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BACKGROUND: Recognized disparities in quality of end-of-life care exist. Our aim was to assess the quality of care for patients dying from cancer, as perceived by bereaved relatives, within hospitals in seven European and South American countries. MATERIALS AND METHODS: A postbereavement survey was conducted by post, interview, or via tablet in Argentina, Brazil, Uruguay, U.K., Germany, Norway, and Poland. Next of kin to cancer patients were asked to complete the international version of the Care Of the Dying Evaluation (i-CODE) questionnaire 6-8 weeks postbereavement. Primary outcomes were (a) how frequently the deceased patient was treated with dignity and respect, and (b) how well the family member was supported in the patient's last days of life. RESULTS: Of 1,683 potential participants, 914 i-CODE questionnaires were completed (response rate, 54%). Approximately 94% reported the doctors treated their family member with dignity and respect "always" or "most of the time"; similar responses were given about nursing staff (94%). Additionally, 89% of participants reported they were adequately supported; this was more likely if the patient died on a specialist palliative care unit (odds ratio, 6.3; 95% confidence interval, 2.3-17.8). Although 87% of participants were told their relative was likely to die, only 63% were informed about what to expect during the dying phase. CONCLUSION: This is the first study assessing quality of care for dying cancer patients from the bereaved relatives' perspective across several countries on two continents. Our findings suggest many elements of good care were practiced but improvement in communication with relatives of imminently dying patients is needed. (ClinicalTrials.gov Identifier: NCT03566732). IMPLICATIONS FOR PRACTICE: Previous studies have shown that bereaved relatives' views represent a valid way to assess care for dying patients in the last days of their life. The Care Of the Dying Evaluation questionnaire is a suitable tool for quality improvement work to help determine areas where care is perceived well and areas where care is perceived as lacking. Health care professionals need to sustain high quality communication into the last phase of the cancer trajectory. In particular, discussions about what to expect when someone is dying and the provision of hydration in the last days of life represent key areas for improvement.
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Neoplasias , Assistência Terminal , Brasil , Família , Alemanha , Hospitais , Humanos , Neoplasias/terapia , Cuidados Paliativos , Qualidade da Assistência à Saúde , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Prolonged use of mechanical ventilation (MV) leads to weakening of the respiratory muscles, especially in patients subjected to sedation, but this effect seems to be preventable or more quickly reversible using respiratory muscle training. The aims of the study were to assess variations in respiratory and hemodinamic parameters with electronic inspiratory muscle training (EIMT) in tracheostomized patients requiring MV and to compare these variations with those in a group of patients subjected to an intermittent nebulization program (INP). METHODS: This was a pilot, prospective, randomized study of tracheostomized patients requiring MV in one intensive care unit (ICU). Twenty-one patients were randomized: 11 into the INP group and 10 into the EIMT group. Two patients were excluded in experimental group because of hemodynamic instability. RESULTS: In the EIMT group, maximal inspiratory pressure (MIP) after training was significantly higher than that before (P = 0.017), there were no hemodynamic changes, and the total weaning time was shorter than in the INP group (P = 0.0192). CONCLUSION: The EIMT device is safe, promotes an increase in MIP, and leads to a shorter ventilator weaning time than that seen in patients treated using INP.
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ABSTRACT OBJECTIVE: To evaluate quality of life according to the level of asthma control and degree of asthma severity in children and adolescents. METHODS: We selected children and adolescents with asthma (7-17 years of age) from the Pediatric Pulmonology Outpatient Clinic of the State University of Campinas Hospital de Clínicas, located in the city of Campinas, Brazil. Asthma control and asthma severity were assessed by the Asthma Control Test and by the questionnaire based on the Global Initiative for Asthma, respectively. The patients also completed the Paediatric Asthma Quality of Life Questionnaire (PAQLQ), validated for use in Brazil, in order to evaluate their quality of life. RESULTS: The mean age of the patients was 11.22 ± 2.91 years, with a median of 11.20 (7.00-17.60) years. We selected 100 patients, of whom 27, 33, and 40 were classified as having controlled asthma (CA), partially controlled asthma (PCA), and uncontrolled asthma (UA), respectively. As for asthma severity, 34, 19, and 47 were classified as having mild asthma (MiA), moderate asthma (MoA), and severe asthma (SA), respectively. The CA and the PCA groups, when compared with the NCA group, showed higher values for the overall PAQLQ score and all PAQLQ domains (activity limitation, symptoms, and emotional function; p < 0.001 for all). The MiA group showed higher scores for all of the PAQLQ components than did the MoA and SA groups. CONCLUSIONS: Quality of life appears to be directly related to asthma control and asthma severity in children and adolescents, being better when asthma is well controlled and asthma severity is lower.
RESUMO OBJETIVO: Avaliar a qualidade de vida de acordo com o nível de controle e gravidade da asma em crianças e adolescentes. MÉTODOS: Foram selecionados crianças e adolescentes com asma (7-17 anos de idade) acompanhados no Ambulatório de Pneumologia Pediátrica do Hospital de Clínicas da Universidade Estadual de Campinas, localizado na cidade de Campinas (SP). O nível de controle e a gravidade da asma foram avaliados pelo Teste de Controle da Asma e pelo questionário baseado na Global Initiative for Asthma, respectivamente. Os pacientes responderam o Paediatric Asthma Quality of Life Questionnaire (PAQLQ), validado para uso no Brasil, para a avaliação de sua qualidade de vida. RESULTADOS: A média de idade dos asmáticos foi de 11,22 ± 2,91 anos, com mediana de 11,20 (7,00-17,60) anos. Foram selecionados 100 pacientes, dos quais 27, 33 e 40, respectivamente, foram classificados com asma controlada (AC), asma parcialmente controlada (APC) e asma não controlada (ANC). Quanto à gravidade da asma, 34, 19 e 47 foram classificados, respectivamente, com asma leve (AL), asma moderada (AM) e asma grave (AG). Os grupos AC e APC, quando comparados ao grupo ANC, apresentaram maiores valores no escore geral do PAQLQ e em seus domínios (limitação de atividades, sintomas e função emocional; p < 0,001 para todos). O grupo AL apresentou os maiores escores em todos os componentes do PAQLQ quando comparado aos grupos AM e AG. CONCLUSÕES: A qualidade de vida parece estar diretamente relacionada com o nível de controle e a gravidade da asma, uma vez que as crianças e adolescentes com maior controle e menor gravidade da doença apresentaram melhor qualidade de vida.
