Evaluation of systemic inflammation in patients being weaned from mechanical ventilation

OBJECTIVES: The aim of this study was to evaluate systemic inflammatory factors and their relation to success or failure in a spontaneous ventilation test. METHODS: This cross-sectional study included a sample of 54 adult patients. Demographic data and clinical parameters were collected, and blood samples were collected in the first minute of the spontaneous ventilation test to evaluate interleukin (IL)-1b, IL-6, IL-8, and IL-10, tumour necrosis factor alpha (TNFa) and C-reactive protein. RESULTS: Patients who experienced extubation failure presented a lower rapid shallow breathing index than those who passed, and these patients also showed a significant increase in C-reactive protein 48 hours after extubation. We observed, moreover, that each unit increase in inflammatory factors led to a higher risk of spontaneous ventilation test failure, with a risk of 2.27 (1.001 – 4.60, p=0.049) for TNFa, 2.23 (1.06 – 6.54, p=0.037) for IL-6, 2.66 (1.06 – 6.70, p=0.037) for IL-8 and 2.08 (1.01 – 4.31, p=0.04) for IL-10, and the rapid shallow breathing index was correlated with IL-1 (r=-0.51, p=0.04). CONCLUSIONS: C-reactive protein is increased in patients who fail the spontaneous ventilation test, and increased ILs are associated with a greater prevalence of failure in this process; the rapid shallow breathing index may not be effective in patients who present systemic inflammation

Effect of the systemic administration of methylprednisolone on the lungs of brain-dead donor rats undergoing pulmonary transplantation

OBJECTIVE: Most lung transplants are obtained from brain-dead donors. The physiopathology of brain death involves hemodynamics, the sympathetic nervous system, and inflammatory mechanisms. Administering methylprednisolone 60 min after inducing brain death in rats has been shown to modulate pulmonary inflammatory activity. Our objective was to evaluate the effects of methylprednisolone on transplanted rat lungs from donors treated 60 min after brain death. METHODS: Twelve Wistar rats were anesthetized, and brain death was induced. They were randomly divided into two groups (n = 6), namely a control group, which was administered saline solution, and a methylprednisolone group, which received the drug 60 min after the induction of brain death. All of the animals were observed and ventilated for 2 h prior to being submitted to lung transplantation. We evaluated the hemodynamic and blood gas parameters, histological score, lung tissue levels of thiobarbituric acid-reactive substances, level of superoxide dismutase, level of tumor necrosis factor-alpha, and level of interleukin-1 beta. RESULTS: After transplantation, a significant reduction in the levels of tumor necrosis factor-alpha and IL-1β was observed in the group that received methylprednisolone (p = 0.0084 and p = 0.0155, respectively). There were no significant differences in tumor necrosis factor-alpha and superoxide dismutase levels between the control and methylprednisolone groups (p = 0.2644 and p = 0.7461, respectively). There were no significant differences in the blood gas parameters, hemodynamics, and histological alterations between the groups. CONCLUSION: The administration of methylprednisolone after brain death in donor rats reduces inflammatory activity in transplanted lungs but has no influence on parameters related to oxidative stress

Relação entre função pulmonar, independência functional e controle de tronco em pacientes após acidente vascular cerebral

Stroke often leads to abnormalities in muscle tone, posture, and motor control that may compromise voluntary motor function, thus affecting the motor control required for maintaining the synergy of both peripheral and respiratory muscles. Objective To evaluate respiratory muscle strength, pulmonary function, trunk control, and functional independence in patients with stroke and to correlate trunk control with the other variables. Methods This was a cross-sectional study of patients diagnosed with stroke. We assessed respiratory muscle strength, trunk control as assessed by the Trunk Impairment Scale, spirometric variables, and the Functional Independence Measure. Results Forty-four patients were included. Pulmonary function and respiratory muscle strength were significantly lower than predicted for the study population, and the mean Trunk Impairment Scale score was 14.3 points. The following significant correlations were found between the variables: trunk control vs. maximal inspiratory pressure (r = 0.26, p < 0.05); trunk control vs. forced vital capacity (r = 0.28, p < 0.05); trunk control vs. forced expiratory volume in one second (r = 0.29, p < 0.05), and trunk control vs. the Functional Independence Measure (r = 0.77, p < 0.05). Conclusion The present study showed that respiratory muscle strength, pulmonary function, functional independence, and trunk control are reduced in patients diagnosed with stroke.Acidente vascular cerebral (AVC) frequentemente leva a anormalidades no tônus muscular, postura e controle motor que podem comprometer a função motora voluntária, afetando o controle motor necessário para manter a sinergia dos músculos periféricos e respiratórios. Objetivo Avaliar a força muscular respiratória, a função pulmonar, o controle do tronco e a independência funcional em pacientes com AVC e correlacionar o controle do tronco com as demais variáveis. Métodos Este foi um estudo transversal, incluindo pacientes diagnosticados com AVC. Avaliamos a força muscular respiratória, o controle do tronco avaliado pela escala de comprometimento de tronco, as variáveis espirométricas e a medida de independência funcional. Resultados Quarenta e quatro pacientes foram incluídos. A função pulmonar e a força muscular respiratória foram significativamente menores do que o previsto para a população estudada, e o escore médio do escala de comprometimento de tronco foi de 14,3 pontos. As seguintes correlações significativas foram encontradas entre as variáveis: controle do tronco vs. pressão inspiratória máxima (r = 0,26, p <0,05); controle do tronco vs capacidade vital forçada (r = 0,28, p <0,05); controle do tronco versus volume expiratório forçado no primeiro segundo (r = 0,29, p <0,05) e controle do tronco vs. medida de independência funcional (r = 0,77, p <0,05). Conclusão O presente estudo demonstrou que a força muscular respiratória, a função pulmonar, a independência funcional e o controle do tronco estão diminuídos em pacientes diagnosticados com AVC

