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1.
Crit Care Res Pract ; 2018: 4298583, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30123586

RESUMO

Background: Deep and respiratory muscle disorders are commonly observed in critically ill patients. Neuromuscular electrical stimulation (NMES) is an alternative to mobilize and to exercise that does not require active patient participation and can be used on bedridden patients. Objective: Evaluate the effectiveness of the NMES therapy in quadriceps versus diaphragm subjects in mechanical ventilation (MV). Methods: Sixty-seven subjects in MV were included, divided into 3 groups: (a) control group (CG, n=26), (b) stimulation of quadriceps (quadriceps group-QG, n=24), and (c) stimulation of diaphragm (diaphragm group-DG, n=17). The QG and DG patients received consecutive daily electrical stimulation sessions at specific points from the first day of randomization until ICU discharge. Respiratory and peripheral muscle strength, MV time, length of hospitalization, and functional independence score (the Functional Status Score-ICU) were recorded. Results: There were studied n=24 (QG), n=17 (DG), and n=26 (CG) patients. Peripheral muscle strength improved significantly in the QG (p=0.030). Functional independence at ICU discharge was significantly better in QG (p=0.013), and the QG presented a better Barthel Index compared to DG and CG (p=0.0049) and also presented better FSS compared to CG (p=0.001). Conclusions: Electrical stimulation of quadriceps had best outcomes for peripheral muscle strength compared with controls or electrical stimulation of diaphragm among mechanically ventilated critically ill subjects and promoted functional independence and decreased length of hospitalization.

2.
Arch. med. deporte ; 34(181): 267-273, sept.-oct. 2017. graf, tab, illus
Artigo em Inglês | IBECS | ID: ibc-170316

RESUMO

Until the moment, no study explored conjunctively the physical activity relation, using the inflammatory biomarkers, with the periodontitis. This way, the objective of this experiment was to evaluate the muscular tissue behavior of rats submitted to physical exercise in aquatic environment with experimental disease. Twenty-four male Wistar rats were divided in 4 groups: 1) control and sedentary (CS); 2) control and active (CA); 3) with the periodontal disease and sedentary (PDS); with the periodontal disease and active (PDA). On the group that the periodontitis was induced, it was for ligature and the groups with active swimming activity have practiced it for 4 weeks. At the end of 30 days the animals were euthanized and a portion of the gingival tissue and the soleus muscle were removed and underwent analysis by ELISA and morphological and morphometrical analysis of the muscle. Data drawn from the analysis was analyzed through ANOVA and Tukey. Results have shown that there is a higher expression of TNF-α in the gingival tissue and on the muscular tissue of the rats that underwent the induced periodontitis independently of the physical activity (PDS and PDA), as a meaningful decrease on the conjunctive tissue on the groups with induced periodontitis, that have or have not undergone active swimming activity which could suggest a predisposition to muscular injury or difficulty of muscular recovering on these groups. Therefore, it was possible to highlight a correlation between the periodontal disease and the muscle morphological changes, and, moreover, the physical swimming activity promoting an acceleration of the regeneration of the muscle tissue


Hasta este momento, ningún estudio ha explorado conjuntamente la relación de la actividad física con la periodontitis utilizando biomarcadores de inflamación. Siendo así, el objetivo de este estudio fue evaluar el comportamiento del tejido muscular de ratas con periodontitis experimental al realizar ejercicio físico en medio acuático. Veinticuatro ratas Wistar machos fueron divididas en cuatro grupos: 1) control y sedentario (CS); 2) control y ejercicio (CA); 3) con enfermedad periodontal y sedentario (PDS); 4) con enfermedad periodontal y ejercicio (PDA). En los grupos con periodontitis, la enfermedad periodontal fue inducida por ligadura y los grupos con ejercicio realizaron natación durante cuatro semanas. A los treinta días, los animales fueron sacrificados y una parte del tejido de las encías y del músculo soleo se resecaron y utilizaron para análisis con ELISA y para análisis morfológicos y morfométricos. Los datos obtenidos fueron analizados y evaluados a través de los tests ANOVA y TUKEY. Los datos mostraron una mayor expresión de TNF-α tanto en el tejido de las encías como en el tejido muscular de los ratones sometidos a periodontitis inducida independiente del ejercicio físico (PDS y PDA). Se percibió también una disminución significativa en el tejido conjuntivo en los grupos con periodontitis inducida sometidos o no al ejercicio de natación, lo que podría sugerir una predisposición a lesión muscular o una dificultad en la reparación de las lesiones musculares de esos grupos. Por lo tanto, fue posible destacar una correlación entre la enfermedad periodontal y los cambios morfológicos musculares y, además, que la actividad física de natación favoreció una aceleración de la regeneración del tejido muscular