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Adolescente , Criança , Feminino , Humanos , Masculino , Asma/prevenção & controle , Asma/psicologia , Qualidade de Vida , Saúde do Adolescente , Brasil , Saúde da Criança , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Inquéritos e QuestionáriosRESUMO
A avaliação da pressão gerada pelos músculos respiratórios é útil para avaliação, diagnóstico e prognóstico em pacientes com disfunçõesrespiratórias. O objetivo deste estudo foi avaliar possíveis diferenças entre os manovacuômetros analógico e digital, comparando-se aos valorespreditos para a população brasileira. Foi realizado um estudo prospectivo e transversal, utilizando-se aparelho digital (GlobalMed MVD 300®) e analógico (Comercial Médica®), em 120 pacientes, pneumopatas. Foram analisadas as medidas em cada um dos testes e os resultados foramcomparados com os valores preditos. Ambos os aparelhos concordam entre si para PImax e para PEmax, de acordo com o coeficiente de correlação intraclasses (CCI), com melhor valor para PImax (CCI= 0,876) que para PEmax (CCI= 0,781). As pressões médias obtidas nos equipamentos analógico e digital foram respectivamente: PImax -71 ± 25,2 e -72,6 ± 26,5 (p= 0,2974) e a PEmax 87,4 ± 26,6 e 93,6 ± 34,5 (p= 0,0008), sendo a PEmax no aparelho analógico menor que no aparelho digital em 72 sujeitos. O valor de referência de PImax foi de -96,8 ± 17,1, e quando comparado aos valores de ambos equipamentos, apresentou p <0,0001 e CCI -0,005. Para PEmax, o valor de referência foi 100,2 ± 22,1, quando comparado aos valores do aparelho digital (p=0,0294) e analógico (p<0,0001), com CCI 0,298 e 0,256, respectivamente. Houve concordância entre os equipamentos e entre as medidas quando classificadas pelos valores preditos, porém estão superestimados na literatura para os pacientes pneumopatas brasileiros em ambos os gêneros.
The evaluation of the pressure generated by the respiratory muscles is useful for assessment, diagnosis, and prognosis in patients with respiratorydisease. This study aimed to evaluate possible differences between the analog and digital manometer by comparing their predicted values forhealthy Brazilian population. A prospective study, cross-sectional, using a digital device (MVD GlobalMed 300 ®) and analog (Commercial Medical ®) was performed with 120 patients with lung disease. The results were compared with the predicted values. Both devices have similar responses for MIP and MEP, according to the intraclass correlation coefficient (ICC), with best value for MIP (ICC=0.876) than MEP (ICC = 0.781). The mean pressures obtained from analog and digital equipment were MIP 71±25.2 and -72.6 ± 26.5 (p=0.2974) and 87.4 ± 26.6 MEP and 93.6 ± 34 5 (p=0.0008), the MEP was smaller in the analog apparatus when compared to the the digital apparatus for 72 subjects. The MIP reference value was -96.8 ± 17.1 when compared to the values of both devices, with p < 0.0001 and CCI -0.005. The MEP reference value was 100.2 ± 22.1, when compared to the values of the digital device with p= 0.0294 and analog p < 0.0001, with CCI of 0.298 and 0.256 respectively. Although an agreement between equipment and measures with respect to the predicted value was observed, these measures are overestimated in literature for lung disease Brazilian patients in both gender.
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OBJECTIVE: To evaluate quality of life according to the level of asthma control and degree of asthma severity in children and adolescents. METHODS: We selected children and adolescents with asthma (7-17 years of age) from the Pediatric Pulmonology Outpatient Clinic of the State University of Campinas Hospital de Clínicas, located in the city of Campinas, Brazil. Asthma control and asthma severity were assessed by the Asthma Control Test and by the questionnaire based on the Global Initiative for Asthma, respectively. The patients also completed the Paediatric Asthma Quality of Life Questionnaire (PAQLQ), validated for use in Brazil, in order to evaluate their quality of life. RESULTS: The mean age of the patients was 11.22 ± 2.91 years, with a median of 11.20 (7.00-17.60) years. We selected 100 patients, of whom 27, 33, and 40 were classified as having controlled asthma (CA), partially controlled asthma (PCA), and uncontrolled asthma (UA), respectively. As for asthma severity, 34, 19, and 47 were classified as having mild asthma (MiA), moderate asthma (MoA), and severe asthma (SA), respectively. The CA and the PCA groups, when compared with the NCA group, showed higher values for the overall PAQLQ score and all PAQLQ domains (activity limitation, symptoms, and emotional function; p < 0.001 for all). The MiA group showed higher scores for all of the PAQLQ components than did the MoA and SA groups. CONCLUSIONS: Quality of life appears to be directly related to asthma control and asthma severity in children and adolescents, being better when asthma is well controlled and asthma severity is lower.
