RESUMO
INTRODUCTION AND AIM: Studies regarding asynchrony in patients in the cardiac postoperative period are still only a few. The main objective of our study was to compare asynchronies incidence and its index (AI) in 3 different modes of ventilation (volume-controlled ventilation [VCV], pressure-controlled ventilation [PCV] and pressure-support ventilation [PSV]) after ICU admission for postoperative care. METHODS: A prospective parallel randomised trialin the setting of a non-profitable hospital in Brazil. The participants were patients scheduled for cardiac surgery. Patients were randomly allocated to VCV or PCV modes of ventilation and later both groups were transitioned to PSV mode. RESULTS: All data were recorded for 5 minutes in each of the three different phases: T1) in assisted breath, T2) initial spontaneous breath and T3) final spontaneous breath, a marking point prior to extubation. Asynchronies were detected and counted by visual inspection method by two independent investigators. Reliability, inter-rater agreement of asynchronies, asynchronies incidence, total and specific asynchrony indexes (AIt and AIspecific) and odds of AI ≥10% weighted by total asynchrony were analysed. A total of 17 patients randomly allocated to the VCV (n=9) or PCV (n=8) group completed the study. High inter-rated agreement for AIt (ICC 0.978; IC95%, 0,963-0.987) and good reliability (r=0.945; p<0.001) were found. Eighty-two % of patients presented asynchronies, although only 7% of their total breathing cycles were asynchronous. Early cycling and double triggering had the highest rates of asynchrony with no difference between groups. The highest odds of AI ≥10% were observed in VCV regardless the phase: OR 2.79 (1.36-5.73) in T1 vs T2, p=0.005; OR 2.61 (1.27-5.37) in T1 vs T3, p=0.009 and OR 4.99 (2.37-10.37) in T2 vs T3, p<0.001. CONCLUSIONS: There was a high incidence of breathing asynchrony in postoperative cardiac patients, especially when initially ventilated in VCV. VCV group had a higher chance of AI ≥10% and this chance remained high in the following PSV phases.
RESUMO
Os distúrbios Osteomusculares Relacionados ao Trabalho (DORT) vêm crescendo substancialmente nas últimas décadas e constituem as mais importantes causas de ausência e incapacitação ao trabalho. O objetivo deste estudo consistiu-se em avaliar os DORT dos trabalhadores da FADE-UFPE. A amostra foi constituída por 60 indivíduos, que foram submetidos à avaliação fisioterapêutica e posteriormente preencheram um questionário para análise das queixas. Observou-se a organização estrutural do ambientte e realizou-se a análise ergonômica e postural durante o trabalho. Verificou-se que 92 dos sujeitos relataram uma ou mais queixas, sendo as mais freqüentes a dor na coluna (24), nos trapézios (22) e no punho (11). A maioria dos profissionais (34) relatou o início do aparecimento dos sintomas no trabalho e utilizavam para o alívio das queixas o alongamento e a mobilização (30) e a massagem (17). As condições que agravavam os sintomas estavam relacionadas à elevação dos membros (22), ao uso contínuo do teclado(25), do mouse (15) e escrita (14). As principais causas de aparecimento destes sintomas relacionavam-se ao movimento repetitivo exigido pela tarefa, a adoção de posturas globais e articulares inadequadas e a ausência de pausas distribuídas ao longo da jornada de trabalho.