Endobronchial perfluorocarbon reduces inflammatory activity before and after lung transplantation in an animal experimental model.

BACKGROUND: The aim of this study was to evaluate the use of liquid perfluorocarbon (PFC) as an adjuvant substance for lung preservation and assess its role in pulmonary protection after transplantation. METHODS: Seventy-two rat lungs were flushed with low-potassium dextran (LPD) solution and randomized into three main groups: control with LPD alone and experimental with 3 (PFC3) and 7 mL/kg (PFC7) of endobronchial PFC instilled just after harvest. Each group was divided into four subgroups according to preservation time (3, 6, 12, and 24 hours). Afterwards, we performed lung transplantation using rat lungs preserved for 12 hours with LPD alone or with 7 mL/kg of endobronchial PFC. RESULTS: There was a significant increase in oxidative stress in the control group at 6 h of cold ischemic time compared with the PFC3 and PFC7 groups. The apoptotic activity and NF-κB expression were significantly higher in the control group compared with the PFC groups at 3, 12, and 24 h of cold preservation. After transplantation, the NF-κB, iNOS, and nitrotyrosine expression as well as caspase 3 activity were significantly lower in the PFC groups. CONCLUSION: The use of endobronchial PFC as an adjuvant to the current preservation strategy improved graft viability.

Maximum oxygen consumption predicts mortality in patients with alcoholic cirrhosis.

BACKGROUND/AIMS: Liver diseases are responsible for metabolic disturbances and the loss of muscle mass and function. This study aims to correlate maximal oxygen uptake (VO2max) with the Model for End Stage Liver Disease (MELD) severity score and associate VO2max with mortality in patients with alcoholic cirrhosis. METHODOLOGY: This prospective study included 27 patients who had a diagnosis of alcoholic liver cirrhosis. All subjects were followed for 3 years and performed an exercise test to determine VO2max. RESULTS: The study included 18 men and 9 women. We observed a strong inverse correlation between VO2max and MELD (r=-0.91, p<0.001). In a survival analysis, individuals who had a VO2max less than 14mL/kg showed 60% mortality when compared with those who had a VO2max greater than 14mL/kg (p<0.0001; OR: 3.29; 95% CI: 1.44-5.25). CONCLUSIONS: The VO2max is directly associated with the survival of patients with alcoholic cirrhosis and demonstrates a strong inverse correlation with the MELD severity score.

PEEP-ZEEP Compared with Bag Squeezing and Chest Compression in Mechanically Ventilated Cardiac Patients: Randomized Crossover Clinical Trial.

Background and Objectives: Perform the bag squeezing and PEEP-ZEEP techniques associated with manual chest compression in mechanically ventilated cardiac patients in order to observe their effectiveness in the removal of pulmonary secretions and safety from a hemodynamic and ventilatory point of view. Methods: This is a randomized crossover clinical trial developed in a hospital in southern Brazil. We included hemodynamically stable male and female patients aged over 18 years who used invasive mechanical ventilation for at least 48 h. The control group was established for the bag-squeezing technique and the intervention group for the PEEP-ZEEP maneuver, both associated with manual chest compression. Tracheal aspiration was performed 2 h before in order to match the groups in relation to the volume of secretion, and also immediately at the end of the techniques in order to measure the amount of secretion collected. Results: The sample had 36 individuals with a mean age of 70.3 years, 21% of the patients were male, and the majority (10.4%) were hospitalized for ischemic heart disease. DBP (p = 0.024), MAP (p = 0.004) and RR (p = 0.041) showed a significant difference in the post-moment in both groups. There was a significant difference in the reduction of peak pressure values (p = 0.011), in the moment after performing the techniques, and also in the Cdyn (p = 0.004) in the control group versus moment. Conclusions: Both maneuvers are safe in terms of hemodynamics and ventilatory mechanics, in addition to being capable of favoring airway clearance through secretion removal, and they can be used in routine physiotherapeutic care.

Brazilian version of the Critical Care Functional Rehabilitation Outcome Measure: translation, cross-cultural adaptation and evaluation of clinimetric properties. / Versão brasileira da Critical Care Functional Rehabilitation Outcome Measure: tradução, adaptação transcultural e avaliação das propriedades clinimétricas.

OBJECTIVE: To translate, crossculturally adapt and evaluate the clinimetric properties of the Critical Care Functional Rehabilitation Outcome Measure for evaluating the functionality of patients admitted to intensive care units in Brazil. METHODS: The process of translation and cross-cultural adaptation involved the following steps: initial translation, synthesis, back-translation, expert committee review and pretesting. The intra- and interrater reliability and agreement were analyzed between two physical therapists who evaluated the same group of patients (n = 35). The evaluations were performed by each therapist independently and blinded to the score assigned by the other professional. The qualitative analysis was performed by the review committee, and the experts adapted and synthesized the Portuguese translation of the Critical Care Functional Rehabilitation Outcome Measure. RESULTS: There was agreement between the initial Brazilian translations of the Critical Care Functional Rehabilitation Outcome Measure scale. The conceptual, idiomatic, semantic and experimental equivalences between the original and translated versions were assessed, resulting in the final Brazilian version of the scale, called the Medida de Resultado da Reabilitação Funcional em Cuidados Intensivos. The evaluation of the clinimetric properties showed evidence of a high degree of agreement and reliability, as all had an intraclass correlation coefficient above 0.75. The overall intraclass correlation coefficient was 0.89. CONCLUSION: The translated version of the Critical Care Functional Rehabilitation Outcome Measure scale for assessing the functionality of patients admitted to an intensive care unit can be used reliably in Brazil following translation and cross-cultural adaptation to Brazilian Portuguese and presents evidence of excellent interrater reliability.