Assuntos
Asma/prevenção & controle , Asma/psicologia , Qualidade de Vida , Adolescente , Saúde do Adolescente , Brasil , Criança , Saúde da Criança , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Inquéritos e QuestionáriosRESUMO
CONTEXT AND OBJECTIVE: Noninvasive mechanical ventilation during the postoperative period (PO) following lung resection can restore residual functional capacity, improve oxygenation and spare the inspiratory muscles. The objective of this study was to assess the efficacy of continuous positive airway pressure (CPAP) associated with physiotherapy, compared with physiotherapy alone after lung resection. DESIGN AND SETTING: Open randomized clinical trial conducted in the clinical hospital of Universidade Estadual de Campinas. METHOD: Sessions were held in the immediate postoperative period (POi) and on the first and second postoperative days (PO1 and PO2), and the patients were reassessed on the discharge day. CPAP was applied for two hours and the pressure adjustment was set between 7 and 8.5 cmH2O. The oxygenation index (OI), Borg scale, pain scale and presence of thoracic drains and air losses were evaluated. RESULTS: There was a significant increase in the OI in the CPAP group in the POi compared to the Chest Physiotherapy (CP) group, P = 0.024. In the CP group the OI was significantly lower on PO1 (P = 0,042), than CPAP group. The air losses were significantly greater in the CPAP group in the POi and on PO1 (P = 0.001, P = 0.028), but there was no significant difference between the groups on PO2 and PO3. There was a statistically significant difference between the groups regarding the Borg scale in the POi (P < 0.001), but there were no statistically significant differences between the groups regarding the pain score. CONCLUSION: CPAP after lung resection is safe and improves oxygenation, without increasing the air losses through the drains. CLINICAL TRIAL REGISTRATION: NCT01285648.
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Pressão Positiva Contínua nas Vias Aéreas/métodos , Pneumonectomia/reabilitação , Adulto , Idoso , Análise de Variância , Dispneia/fisiopatologia , Feminino , Humanos , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Medição da Dor , Cuidados Pós-Operatórios , Período Pós-Operatório , Testes de Função Respiratória , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do TratamentoRESUMO
CONTEXT AND OBJECTIVE: Noninvasive mechanical ventilation during the postoperative period (PO) following lung resection can restore residual functional capacity, improve oxygenation and spare the inspiratory muscles. The objective of this study was to assess the efficacy of continuous positive airway pressure (CPAP) associated with physiotherapy, compared with physiotherapy alone after lung resection. DESIGN AND SETTING: Open randomized clinical trial conducted in the clinical hospital of Universidade Estadual de Campinas. METHOD: Sessions were held in the immediate postoperative period (POi) and on the first and second postoperative days (PO1 and PO2), and the patients were reassessed on the discharge day. CPAP was applied for two hours and the pressure adjustment was set between 7 and 8.5 cmH2O. The oxygenation index (OI), Borg scale, pain scale and presence of thoracic drains and air losses were evaluated. RESULTS : There was a significant increase in the OI in the CPAP group in the POi compared to the Chest Physiotherapy (CP) group, P = 0.024. In the CP group the OI was significantly lower on PO1 (P = 0,042), than CPAP group. The air losses were significantly greater in the CPAP group in the POi and on PO1 (P = 0.001, P = 0.028), but there was no significant difference between the groups on PO2 and PO3. There was a statistically significant difference between the groups regarding the Borg scale in the POi (P < 0.001), but there were no statistically significant differences between the groups regarding the pain score. CONCLUSION: CPAP after lung resection is safe and improves oxygenation, without increasing the air losses through the drains. CLINICAL TRIAL REGISTRATION: NCT01285648 .
CONTEXTO E OBJETIVO: A ventilação mecânica não invasiva no período pós-operatório (PO) de ressecção pulmonar pode restaurar a capacidade residual funcional, melhorar a oxigenação e poupar os músculos inspiratórios. O objetivo deste estudo foi avaliar a eficácia da CPAP associada à fisioterapia comparada à fisioterapia unicamente após ressecção pulmonar. ESTUDO E LOCAL: Ensaio clínico randomizado aberto, realizado no Hospital das Clínicas da Universidade Estadual de Campinas. MÉTODO: Os atendimentos foram realizados nos PO imediato (POi), primeiro e segundo (PO1, PO2) dias, e a reavaliação na alta hospitalar. A CPAP foi aplicada durante duas horas e o ajuste pressórico estabelecido entre 7 e 8,5 cmH2O. Foram analisados índice de oxigenação (IO), escala de Borg e de dor, presença e perda aérea dos drenos torácicos. RESULTADOS: No grupo CPAP ocorreu aumento significativo do IO no POi (P = 0,024), comparado com o grupo fisioterapia respiratória. Houve redução significativa do IO no PO1 (P = 0,042) para o grupo fisioterapia respiratória, comparando-se à CPAP. A perda aérea foi significativamente maior para o grupo CPAP no POi e PO1 (0,001; 0,028), mas nos PO2 e no PO3 não houve diferença significativa entre os grupos. Foi verificada diferença significativa entre os grupos para a escala de Borg no POi (P < 0,001), porém para a escala de dor não foram verificadas diferenças significativas entre os grupos. CONCLUSÃO: A CPAP após ressecção pulmonar é segura e melhora a oxigenação sem aumentar a perda aérea pelos drenos. REGISTRO DE ENSAIO CLÍNICO: NCT01285648 .
