RESUMO
Early mobilization strategies in the intensive care unit may result in the prevention and reduction of polyneuromyopathy in the critical patient, improved quality of life, shortened ICU and hospital stay, and lesser mortality during hospitalization. However, it is well known that factors such as the protocol used, the population included in the studies, the timing of the strategy, the severity of the patients and different barriers directly influence the outcomes. This study examines the main protocols described in the literature and their associated results. The main techniques used were kinesitherapy, transfer and locomotion training, as well as neuromuscular electrical stimulation and cycle ergometry. Although two trials and a meta-analysis found no positive results with mobilization, programs that focus on specific populations, such as patients with weakness due to immobility and with preserved neuromuscular excitability can derive more positive effects from such treatment.
Assuntos
Cuidados Críticos/métodos , Deambulação Precoce , Protocolos Clínicos , Ensaios Clínicos como Assunto , Contraindicações de Procedimentos , Deambulação Precoce/métodos , Humanos , Unidades de Terapia Intensiva , Tempo de Internação/estatística & dados numéricos , Metanálise como Assunto , Força Muscular , Atrofia Muscular/prevenção & controle , Doenças Neuromusculares/prevenção & controle , Qualidade de Vida , Recuperação de Função Fisiológica , Resultado do TratamentoRESUMO
Transcutaneous electrical nerve stimulation (TENS) increases peripheral blood flow by attenuation of the muscle metaboreflex, improving oxygen supply to working muscles. We tested the hypothesis that application of TENS at ganglion improves exercise performance. 11 subjects underwent constant-work rate tests (CWR) to the limit of tolerance (Tlim) while receiving TENS or placebo. Oxygen uptake (V.O2), carbon dioxide (V.CO2), minute ventilation (V.E), ventilatory equivalent (V.E/V.CO2), heart rate (HR) and oxygen pulse (V.O2/HR) were analyzed at isotime separated by percentile and Tlim. V.O2 was lower and V.CO2 was higher at 100% of isotime during TENS, while there were no differences in V.E and V.E/V.CO2. HR was lower during exercise with TENS, and V.O2/HR increased at peak exercise (17.96±1.9 vs. 20.38±1 ml/min/bpm, P<0.05). TENS increased mechanical efficiency at isotime and Tlim (4.10±0.50 vs. 3.39±0.52%, P<0.05 and 3.95±0.67 vs. 3.77±0.45%, P<0.05) and exercise tolerance compared to P-TENS (390±41 vs. 321±41 s; P<0.05). Our data shows that the application of TENS can potentially increase exercise tolerance and oxygen supply in healthy subjects.