Oxidative stress and immune system analysis after cycle ergometer use in critical patients.

OBJECTIVE:: The passive cycle ergometer aims to prevent hypotrophy and improve muscle strength, with a consequent reduction in hospitalization time in the intensive care unit and functional improvement. However, its effects on oxidative stress and immune system parameters remain unknown. The aim of this study is to analyze the effects of a passive cycle ergometer on the immune system and oxidative stress in critical patients. METHODS:: This paper describes a randomized controlled trial in a sample of 19 patients of both genders who were on mechanical ventilation and hospitalized in the intensive care unit of the Hospital Agamenom Magalhães. The patients were divided into two groups: one group underwent cycle ergometer passive exercise for 30 cycles/min on the lower limbs for 20 minutes; the other group did not undergo any therapeutic intervention during the study and served as the control group. A total of 20 ml of blood was analysed, in which nitric oxide levels and some specific inflammatory cytokines (tumour necrosis factor alpha (TNF-α), interferon gamma (IFN-γ) and interleukins 6 (IL-6) and 10 (IL-10)) were evaluated before and after the study protocol. RESULTS:: Regarding the demographic and clinical variables, the groups were homogeneous in the early phases of the study. The nitric oxide analysis revealed a reduction in nitric oxide variation in stimulated cells (p=0.0021) and those stimulated (p=0.0076) after passive cycle ergometer use compared to the control group. No differences in the evaluated inflammatory cytokines were observed between the two groups. CONCLUSION:: We can conclude that the passive cycle ergometer promoted reduced levels of nitric oxide, showing beneficial effects on oxidative stress reduction. As assessed by inflammatory cytokines, the treatment was not associated with changes in the immune system. However, further research in a larger population is necessary for more conclusive results.

Oxidative stress and immune system analysis after cycle ergometer use in critical patients

OBJECTIVE: The passive cycle ergometer aims to prevent hypotrophy and improve muscle strength, with a consequent reduction in hospitalization time in the intensive care unit and functional improvement. However, its effects on oxidative stress and immune system parameters remain unknown. The aim of this study is to analyze the effects of a passive cycle ergometer on the immune system and oxidative stress in critical patients. METHODS: This paper describes a randomized controlled trial in a sample of 19 patients of both genders who were on mechanical ventilation and hospitalized in the intensive care unit of the Hospital Agamenom Magalhães. The patients were divided into two groups: one group underwent cycle ergometer passive exercise for 30 cycles/min on the lower limbs for 20 minutes; the other group did not undergo any therapeutic intervention during the study and served as the control group. A total of 20 ml of blood was analysed, in which nitric oxide levels and some specific inflammatory cytokines (tumour necrosis factor alpha (TNF-α), interferon gamma (IFN-γ) and interleukins 6 (IL-6) and 10 (IL-10)) were evaluated before and after the study protocol. RESULTS: Regarding the demographic and clinical variables, the groups were homogeneous in the early phases of the study. The nitric oxide analysis revealed a reduction in nitric oxide variation in stimulated cells (p=0.0021) and those stimulated (p=0.0076) after passive cycle ergometer use compared to the control group. No differences in the evaluated inflammatory cytokines were observed between the two groups. CONCLUSION: We can conclude that the passive cycle ergometer promoted reduced levels of nitric oxide, showing beneficial effects on oxidative stress reduction. As assessed by inflammatory cytokines, the treatment was not associated with changes in the immune system. However, further research in a larger population is necessary for more conclusive results.

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.

