Safety and feasibility of a functional electrical stimulation cycling-based muscular dysfunction diagnostic method in mechanically ventilated patients.

BACKGROUND: A nonvolitional diagnostic method based on FES-Cycling technology has recently been demonstrated for mechanically ventilated patients. This method presents good sensitivity and specificity for detecting muscle dysfunction and survival prognosis, even in unconscious patients. As the clinical relevance of this method has already been reported, we aimed to evaluate its safety and feasibility. METHODS: An observational prospective study was carried out with 20 critically ill, mechanically ventilated patients. The FES-cycling equipment was set in a specific diagnostic mode. For safety determination, hemodynamic parameters and peripheral oxygen saturation were measured before and immediately after the diagnostic protocol, as well as venous oxygen saturation and blood lactate. The creatine phosphokinase level (CPK) was measured before and 24, 48, and 72 h after the test. The time taken to carry out the entire diagnostic protocol and the number of patients with visible muscle contraction (capacity of perceptive muscular recruitment) were recorded to assess feasibility. RESULTS: Heart rate [91 ± 23 vs. 94 ± 23 bpm (p = 0.0837)], systolic [122 ± 19 vs. 124 ± 19 mm Hg (p = 0.4261)] and diastolic blood pressure [68 ± 13 vs. 70 ± 15 mm Hg (p = 0.3462)], and peripheral [98 (96-99) vs. 98 (95-99) % (p = 0.6353)] and venous oxygen saturation [71 ± 14 vs. 69 ± 14% (p = 0.1317)] did not change after the diagnostic protocol. Moreover, blood lactate [1.48 ± 0.65 vs. 1.53 ± 0.71 mmol/L (p = 0.2320)] did not change. CPK did not change up to 72 h after the test [99 (59-422) vs. 125 (66-674) (p = 0.2799) vs. 161 (66-352) (p > 0.999) vs. 100 (33-409) (p = 0.5901)]. The time taken to perform the diagnostic assessment was 11.3 ± 1.1 min. In addition, 75% of the patients presented very visible muscle contractions, and 25% of them presented barely visible muscle contractions. CONCLUSIONS: The FES cycling-based muscular dysfunction diagnostic method is safe and feasible. Hemodynamic parameters, peripheral oxygen saturation, venous oxygen saturation, and blood lactate did not change after the diagnostic protocol. The muscle damage marker (CPK) did not increase up to 72 h after the diagnostic protocol.

Características de recém-nascidos portadores de hemoglobina S detectados através de triagaem em sangue de cordäo umbilical / Hemoglobin S positive newborn detected by cord blood and its characteristics

Objetivo: verificar a prevalência de Hemoglobina "S" (Hb"S") em recém-nascidos (RN) no Instituto Materno Infantil de Pernambuco (IMIP) e sua ocorrênciaa segundo o sexo, peso e Apgar. Metodologia: Foram analisados 1.988 RN no período de outubro/96 a março/97 para detecçäo de Hb "S" em sangue de cordäo umbilical através de eletroforese de Hb em pH acalino. Näo houve nenhum critério de exclusäo. Os dados sobre variáveis dos RN foram obtidos através de consulta aos prontuários médicos. A análise dos dados foi feita através do "software" EPI-INFO 6.0. Resultados: Foram encontrados 105 (5,3 por cento) RN com presença de Hb "S". Destes, 102 (5,1 por cento) apresentavam-se na forma de traço falciforme (Hb "FAS") e 3 (0,2 por cento) sob a forma de doença falciforme (Hb "SC"). Näo foi encontrado nenhum RN com hemozigose para Hb "S". Näo foi observada diferença estatisticamente significante entre os RN portadores ou näo de Hb "S" quanto ao sexo, peso e Apgar. Conclusöes: Sugerimos a realizaçäo de triagaem neonatal de hemoglobinopatias em todos os RN na cidade de Recife com posterior seguimento dos casos positivos e suspeitos e subseqüênte aconselhamento genético às famílias acometidas