Assuntos
Ratos , Periodontite/fisiopatologia , Músculo Esquelético/fisiologia , Exercício/fisiologia , Modelos Animais de Doenças , Natação/fisiologia , Fator de Necrose Tumoral alfa/análise , Regeneração/fisiologia
3.
Inflammation ; 40(6): 2000-2011, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28822015

RESUMO

This study aims to evaluate if ligature-induced periodontitis can potentiates the deleterious effects of immobilization in the skeletal striated muscle, contributing to the development of muscle atrophy due to disuse. Forty Wistar rats were divided into four groups: (1) Control Group (CG), (2) Periodontal Disease (PDG), (3) Immobilized (IG), and (4) Immobilized with Periodontal Disease (IPDG). Periodontal disease was induced for 30 days, with ligature method, and the immobilization was performed with cast bandage for 15 days. Prior to euthanasia, nociceptive threshold and muscular grasping force were evaluated. Afterwards, the soleus muscle was dissected and processed for sarcomere counting and morphological/morphometric analysis. For data analysis, was used the one-way ANOVA and post-test Tukey (p < 0.05). The IG and IPDG presented lower muscle weight, lower muscular grip strength, and less number of sarcomeres compared to CG. The PDG showed reduction of muscle strength and nociceptive threshold after 15 days of periodontal disease and increased connective tissue compared to CG. The IPDG presented lower muscle length and nociceptive threshold. The IG presented reduction in cross-sectional area and smaller diameter, increase in the number of nuclei and a nucleus/fiber ratio, decrease in the number of capillaries and capillary/fiber ratio, with increase in connective tissue. The IPDG had increased nucleus/fiber ratio, decreased capillaries, and increased connective tissue when compared to the IG. The IPDG presented greater muscle tissue degeneration and increased inflammatory cells compared to the other groups. Ligature-induced periodontitis potentiated the deleterious effects of immobilization of the skeletal striated muscle.


Assuntos
Imobilização/efeitos adversos , Músculo Esquelético/patologia , Periodontite/patologia , Animais , Força Muscular , Músculo Esquelético/irrigação sanguínea , Atrofia Muscular/patologia , Dor Nociceptiva , Ratos Wistar
4.
Respir Care ; 60(11): 1527-35, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26152472

RESUMO

BACKGROUND: Failure to wean can prolong ICU stay, increase complications associated with mechanical ventilation, and increase morbidity and mortality. The spontaneous breathing trial (SBT) is one method used to assess weaning. The aim of this study was to assess proportional assist ventilation plus (PAV+) as an SBT by comparing its applicability, safety, and efficacy with T-tube and pressure support ventilation (PSV). METHODS: A randomized study was performed involving 160 adult subjects who remained on mechanical ventilation for > 24 h. Subjects were randomly assigned to the PAV+, PSV, or T-tube group. When subjects were ready to perform the SBT, subjects in the PAV+ group were ventilated in PAV+ mode (receiving support of up to 40%), the pressure support was reduced to 7 cm H2O in the PSV group, and subjects in the T-tube group were connected to one T-piece with supplemental oxygen. Subjects were observed for signs of intolerance, whereupon the trial was interrupted. When the trial succeeded, the subjects were extubated and assessed until discharge. RESULTS: The subjects were predominantly male (66.5%), and the leading cause of admission was traumatic brain injury. The groups were similar with respect to baseline characteristics, and no significant difference was observed among the groups regarding extubation success or failure. Analysis of the specificity and sensitivity revealed good sensitivity for all groups; however, the PAV+ group had higher specificity (66.6%) and higher sensitivity (97.6%), with prediction of ∼ 92.1% of the success and failure events. CONCLUSIONS: No significant differences in the groups was observed regarding the rate of extubation failure, duration of mechanical ventilation, and ICU and hospital stay, indicating that PAV+ is an alternative for use as an SBT.


