Inspiratory Muscle Training With an Electronic Resistive Loading Device Improves Prolonged Weaning Outcomes in a Randomized Controlled Trial.

OBJECTIVES: To test if the use of an inspiratory muscle training program with an electronic resistive loading device is associated with benefits as to muscle strength, weaning, and survival in the ICU. DESIGN: Prospective randomized controlled trial. SETTINGS: Study conducted at the ICU of a Navy's hospital, Rio de Janeiro, Brazil, from January 2016 to September 2018. PATIENTS: Tracheostomized patients (18-86 yr) on prolonged weaning. INTERVENTIONS: Participants were assigned to inspiratory muscle training (intervention group) or a traditional T-piece protocol (control group). In the inspiratory muscle training group, participants underwent training with an electronic inspiratory training device (POWERbreathe K-5; Technologies Ltd, Birmingham, United Kingdom). MEASUREMENTS AND MAIN RESULTS: Changes in respiratory muscle strength and rates of ICU survival and weaning success were compared between groups. Forty-eight participants in the inspiratory muscle training group and 53 ones in the control group were included in the final analysis. The inspiratory muscle training was associated with a substantially higher gain on muscle strength as assessed by the maximal inspiratory pressure (70.5 [51.0-82.5] vs -48.0 cm H2O [36.0-72.0 cm H2O]; p = 0.003) and the timed inspiratory effort index (1.56 [1.25-2.08] vs 0.99 cm H2O/s [0.65-1.71 cm H2O/s]; p = 0.001). Outcomes at the 60th day of ICU were significantly better in the intervention group regarding both survival (71.1% vs 48.9%; p = 0.030) and weaning success (74.8% vs 44.5%; p = 0.001). CONCLUSIONS: The use of an inspiratory muscle training program with an electronic resistive loading device was associated with substantial muscle strength gain and positive impacts in two very relevant clinical outcomes: the rates of ICU survival and successful weaning.

Correlação entre os picos pressóricos da curva tensional diária e do teste de sobrecarga hídrica: estudo em pacientes com glaucoma primário de ângulo aberto em uso de timolol e dorzalamida / Correlaction between intraocular pressure peaks in the diurnal tension curve and in the water-drinking provocative test. A study in primary open-angle glaucoma patients using timolol and dorzolamide

Objetivo: Avaliar a correlação entre o pico de pressão intra-ocular (PIO) obtido durante a curva diária (CTD) e o pico pressórico do teste de sobrecarga hídrica (TSH) em pacientes com glaucoma primário de ângulo aberto (GPAA) em tratamento com timolol e dorzolamida. Local: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Métodos: Treze pacientes (24 olhos) com GPAA, em uso de Timolol 12/12h e Dorzolamida 12/12h, foram submetidos a CTD (6h-20h) seguida pelo TSH. Foi avaliada a correlação entre os picos pressóricos dos dois testes. Resultados: Houve correção estatisticamente significativa (p=0,0003) entre os picos pressóricos da CTD e do TSH. A média ñ desvio-padrão da diferença entre os picos foi de 0,25 ñ 4,00mmHg, e não diferiu significativamente da média idela de zero. Conclusão: Há correlação significativa entre os picos pressóricos obtidos na curva tensional diária e no teste de sobrecarga hídrica, o que pode ser valioso no acompanhamento de alguns pacientes com glaucoma.