar a qualidade de vida dos pacientes com Doença Pulmonar Obstrutiva Crônica após a alta da UTI baseado na GOLD. Método: Coorte prospectiva multicêntrica, onde foram coletados dados referentes à internação na UTI, intervenções e desfechos após a alta hospitalar (pós-alta imediato, após 3 e 6 meses). A qualidade de vida foi avaliada através do questionário SF12v2, a independência funcional através do índice de Barthel; e a presença de ansiedade e depressão através da Escala Hospitalar de ansiedade e depressão (HADS). Resultados: Houve uma redução significativa nos escores de Limitação por Aspectos Emocionais (57,4±7,2; p<0,046), Saúde Mental (49,4±2,4; p<0,004) e Componente Mental (40,8±2,4; p<0,008) do SF-12 após 6 meses da alta hospitalar. Quanto ao componente mental, a interação com GOLD foi significativa (p=0,013). Quando avaliadas as diferenças ao longo do tempo conforme GOLD, observa-se que houve diferença significativa entre o índice de Barthel (p=0,012), sendo o grupo de GOLD C/D os que reduziram significativamente o índice de Barthel do basal para os 3m e 6m (que não diferiram entre si). A probabilidade de sobrevida ao longo do tempo na amostra total de 77 pacientes foi em 15 dias (93,5%), em um mês (90,9%), em três meses (77,9%) e em seis meses (72,7%). Conclusão: Os scores de limitação por aspectos emocionais, saúde mental e componente mental do questionário SF-12 apresentaram redução significativa após seis meses da alta hospitalar. O índice de barthel avaliado ao longo do tempo conforme a GOLD apresentou diferença significativa, sendo o GOLD C/D o que mais apresentou redução.Objective: To evaluate the quality of life of patients with Chronic Obstructive Pulmonary Disease after discharge from the ICU based on GOLD. Methods: A multicenter prospective study, which were collected data on ICU admission, interventions and outcomes after hospital discharge (Post-discharge immediately after 3 and 6 months). Quality of life was assessed using the SF12v2 questionnaire, the functional independence through Barthel index; and the presence of anxiety and depression by anxiety and depression scale HADS. Results: There was a significant reduction in the Limitations for Emotional Aspects (57.4 ± 7.2, p <0.046), Mental Health (49.4 ± 2.4, p <0.004) and Mental Component (40.8 ± 2, 4, p <0.008) of SF-12 after 6 months of hospital discharge. Regarding the mental component, there was a reduction significant Gold (p = 0.013). When assessing the differences over time according to Gold, it was observed that there was a significant interaction between the Barthel index (p = 0.012), and the Gold C / D group significantly reduced the Barthel index from baseline to 3m and 6m (which did not differ from each other). The probability of survival over time in the 77 patients was 15 days (93.5%), one month (90.9%), three months (77.9%) and six months (72,7%). Conclusion: The limitation scores for emotional aspects, mental health and mental component of the SF-12 questionnaire presented a significant reduction after six months of hospital discharge. The barthel index evaluated over time according to Gold presented significant interaction, with Gold C / D the one that presented the most reduction

Comportamento da mecânica ventilatória durante a realização de um atendimento de fisioterapia respiratória

