Practice recommendations for the role of physiotherapy in the management of sleep disorders: the 2022 Brazilian Sleep Association Guidelines.

This clinical guideline supported by the Brazilian Sleep Association comprises a brief history of the development of Brazilian sleep physiotherapy, outlines the role of the physiotherapist as part of a sleep health team, and describes the clinical guidelines in respect of the management of some sleep disorders by the physiotherapist (including sleep breathing disorders, i.e., obstructive sleep apnea, central sleep apnea, upper airway resistance syndrome, hypoventilation syndromes and overlap syndrome, and pediatric sleep breathing disorders; sleep bruxism; circadian rhythms disturbances; insomnia; and Willis-Ekbom disease/periodic limb movement disorder. This clinical practice guideline reflects the state of the art at the time of publication and will be reviewed and updated as new information becomes available.

Pressure support-ventilation versus spontaneous breathing with "T-Tube" for interrupting the ventilation after cardiac operations / Pressão de suporte ventilatório versus respiração espontânea em "Tubo-T" para a interrupção da ventilação após as operações cardíacas

OBJECTIVE: To compare pressure-support ventilation with spontaneous breathing through a T-tube for interrupting invasive mechanical ventilation in patients undergoing cardiac surgery with cardiopulmonary bypass. METHODS: Adults of both genders were randomly allocated to 30 minutes of either pressure-support ventilation or spontaneous ventilation with "T-tube" before extubation. Manovacuometry, ventilometry and clinical evaluation were performed before the operation, immediately before and after extubation, 1h and 12h after extubation. RESULTS: Twenty-eight patients were studied. There were no deaths or pulmonary complications. The mean aortic clamping time in the pressure support ventilation group was 62 ± 35 minutes and 68 ± 36 minutes in the T-tube group (P=0.651). The mean cardiopulmonary bypass duration in the pressure-support ventilation group was 89 ± 44 minutes and 82 ± 42 minutes in the T-tube group (P=0.75). The mean Tobin index in the pressure support ventilation group was 51 ± 25 and 64.5 ± 23 in the T-tube group (P=0.153). The duration of intensive care unit stay for the pressure support ventilation group was 2.1 ± 0.36 days and 2.3 ± 0.61 days in the T-tube group (P=0.581). The atelectasis score in the T-tube group was 0.6 ± 0.8 and 0.5 ± 0.6 (P=0.979) in the pressure support ventilation group. The study groups did not differ significantly in manovacuometric and ventilometric parameters and hospital evolution. CONCLUSION: The two trial methods evaluated for interruption of mechanical ventilation did not affect the postoperative course of patients who underwent cardiac operations with cardiopulmonary bypass.

OBJETIVO: Comparar a pressão de suporte ventilatório com a respiração espontânea em "Tubo-T" para interrupção da ventilação invasiva em pacientes submetidos à operação cardíaca. MÉTODOS: Adultos de ambos os sexos foram alocados para pressão de suporte ventilatório por 30 minutos ou o mesmo período de ventilação espontânea com "Tubo-T" antes da extubação. Realizou-se manovacuometria, ventilometria e avaliação clínica antes da operação, imediatamente antes e após a extubação, 1h e 12h após extubação. RESULTADOS: Vinte e oito pacientes foram estudados. Não ocorreram mortes ou complicações respiratórias. O tempo de pinçamento da aorta no grupo suporte ventilatório foi 62 ± 35 minutos e de 68 ± 36 minutos para o "Tubo-T" (P=0,651). O tempo de CEC no grupo suporte ventilatório foi 89 ± 44 minutos e para o "Tubo-T" de 82 ± 42 minutos (P=0,75). O índice de Tobin para o grupo suporte ventilatório foi 51 ± 25 e para o grupo "Tubo-T", 64,5 ± 23 (P=0,153). O tempo na unidade de terapia intensiva para o grupo suporte ventilatório foi 2,1 ± 0,36 dias e para o grupo "Tubo-T", 2,3±0,61 dias (P=0,581). O escore de atelectasia para o grupo "Tubo-T" foi 0,6 ± 0,8 e para o suporte ventilatório foi 0,5 ± 0,6 (P=0,979). Não houve diferença significativa na evolução clínica e nos valores de gasometria, manovacuometria e ventilometria entre ambos os grupos. CONCLUSÃO: O método utilizado para testar a adequação da interrupção da ventilação mecânica invasiva não afetou a evolução pós-operatória dos pacientes submetidos a operações cardíacas com circulação extracorpórea.

Pressure support-ventilation versus spontaneous breathing with "T-Tube" for interrupting the ventilation after cardiac operations.