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Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pressão Positiva Contínua nas Vias Aéreas/métodos , Pneumonectomia/reabilitação , Análise de Variância , Dispneia/fisiopatologia , Pulmão/fisiopatologia , Oxigênio/sangue , Medição da Dor , Cuidados Pós-Operatórios , Período Pós-Operatório , Testes de Função Respiratória , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do TratamentoRESUMO
A ressecção pulmonar é a principal opção de cura para pacientes com neoplasia, entretanto representa risco de complicações pulmonares pós-operatórias (CPPO). A fisioterapia respiratória no pré-operatório é fundamental para reduzir tais complicações, além da avaliação submáxima da capacidade ao exercício através do teste de caminhada de seis minutos (TC6). O objetivo deste estudo foi avaliar a distância percorrida no TC6 no pré-operatório de pacientes com neoplasia pulmonar e a correlação com o surgimento de CPPO e caracterizar os atendimentos de fisioterapia. Realizou-se um estudo retrospectivo através da revisão de prontuários de janeiro de 2009 a setembro de 2011. Os dados foram armazenados no programa Microsoft Excel 2007, e, posteriormente, analisados através do Statistical Package for the Social Sciences (SPSS) versão 17.0 para Windows. Avaliou-se 85 prontuários, porém apenas 21 foram incluídos no estudo, onde constava a avaliação física e funcional pré-operatória. Observou-se que não houve correlação entre a distância percorrida e o surgimento de CPPO (r=0,148). Dentre os incluídos, 76,2% eram do gênero masculino, 52,38% ex-tabagistas, 28,57% apresentaram carcinoma epidermóide e outros 28,57% adenocarcinoma. Quanto à cirurgia, 76,2% foram submetidos à lobectomia. O tempo médio de internação hospitalar foi de 11,38 dias e na UTI 3,34 dias. Concluiu-se que a média da distância percorrida foi de 414,16m e que não houve correlação entre a distância percorrida e o aparecimento de CPPO. Em relação ao acompanhamento fisioterapêutico, ocorreram em média 6,9 atendimentos por internação por paciente, sendo realizados, principalmente, exercícios de reexpansão pulmonar.
Pulmonary resection is the primary curative therapy for patients with cancer, however represents the risk of postoperative pulmonary complications (PPC). Either respiratory physiotherapy and the evaluation of sub-maximal exercise capacity by the Six Minutes Walk Test (6MWT) are essential to reduce such complications. The aim of this study was to evaluate the distance traveled in the 6MWT in preoperative of patients with lung cancer and the correlation with PPC and to characterize the physiotherapy care. It was conducted a retrospective study by chart review from January 2009 to September 2011. The data were stored in Microsoft Excel 2007, and subsequently analyzed using the Statistical Package for Social Sciences (SPSS) version 17.0 for Windows. It was evaluated 85 charts, but only 21 were included in the study, since it contained a physical and preoperative functional evaluation. There was no correlation between the distance traveled in the 6MWT and the emergence of PPC (r=0,148). Among those patients studied, 76.2% were male, 52.38% were ex-smokers, 28.57% had squamous cell carcinoma and 28,57% presented adenocarcinoma. Concerning the surgery, 76.2% underwent lobectomy. The average hospital stay was 11.38 days and 3.34 days in the ICU. The average distance traveled was 414.16 m there was no correlation between the traveled distance and the emergence of PPC. In relation to physiotherapy, on average 6.9 sessions per patient per hospitalization occurred and pulmonary expansion exercises were performed mainly.
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A avaliação da dispneia tem sido feita por meio de instrumentoscomo escala de Borg modificada, a escala de cores e a escala do MedicalResearch Council modificada (mMRC). O objetivo deste estudofoi correlacionar a frequência respiratória com a sensação de dispneia,através das escalas citadas, correlacioná-las entre si e verificar se ograu de alfabetização influenciou na resposta do paciente sobre asensação de dispneia. Para avaliar o esforço físico utilizou-se o testede caminhada de seis minutos. Este foi um estudo prospectivo,transversal e analítico-descritivo composto por 124 voluntárioscom diagnóstico de doença pulmonar. Para comparar as variáveiscategóricas entre os grupos foram utilizados os testes Qui-Quadradoe exato de Fisher. Para comparar as variáveis contínuas foi utilizadoo teste Kruskal-Wallis e para análise de correlação foi utilizado ocoeficiente de correlação de Spearman. A idade média foi de 55,9 (±13,08 anos), 14% eram analfabetos. Nos tempos de análise houvecorrelação positiva entre as escalas mMRC e Borg, r = 0,43, r = 0,61e r = 0,55. Entre as escalas mMRC e Cores, observou-se correlaçãonegativa. Concluiu-se que a frequência respiratória correlacionou-secom as três escalas. O grau de alfabetização não modificou a respostado paciente em relação à sensação de dispneia...
The evaluation of dyspnea has been measured using instrumentssuch as modified Borg Scale, the Colors Scale and modified Scaleof Medical Research Council (mMRC). The aim of this studywas to correlate the respiratory rate with dyspnea sensation usingthese scales, correlate them and identify if scholar level influenceson patients responses of dyspnea perception. The six-minute walkwas used to assess the physical effort. This was a prospective, cross--sectional and analytical descriptive study, which was composed of124 subjects with lung disease. The Chi-square and Fischer exact testwere used to compare the categorical variables among the groups.We used the Kruskal-Wallis test to compare the continuous variableand the Spearman correlation coefficient to analyze correlation. Themean age was 55.9 ± 13.08 years, 14% are illiterate. We observedpositive correlation between the mMRC and Borg scale, r = 0.43, r= 0.61 and r = 0.55. Among the mMRC and colors scale there wasa negative correlation. The results showed correlation between thescales mMRC, Borg and color Scale with respiratory rate and literacydid not change the patients response about dyspnea sensation...