Question: Can Respiratory therapy alter the lung mechanics in patients with invasive mechanical ventilation? The data available in the literature remain controversial. This study aims to assess the changes of pulmonary mechanics in patients with invasive mechanical ventilation, comparing hemodynamic and ventilatory parameters one hour prior to application of the service, immediately after and one hour after the service. Design: Participants: Patients on mechanical ventilation for at least 48 hours with oro-tracheal tube. Intervention: Patients underwent a protocol of respiratory therapy and hemodynamic variables were recorded at different times. Outcome measures: The following variables were measured one hour before, immediately after and one hour after application of the protocol of respiratory therapy. Dynamic lung compliance (Cdyn), respiratory system resistance (Rsr), Tidal Volume (Vt), Positive End Expiratory Pressure (PEEP), Peak inspiratory pressure (PIP), Heart Rate (HR), Respiratory frequency (RF), and Saturation peripheral oxygen (SpO2). Results: The variables obtained the following mean and standard deviation: HR 88.9 ± 18.7 an hour before the service, presented an increase to 93.7 ± 19.2 immediately after the service, which fell one hour after the service, 88.5 ± 17.1. So we can conclude that heart rate showed an increase after treatment of respiratory therapy and one hour after this variable had a value less than the obtained in the beginning. SpO2 96.5 ± 2.29 one hour before the service, with an increase to 98.2 ± 1.62 immediately after the service, and a slight decrease to 97.8 ± 1.79 one hour after the service. We can conclude that the oxygen saturation showed a significant improvement one hour after the service, not returning to the value obtained one hour before the service. RF 20.8 ± 5.40 one hour before the service, increasing to 21.9 ± 5.89 immediately after the service and presenting a decrease of 19.4 ± 1.79 one hour after the service, when compared to one hour before the service. Rsr 14.2 ± 4.63 one hour before the service, down immediately after the service 11.0 ± 3.43 and a small increase one hour after the service, but did not return to baseline. Vt 550± 134 one hour before the service, increasing significantly to 698 ± 155 and presenting a decrease 672 ± 146, although it remained higher than the value obtained one hour before the service. PIP 22.2 ± 5.54 one hour before the service, with a slowdown that does not differ from the Bonferroni test with the value immediately after the service, and decreased to 21.5 ± 5.24, when compared with the previous two times . Cdyn 52.3 ± 16.1 one hour before the service, increased significantly immediately after the service 65.1 ± 19.1 and decreased to 64.7 ± 20.2 one hour after the service, with no significant difference if compared to the second time, and significant difference if compared with the first time. Peep 5.93 ± 1.80 one hour before the service, 5.89 ± 1.71 immediately after the service and 5.91 ± 1.70 one hour after the service. This was the only variable that showed no significant difference in any of the times compared. In Conclusion: The variables HR, SpO2, RF, Rsr, Vt and Cdyn obtained significance p < 0,01.Variable PIP gained significance with p <0, 013

Changes in respiratory mechanics during respiratory physiotherapy in mechanically ventilated patients

RESUMO Objetivo: Avaliar as alterações da mecânica ventilatória e da hemodinâmica que ocorrem em pacientes dependentes de ventilação mecânica submetidos a um protocolo padrão de fisioterapia respiratória. Métodos: Estudo experimental e prospectivo realizado em duas unidades de tratamento intensivo, nas quais pacientes dependentes de ventilação mecânica por mais de 48 horas foram alocados, de forma consecutiva, e submetidos a um protocolo estabelecido de manobras de fisioterapia respiratória. Variáveis ventilatórias (complacência pulmonar dinâmica, resistência do sistema respiratório, volume corrente, pressão de pico inspiratório, frequência respiratória e saturação periférica de oxigênio) e hemodinâmicas (frequência cardíaca) foram mensuradas 1 hora antes (T-1), imediatamente (T0) e após 1 hora (T+1) da realização do protocolo de manobras de fisioterapia respiratória. Resultados: Durante o período de coleta dos dados, 104 pacientes foram incluídos no estudo. Quanto às variáveis ventilatórias, houve aumento da complacência pulmonar dinâmica (T-1 = 52,3 ± 16,1mL/cmH2O versus T0 = 65,1 ± 19,1mL/cmH2O; p < 0,001), do volume corrente (T-1 = 550 ± 134mL versus T0 = 698 ± 155mL; p < 0,001) e da saturação periférica de oxigênio (T-1 = 96,5 ± 2,29% versus T0 = 98,2 ± 1,62%; p < 0,001), além de redução da resistência do sistema respiratório (T-1 = 14,2 ± 4,63cmH2O/L/s versus T0 = 11,0 ± 3,43cmH2O/L/s; p < 0,001) logo após a realização das manobras de fisioterapia respiratória. Todas as alterações se mantiveram na avaliação realizada 1 hora (T+1) após as manobras de fisioterapia respiratória. Já com relação às variáveis hemodinâmicas, houve elevação imediata, porém não sustentada da frequência cardíaca (T-1 = 88,9 ± 18,7bpm versus T0 = 93,7 ± 19,2bpm versus T+1 = 88,5 ± 17,1bpm; p < 0,001). Conclusão: Manobras de fisioterapia respiratória geram mudanças imediatas na mecânica pulmonar e na hemodinâmica dos pacientes dependentes da ventilação mecânica, e as alterações ventilatórias provavelmente permanecem por pelo menos 1 hora