ABSTRACT
BACKGROUND: Patients with sepsis and immobility in the intensive care unit are associated with muscle weakness, and early mobilisation can counteract it. However, during septic shock, mobilisation is often delayed due to the severity of the illness. Neuromuscular electrical stimulation (NMES) may be an alternative to mobilise these patients early. This study aims to identify whether NMES performed within the first 72 hours of septic shock diagnosis or later is safe from a metabolic perspective. METHODS: This is the analysis of two randomised controlled crossover studies. Patients with acute septic shock (within the first 72 hours of diagnosis) and sepsis and septic shock in the late phase (after 72 hours of diagnosis) were eligible. Patients were submitted in a random order to the intervention protocol (dorsal decubitus position with the lower limbs raised and NMES) and control (dorsal decubitus position with the lower limbs raised without NMES). The patients were allocated in group 1 (intervention and control) or group 2 (control and intervention) with a wash-out period of 4 to 6 hours. Metabolic variables were evaluated by indirect calorimetry. RESULTS: Sixteen patients were analysed in the acute septic shock study and 21 in the late sepsis/septic shock study. There were no significant differences between Oxygen Consumption (VO2) values in the acute phase of septic shock when the baseline period, intervention, and control protocols were compared (186.59 ± 46.10; 183.64 ± 41.39; 188.97 ± 44.88, p>0.05- expressed in mL/Kg/min). The same was observed when the VO2 values in the late phase were compared (224.22 ± 53.09; 226.20 ± 49.64; 226.79 ± 58.25, p>0.05). The other metabolic variables followed the same pattern, with no significant differences between the protocols. When metabolic variables were compared between acute to late phase, significant differences were observed (p<0.05). CONCLUSIONS: As metabolic rates in septic shock patients had no increase during NMES, either in the first 72 hours of diagnosis or later, NMES can be considered safe from a metabolic viewpoint, even despite the higher metabolic demand in the acute phase of shock. TRIAL REGISTRATION: NCT03193164; NCT03815994. Registered on June 5, 2017; November 13, 2018 (clinicaltrials.gov/).
Subject(s)
Electric Stimulation Therapy/methods , Exercise Therapy/methods , Lower Extremity/blood supply , Muscle Weakness/therapy , Oxygen Consumption , Shock, Septic/complications , Case-Control Studies , Cross-Over Studies , Female , Humans , Male , Middle Aged , Muscle Weakness/etiology , Muscle Weakness/metabolism , Muscle Weakness/pathologyABSTRACT
INTRODUCTION: Septic shock is a potentially fatal organ dysfunction caused by an imbalance of the host response to infection. The changes in microcirculation during sepsis can be explained by the alterations in the endothelial barrier function. Endothelial progenitor cells (EPCs) are a potential recovery index of endothelial function and it an increase in response to neuromuscular electrical stimulation (NMES) was demonstrated. Therefore, the objective of this study is to investigate the effects of NMES in patients with septic shock. METHODS AND ANALYSIS: It is a study protocol for a randomized cross-over design in an intensive care unit of a tertiary University hospital. Thirty-one patients aged 18 to 65 years. The study will be divided in 2 phases: the phase one will be held in the first 72âhours of septic shock and the phase two after 3 days of first assessment. Patients will be randomly selected to the intervention protocol (decubitus position with the limbs raised and NMES) and control protocol (decubitus position with the limbs raised without NMES). After this procedure, the patients will be allocated in group 1 (intervention and control protocol) or group 2 (control and intervention protocol) with a wash-out period of 4 to 6âhours between them. The main outcome is mobilization of EPCs. The secondary outcome is metabolic and hemodynamic data. A linear mixed model will be used for analysis of dependent variables and estimated values of the mean of the differences of each effect.