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Humanos , Dispneia , Especialidade de FisioterapiaRESUMO
Objetivo - Avaliar e comparar a distância percorrida pelos diferentes distúrbios pulmonares com a predita por Enright-Sherrill, assim como a velocidade média durante o teste de caminhada de seis minutos (TC6). Além de verificar se a idade, o índice de massa corporal (IMC), os índices espirométricos e a velocidade média poderiam influenciar na resposta do TC6. Métodos - Participaram 124 indivíduos com diagnóstico de doenças pulmonares, que foram divididos a partir da espirometria em três grupos: obstrutivo, restritivo e misto. Foram avaliados os dados antropométricos e pessoais destes, e depois encaminhados para realizar o TC6 segundo a ATS. Resultados - Observou-se diferença estatística (p<0,001) entre a distância percorrida pelos três grupos durante o TC6 com a predita por Enright-Sherrill. No entanto, quando avaliada a distância entre os grupos não foi observada diferença estatística (p>0,05). Em relação à velocidade média não houve diferença entre os grupos (p=0,666). Contudo, observou-se que esta variável é influenciada pelo tempo (p<0,001). Também se observou correlação entre a idade (r=-0,29) e a velocidade média (r=0,93) com a distância percorrida. Já a distância predita, apresentou correlação com o IMC (r=-0,84), idade (r=-0,36) e velocidade média (r=0,37). Conclusões - Quanto ao distúbioo pulmonar, não houve interferência deste sobre a distância percorrida e predita no TC6, e sobre a velocidade média. No entanto, observou-se que a idade, o IMC e a velocidade média são os responsáveis pela resposta do TC6.
Objective -To evaluate and compare the six-minute walking distance (6MWD) in different lung disorders with the predicted by Enright-Sherrill; as well as the average speed during the six-minute walk test (6MWT). Beyond this, check if age, body-mass index, lung function and average speed can influence the response of 6MWT. Methods - This study included 124 subjects with lung diseases, which have been divided from the lung functions results in three groups: obstructive, restrictive and mixed. The anthropometrics and personal data was evaluated, and then, they were sent to perform the 6MWT, according to ATS. Results - We observed statistical difference (p<0.001) between the 6MWD obtained by the groups and the predicted by Enright-Sherrill. However, we didn't observed statistical difference among the groups, when we evaluate the 6MWD. In relation to average speed, we didn't find difference among groups (p=0.666). However, we observed that the time influenced this variable (p<0.001). Also, we observed correlation between the age (r=-0.29) and average speed (r=0.93) with the 6MWD. Already, the predicted 6MWD had correlation with body-mass index (r=-0.84), age (r=-0.36) and average speed (r=0.37). Conclusions - As to lung disorders, there was no interference about six-minute walk distance and predicted 6MWD, as well as about average speed. However, has been observed that age, body-mass index and average speed are the responsible for the response of 6MWT.
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Humanos , Masculino , Feminino , Espirometria/estatística & dados numéricos , Espirometria , Doença Pulmonar Obstrutiva Crônica , Fibrose Pulmonar , Pneumopatias/diagnóstico , Pneumopatias/patologia , Pneumopatias/prevenção & controle , Teste de Esforço/instrumentação , Teste de Esforço/métodosRESUMO
OBJETIVO: Analisar os casos de insuficiência respiratória aguda decorrente de edema agudo de pulmão e de agudização da doença pulmonar obstrutiva crônica, submetidos à ventilação mecânica não invasiva, a fim de identificar fatores associados ao sucesso ou ao insucesso do método em um serviço de urgência e emergência. MÉTODOS: Estudo descritivo e analítico prospectivo. Foram incluídos pacientes de ambos os gêneros, com idade >18 anos, que utilizaram ventilação mecânica não invasiva devido ao quadro de insuficiência respiratória secundária a edema agudo de pulmão ou agudização da doença pulmonar obstrutiva crônica. Foram excluídos os pacientes com insuficiência respiratória aguda secundária a patologias diferentes de edema agudo de pulmão e doença pulmonar obstrutiva crônica, ou que apresentavam contraindicação para a técnica. A rotina da instituição é utilizar a pressão expiratória entre 5 e 8 cmH2O, e a inspiratória entre 10 a 12 cmH2O, além de suplementação de oxigênio para manter a saturação periférica de oxigênio >90%. A variável "desfecho" considerada foi a intubação endotraqueal. RESULTADOS: Foram incluídos 152 pacientes. A mediana do tempo de ventilação mecânica não invasiva foi de 6 (1 - 32) horas para os pacientes com doença pulmonar obstrutiva crônica (n=60) e de 5 (2 - 32) horas para os pacientes com edema agudo de pulmão (n=92); 75,7% evoluíram com sucesso. Foram observados pior escore de APACHE II e menor saturação periférica de oxigênio, de forma estatisticamente significante, nos pacientes que evoluíram para intubação (p<0,001). O uso de BiPAP relacionou-se a 2,3 vezes mais chance de ocorrência de intubação endotraqueal que o de CPAP (p=0,032). Entre os pacientes com diagnóstico de edema agudo de pulmão e com pontuação mais elevada na ECG também apresentaram mais chance de sucesso CONCLUSÃO: As variáveis associadas à intubação endotraqueal foram frequência respiratória > 25rpm, maior valor de APACHE II, uso de BiPAP e diagnóstico de doença pulmonar obstrutiva crônica. Já maiores valores de ECG e SpO2 estão associados ao sucesso da ventilação mecânica não invasiva. A ventilação mecânica não invasiva pode ser utilizada em serviços de urgência/emergência para casos de insuficiência respiratória aguda decorrente de edema agudo de pulmão e exacerbação da doença pulmonar obstrutiva crônica, com cuidado especial na monitoração dos pacientes com variáveis relacionadas à maior porcentagem de intubação endotraqueal.