OBJETIVO: Realizar a tradução, a adaptação transcultural e a avaliação das propriedades clinimétricas da Critical Care Functional Rehabilitation Outcome Measure para avaliação da funcionalidade de pacientes internados em unidades de terapia intensiva no Brasil. MÉTODOS: O processo de tradução e adaptação transcultural seguiu as seguintes etapas: tradução inicial, síntese, retrotradução, revisão por comitê de especialistas e pré-teste. Foram analisadas a confiabilidade intra e interavaliador e a concordância, com dados gerados a partir da avaliação de dois fisioterapeutas no mesmo grupo de pacientes (n = 35). As avaliações foram feitas de forma independente e cega quanto ao escore atribuído pelo outro profissional. A análise qualitativa foi realizada pelo comitê de revisão, e os especialistas adaptaram e sintetizaram a tradução da escala Critical Care Functional Rehabilitation Outcome Measure na língua portuguesa. RESULTADOS: Observou-se concordância entre as traduções da escala Critical Care Functional Rehabilitation Outcome Measure para versão brasileira.As equivalências conceitual, idiomática, semântica e experimental entre a versão original e a traduzida foram obtidas, resultando na versão brasileira, denominada Medida de Resultado da Reabilitação Funcional em Cuidados Intensivos. A avaliação das propriedades clinimétricas demonstrou evidências de alto grau de concordância e de confiabilidade, visto que todos tiveram Coeficiente de Correlação Intraclasse acima de 0,75. O Coeficiente de Correlação Intraclasse total foi de 0,89. CONCLUSÃO: A versão da escala Critical Care Functional Rehabilitation Outcome Measure para avaliação da funcionalidade de pacientes internados em unidade de terapia intensiva pode ser utilizada de forma confiável no Brasil, pois foi traduzida e adaptada transculturamente para o português brasileiro e apresenta evidências de excelentes propriedades.

Ventilator versus manual hyperinflation in adults receiving mechanical ventilation: A systematic review.

INTRODUCTION: Manual hyperinflation (MHI) or with a mechanical ventilator (VHI) are alternatives in bronchial hygiene therapy, in recent years several studies have emerged with the objective of verifying the effectiveness and safety of the techniques. OBJECTIVE: Systematically review and analyze the most recent studies in the literature on MHI and VHI, compare both techniques and demonstrate their effectiveness in bronchial hygiene therapy in mechanically ventilated patients. METHODS: We conducted this systematic review based on the PICO strategy and used the databases Ovid, LILACS, CINAHL, Pubmed and CENTRAL. Search, selection and analysis of randomized controlled trials on MHI, VHI or comparing both techniques. We performed a comparison on secretion elimination, static and dynamic compliance, oxygenation and clinical outcomes. The studies were analyzed by two independent evaluators. RESULTS: Nine articles were selected comparing MHI with usual care, demonstrating improved compliance in the MHI group, but with no impact on secretion removal. Four studies compared VHI with usual care, with three showing increased secretion elimination and compliance in the HVM group. Another four articles compared MHI with VHI but none of the studies showed superiority in terms of elimination of secretion and three studies found improvement in static compliance. CONCLUSION: Both techniques have proven to be effective alternatives to bronchial hygiene therapy.

Multicomponent or Resistance Training for Nursing Home Residents: A Systematic Review With Meta-Analysis.

OBJECTIVES: To perform a systematic review with meta-analysis to verify the effects of multicomponent and resistance training on the physical performance in older adult residents in long-term care, as well as to compare these modalities. DESIGN: Systematic review with meta-analysis of randomized controlled trials. SETTING AND PARTICIPANTS: Older adults age over 60 years who are nursing home residents in long-term care. METHODS: Seven electronic databases (PubMed, Embase, Central, Web of Science, SportDiscus, LILACS, and SCIELO) were searched from their inception until May 1, 2022. The methodological quality was assessed using PEDro scale. Mean difference and 95% confidence interval were pooled using a random-effects model. The significance level established was P value of ≤.05 for all analyses. RESULTS: A total of 30 studies were included in the qualitative review (n = 1887, mean age 82.68 years and 70% female). Multicomponent training appeared in 19 studies and resistance training in 12 studies. Out of these, 17 studies were incorporated into the meta-analysis. Multicomponent training and resistance training showed statistically significant difference (P ≤ .05) in the physical performance of institutionalized older adults compared with the control groups (usual care); this was evaluated with the Short Physical Performance Battery (+1.2 points; +2 points), 30-second chair-stand (approximately +3 repetitions; both), and Timed Up and Go (-4 seconds on mean; both) tests. Comparisons between multicomponent and resistance training did not show statistically significant differences in any of the physical outcomes evaluated. CONCLUSIONS AND IMPLICATIONS: The studies provide evidence that both multicomponent training and resistance training may be effective in improving the physical performance of institutionalized older adults. Further studies with more representative sample numbers, an improvement in methodological quality, and a more specified prescription of the training used are necessary.