Subject(s)
Endothelial Progenitor Cells/physiology , Multiple Organ Failure/prevention & control , Shock, Septic/therapy , Transcutaneous Electric Nerve Stimulation/methods , Adult , Critical Care/methods , Cross-Over Studies , Female , Humans , Male , Microcirculation/physiology , Middle Aged , Multiple Organ Failure/etiology , Outcome Assessment, Health Care , Research Design , Shock, Septic/complicationsABSTRACT
BACKGROUND: This study seeks to assess the effect of inspiratory muscle training (IMT) on pulmonary function, respiratory muscle strength, and endurance in morbidly obese patients submitted to bariatric surgery. METHODS: Thirty patients were randomly assigned to sham muscular training, or to IMT with a threshold device (40% of maximum inspiratory pressure, MIP), for 30 min/day, from the 2nd until 30th postoperative (PO) day. All of them were submitted to a standard respiratory kinesiotherapy and early deambulation protocol. Data on spirometry, maximum static respiratory pressures, and respiratory muscle endurance were collected on the PO days 2, 7, 14, and 30 in a blinded matter. RESULTS: IMT enabled increases in PO MIP and endurance, and an earlier recovery of the spirometry parameters FEV(1), PEF, and FEF(25-75%). Comparing to preoperative values, MIP was increased by 13% at the 30th PO day in the trained group, whereas control group had a reduction of 8%, with higher values for the IMT group (30th PO, IMT-130.6 ± 22.9 cmH(2)O; controls-112.9 ± 25.1 cmH(2)O; p < 0.05). Muscular endurance at the 30th PO day was increased in the trained group comparing to preoperative value (61.5 ± 39.6 s vs 114.9 ± 55.2 s; p < 0.05), a finding not observed in the control group (81.7 ± 44.3 vs 95.2 ± 42.0 s). CONCLUSIONS: IMT improves inspiratory muscle strength and endurance and accounts for an earlier recovery of pulmonary airflows in morbidly obese patients submitted to bariatric surgery.
Subject(s)
Breathing Exercises , Gastric Bypass , Gastroplasty , Lung Diseases/prevention & control , Obesity, Morbid/surgery , Postoperative Complications/prevention & control , Recovery of Function , Adult , Female , Humans , Lung Diseases/etiology , Male , Middle Aged , Obesity, Morbid/physiopathology , Physical Endurance , Pulmonary Ventilation , SpirometryABSTRACT
OBJECTIVE: To determine whether inspiratory muscle training can increase strength and endurance of these muscles in quadriplegic patients. METHODS: Eight quadriplegic patients (7 males and 1 female) with injury to the lower cervical spine (segments C4-C7) were submitted to inspiratory muscle training with a threshold inspiratory muscle trainer adjusted to 30% of MIP. The training sessions were carried out with the patients in a sitting position, 5 days a week for 8 weeks. Endurance time, MIP, MEP and FVC were determined at baseline, week 4 and week 8. RESULTS: In comparison with the mean baseline value, there was an increase in MIP, measured in the sitting position, at weeks 4 and 8 (-83.0 +/- 18.9 cmH2O vs. -104.0 +/- 19.4 cmH2O and -111.3 +/- 22.7 cmH2O). There was an increase in MEP, also in the sitting position, at week 4 (from 36.8 +/- 8.1 to 42.6 +/- 8.8 cmH2O). There was an improvement in FVC at week 4 (from 2.1 +/- 0.8 to 2.5 +/- 0.6 L, representing an increase of 24 +/- 22%). Although there was an increase in endurance (sitting) at week 8, the difference was not significant in comparison with the baseline value (29.8 +/- 21.0 vs. 35.9 +/- 15.5 min, an increase of 173 +/- 233%). CONCLUSIONS: Quadriplegic patients can benefit from training at low loads (30% of MIP), which can improve inspiratory muscle strength, FVC and expiratory muscle performance.