Assuntos
Extubação , Suporte Ventilatório Interativo , Respiração , Desmame do Respirador/métodos , Adulto , Feminino , Humanos , Unidades de Terapia Intensiva , Intubação Intratraqueal , Masculino , Estudos Prospectivos , Testes de Função Respiratória , Sensibilidade e Especificidade
5.
J Crit Care ; 30(3): 655.e1-6, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25622762

RESUMO

PURPOSE: To assess the effects of passive orthostatism on various clinicophysiologic parameters of adult intensive care unit (ICU) patients, by daily placement on a tilt table. MATERIALS AND METHODS: This prospective cohort study was performed in a general ICU. Twenty-three patients 18 years or older, intubated or tracheostomized, without sedation and under weaning from mechanical ventilation, were analyzed. All variables were evaluated at tilting of 30°, 45°, 60°, 75°, and 90°. RESULTS: Glasgow Coma Scale increased during tilt in the first and second day, as well as Richmond Agitation-Sedation Scale. No significant differences were detected in the physiological parameters; however, there was a nonsignificant decrease on the mean arterial pressure at angles of 75° and 90°. The maximum inspiratory pressure significantly increased at 60° compared with 30° on day 1 of the intervention. No significant differences were observed for maximum expiratory pressure, rapid shallow breathing index, and the tidal volume. CONCLUSION: A protocol with daily use of a tilt table for ICU patients is safe and improves the level of consciousness and inspiratory maximum pressure, without causing deleterious acute physiological effects.


Assuntos
Estado de Consciência , Cuidados Críticos , Deambulação Precoce , Posicionamento do Paciente/métodos , Adulto , Idoso , Estudos de Coortes , Feminino , Escala de Coma de Glasgow , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Respiração Artificial , Volume de Ventilação Pulmonar
6.
Crit Care Res Pract ; 2014: 546349, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24982804

RESUMO

Background. We compare the incidence of delirium before and after extubation and identify the risk factors and possible predictors for the occurrence of delirium in this group of patients. Methods. Patients weaned from mechanical ventilation (MV) and extubated were included. The assessment of delirium was conducted using the confusion assessment method for the ICU and completed twice per day until discharge from the intensive care unit. Results. Sixty-four patients were included in the study, 53.1% of whom presented with delirium. The risk factors of delirium were age (P = 0.01), SOFA score (P = 0.03), APACHE score (P = 0.01), and a neurological cause of admission (P = 0.01). The majority of the patients began with delirium before or on the day of extubation. Hypoactive delirium was the most common form. Conclusion. Acute (traumatic or medical) neurological injuries were important risk factors in the development of delirium. During the weaning process, delirium developed predominantly before or on the same day of extubation and was generally hypoactive (more difficult to detect). Therefore, while planning early prevention strategies, attention must be focused on neurological patients who are receiving MV and possibly even on patients who are still under sedation.

7.
Rev Bras Ter Intensiva ; 26(2): 169-75, 2014.
Artigo em Inglês, Português | MEDLINE | ID: mdl-25028952

RESUMO

OBJECTIVE: This study sought to assess the influence of prone positioning on the stress of newborn premature infants through the measurement of the salivary cortisol concentration and the evaluation of physiological and behavioral responses before and after changes in body positioning. METHODS: Saliva samples were collected from newborn infants at two different times: the first (corresponding to the baseline) after a period of 40 minutes during which the infants were not subjected to any manipulation and were placed in the lateral or supine position, and the second 30 minutes after placement in the prone position. Variables including heart rate, respiratory rate, peripheral oxygen saturation, and the Brazelton sleep score were recorded before, during, and at the end of the period in the prone position. RESULTS: The sample comprised 16 newborn premature infants (56.3% male) with a gestational age between 26 and 36 weeks, postnatal age between 1 and 33 days, birth weight of 935 to 3,050g, and weight at the time of intervention of 870 to 2,890g. During the intervention, six participants breathed room air, while the remainder received oxygen therapy. The median salivary cortisol concentration was lower in the prone position compared to baseline (0.13 versus 0.20; p=0.003), as was the median Brazelton sleep score (p=0.02). The average respiratory rate was lower after the intervention (54.88±7.15 versus 60±7.59; p=0.0004). The remainder of the investigated variables did not exhibit significant variation. CONCLUSION: Prone positioning significantly reduced the salivary cortisol level, respiratory rate, and Brazelton sleep score, suggesting a correlation between prone positioning and reduction of stress in preterm infants.