OBJECTIVE: This study analyzed acute respiratory failure caused by acute pulmonary edema, as well as chronic obstructive pulmonary disease exacerbation, that was treated with non-invasive mechanical ventilation to identify the factors that are associated with the success or failure non-invasive mechanical ventilation in urgent and emergency service. METHODS: This study was a prospective, descriptive and analytical study. We included patients of both genders aged >18 years who used non-invasive mechanical ventilation due to acute respiratory failure that was secondary to acute pulmonary edema or chronic obstructive pulmonary disease exacerbation. Patients with acute respiratory failure that was secondary to pathologies other than acute pulmonary edema and chronic obstructive pulmonary disease or who presented with contraindications for the technique were excluded. Expiratory pressures between 5 and 8 cmH2O and inspiratory pressures between 10 and 12 cmH2O were used. Supplemental oxygen maintained peripheral oxygen saturation at >90%. The primary outcome was endotracheal intubation. RESULTS: A total of 152 patients were included. The median non-invasive mechanical ventilation time was 6 hours (range 1 - 32 hours) for chronic obstructive pulmonary disease patients (n=60) and 5 hours (range 2 - 32 hours) for acute pulmonary edema patients (n=92). Most (75.7%) patients progressed successfully. However, reduced APACHE II scores and lower peripheral oxygen saturation were observed. These results were statistically significant in patients who progressed to intubation (p<0.001). BiPAP (Bi-level Positive Airway Pressure portable ventilator), as continuous positive airway pressure use increased the probability of endotracheal intubation 2.3 times (p=0.032). Patients with acute pulmonary edema and elevated GCS scores also increased the probability of success. CONCLUSION: Respiratory frequency >25 rpm, higher APACHE II scores, BiPAP use and chronic obstructive pulmonary disease diagnosis were associated with endotracheal intubation. Higher GCS and SpO2 values were associated with NIV success. Non-invasive mechanical ventilation can be used in emergency services in acute respiratory failure cases caused by acute pulmonary edema and chronic obstructive pulmonary disease exacerbation, but patients with variables related to a higher percentage of endotracheal intubation should be specially monitored.
RESUMO
OBJECTIVE: This study analyzed acute respiratory failure caused by acute pulmonary edema, as well as chronic obstructive pulmonary disease exacerbation, that was treated with non-invasive mechanical ventilation to identify the factors that are associated with the success or failure non-invasive mechanical ventilation in urgent and emergency service. METHODS: This study was a prospective, descriptive and analytical study. We included patients of both genders aged >18 years who used non-invasive mechanical ventilation due to acute respiratory failure that was secondary to acute pulmonary edema or chronic obstructive pulmonary disease exacerbation. Patients with acute respiratory failure that was secondary to pathologies other than acute pulmonary edema and chronic obstructive pulmonary disease or who presented with contraindications for the technique were excluded. Expiratory pressures between 5 and 8 cmH2O and inspiratory pressures between 10 and 12 cmH2O were used. Supplemental oxygen maintained peripheral oxygen saturation at >90%. The primary outcome was endotracheal intubation. RESULTS: A total of 152 patients were included. The median non-invasive mechanical ventilation time was 6 hours (range 1 - 32 hours) for chronic obstructive pulmonary disease patients (n=60) and 5 hours (range 2 - 32 hours) for acute pulmonary edema patients (n=92). Most (75.7%) patients progressed successfully. However, reduced APACHE II scores and lower peripheral oxygen saturation were observed. These results were statistically significant in patients who progressed to intubation (p<0.001). BiPAP (Bi-level Positive Airway Pressure portable ventilator), as continuous positive airway pressure use increased the probability of endotracheal intubation 2.3 times (p=0.032). Patients with acute pulmonary edema and elevated GCS scores also increased the probability of success. CONCLUSION: Respiratory frequency >25 rpm, higher APACHE II scores, BiPAP use and chronic obstructive pulmonary disease diagnosis were associated with endotracheal intubation. Higher GCS and SpO2 values were associated with NIV success. Non-invasive mechanical ventilation can be used in emergency services in acute respiratory failure cases caused by acute pulmonary edema and chronic obstructive pulmonary disease exacerbation, but patients with variables related to a higher percentage of endotracheal intubation should be specially monitored.
RESUMO
OBJECTIVE: To evaluate the effect of chemotherapy on the physical condition of patients with advanced lung cancer. METHODS: We evaluated 50 patients with non-small cell lung cancer (in stages IIIB and IV) and Eastern Cooperative Oncology Group (ECOG) performance status scale scores between zero and two. All patients underwent chemotherapy using paclitaxel and platinum derivatives and were evaluated at three time points (prechemotherapy, postchemotherapy and six months after starting the treatment), at which the ECOG scale, the body mass index (BMI) and the six-minute walk distance (6MWD) were assessed. RESULTS: Of the 50 patients included in the study, 14 died, 5 were excluded due to the worsening of their performance status, and 31 completed the six-month follow-up. There was no statistically significant difference between the time points of assessment for BMI (prechemotherapy vs. postchemotherapy, p = 1.00; and prechemotherapy vs. six months later, p = 0.218) or for 6MWD. Performance status improved, and this was especially due to the increase in the number of asymptomatic patients after the six-month follow-up (p = 0.031). CONCLUSIONS: Chemotherapy had a beneficial effect on the performance status of the patients. No significant changes in BMI or 6MWD were found during the study period, which might suggest the maintenance of the physical condition of the patients.
Assuntos
Adenocarcinoma/tratamento farmacológico , Índice de Massa Corporal , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Tolerância ao Exercício/fisiologia , Neoplasias Pulmonares/tratamento farmacológico , Caminhada/fisiologia , Adenocarcinoma/fisiopatologia , Adenocarcinoma de Pulmão , Adulto , Idoso , Antineoplásicos Fitogênicos/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/fisiopatologia , Tolerância ao Exercício/efeitos dos fármacos , Feminino , Humanos , Neoplasias Pulmonares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Paclitaxel/uso terapêutico , Compostos de Platina/uso terapêuticoRESUMO
OBJETIVO: Avaliar o efeito da quimioterapia sobre a condição física de pacientes com câncer de pulmão avançado. MÉTODOS: Foram avaliados 50 pacientes com câncer de pulmão não pequenas células nos estágios IIIB e IV e com status de performance segundo a escala do Eastern Cooperative Oncology Group (ECOG) entre zero e dois. Todos receberam quimioterapia com as drogas paclitaxel e derivados da platina e foram avaliados em três momentos (pré-quimioterapia, pós-quimioterapia e seis meses após o início do tratamento), nos quais a escala ECOG, o índice de massa corpórea (IMC) e a Distância percorrida no Teste de Caminhada de Seis minutos (DTC6) foram avaliados. RESULTADOS: Dos 50 pacientes incluídos, 14 foram a óbito, 5 foram excluídos do estudo por apresentar piora do status de performance, e 31 concluíram o seguimento de seis meses. Não houve diferença estatisticamente significativa para o IMC (p = 1,00, pré-quimioterapia vs. pós-quimioterapia; e p = 0,218, pré-quimioterapia vs. seis meses após) ou para a DTC6 entre os momentos de avaliação. O status de performance melhorou, principalmente com o aumento do número de pacientes assintomáticos após seis meses de acompanhamento (p = 0,031). CONCLUSÕES: O uso de quimioterapia teve um efeito benéfico no status de performance dos pacientes. Não houve alterações no IMC ou na DTC6 durante o período do estudo, o que pode sugerir a manutenção da condição física dos pacientes.