The Perme scale score as a predictor of functional status and complications after discharge from the intensive care unit in patients undergoing liver transplantation. / Escala Perme como preditor de funcionalidade e complicações após a alta da unidade de terapia intensiva em pacientes submetidos a transplante hepático.

OBJECTIVE: To assess the Perme mobility scale score as a predictor of functional status and complications in the postoperative period in patients undergoing liver transplantation. METHODS: The sample consisted of 30 patients who underwent liver transplantation. The patients were evaluated at two time points to determine their perception of pain, degree of dyspnea, peripheral muscle strength, and functional status according to the Perme scale. The collected data were analyzed by descriptive and inferential statistics. To compare the means between the evaluations, Student's t test for paired samples was applied. In case of asymmetry, the Wilcoxon test was used. In the evaluation of the association between the quantitative variables, the Pearson or Spearman correlation tests were applied. RESULTS: A total of 30 individuals who underwent liver transplantation were included. The patients were predominantly male, and the mean age was 58.4 ± 9.9 years. The most prevalent underlying pathology was cirrhosis C virus (23.3%). Significant associations of the time on mechanical ventilation with the Perme scale score at discharge from the intensive care unit (r = -0.374; p = 0.042) and the number of physical therapy treatments (r = -0.578; p = 0.001) were recorded. When comparing the results of the initial evaluation and the evaluation at hospital discharge, there was a significant improvement in functional status (p < 0.001). CONCLUSION: Functional mobility, peripheral muscle strength, pain perception, and dyspnea are significantly improved at hospital discharge compared with those at inpatient unit admission.

OBJETIVO: Avaliar a pontuação da escala Perme de mobilidade como preditor de funcionalidade e complicações no pós-operatório de pacientes submetidos a transplante hepático. MÉTODOS: A amostra foi composta por 30 pacientes que realizaram transplante hepático. Os pacientes foram avaliados em dois momentos, a fim de verificar a percepção da dor, o grau de dispneia, a força muscular periférica e a funcionalidade do paciente de acordo com a escala Perme. Os dados coletados foram analisados por estatística descritiva e inferencial. Para comparar médias entre as avaliações, foi aplicado o teste t de Student para amostras pareadas. Em caso de assimetria, o teste de Wilcoxon foi utilizado. Na avaliação da associação entre as variáveis quantitativas, os testes de correlação de Pearson ou Spearman foram aplicados. RESULTADOS: Foram incluídos 30 indivíduos que realizaram transplante hepático. Houve predomínio de pacientes do sexo masculino, e a média de idade foi 58,4 ± 9,9 anos. A patologia de base mais prevalente foi a cirrose por vírus C (23,3%). Foram registradas associações significativas entre o tempo de ventilação mecânica e a escala Perme na alta da unidade de terapia intensiva (r = -0,374; p = 0,042) e entre o número de atendimentos fisioterapêuticos (r = -0,578; p = 0,001). Quando comparados os resultados da avaliação inicial e na alta hospitalar, houve significativa melhora da funcionalidade (p < 0,001). CONCLUSÃO: Mobilidade funcional, força muscular periférica, percepção da dor e dispneia melhoram significativamente no momento da alta hospitalar em relação à admissão na unidade de internação.

Relationship between pulmonary function, functional independence, and trunk control in patients with stroke.

OBJECTIVE: 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. 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.

Melatonin effects on pulmonary tissue in the experimental model of Hepatopulmonary Syndrome.

OBJECTIVE: To evaluate the pulmonary alterations of animals with Hepatopulmonary Syndrome (HPS) submitted to Biliary Duct Ligature (BDL), as well as the antioxidant effect of Melatonin (MEL). METHODS: Sixteen male Wistar rats, divided into four Sham groups: BDL group, Sham + MEL group and BDL + MEL. The pulmonary and hepatic histology, lipoperoxidation and antioxidant activity of lung tissue, alveolar-arterial O2 difference and lung / body weight ratio (%) were evaluated. RESULTS: When comparing the groups, could be observed an increase of vasodilation and pulmonary fibrosis in the BDL group and the reduction of this in relation to the BDL + MEL group. It was also observed significant changes in the activity of catalase, ApCO2, ApO2 in the LBD group when compared to the other groups. CONCLUSION: The use of MEL has been shown to be effective in reducing vasodilation, fibrosis levels and oxidative stress as well as gas exchange in an experimental HPS model.

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 (p<0.001 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.