Assuntos
Hidrocortisona/metabolismo , Taxa Respiratória/fisiologia , Saliva/metabolismo , Estresse Fisiológico/fisiologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Oxigênio/metabolismo , Posicionamento do Paciente , Projetos Piloto , Decúbito Ventral/fisiologia , Sono/fisiologia
8.
Rev. bras. ter. intensiva ; 26(2): 169-175, Apr-Jun/2014. tab, graf
Artigo em Português | LILACS | ID: lil-714833

RESUMO

Objetivo: Avaliar a influência da postura em prona sobre o estresse no recém-nascido prematuro por meio da dosagem do cortisol salivar e da avaliação das respostas fisiológicas e comportamentais, antes e após o posicionamento. Métodos: Foi realizada a coleta de saliva em cada recém-nascido em dois momentos: o primeiro (correspondente ao basal), sem manipulação prévia por 40 minutos, em decúbito lateral ou supino; e o segundo, 30 minutos após o posicionamento em prona. A frequência cardíaca e respiratória, saturação periférica de oxigênio e escala de sono de Brazelton foram registradas antes, durante e ao final do posicionamento em prona. Resultados: Participaram do estudo 16 recém-nascidos prematuros (56,3% masculino) com idade gestacional de 26 a 36 semanas, com 1 a 33 dias de vida, e peso variando de 935 a 3.050g ao nascimento e de 870 a 2.890g no dia da intervenção. Durante o posicionamento, seis recém-nascidos estavam em ar ambiente e os demais recebiam oxigênio suplementar. A mediana dos níveis de cortisol salivar foi menor durante o posicionamento em prona comparativamente ao basal (0,13 e 0,20; p=0,003), assim como a do escore de sono de Brazelton (p=0,02). A média da frequência respiratória foi menor após a intervenção (54,88±7,15 e 60±7,59; p=0,0004). As demais variáveis analisadas não apresentaram variação significativa. Conclusão: O posicionamento em prona diminuiu significativamente os níveis de cortisol salivar, da frequência respiratória e do escore de sono de Brazelton, sugerindo a correlação entre essa postura e a diminuição do estresse nesses recém-nascidos. .


Objective: This study sought to assess the influence of prone positioning on the stress of newborn premature infants through the measurement of the salivary cortisol concentration and the evaluation of physiological and behavioral responses before and after changes in body positioning. Methods: Saliva samples were collected from newborn infants at two different times: the first (corresponding to the baseline) after a period of 40 minutes during which the infants were not subjected to any manipulation and were placed in the lateral or supine position, and the second 30 minutes after placement in the prone position. Variables including heart rate, respiratory rate, peripheral oxygen saturation, and the Brazelton sleep score were recorded before, during, and at the end of the period in the prone position. Results: The sample comprised 16 newborn premature infants (56.3% male) with a gestational age between 26 and 36 weeks, postnatal age between 1 and 33 days, birth weight of 935 to 3,050g, and weight at the time of intervention of 870 to 2,890g. During the intervention, six participants breathed room air, while the remainder received oxygen therapy. The median salivary cortisol concentration was lower in the prone position compared to baseline (0.13 versus 0.20; p=0.003), as was the median Brazelton sleep score (p=0.02). The average respiratory rate was lower after the intervention (54.88±7.15 versus 60±7.59; p=0.0004). The remainder of the investigated variables did not exhibit significant variation. Conclusion: Prone positioning significantly reduced the salivary cortisol level, respiratory rate, and Brazelton sleep score, suggesting a correlation between prone positioning and reduction of stress in preterm infants. .


Assuntos
Feminino , Humanos , Recém-Nascido , Masculino , Hidrocortisona/metabolismo , Taxa Respiratória/fisiologia , Saliva/metabolismo , Estresse Fisiológico/fisiologia , Idade Gestacional , Recém-Nascido Prematuro , Oxigênio/metabolismo , Posicionamento do Paciente , Projetos Piloto , Decúbito Ventral/fisiologia , Sono/fisiologia
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