OBJECTIVE: To evaluate the effect of chemotherapy on the physical condition of patients with advanced lung cancer. METHODS: We evaluated 50 patients with non-small cell lung cancer (in stages IIIB and IV) and Eastern Cooperative Oncology Group (ECOG) performance status scale scores between zero and two. All patients underwent chemotherapy using paclitaxel and platinum derivatives and were evaluated at three time points (prechemotherapy, postchemotherapy and six months after starting the treatment), at which the ECOG scale, the body mass index (BMI) and the six-minute walk distance (6MWD) were assessed. RESULTS: Of the 50 patients included in the study, 14 died, 5 were excluded due to the worsening of their performance status, and 31 completed the six-month follow-up. There was no statistically significant difference between the time points of assessment for BMI (prechemotherapy vs. postchemotherapy, p = 1.00; and prechemotherapy vs. six months later, p = 0.218) or for 6MWD. Performance status improved, and this was especially due to the increase in the number of asymptomatic patients after the six-month follow-up (p = 0.031). CONCLUSIONS: Chemotherapy had a beneficial effect on the performance status of the patients. No significant changes in BMI or 6MWD were found during the study period, which might suggest the maintenance of the physical condition of the patients.
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adenocarcinoma/tratamento farmacológico , Índice de Massa Corporal , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Tolerância ao Exercício/fisiologia , Neoplasias Pulmonares/tratamento farmacológico , Caminhada/fisiologia , Adenocarcinoma/fisiopatologia , Antineoplásicos Fitogênicos/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/fisiopatologia , Tolerância ao Exercício/efeitos dos fármacos , Neoplasias Pulmonares/fisiopatologia , Paclitaxel/uso terapêutico , Compostos de Platina/uso terapêuticoRESUMO
A Síndrome Kartagener é uma doença autossômica recessiva rara que se caracteriza por situs inversus e discinesia ciliar, Além disso essa enfermidade pode desencadear sinusite paranasal e bronquiectasia. Desse modo, o objetivo deste estudo foi avaliar a evolução das variáveis ventilatórias, da força muscular respiratória e da capacidade funcional submáxima de uma paciente com 27 anos e diagnóstico clínico de Síndrome de Kartagener, submetida a fisioterapia respiratória. O protocolo fisioterapêutico implementado constou de 10 sessões, duas vezes por semana, por meio de treinamento muscular inspiratório (Threshold IMT®), reeducação diafragmática, manobras de higiene brônquica, exercícios respiratórios e treinamento dinâmico de membros inferiores. As variáveis analisadas antes e após o protocolo foram, pico de fluxo expiratório, pressões respiratórias máximas (PImáx e PEmáx), teste de caminhada de seis minutos (TC6?) e cirtometria toracoabdominal. De acordo com o presente estudo, concluiu-se que houve melhora dos resultados das variáveis analisadas, demonstrando a importância da intervenção fisioterapêutica, podendo auxiliar na diminuição das recidivas do processo infeccioso.
The Kartagener Syndrome is a rare recessive autosomal illness, which is characterized by situs inversus and ciliarydyskinesia, and this can trigger paranasal sinusitis and bronquiectasis. The objective of this study was to evaluate the variables ventilatory, respiratory muscle strength and submaximal functional capacity in patient of 27 years with clinical diagnosis of Kartagener Syndrome submitted a respiratory therapy. The physical therapy protocol implemented consisted of 10 sessions, twice a week, including inspiratory muscle training (Threshold IMT®), diaphragmatic training, bronchial hygiene maneuvers, breathing exercises and dynamic training of the lower limbs. The treatment was performed in the physiotherapy clinic of a university hospital . The variables analyzed before and after the protocol were: peak expiratory flow, maximal respiratory pressures (MIP and MEP), 6-min walk test (6MWT) and thoracoabdominal circumference measurements. According to this study we concluded that there was an improvement of results of variables, demonstrating the importance of physical therapy intervention, it can help in reducing the recurrence of the infectious process.
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Humanos , Transtornos da Motilidade Ciliar , Síndrome de Kartagener , Modalidades de FisioterapiaRESUMO
CONTEXT AND OBJECTIVE: There is increasing involvement of health professionals in organizing protocols to determine the impact of lung surgery on functional state and activities of daily living, with the aim of improving quality of life (QoL). The objective of this study was to investigate predictors of QoL improvement among patients undergoing parenchyma resection due to lung cancer. DESIGN AND SETTING: Prospective study, at teaching hospital of Universidade Estadual de Campinas (Unicamp). METHODS: 36 patients with lung cancer diagnosis were assessed before surgery and on the 30th, 90th and 180th days after surgery. The Short-Form Health Survey (SF-36) was used as the dependent variable. The independent variables were the Hospital Anxiety and Depression (HAD) scale, a six-minute walking test (6-MWT), a visual analogue scale for pain, forced vital capacity (FVC), type of surgery and use of radiotherapy and chemotherapy. Generalized estimation equations (GEE) were utilized. RESULTS: The median age for these 20 men and 16 women was 55.5 +/- 13.4 years. Both FVC and 6-MWT were predictors of improvement in the physical dimensions of QoL (p = 0.011 and 0.0003, respectively), as was smaller extent of surgical resection (p = 0.04). The social component of QoL had improved by the third postoperative month (p = 0.0005). CONCLUSION: The predictors that affected QoL positively were better FVC and 6-MWT results and less extensive lung resection. Three months after the surgery, an improvement in social life was already seen.