OBJECTIVE: To compare pressure-support ventilation with spontaneous breathing through a T-tube for interrupting invasive mechanical ventilation in patients undergoing cardiac surgery with cardiopulmonary bypass. METHODS: Adults of both genders were randomly allocated to 30 minutes of either pressure-support ventilation or spontaneous ventilation with "T-tube" before extubation. Manovacuometry, ventilometry and clinical evaluation were performed before the operation, immediately before and after extubation, 1h and 12h after extubation. RESULTS: Twenty-eight patients were studied. There were no deaths or pulmonary complications. The mean aortic clamping time in the pressure support ventilation group was 62 ± 35 minutes and 68 ± 36 minutes in the T-tube group (P=0.651). The mean cardiopulmonary bypass duration in the pressure-support ventilation group was 89 ± 44 minutes and 82 ± 42 minutes in the T-tube group (P=0.75). The mean Tobin index in the pressure support ventilation group was 51 ± 25 and 64.5 ± 23 in the T-tube group (P=0.153). The duration of intensive care unit stay for the pressure support ventilation group was 2.1 ± 0.36 days and 2.3 ± 0.61 days in the T-tube group (P=0.581). The atelectasis score in the T-tube group was 0.6 ± 0.8 and 0.5 ± 0.6 (P=0.979) in the pressure support ventilation group. The study groups did not differ significantly in manovacuometric and ventilometric parameters and hospital evolution. CONCLUSION: The two trial methods evaluated for interruption of mechanical ventilation did not affect the postoperative course of patients who underwent cardiac operations with cardiopulmonary bypass.

Avaliação da ventilação não-invasiva com dois níveis de pressão positiva nas vias aéreas após cirurgia cardíaca / Assessment of noninvasive ventilation with two levels of positive airway pressure in patients after cardiac surgery

INTRODUÇÃO: A aplicação de ventilação por dois níveis de pressão positiva (BiPAP®) associada à fisioterapia respiratória convencional (FRC) no pós-operatório (PO) imediato de cirurgia cardíaca pode contribuir para a diminuição das complicações pulmonares. OBJETIVO: Avaliar a segurança e a adesão da aplicação preventiva do BiPAP® associado a FRC no PO imediato de revascularização do miocárdio. MÉTODOS: Vinte e seis pacientes submetidos a revascularização do miocárdio foram aleatoriamente alocados. O Grupo Controle (GC) foi tratado com FRC, o Grupo BiPAP (GB) foi submetido a 30 minutos de BiPAP®, duas vezes ao dia, associado à FRC. A FRC foi realizada em ambos os grupos, duas vezes ao dia. Todos os pacientes foram avaliados quanto: capacidade vital, permeabilidade das vias aéreas, pressões respiratórias máximas, saturação de oxigênio, frequência cardíaca, frequência respiratória, volume minuto, volume corrente, pressões arteriais sistólica e diastólica. As avaliações foram realizadas durante a internação no pré-operatório, imediatamente após a extubação, e na 24ª e 48ª horas após extubação. RESULTADOS: No GC, 61,5 por cento dos pacientes tiveram algum grau de atelectasias, no GB, 54 por cento (P=0,691). A capacidade vital foi estatisticamente maior no GB no PO (P<0,015). Todos os outros parâmetros de ventilometria, gasometria, manovacuometria e hemodinâmicos foram semelhantes entre os grupos. CONCLUSÃO: A cirurgia de revascularização do miocárdio leva à degradação da função respiratória no PO, e a aplicação da ventilação com pressão positiva (BiPAP®) pode ser benéfica para reestabelecer a função pulmonar mais rapidamente, principalmente a capacidade vital, de forma segura, sendo bem aceita pelos paciente, devido ao maior conforto em relação à sensação de dor durante a execução da fisioterapia respiratória.

INTRODUCTION: The application of two levels of ventilation by positive pressure (BiPAP®) associated with conventional respiratory therapy (CRT) in postoperative periord of cardiac surgery may contribute to reduction of pulmonary complications. OBJECTIVES: To evaluate the safety and compliance of preventive application of BiPAP® CRT associated with immediate postoperative myocardial revascularization. METHODS: 26 patients undergoing coronary artery bypass grafting were randomly allocated in one of the groups. Patients of the Control Group (CG) were treated only with conventional respiratory therapy, compared to BiPAP group (BG) (in addition to conventional respiratory therapy the patients were subjected to 30 minutes of ventilation by two levels twice a day). The conventional respiratory therapy was held in both groups, twice a day. All patients were evaluated for vital capacity, airway permeability, maximal respiratory pressures, oxygen saturation, heart rate, respiratory frequency, Volume Minute, tidal volume, systolic and diastolic blood pressure. Evaluations were performed during hospitalization preoperatively, immediately after extubation, 24h and 48h after extubation. RESULTS: In CG 61.5 percent of patients had some degree of atelectasias, in comparison to 54 percent of BG (P=0.691). The vital capacity was higher in the GB postoperatively (P<0.015). All the other ventilometric, gasometric, hemodynamic and manometric parameters were similar between groups. CONCLUSION: Coronary artery bypass grafting leads to deterioration of respiratory function postoperatively, and the application of positive pressure ventilation (BiPAP®) may be beneficial to restore lung function more quickly, especially vital capacity, safely, and well accepted by patients due to greater comfort with the sensation of pain during the execution of respiratory therapy.