Efetividade de um plano de metas fisioterapêuticas em pacientes internados em uma unidade de terapia intensiva: uma análise retrospectiva vs. prospectiva / Effectiveness of a plan of physiotherapy goals in patients hospitalized in an intensive care unit: a retrospective analysis vs. prospective

Introdução: A fisioterapia na unidade de terapia intensiva (UTI) apresenta como objetivo utilizar estratégias de mobilização precoce a fim de reduzir o impacto da fraqueza muscular adquirida na UTI. Logo, este estudo apresenta como objetivo avaliar a efetividade de um plano de metas fisioterapêuticas para pacientes internados em uma Unidade de Terapia Intensiva.Métodos: Estudo de coorte retrospectivo e prospectivo comparativo realizado em uma UTI de um hospital público de Porto Alegre. Foram incluídos pacientes internados entre os meses de janeiro e junho de 2019, maiores de 18 anos e que tiveram alta da UTI. A coleta de dados foi realizada através de informações e relatório que constam no prontuário eletrônico utilizado na Instituição. Foi analisado o desfecho das metas estabelecidas na admissão para sentar fora do leito e deambular.Resultados: A maioria dos pacientes foi do sexo masculino (57,5%). A média de idade foi de 60,52 ± 17,64 anos. A maioria das metas estabelecidas, tanto para sentar fora do leito como para deambular, foram atingidas (89% e 86,9%, respectivamente). Houve correlação significativa entre o alcance de meta para deambulação e ganho de força muscular pelo escore MRC (p = 0,041) e ganho de força muscular quando comparada admissão e alta da UTI (p = 0,004).Conclusão: Este estudo observou que estabelecer metas para sentar fora do leito e deambular para pacientes internados em UTI é efetivo.

Introduction: Physiotherapy in the intensive care unit (ICU) aims to use early mobilization strategies in order to reduce the impact of muscle acquired weakness in the ICU. Therefore, this study aims to evaluate the effectiveness of a physiotherapeutic goal plan for patients admitted to an Intensive Care Unit. Methods: Retrospective and comparative prospective cohort study carried out in an ICU of a public hospital in Porto Alegre. Patients hospitalized between January and June 2019, over 18 years old and discharged from the ICU were included. Data collection was carried out through information and report contained in the electronic medical record used in the Institution. The outcome of goals established at admission for sitting out of bed and walking was analyzed. Results: Most patients were male (57.5%). The mean age was 63.2 ± 16.2 years. Most established goals, both for sitting out of bed and walking, were achieved (89% and 86.9%, respectively). There was a significant correlation between reaching the ambulation goal and muscle strength gain by the MRC score (p= 0.041) and muscle strength gain when comparing admission and discharge from the ICU (p = 0.004). Conclusion: This study observed that establishing goals for sitting out of bed and walking for ICU patients is effective.

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)-1ß, IL-6, IL-8, and IL-10, tumour necrosis factor alpha (TNFα) 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 TNFα, 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.

Evaluation and Comparison of Respiratory Muscular Strength, Functionality, and Pelvic Floor in the Immediate Postpartum of Normal and Cesarean Birth / Avaliação e comparação da força muscular respiratória, funcionalidade, e de assoalho pélvico no puerpério imediato de parto normal e cesárea

Abstract Objective: To evaluate and compare peripheral, pelvic floor, respiratory muscle strength, and functionality in the immediate puerperium of normal delivery and cesarean section. Methods: This is a cross-sectional study that verified respiratory, pelvic floor, peripheral, and functional muscle strength through manovacuometry, pelvic floor functional assessment (PFF), dynamometry, and the Time Up and Go (TUG) test, respectively. The groups were divided according to the type of delivery, into a cesarean section group and a normal parturition group. Results: The sample was composed of 72 postpartum puerperae, 36 of normal parturition, and 36 of cesarean section, evaluated before hospital discharge, mean age ranged from 25.56 ± 6.28 and 28.57 ± 6.47 years in puerperae of normal parturition and cesarean section respectively. Cesarean showed higher pelvic floor strength (PFF) compared to normal parturition (p < 0.002), but puerperae from normal delivery showed better functionality (p < 0.001). As for peripheral muscle strength and respiratory muscle strength, there was no significance when comparing the types of parturirion. Conclusion: There is a reduction in pelvic muscle strength in puerperae of normal delivery and a decrease in functionality in puerperae of cesarean section.

Resumo Objetivo: Avaliar e comparar o pavimento pélvico periférico, a força muscular respiratória e a funcionalidade no puerpério imediato do parto normal e da cesariana. Métodos: Este é um estudo transversal que verificou a força muscular respiratória, pavimento pélvico, periférico e funcional através da manovacuometria, avaliação funcional do pavimento pélvico (PFF), dinamometria, e o teste Time Up e Go (TUG), respectivamente. Os grupos foram divididos de acordo com o tipo de parto, num grupo de cesariana e num grupo de parto normal. Resultados: A amostra foi composta por 72 puérperas pós-parto, 36 de parto normal e 36 de cesariana, avaliados antes da alta hospitalar, a idade média variou entre 25,56 ± 6,28 e 28,57 ± 6,47 anos em puérperas de parto normal e cesariana, respectivamente. A cesariana mostrou maior resistência do pavimento pélvico (TFP) em comparação com o parto normal (p < 0,002), mas as puérperas de parto normal mostraram melhor funcionalidade (p < 0,001). Quanto à força muscular periférica e à força muscular respiratória, não houve significado ao comparar os tipos de parto. Conclusão: Há uma redução da força muscular pélvica em puérperas de parto normal e uma diminuição da funcionalidade em puérperas de cesarianas.