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Neoplasias Pulmonares/cirurgia , Qualidade de Vida , Adulto , Ansiedade/diagnóstico , Depressão/diagnóstico , Teste de Esforço , Feminino , Humanos , Neoplasias Pulmonares/psicologia , Masculino , Estudos Prospectivos , Recuperação de Função Fisiológica , Inquéritos e Questionários , Fatores de TempoRESUMO
OBJECTIVE: To evaluate the health-related quality of life of patients submitted to resection of the pulmonary parenchyma due to neoplasia. METHODS: The Medical Outcomes Study 36-item Short-Form Health Survey was used to evaluate patients in the preoperative period and on postoperative days 30, 90 and 180. We used the GEE statistical model, in which the dependent variable (quality of life) changes for each patient over the course of the evaluation. Independent variables were gender, age, educational level, type of surgery, radiotherapy, chemotherapy, forced vital capacity and 6-minute walk test. The level of significance adopted was 5%. RESULTS: The final study sample comprised 36 patients, 20 of whom were men. Of those 36 patients, 17 were submitted to lobectomy, 10 to pneumonectomy, 6 to segmentectomy, and 3 to bilobectomy. Chemotherapy was used in 15 patients, radiotherapy in 2, and a combination of radiotherapy and chemotherapy in 2. Improved quality of life was seen in the following domains: social (on postoperative day 90); physical/functional (some patients presenting better forced vital capacity and 6-minute walk test performance); and physical (in patients undergoing smaller resections). Lowered quality of life was seen in the following domains: social (for female patients); physical/social (resulting from radiotherapy, chemotherapy or both); and physical/functional (by postoperative day 30). CONCLUSIONS: It is important that studies evaluating the various determinants of quality of life, as well as the impact that cancer treatment modalities have on such variables, be conducted. The knowledge provided by such studies can contribute to improving the quality of life of patients undergoing pulmonary resection due to neoplasia.
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Neoplasias Pulmonares/cirurgia , Qualidade de Vida , Adolescente , Adulto , Idoso , Teste de Esforço , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/psicologia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Cuidados Pré-Operatórios , Estudos Prospectivos , Procedimentos Cirúrgicos Pulmonares/métodos , Inquéritos e Questionários , Resultado do Tratamento , Capacidade VitalRESUMO
CONTEXT: Pulmonary complications are the most common forms of postoperative morbidity in thoracic surgery, especially atelectasis and pneumonia. The first step in avoiding these complications during the postoperative period is to detect the patients that may develop them. OBJECTIVE: To identify risk variables leading to early postoperative pulmonary complications in thoracic surgery. DESIGN: Prospective study. SETTING: Hospital das Clínicas, Faculdade de Ciências Médicas, Universidade Estadual de Campinas. PATIENTS: 145 patients submitted to elective surgery were classified as low, moderate and high risk for postoperative pulmonary complications using a risk assessment scale. PROCEDURES: The patients were followed up for 72 hours after the operation. Postoperative pulmonary complications were defined as atelectasis, pneumonia, tracheobronchitis, wheezing, prolonged intubation and/or prolonged mechanical ventilation. MAIN MEASUREMENTS: Univariate analysis was applied in order to study these independent variables: age, nutritional status, body mass index, respiratory disease, smoking habit, spirometry and surgery duration. Multivariate logistic regression analysis was performed in order to evaluate the relationship between independent and dependent variables. RESULTS: The incidence of postoperative complications was 18.6%. Multivariate logistic regression analysis showed that the variables increasing the chances of postoperative pulmonary complications were wheezing (odds ratio, OR = 6.2), body mass index (OR = 1.15), smoking (OR = 1.04) and surgery duration (OR = 1.007). CONCLUSION: Wheezing, body mass index, smoking and surgery duration increase the chances of postoperative pulmonary complications in thoracic surgery
Assuntos
Pneumopatias/etiologia , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , RiscoRESUMO
CONTEXT: Pulmonary complications are the most common forms of postoperative morbidity in thoracic surgery, especially atelectasis and pneumonia. The first step in avoiding these complications during the postoperative period is to detect the patients that may develop them. OBJECTIVE: To identify risk variables leading to early postoperative pulmonary complications in thoracic surgery. DESIGN: Prospective study. SETTING: Hospital das Clínicas, Faculdade de Ciências Médicas, Universidade Estadual de Campinas. PATIENTS: 145 patients submitted to elective surgery were classified as low, moderate and high risk for postoperative pulmonary complications using a risk assessment scale. PROCEDURES: The patients were followed up for 72 hours after the operation. Postoperative pulmonary complications were defined as atelectasis, pneumonia, tracheobronchitis, wheezing, prolonged intubation and/or prolonged mechanical ventilation. MAIN MEASUREMENTS: Univariate analysis was applied in order to study these independent variables: age, nutritional status, body mass index, respiratory disease, smoking habit, spirometry and surgery duration. Multivariate logistic regression analysis was performed in order to evaluate the relationship between independent and dependent variables. RESULTS: The incidence of postoperative complications was 18.6 per cent. Multivariate logistic regression analysis showed that the variables increasing the chances of postoperative pulmonary complications were wheezing (odds ratio, OR = 6.2), body mass index (OR = 1.15), smoking (OR = 1.04) and surgery duration (OR = 1.007).