Respiratory Muscle Strength and Quality of Life in Patients With Heart Failure and Their Main Correlated Factors: A Cross-sectional Study.

BACKGROUND: Heart failure may cause peripheral and respiratory muscle alterations, dyspnea, fatigue, and exercise intolerance, worsening the quality of life of patients. OBJECTIVES: The aims of this study were to analyze respiratory muscle strength and quality of life of patients with heart failure and correlate them with clinical variables and functional classification. METHODS: This cross-sectional study involved patients with heart failure. A manovacuometer assessed maximum inspiratory and expiratory pressures, and quality of life was assessed using the Minnesota Living with Heart Failure Questionnaire. Functional classification was categorized according to the New York Heart Association (NYHA) class in I, II, III, or IV. RESULTS: We included 60 patients (66.7% male) with a mean age of 62.0 years and mean left ventricular ejection fraction of 42.0%. Maximum inspiratory pressure and maximum expiratory pressure were close to normal (>70% of predicted) in most patients; however, a subgroup composed mostly of patients with dilated heart failure and NYHA class III (n = 21) presented low maximum inspiratory pressure values (59.2%; 95% confidence interval, 55.7%-62.8%). The mean total score of the Minnesota Living with Heart Failure Questionnaire was 44.4 points, being negatively correlated with left ventricular ejection fraction (r = -0.29, P = .02). Patients with NYHA class III and disease duration longer than 120 months presented higher total (P < .01) and physical dimension scores. CONCLUSIONS: Most patients had respiratory muscle strength close to normal; however, those with dilated heart failure and NYHA class III presented low maximum inspiratory pressure values. Quality of life was moderately compromised, mainly because of long disease duration, NYHA class III, and low left ventricular ejection fraction.

Efficacy of a rehabilitation protocol on pulmonary and respiratory muscle function and ultrasound evaluation of diaphragm and quadriceps femoris in patients with post-COVID-19 syndrome: a series of cases.

This study assessed the efficacy of a pulmonary rehabilitation (PR) on pulmonary and respiratory muscle function and thickness of quadriceps femoris and diaphragm of patients with post-COVID-19 syndrome. This series of cases followed nine patients who performed PR twice a week for six weeks. Patients received the following PR program: lung expansion therapy; respiratory muscle training; upper limb strength exercises; aerobic exercises on a treadmill. After the program, we observed increased peak expiratory flow (26.03%), forced vital capacity (FVC) (7.14%), forced expiratory volume in the first second (FEV1) (9.55%), and ratio between FEV1/FVC (6.19%). All parameters of respiratory muscle strength and endurance were improved. Diaphragmatic thickening fraction and thickness of quadriceps femoris also improved, whereas echo intensity of quadriceps reduced. Thus, RP protocol improved pulmonary function, respiratory muscle strength and endurance, and thickness of diaphragm and quadriceps femoris, and reduced echo intensity of quadriceps in patients with post-COVID-19 syndrome.

Distinct phenotypes in COVID-19 may require distinct pulmonary rehabilitation strategies.

The novel coronavirus (SARS-CoV-2) has distinct clinical manifestations that can vary from an asymptomatic condition to severe acute respiratory failure. Phenotypes are attributable to different pathophysiological mechanisms and require different treatment strategies. The assessment and identification of different phenotypes can guide therapy configurations such as oxygen therapy, non-invasive ventilation, airway management, and tracheal intubation. Further studies are essential to provide information on the influence of phenotypes in the decision of rehabilitation strategies. The sequelae left in the respiratory system of COVID-19 survivors and its limitations will be a challenge for rehabilitation services worldwide. Lung injuries are directly related to the phenotypes presented, and depending on the degree of these injuries, rehabilitation strategies can be targeted. We believe that differentiating patients, according to their respective phenotypes, can improve decision-making in treatment and individualized rehabilitation.

Quality of life and physical activity in intensive care professionals from middle São Francisco.

OBJECTIVE: The objective was to assess the level of physical activity (LPA) and the quality of life QL of the professionals who work in ICU. METHOD: This was a cross-sectional study carried out in Adult ICUs. LPA was assessed by the International Questionnarie of Physical Activity--short form (IQPA-SF) and the QL by the Medical Outcomes Study 36 (SF-36) questionnaire. RESULTS: It was classified active 50.89% out of a total of 59 professionals. Nursing technicians were considered the most active with 60.6%. The QL of the professionals who were considered active were better when compared to inactives, with statistical differences to the category of physical aspects limitation, social aspects and mental health. The working hours were higher than recommend, the physicians were higher than the physical therapist, nurses and technicians nurses (p = 0.046). CONCLUSION: Physically active professionals who work in ICU had higher quality of life probably why have lower hours of work and consequently more free time to engage in physical activity.

Effects of electrical muscle stimulation early in the quadriceps and tibialis anterior muscle of critically ill patients.

BACKGROUND: Electrical muscle stimulation (EMS) is applied to critically ill patients in order to improve their muscle strength, thereby preventing hypotrophy and promoting functional recovery. OBJECTIVE: To assess the effects of early EMS on the range of movement of the ankle joint, and on thigh and leg circumference in critically ill patients. METHODS: This is a prospective randomized clinical trial comprising 11 patients undergoing mechanical ventilation. Before and after EMS the thigh and leg circumference in both lower limbs and the goniometry of the tibiotarsal joint were measured. The angle of 90° on the goniometer was taken as the standard neutral position (NP), with the arm fixed on the lateral malleolus of the ankle joint. Other measurements, namely dorsiflexion and plantar flexion, referred to as mobile arm, were taken from the NP. These recordings were obtained following an active contraction of the patients' muscles. RESULTS: Compared with the electrostimulated limb, a difference in dorsiflexion of the control limb was observed (96.2 ± 24.9 versus 119.9 ± 14.1°; p = 0.01). A girth of 10 cm of the leg was found in limb reduction when compared to the electrostimulated one (24.7 ± 3.1 versus 26.4 ± 4.0 cm; p = 0.03). CONCLUSIONS: EMS used at low current intensity and for a short duration failed to prevent muscle atrophy in critically ill patients. However, we did find a significant improvement in active dorsiflexion of the ankle joint suggesting that it could help to prevent against stance plantar flexion in these patients.