Influência da mobilização precoce na força muscular periférica e respiratória em pacientes críticos / Influence of early mobilization on respiratory and peripheral muscle strength in critically ill patients

OBJETIVO: Avaliar os efeitos de um protocolo de mobilização precoce na musculatura periférica e respiratória de pacientes críticos. MÉTODOS: Ensaio clínico, controlado e randomizado realizado em 59 pacientes de ambos os gêneros, em ventilação mecânica. Os pacientes foram divididos em grupo fisioterapia convencional - grupo controle, n=14, que realizou a fisioterapia do setor, e grupo mobilização precoce, n=14, que recebeu um protocolo sistemático de mobilização precoce. A força muscular periférica foi avaliada por meio do Medical Research Council e a força muscular respiratória (dada por pressão inspiratória máxima e pressão expiratória máxima) foi mensurada pelo manovacuômetro com uma válvula unidirecional. A mobilização precoce sistemática foi realizada em cinco níveis. RESULTADOS: Para os valores de pressão inspiratória máxima e do Medical Research Council, foram encontrados ganhos significativos no grupo mobilização precoce. Entretanto, a pressão expiratória máxima e o tempo de ventilação mecânica (dias), tempo de internamento na unidade de terapia intensiva (dias), e tempo de internamento hospitalar (dias) não apresentaram significância estatística. CONCLUSÃO: Houve ganho da força muscular inspiratória e periférica para a população estudada quando submetida a um protocolo de mobilização precoce e sistematizado.

OBJECTIVE:To evaluate the effects of an early mobilization protocol on respiratory and peripheral muscles in critically ill patients. METHODS: A randomized controlled clinical trial was conducted with 59 male and female patients on mechanical ventilation. The patients were divided into a conventional physical therapy group (control group, n=14) that received the sector's standard physical therapy program and an early mobilization group (n=14) that received a systematic early mobilization protocol. Peripheral muscle strength was assessed with the Medical Research Council score, and respiratory muscle strength (determined by the maximal inspiratory and expiratory pressures) was measured using a vacuum manometer with a unidirectional valve. Systematic early mobilization was performed on five levels. RESULTS: Significant increases were observed for values for maximal inspiratory pressure and the Medical Research Council score in the early mobilization group. However, no statistically significant improvement was observed for maximal expiratory pressure or MV duration (days), length of stay in the intensive care unit (days), and length of hospital stay (days). CONCLUSION: The early mobilization group showed gains in inspiratory and peripheral muscle strength.

Influence of early mobilization on respiratory and peripheral muscle strength in critically ill patients. / Influência da mobilização precoce na força muscular periférica e respiratória em pacientes críticos.

OBJECTIVE: To evaluate the effects of an early mobilization protocol on respiratory and peripheral muscles in critically ill patients. METHODS: A randomized controlled clinical trial was conducted with 59 male and female patients on mechanical ventilation. The patients were divided into a conventional physical therapy group (control group, n=14) that received the sector's standard physical therapy program and an early mobilization group (n=14) that received a systematic early mobilization protocol. Peripheral muscle strength was assessed with the Medical Research Council score, and respiratory muscle strength (determined by the maximal inspiratory and expiratory pressures) was measured using a vacuum manometer with a unidirectional valve. Systematic early mobilization was performed on five levels. RESULTS: Significant increases were observed for values for maximal inspiratory pressure and the Medical Research Council score in the early mobilization group. However, no statistically significant improvement was observed for maximal expiratory pressure or MV duration (days), length of stay in the intensive care unit (days), and length of hospital stay (days). CONCLUSION: The early mobilization group showed gains in inspiratory and peripheral muscle strength.

Ruídos na unidade de terapia intensiva: quantificação e percepção dos profissionais de saúde / Noise in the intensive care unit: quantification and perception by healthcare professionals