Early mobilization practices of mechanically ventilated patients : a 1-day point-prevalence study in southern Brazil

OBJECTIVES: To assess early mobilization practices of mechanically ventilated patients in southern Brazilian intensive care units (ICUs) and to identify barriers associated with early mobilization and possible complications. METHODS: A prospective, observational, multicenter, 1-day point-prevalence study was conducted across 11 ICUs and included all mechanically ventilated adult patients. Hospital and ICU characteristics and patients’ demographic data, the highest level of mobilization achieved in the 24 hours prior to the survey and related barriers, and complications that occurred during mobilization were collected in the hospital and the ICU. RESULTS: A total of 140 patients were included with a mean age of 57±17 years. The median and interquartile range was 7 (3-17) days for the length of ICU stay to the day of the survey and 7 (3-16) days for the duration of mechanical ventilation (MV). The 8-level mobilization scale was classified into two categories: 126 patients (90%) remained in bed (level 1–3) and 14 (10%) were mobilized out of bed (level 4–8). Among patients with an endotracheal tube, tracheostomy, and noninvasive ventilation, 2%, 23%, and 50% were mobilized out of bed, respectively (po0.001 for differences among the three groups). Weakness (20%), cardiovascular instability (19%), and sedation (18%) were the most commonly observed barriers to achieving a higher level of mobilization. No complications were reported. CONCLUSIONS: In southern Brazilian ICUs, the prevalence of patient mobilization was low, with only 10% of all mechanically ventilated patients and only 2% of patients with an endotracheal tube mobilized out of bed as part of routine care

Inovações e tecnologias para a prevenção da úlcera por pressão em calcâneo

Justificativa e objetivos: Diversos dispositivos de prevenção para úlcera por pressão têm surgido no mercado atual, no entanto, muitos destes não atendem as diretrizes de prevenção e podem contribuir para o aumento do risco de desenvolvimento da úlcera. O objetivo deste estudo foi realizar uma revisão da literatura sobre as principais inovações e tecnologias desenvolvidas nos últimos dez anos para a prevenção da úlcera por pressão, abrangendo a região do calcâneo. Conteúdo: A pesquisa da literatura caracterizou-se por busca de artigos no meio on-line publicados no período de janeiro de 2006 a fevereiro de 2016, e disponíveis nos idiomas português, inglês e espanhol. A procura dos artigos foi realizada nas bases de dados do SciELO, IBECS, MEDLINE, LILACS e PubMed, por meio dos seguintes descritores combinados: pressure ulcer AND prevention and control OR pressure ulcer AND calcaneus OR pressure ulcer AND inventions OR pressure ulcer AND equipment and hospital supplies OR pressure ulcer AND diffusion of innovation. Foram identificados 2.145 artigos, e, após a leitura dos títulos e resumos, 14 se adequavam aos critérios de inclusão e compuseram a leitura para esta revisão. Conclusão: Verificou-se que as inovações e tecnologias desenvolvidas nos últimos dez anos são úteis e podem ser incorporadas em protocolos de prevenção global da úlcera por pressão. Contudo, inovações e tecnologias específicas para a prevenção da úlcera por pressão na região do calcâneo são escassas. Sugere-se o desenvolvimento de dispositivo de prevenção da úlcera por pressão para a região do calcâneo, baseado em evidências científicas

Innovations and technologies for the prevention of pressure ulcers in the calcaneus

Background and Objectives: Several prevention devices for pressure ulcers have emerged in the market recently; however, many do not meet the prevention guidelines and can contribute to increase the risk of developing ulcers. The objective of the present study was to carry out a literature review on the main innovations and technologies developed in the past ten years to prevent calcaneal pressure ulcer. Contents: The literature survey consisted of searching for papers published from January 2006 to February 2016 in Portuguese, English and Spanish. The consulted databases were SciELO, IBECS, MEDLINE, LILACS and PubMed, by combining descriptors and Boolean operators as follows: pressure ulcer AND prevention AND control OR pressure ulcer AND calcaneus OR pressure ulcer AND inventions OR pressure ulcer AND equipment AND hospital supplies OR pressure ulcer AND diffusion of innovation. The search resulted in 2,145 papers, and reading of title and abstracts allowed the selection of 14 publications that met the inclusion criteria and were included in the sample of this review. Conclusions: Innovations and technologies developed in the past ten years are useful and can be incorporated in global prevention protocols for pressure ulcers. Nevertheless, innovations and technologies for prevention of calcaneal pressure ulcers are sparse. The authors suggest the development of specific devices for prevention of calcaneal pressure ulcers based on scientific evidence. Descriptors: Pressure ulcers. Inventions. Hospital supplies and equipment. Diffusion of innovation