Subject(s)
Breathing Exercises , Exercise Therapy/methods , Muscle Strength/physiology , Physical Endurance/physiology , Quadriplegia/rehabilitation , Respiratory Muscles/physiopathology , Adult , Female , Humans , Male , Middle Aged , Posture/physiology , Quadriplegia/physiopathology , Vital Capacity/physiology , Young AdultABSTRACT
OBJETIVO: Determinar se o treinamento de músculos inspiratórios pode aumentar a força e endurance desses músculos em pacientes com quadriplegia. MÉTODOS: Oito pacientes quadriplégicos (7 homens e 1 mulher) com lesão medular cervical entre C4 e C7 foram submetidos ao treinamento de músculos inspiratórios utilizando-se um resistor de carga linear ajustado em 30 por cento da PImáx. As sessões de treinamento foram realizadas com os pacientes sentados 5 vezes por semana por 8 semanas. Tempo de endurance, PImáx, PEmáx e CVF foram medidos antes do treinamento e nas semanas 4 e 8. RESULTADOS: Em comparação ao valor basal médio, houve um aumento da PImáx, mensurada na posição sentada, nas semanas 4 e 8 (-83,0 ± 18,9 cmH2O vs. -104,0 ± 19,4 e -111,3 ± 22,7 cmH2O). Houve aumento da PEmáx, também na posição sentada, na semana 4 (de 36,8 ± 8,1 a 42,6 ± 8,8 cmH2O). Houve uma melhora na FVC na 4ª semana (de 2,1 ± 0,8 a 2,5 ± 0,6 L, representando um incremento de 24 ± 22 por cento). O tempo de endurance (sentado) não apresentou um aumento significativo entre o momento basal e a semana 8 (29,8 ± 21,0 min vs. 35,9 ± 15,5 min; aumento de 173 ± 233 por cento). CONCLUSÕES: Pacientes com quadriplegia podem se beneficiar com o treinamento com baixas cargas (30 por cento da PImáx), com melhora da força dos músculos inspiratórios, CVF e efetividade dos músculos expiratórios.
OBJECTIVE: To determine whether inspiratory muscle training can increase strength and endurance of these muscles in quadriplegic patients. METHODS: Eight quadriplegic patients (7 males and 1 female) with injury to the lower cervical spine (segments C4-C7) were submitted to inspiratory muscle training with a threshold inspiratory muscle trainer adjusted to 30 percent of MIP. The training sessions were carried out with the patients in a sitting position, 5 days a week for 8 weeks. Endurance time, MIP, MEP and FVC were determined at baseline, week 4 and week 8. RESULTS: In comparison with the mean baseline value, there was an increase in MIP, measured in the sitting position, at weeks 4 and 8 (-83.0 ± 18.9 cmH2O vs. -104.0 ± 19.4 cmH2O and -111.3 ± 22.7 cmH2O). There was an increase in MEP, also in the sitting position, at week 4 (from 36.8 ± 8.1 to 42.6 ± 8.8 cmH2O). There was an improvement in FVC at week 4 (from 2.1 ± 0.8 to 2.5 ± 0.6 L, representing an increase of 24 ± 22 percent). Although there was an increase in endurance (sitting) at week 8, the difference was not significant in comparison with the baseline value (29.8 ± 21.0 vs. 35.9 ± 15.5 min, an increase of 173 ± 233 percent). CONCLUSIONS: Quadriplegic patients can benefit from training at low loads (30 percent of MIP), which can improve inspiratory muscle strength, FVC and expiratory muscle performance.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Young Adult , Breathing Exercises , Exercise Therapy/methods , Muscle Strength/physiology , Physical Endurance/physiology , Quadriplegia/rehabilitation , Respiratory Muscles/physiopathology , Posture/physiology , Quadriplegia/physiopathology , Vital Capacity/physiology , Young AdultABSTRACT
Objetivo: O objetivo do trabalho foi avaliar os efeitos da fisioterapia respiratória (caminhada, tosse e cinesioterapia) sobre a função pulmonar dos pacientes em pós-operatório de cirurgia abdominal alta. Métodos: Foram avaliados clinicamente 30 pacientes (14 do sexo feminino e 16 do masculino, com idade média de 53 anos), por testes de função pulmonar, medidas de força da musculatura respiratória e saturação arterial de oxigênio. Aleatoriamente, os pacientes foram incluídos no Grupo A (caminhada e tosse) ou Grupo B (caminhada, tosse e cinesioterapia exercícios respiratórios diafragmáticos, em tempos e inspiração sustentada). Rresultados: Comparando-se aos valores de pré-operatório, o volume expiratório forçado de primeiro segundo diminuiu 24 por cento no primeiro dia de pós-operatório no Grupo A e 31 por cento no Grupo B, mantendo uma redução, no quinto dia de pós-operatório de 7 e 14 por cento (não significante); a capacidade vital forçada diminuiu 27 e 33 por cento, no primeiro dia de pós-operatório, nos Grupos A e B, mantendo no quinto dia 12 (não significante) e 20 por cento; a pressão inspiratória máxima diminuiu 16 por cento no primeiro dia de pós-operatório, nos Grupos A e B, mantendo, no quinto dia, uma diminuição de 4 por cento (não significante) em ambos; a pressão expiratória máxima diminuiu, no primeiro dia, 20 e 18 por cento nos Grupos A e B e, no quinto dia 14 e 15 por cento. Cconclusão: A evolução do Grupo A foi semelhante ao Grupo B (este, porém, com maior risco de complicações) sugerindo que a inclusão da cinesioterapia foi benéfica.