Ventilatory Muscle Strength Six Months After Coronary Artery Bypass Grafting in Patients Submitted to Inspiratory Muscular Training Based on Anaerobioc Threshold: A Clinical Trial

Abstract Introduction Coronary artery bypass grafting (CABG) surgery is associated with a decline in ventilatory muscle strength and lung function. Inspiratory muscle training (IMT) based on anaerobic threshold (AT) has been used to minimize the impact of CABG on these parameters, but the long-term impact is unknown. Objective To test the hypothesis that AT-based IMT improves inspiratory muscle strength and lung function even six months after CABG. Methods This is a randomized controlled clinical trial. In the preoperative period, maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), vital capacity (VC) and peak expiratory flow (PEF) rate were assessed. On the first postoperative day, patients were randomized into two groups: AT-based IMT (IMT-AT) (n=21) where the load was prescribed based on glycemic threshold and conventional IMT (IMT-C) (n=21), with load of 40% of MIP. Patients were trained during hospitalization until the day of discharge and were assessed at discharge and six months later. For within-group comparison, paired Student's t-test or Wilcoxon test was used, and independent Student's t-test or the Mann-Whitney test was used to analyze the different time points. A p<0.05 was considered significant. Results At six months after CABG surgery, statistical difference was found between the IMT-AT and the IMT-C groups in MIP (difference between the means of -5cmH2; 95% CI=- 8.21to-1.79) and VC (difference between the means of -2ml/kg;95%CI=-3.87to-0.13). No difference was found between groups in the other variables analyzed. Conclusion IMT-AT promoted greater recovery of inspiratory muscle strength and VC after six months of CABG when compared to conventional training.

Clinimetric properties of the Perme Intensive Care Unit Mobility Score -a multicenter study for minimum important difference and responsiveness analysis

Background: The use of instruments in clinical practice with measurement properties tested is highly recommended, in order to provide adequate assessment and measurement of outcomes. Objective: To calculate the minimum clinically important difference (MCID) and responsiveness of the Perme Intensive Care Unit Mobility Score (Perme Score). Methods: This retrospective, multicentric study investigated the clinimetric properties of MCID, estimated by constructing the Receiver Operating Characteristic (ROC). Maximizing sensitivity and specificity by Youden's, the ROC curve calibration was performed by the Hosmer and Lemeshow goodness-of-fit test. Additionally, we established the responsiveness, floor and ceiling effects, internal consistency, and predictive validity of the Perme Score. Results: A total of 1.200 adult patients records from four mixed general intensive care units (ICUs) were included. To analyze which difference clinically reflects a relevant evolution we calculated the area under the curve (AUC) of 0.96 (95% CI: 0.95-0.98), and the optimal cut-off value of 7.0 points was established. No substantial floor (8.8%) or ceiling effects (4.9%) were observed at ICU discharge. However, a moderate floor effect was observed at ICU admission (19.3%), in contrast to a very low incidence of ceiling effect (0.6%). The Perme Score at ICU admission was associated with hospital mortality, OR 0.86 (95% CI: 0.82-0.91), and the predictive validity for ICU stay presented a mean ratio of 0.97 (95% CI: 0.96-0.98). Conclusion: Our findings support the establishment of the minimum clinically important difference and responsiveness of the Perme Score as a measure of mobility status in the ICU.

Antecedentes: Se recomienda encarecidamente el uso de instrumentos en la práctica clínica con propiedades de medición probadas, con el fin de proporcionar una evaluación y medición adecuada de los resultados. Objetivo: Calcular la diferencia mínima clínicamente importante (MCID) y la capacidad de respuesta de la puntuación de movilidad de la unidad de cuidados intensivos de Perme (Perme Score). Métodos: Este estudio multicéntrico retrospectivo investigó las propiedades clinimétricas de MCID, estimadas mediante la construcción de la característica operativa del receptor (ROC). Maximizando la sensibilidad y especificidad mediante la prueba de Youden, la calibración de la curva ROC se realizó mediante la prueba de bondad de ajuste de Hosmer y Lemeshow. Además, establecimos la capacidad de respuesta, los efectos suelo y techo, la consistencia interna y la validez predictiva del Perme Score. Resultados: Se incluyeron un total de 1,200 registros de pacientes adultos de cuatro unidades de cuidados intensivos (UCI) generales mixtas. Para analizar qué diferencia refleja clínicamente una evolución relevante calculamos el área bajo la curva (AUC) de 0.96 (95% CI: 0.95-0.98); y se estableció el valor de corte óptimo de 7.0 puntos. No se observaron efectos suelo (8.8%) o techo (4.9%) sustanciales al alta de la UCI. Sin embargo, se observó un efecto suelo moderado al ingreso en la UCI (19.3%), en contraste con una incidencia muy baja del efecto techo (0.6%). El Perme Score al ingreso en UCI se asoció con la mortalidad hospitalaria, OR 0.86 (95% CI: 0.82-0.91), y la validez predictiva de estancia en UCI presentó una relación media de 0.97 (95% CI: 0.96-0.98). Conclusiones: Nuestros hallazgos respaldan el establecimiento de la diferencia mínima clínicamente importante y la capacidad de respuesta de el Perme Score como medida del estado de movilidad en la UCI.