OBJETIVO: Em uma unidade de terapia intensiva, a circulação de pessoas da equipe multidisciplinar e o número considerável de equipamentos e alarmes sonoros deixam o ambiente ruidoso. O objetivo desta pesquisa foi mensurar os níveis de ruídos de uma unidade de terapia intensiva da cidade de Recife e avaliar sua percepção pelos profissionais da unidade. MÉTODOS: Durante uma semana, 24 horas por dia, foi utilizado um decibelímetro para realizar mensurações a cada cinco segundos. Após as aferições, foi aplicado um questionário aos profissionais sobre sua percepção e incômodo causados pelo ruído, e se eles achavam possível reduzir o barulho. RESULTADOS: A média de ruído verificada foi de 58,21 ± 5,93 dB. O período diurno apresentou maiores níveis de ruídos que o noturno (60,86 ± 4,90 vs 55,60 ± 5,98 dB; p < 0,001), assim como os dias úteis quando comparados ao final de semana (58,77 ± 6,05 vs 56,83 ± 5,90 dB; p < 0,001) e a passagem de plantão noturna quando comparada a diurna (62,31 ± 4,70 vs 61,35 ± 5,08 dB; p < 0,001). Dos 73 profissionais que responderam o questionário, 97,3 por cento acham que a unidade de terapia intensiva tem ruído de moderado a intenso, 50,7 por cento se sentem prejudicados pelo barulho e 98,6 por cento acham que é possível reduzir o nível de ruídos. CONCLUSÃO: Os níveis de ruídos encontrados estavam acima dos recomendados. Programas preventivos e educativos conscientizando da importância da redução do nível de ruído devem ser estimulados, envolvendo todos os profissionais que compõem a equipe da unidade de terapia intensiva.

OBJECTIVE: The several multidisciplinary team personnel and device alarms make intensive care units noisy environments. This study aimed to measure the noise level of a medical-surgical intensive care unit in Recife, Brazil, and to assess the noise perception by the unit's healthcare professionals. METHODS: A decibel meter was used for continuous every five seconds one week noise levels recording. After this measurement, an interview shaped noise perception questionnaire was applied to the healthcare professionals, approaching the discomfort level and noise control possibilities. RESULTS: Mean 58.21 ± 5.93 dB noise was recorded. The morning noise level was higher than at night (60.85 ± 4.90 versus 55.60 ± 5.98, p <0.001), as well as work-days versus weekend (58. 77 ± 6.05 versus 56.83 ± 5.90, p <0.001). The evening staff shift change noise was louder than by daytime change (62.31 ± 4.70 versus 61.35 ± 5.08 dB; p < 0.001). Of the 73 questionnaire respondents, 97.3 percent believe that the intensive care unit has moderate or intense noise levels; 50.7 percent consider the noise harmful; and 98.6 percent believe that noise levels can be reduced. CONCLUSION: The measured noise levels were above the recommended. Preventive and educational programs approaching the importance of noise levels reduction should be encouraged in intensive care units.

Noise in the intensive care unit: quantification and perception by healthcare professionals. / Ruídos na unidade de terapia intensiva: quantificação e percepção dos profissionais de saúde.

OBJECTIVE: The several multidisciplinary team personnel and device alarms make intensive care units noisy environments. This study aimed to measure the noise level of a medical-surgical intensive care unit in Recife, Brazil, and to assess the noise perception by the unit's healthcare professionals. METHODS: A decibel meter was used for continuous every five seconds one week noise levels recording. After this measurement, an interview shaped noise perception questionnaire was applied to the healthcare professionals, approaching the discomfort level and noise control possibilities. RESULTS: Mean 58.21 ± 5.93 dB noise was recorded. The morning noise level was higher than at night (60.85 ± 4.90 versus 55.60 ± 5.98, p <0.001), as well as work-days versus weekend (58. 77 ± 6.05 versus 56.83 ± 5.90, p <0.001). The evening staff shift change noise was louder than by daytime change (62.31 ± 4.70 versus 61.35 ± 5.08 dB; p < 0.001). Of the 73 questionnaire respondents, 97.3% believe that the intensive care unit has moderate or intense noise levels; 50.7% consider the noise harmful; and 98.6% believe that noise levels can be reduced. CONCLUSION: The measured noise levels were above the recommended. Preventive and educational programs approaching the importance of noise levels reduction should be encouraged in intensive care units.