Subject(s)
Abdomen , Breathing Exercises , Cough , Kinesiology, Applied/methods , Physical Therapy Modalities , Postoperative Period , Exercise Therapy/methodsABSTRACT
JUSTIFICATIVA E OBJETIVOS: Em 2000, foi publicado o II Consenso Brasileiro de Ventilação Mecânica. Desde então, o conhecimento na área da ventilação mecânica avançou rapidamente, com a publicação de inúmeros estudos clínicos que acrescentaram importantes informações para o manuseio de pacientes críticos em ventilação artificial. Além disso, a expansão do conceito de Medicina Baseada em Evidências determinou a hierarquização das recomendações clínicas, segundo o rigor metodológico dos estudos que as embasaram. Essa abordagem explícita vem ampliando a compreensão e a aplicação das recomendações clínicas. Por esses motivos, a AMIB - Associação de Medicina Intensiva Brasileira - e a SBPT - Sociedade Brasileira de Pneumologia e Tisiologia - julgaram conveniente a atualização das recomendações descritas no Consenso anterior. Dentre os tópicos selecionados a Fisioterapia durante a Ventilação Mecânica foi um dos temas propostos. O objetivo foi descrever os pontos mais importantes relacionados à atuação do fisioterapeuta no ambiente da terapia Intensiva com ênfase na ventilação mecânica. MÉTODO: Objetivou-se chegar a um documento suficientemente sintético, que refletisse a melhor evidência disponível na literatura. A revisão bibliográfica baseou-se na busca de estudos através de palavras-chave e em sua gradação conforme níveis de evidência. As palavras-chave utilizadas para a busca foram: mechanical ventilation e physical therapy. RESULTADOS: São apresentadas recomendações quanto aos principais procedimentos fisioterápicos, as técnicas e suas aplicações. CONCLUSÕES: A fisioterapia ocupa hoje papel relevante no ambiente da terapia intensiva, principalmente para os pacientes sob ventilação mecânica invasiva ou não invasiva.
BACKGROUND AND OBJECTIVES: The II Brazilian Consensus Conference on Mechanical Ventilation was published in 2000. Knowledge on the field of mechanical ventilation evolved rapidly since then, with the publication of numerous clinical studies with potential impact on the ventilatory management of critically ill patients. Moreover, the evolving concept of evidence - based medicine determined the grading of clinical recommendations according to the methodological value of the studies on which they are based. This explicit approach has broadened the understanding and adoption of clinical recommendations. For these reasons, AMIB - Associação de Medicina Intensiva Brasileira and SBPT - Sociedade Brasileira de Pneumologia e Tisiologia - decided to update the recommendations of the II Brazilian Consensus. Physical therapy during mechanical ventilation has been one of the updated topics. This objective was described the most important topics on the physical therapy during mechanical ventilation. METHODS: Systematic review of the published literature and gradation of the studies in levels of evidence, using the key words: mechanical ventilation and physical therapy. RESULTS: Recommendations on the most important techniques applied during mechanical ventilation. CONCLUSIONS: Physical therapy has a central role at the Intensive Care environment, mainly in patients submitted to a mechanical ventilatory support invasive or non invasive.