Versão brasileira da Critical Care Functional Rehabilitation Outcome Measure: tradução, adaptação transcultural e avaliação das propriedades clinimétricas / Brazilian version of the Critical Care Functional Rehabilitation Outcome Measure: translation, cross-cultural adaptation and evaluation of clinimetric properties

RESUMO Objetivo: Realizar a tradução, a adaptação transcultural e a avaliação das propriedades clinimétricas da Critical Care Functional Rehabilitation Outcome Measure para avaliação da funcionalidade de pacientes internados em unidades de terapia intensiva no Brasil. Métodos: O processo de tradução e adaptação transcultural seguiu as seguintes etapas: tradução inicial, síntese, retrotradução, revisão por comitê de especialistas e pré-teste. Foram analisadas a confiabilidade intra e interavaliador e a concordância, com dados gerados a partir da avaliação de dois fisioterapeutas no mesmo grupo de pacientes (n = 35). As avaliações foram feitas de forma independente e cega quanto ao escore atribuído pelo outro profissional. A análise qualitativa foi realizada pelo comitê de revisão, e os especialistas adaptaram e sintetizaram a tradução da escala Critical Care Functional Rehabilitation Outcome Measure na língua portuguesa. Resultados: Observou-se concordância entre as traduções da escala Critical Care Functional Rehabilitation Outcome Measure para versão brasileira. As equivalências conceitual, idiomática, semântica e experimental entre a versão original e a traduzida foram obtidas, resultando na versão brasileira, denominada Medida de Resultado da Reabilitação Funcional em Cuidados Intensivos. A avaliação das propriedades clinimétricas demonstrou evidências de alto grau de concordância e de confiabilidade, visto que todos tiveram Coeficiente de Correlação Intraclasse acima de 0,75. O Coeficiente de Correlação Intraclasse total foi de 0,89. Conclusão: A versão da escala Critical Care Functional Rehabilitation Outcome Measure para avaliação da funcionalidade de pacientes internados em unidade de terapia intensiva pode ser utilizada de forma confiável no Brasil, pois foi traduzida e adaptada transculturamente para o português brasileiro e apresenta evidências de excelentes propriedades

ABSTRACT Objective: To translate, crossculturally adapt and evaluate the clinimetric properties of the Critical Care Functional Rehabilitation Outcome Measure for evaluating the functionality of patients admitted to intensive care units in Brazil. Methods: The process of translation and cross-cultural adaptation involved the following steps: initial translation, synthesis, back-translation, expert committee review and pretesting. The intra- and interrater reliability and agreement were analyzed between two physical therapists who evaluated the same group of patients (n = 35). The evaluations were performed by each therapist independently and blinded to the score assigned by the other professional. The qualitative analysis was performed by the review committee, and the experts adapted and synthesized the Portuguese translation of the Critical Care Functional Rehabilitation Outcome Measure. Results: There was agreement between the initial Brazilian translations of the Critical Care Functional Rehabilitation Outcome Measure scale. The conceptual, idiomatic, semantic and experimental equivalences between the original and translated versions were assessed, resulting in the final Brazilian version of the scale, called the Medida de Resultado da Reabilitação Funcional em Cuidados Intensivos. The evaluation of the clinimetric properties showed evidence of a high degree of agreement and reliability, as all had an intraclass correlation coefficient above 0.75. The overall intraclass correlation coefficient was 0.89. Conclusion: The translated version of the Critical Care Functional Rehabilitation Outcome Measure scale for assessing the functionality of patients admitted to an intensive care unit can be used reliably in Brazil following translation and cross-cultural adaptation to Brazilian Portuguese and presents evidence of excellent interrater reliability.

Incidência e fatores de risco associados à falha na ventilação não invasiva em pacientes pediátricos / Incidence and risk factors associated with noninvasive ventilation failure in pediatric patients