Assessment of noninvasive ventilation with two levels of positive airway pressure in patients after cardiac surgery.

INTRODUCTION: The application of two levels of ventilation by positive pressure (BiPAP®) associated with conventional respiratory therapy (CRT) in postoperative periord of cardiac surgery may contribute to reduction of pulmonary complications. OBJECTIVES: To evaluate the safety and compliance of preventive application of BiPAP® CRT associated with immediate postoperative myocardial revascularization. METHODS: 26 patients undergoing coronary artery bypass grafting were randomly allocated in one of the groups. Patients of the Control Group (CG) were treated only with conventional respiratory therapy, compared to BiPAP group (BG) (in addition to conventional respiratory therapy the patients were subjected to 30 minutes of ventilation by two levels twice a day). The conventional respiratory therapy was held in both groups, twice a day. All patients were evaluated for vital capacity, airway permeability, maximal respiratory pressures, oxygen saturation, heart rate, respiratory frequency, Volume Minute, tidal volume, systolic and diastolic blood pressure. Evaluations were performed during hospitalization preoperatively, immediately after extubation, 24h and 48h after extubation. RESULTS: In CG 61.5% of patients had some degree of atelectasias, in comparison to 54% of BG (P=0.691). The vital capacity was higher in the GB postoperatively (P<0.015). All the other ventilometric, gasometric, hemodynamic and manometric parameters were similar between groups. CONCLUSION: Coronary artery bypass grafting leads to deterioration of respiratory function postoperatively, and the application of positive pressure ventilation (BiPAP®) may be beneficial to restore lung function more quickly, especially vital capacity, safely, and well accepted by patients due to greater comfort with the sensation of pain during the execution of respiratory therapy.

Efeitos fisiológicos da fisioterapia respiratória convencional associada à aplicação de BiPAP no pós-operatório de cirurgia cardíaca / Physiological effects of the conventional respiratory physical therapy associated to BiPAP in post cardiac surgery

O objetivo deste estudo foi avaliar as alterações da função pulmonar pela Força Muscular Respiratória (FMR-PImax e PEmax), Capacidade Vital (CV), Freqüência Respiratória (FR) e Oxigenação (SpO2) do pré-operatório ao 1º pós-operatório (PO) e deste à pré-alta; e verificar a eficácia da Fisioterapia Respiratória Convencional (FRC) associada à Ventilação não-invasiva (BiPAP) no PO de cirurgia cardíaca. Incluiu-se 27 pacientes, 12 tratados com FRC associada à BiPAP (Grupo1-G1) e 15 com FRC (Grupo2- G2), com avaliação das variáveis citadas no pré-operatório, 1ºPO, 3ºPO e pré-alta. Para a análise utilizou-se Friedman ANOVA e Mann-Whitney (p ≤ 0,05). Quanto a FMR, apenas G1 aumentou significativamente do 1ºPO para pré-alta, e os valores de PImax apresentaram-se significativamente maiores que G2. Em ambos os grupos, a CV aumentou significativamente do 1º para o 3ºPO, mas apenas G1 mostrou valores da pré-alta próximos ao pré-operatório. A oxigenação aumentou do 3ºPO à pré-alta para ambos, mas apenas o G1 aproximou-se dos valores do pré-operatório. Quanto à FR, apenas o G1 reduziu significativamente no PO. A FRC associada à BiPAP mostrou-se mais eficiente do que a FRC isolada, no aumento da FMR, CV e oxigenação, e na reversão da FR, apesar dos valores não terem sido recuperados completamente até a pré-alta.

The aim of this study was to evaluate the pulmonary function alterations by the Respiratory Muscular Force (RMF- MIP and MEP), Vital Capacity (VC), Breathing Frequency (BF) and Oxigenation (SpO2) from the Pre-operation to the 1st post-operation (PO) and from that one to the pre-discharge; and to verify the efficiency of the Conventional Respiratory Physical Therapy (CRP) associated to the Non-invasive ventilation (BiPAP) in the cardiac surgery PO. 27 patients were included; 12 of them were treated with FRC associated to the BiPAP (Group 1-G1) and 15 with FRC (Group 2-G2). These patients were evaluated in the pre-operation ,1st PO, 3rd PO and pre-discharge as for the mentioned variables. To the analysis were used Friedman ANOVA and Mann-Whitney (p ≤ 0,05). As for the RMF, only G1 increased significantly from the first PO to the pre-discharge, and the values of MIP were significantly bigger than G2. In both groups, the VC increased significantly from the 1st to the 3rd PO, but only G1 presented pre-discharge values near to the pre-operation. The oxigenation increased from the 3rd PO to the pre-discharge for both, but only the G1 came near to the preoperation values. As for RF, only the G1 decreased significantly in the PO. In conclusion, the CRF associated to the BiPAP seemed be more efficient than the isolated CRF, in the RMF increasing, VC and oxigenation, and in the RF reversion, despite of the values have not been completely recuperated until the pre-discharge.