Introdução: O suporte ventilatório é usado para o tratamento de pacientes com insuficiência respiratória aguda (IRpA) ou crônica agudizada. A ventilação não-invasiva (VNI) na IRpA pediátrica é amplamente usada em bebês prematuros e crianças, porém até a data atual os estudos têm sido escassos. Portanto, o objetivo do presente estudo foi determinar os fatores de risco associados à falha na VNI em uma unidade de terapia intensiva pediátrica.Métodos: Coorte retrospectiva a partir de prontuários de pacientes admitidos na unidade de terapia intensiva (UTI) Pediátrica de um Hospital de Caxias do Sul, entre maio de 2017 e outubro de 2019, que utilizaram VNI.Resultados: A incidência de falha na VNI foi de 33%. Asma (RR = 1,36; IC95% = 1,08-1,72), uso de VNI em pacientes pós-extubação (RR = 1,97; IC95% = 1,17-3,29), uso contínuo da VNI (RR = 2,44; IC95% = 1,18-5,05), encerramento à noite (RR = 2,52; IC95% = 1,53-4,14), modalidade final ventilação mandatória intermitente sincronizada (SIMV) (RR = 4,20; IC95% = 2,20-7,90), pressão expiratória positiva final (PEEP) no início da ventilação (6,8 ± 1,1; p < 0,01) e fração inspiratória de O2 (FIO2) final (53,10 ± 18,50; p < 0,01) foram associados à falha. Adicionalmente, a pressão arterial sistólica (PAS) inicial (118,68 ± 18,68 mmHg; p = 0,02), a frequência respiratória inicial (FR) (47,69 ± 14,76; p = 0,28) e final (47,54 ± 14,76; p < 0,01) foram associados a falha.Conclusão: A modalidade ventilatória final SIMV, demostra ser o melhor preditor de risco de falha, seguido do turno em que a VNI é finalizada, onde à noite existe maior risco de falha. Além disso, foram preditores de falha, porém com menor robustez, a pressão positiva inspiratória (PIP) final e a FR final.

Introduction: Ventilatory support is used for the treatment of patients with acutely chronic or acute respiratory failure (ARF). Noninvasive ventilation (NIV) in pediatric ARF is widely used in preterm infants and children, but studies to date have been limited. Therefore, the aim of the present study was to determine the risk factors associated with NIV failure in a pediatric intensive care unit.Methods: This retrospective cohort study was based on medical records of patients admitted to the pediatric intensive care unit of a hospital in Caxias do Sul, southern Brazil, between May 2017 and October 2019, who used NIV.Results: The incidence of NIV failure was 33%. Asthma (relative risk [RR] = 1.36; 95% confidence interval [CI] = 1.08-1.72), post-extubation use of NIV (RR = 1.97; 95% CI = 1.17-3.29), continuous use of NIV (RR = 2.44; 95% CI = 1.18-5.05), completion at night (RR = 2.52; 95% CI = 1.53-4.14), final mode synchronized intermittent mandatory ventilation (SIMV) (RR = 4.20; 95% CI = 2.20-7.90), positive end-expiratory pressure at the beginning of ventilation (6.8 ± 1.1; p < 0.01), and final fraction of inspired oxygen (53.10 ± 18.50; p < 0.01) were associated with failure. Additionally, initial systolic blood pressure (118.68 ± 18.68 mmHg; p = 0.02), initial respiratory rate (IRR) (47.69 ± 14.76; p = 0.28), and final respiratory rate (47.54 ± 14.76; p < 0.01) were associated with failure.Conclusion: The final ventilatory mode SIMV proves to be the best failure risk predictor, followed by the shift in which NIV is completed, as there is a greater risk of failure at night. In addition, final positive inspiratory pressure and final respiratory rate were less robust predictors of failure.

Desfecho da aplicação da ventilação mecânica não invasiva na bronquiolite / Outcome of the application of noninvasive mechanical ventilation in bronchiolitis

A bronquiolite é uma infecção viral que pode levar a insuficiência ventilatória, nestes casos a aplicação de ventilação não invasiva é uma opção ao tratamento convencional. O objetivo deste estudo é identificar o desfecho da aplicação de ventilação não invasiva em crianças com bronquiolite. Trata-se de uma revisão da literatura, com busca de artigos nas bases de dados Biblioteca Virtual em Saúde, Cochrane Library, PEDro, Pubmed, Scielo e Science Direct, sem restrição de período, a partir das palavras chave Noninvasive ventilation AND Bronchiolitis. De um total de 1.192 artigos encontrados, 11 foram inclusos no presente estudo, quatro abordaram o desfecho relacionado à aspectos clínicos gerais (aumento no uso de VNI; menor tempo de internação; redução da frequência respiratória e fração inspirada de oxigênio) e sete relataram o índice de sucesso ou falha, e apesar da diferença entre as médias (sucesso 88,5 versus falha 15,1) não houve diferença significativa. Conclui-se que o desfecho de falha tem alta prevalência (11,5%), apesar disso, os estudos encontraram diferentes benefícios advindos do incremento na aplicação de VNI (redução da necessidade de ventilação mecânica invasiva, menor tempo de permanência em UTI, redução da mortalidade, melhora da frequência respiratória e da fração inspirada de oxigênio). (AU)

Bronchiolitis is a viral infection that can lead to ventilatory failure. In such cases, the application of noninvasive ventilation (NIV) is an alternative to conventional treatment. The aim of this study is to identify the outcome of the application of NIV in children with bronchiolitis. This is a literature review whose search for articles included the Virtual Health Library, Cochrane Library, PEDro, PubMed, SciELO, and Science Direct databases, with no date restriction, based on the keywords Noninvasive ventilation AND Bronchiolitis. Of a total of 1192 articles found, 11 were included in the present study. Four addressed the outcome related to general clinical aspects (increased use of NIV, shorter hospital stay, and reduced respiratory rate and inspired oxygen fraction) and seven reported the success or failure rate. Despite the difference between the means (success 88.5 versus failure 15.1) there was no significant difference. In conclusion, the failure outcome has a high prevalence (11.5%); however, studies have found different benefits arising from the increased application of NIV (reduced need for invasive mechanical ventilation, shorter intensive care unit stay, reduced mortality, and improved respiratory rate and inspired oxygen fraction). (AU)

Lung hyperinflation by mechanical ventilation versus isolated tracheal aspiration in the bronchial hygiene of patients undergoing mechanical ventilation.

OBJECTIVE: To determine the efficacy of lung hyperinflation maneuvers via a mechanical ventilator compared to isolated tracheal aspiration for removing secretions, normalizing hemodynamics and improving lung mechanics in patients on mechanical ventilation. METHODS: This was a randomized crossover clinical trial including patients admitted to the intensive care unit and on mechanical ventilation for more than 48 hours. Patients were randomized to receive either isolated tracheal aspiration (Control Group) or lung hyperinflation by mechanical ventilator (MVH Group). Hemodynamic and mechanical respiratory parameters were measured along with the amount of aspirated secretions. RESULTS: A total of 50 patients were included. The mean age of the patients was 44.7 ± 21.6 years, and 31 were male. Compared to the Control Group, the MVH Group showed greater aspirated secretion amount (3.9g versus 6.4g, p = 0.0001), variation in mean dynamic compliance (-1.3 ± 2.3 versus -2.9 ± 2.3; p = 0.008), and expired tidal volume (-0.7 ± 0.0 versus -54.1 ± 38.8, p = 0.0001) as well as a significant decrease in peak inspiratory pressure (0.2 ± 0.1 versus 2.5 ± 0.1; p = 0.001). CONCLUSION: In the studied sample, the MVH technique led to a greater amount of aspirated secretions, significant increases in dynamic compliance and expired tidal volume and a significant reduction in peak inspiratory pressure.

Utilização da ventilação mecânica não invasiva em pacientes internados na unidade de terapia intensiva adulto: sucesso, insucesso, motivo da VNI, tempo de internação, alta ou óbito / Use of noninvasive ventilation in patients admitted to the adult intensive care unit: success, failure, reason for NIV, length of hospital stay, discharge or death

Introdução: A utilização da ventilação não invasiva (VNI) é importante no tratamento de pacientes críticos internados em unidades de terapia intensiva (UTI), apresentando resultados significativos quando avaliada e instituida no momento adequado. Os benefícios da VNI são evidentes em diferentes etiologia, favorecendo a evolução clínica dos pacientes e diminuindo tempo de internação. O uso da VNI como resgate apresenta resultados desfavoráveis, porém o uso de VNI preventiva ou, facilitadora parece promissor neste cenário. Objetivo: Avaliar as indicações para utilização da VNI em pacientes críticos, identificar, e analisar os desfechos da resposta à VNI, o tempo de internação, e outros benefícios para estabelecer possíveis desfechos nos pacientes críticos internados nesta unidade. Métodos: Estudo de coorte retrospectivo, realizado através de análise de prontuários de pacientes maiores de 18 anos, ambos os sexos, admitidos na UTI adulto e submetidos a VNI, no período de agosto de 2018 a agosto de 2019. Resultados: Foram incluídos 114 pacientes, 57% do sexo masculino, com idade de 69 ±13 anos, que ficaram internados por 13,2 ± 11,8 dias, apresentando uma pontuação de SAPS 3 59±14 pontos, sendo a IRpA o motivo do uso de VNI mais frequente, representando 64,9% da amostra, seguido da VNI de forma preventiva após extubação (17,5%). Obtivemos um total de 66,9% de sucesso na utilização da VNI. Conclusão: A utilização da VNI no perfil dos pacientes críticos internados, apresentaram sucesso para o uso na maioria dos casos, mostrando melhores desfechos clínicos e propiciando diminuir o tempo de internação na UTI, e alta desta unidade. (AU)

Introduction: The use of noninvasive ventilation (NIV) is important in the treatment of critically ill patients admitted to the intensive care unit (ICU), showing significant results when evaluated and introduced at the appropriate time. The benefits of NIV are evident in different etiologies by favoring the clinical outcome of patients and reducing the length of hospital stay. The use of NIV as a rescue therapy has produced unfavorable results. However, the use of preventive or facilitating NIV seems promising in this scenario. Objective: To evaluate indications for the use of NIV in critically ill patients and to identify and analyze the outcomes of NIV response, length of hospital stay, and other benefits in order to establish possible outcomes in critically ill ICU patients. Methods: This was a cohort study with a retrospective review of the medical records of patients aged 18 years or older, of both sexes, who were admitted to the adult ICU and received NIV from August 2018 to August 2019. Results: A total of 114 patients were included, 57% were men and the mean age was 69 (SD, 13) years. The mean length of hospital stay was 13.2 (SD, 11.8) days, and SAPS score was 3.59 (SD, 14). Acute respiratory failure was the main reason for NIV use, accounting for 64.9% of cases, followed by preventive NIV after extubation (17.5%). The success rate of NIV use was 66.9%. Conclusions: The use of NIV in critically ill ICU patients was successful in most cases, leading to improved clinical outcomes and reduced length of ICU stay, with faster discharge from this unit. (AU)