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Esta revisão de escopo tem como objetivo descrever as repercussões da posição prona na aeração pulmonar de adultos com COVID-19 ventilados mecanicamente. Duas avaliadoras independentes realizaram a pesquisa nas bases de dados LILACS, PubMED, MEDLINE e SciELO. Incluímos estudos com avaliação das repercussões da posição prona na aeração e oxigenação pulmonar – PaO2/FiO2. Além da identificação das implicações nos dias de ventilação mecânica invasiva e mortalidade. Foram identificados 150 artigos e seis compuseram a amostra. Um total de 70 pacientes foram avaliados por meio de ultrassonografia pulmonar, tomografia de impedância elétrica e tomografia computadorizada de tórax, antes, durante e/ou após o posicionamento prona. Mesmo diante da heterogeneidade da amostra e protocolos utilizados a aeração pulmonar aumentou em algumas regiões pulmonares após a posição prona.

To investigate the repercussions of traumatic brachial plexus injury (TBPI) on diaphragmatic mobility and exercise capacity, compartmental volume changes, as well as volume contribution of each hemithorax and ventilation asymmetry during different respiratory maneuvers, and compare with healthy individuals. The velocity of shortening of the diaphragm, inspiratory, and expiratory muscles were also assessed.The cross-sectional study was conducted with 40 male individuals (20 with TBPI who have not undergone nerve transfer surgery [mean age 30.1 ± 5.3] and 20 healthy paired by age and body mass index). Only patients with C8-T1 root avulsion were studied.Compartmental and hemithoracic volumes, as well as asymmetry between the affected and unaffected sides were assessed using optoelectronic plethysmography. The 6 minute walking test was performed to evaluate exercise capacity, while diaphragm mobility was assessed during quiet breathing (QB) using an ultrasound device.TBPI patients with mean lesion time of 174 ± 45.24 days showed a decreased pulmonary function, respiratory muscle strength, exercise capacity, and diaphragm mobility (all p.001) compared with healthy. The pulmonary ribcage compartment of the affected side was the main contributor to the reduction in volume during inspiratory capacity, vital capacity, and inspiratory load imposition (all p.05). This compartment also exhibited a higher ventilation asymmetry with reduced shortening velocity of the inspiratory ribcage muscles.Compared with healthy, TBPI patients who have not undergone nerve transfer surgery present low exercise capacity and diaphragmatic mobility, as well as reduced volume of the upper ribcage compartment on the affected side that leads to reduced shortening velocity and ventilation asymmetry.

Objetivo: O objetivo deste trabalho foi testar a hipótese que o teste de AVD-Glittre (TGlittre) tem validade concorrente e reprodutibilidade intra-avaliador em indivíduos com apneia obstrutiva do sono (AOS). Métodos: Foram avaliados 22 indivíduos, de ambos os sexos, com diagnóstico AOS. O TGlittre e o teste de esforço cardiopulmonar (TECP) foram realizados em dois dias diferentes, duas vezes cada, e a ordem era determinada por randomização. Resultados: A FC máxima (FCmáx) obtida no TGlittre foi de 130,6 ± 13,3 bpm e o tempo total para a realização do teste foi de 3,4 ± 0,5 min. Sobre as varáveis analisadas no TECP, foram obtidos os seguintes valores: consumo máximo de oxigênio (VO2máx) = 2,4 ± 5,3 ml/kg/min, VO2 no primeiro limiar = 19,4 ± 3,9 ml/kg/min, FCmáx = 161,3 ± 15,2 bpm e o tempo total de realização do teste foi de 8,3 ± 1,6 min. Uma correlação negativa moderada foi verificada entre o tempo de realização do TGlittre e VO2max (r = -0,424; p = 0,049). Na análise da confiabilidade teste-reteste do tempo total de realização do TGlittre, foi observada uma excelente concordância e consistência entre as medidas (coeficiente de correlação intraclasse (CCI) = 0,865; IC95%: 0,379-0,965 (p ≤ 0,0001). Conclusão: O teste de TGlittre é válido e reprodutível na AOS. Além disso, é um teste de intensidade submáxima, fácil aplicação e baixo custo, que pode ser utilizado em larga escala.

BACKGROUND: Oxygen uptake efficiency slope (OUES) is a method for investigating cardiorespiratory fitness and is proposed as an alternative to overcome the limitations of traditional measures such as peak oxygen consumption (VO(2peak)) for patients who do not achieve a maximum response, such as in Parkinson's disease (PD). OBJECTIVE: To assess the performance of individuals with PD during the six-minute walk test (6MWT) using the OUES. METHODS: This is an observational cross-sectional study including 12 individuals with PD and 12 healthy controls. Participants performed the 6MWT along with an analysis of exhaled gas kinetics. The OUES was determined from the last 16 s of the walk test. Multiple linear regression analyses were computed to explore associations between the independent (OUES) and the dependent variables (VO(2peak)) controlled by group. RESULTS: The OUES was associated to VO(2peak) on the 6MWT (β=0.24, p

We investigated respiratory muscle strength, diaphragm mobility, lung function, functional capacity, quality of life, body composition, breathing pattern, and chest wall (A cross-sectional study with data analyzed separately according to age group. A total of 68 individuals (34 MPS and 34 matched-healthy subjects) were included. Six-minute walking test assessed functional capacity and ultrasound assessed diaphragm mobility during quiet spontaneous breathing (QB). Optoelectronic plethysmography assessedBody composition, lung function, respiratory muscle strength, and functional capacity were reduced in MPS (allLung function, respiratory muscle strength, functional capacity, diaphragm mobility, and quality of life are reduced in MPS compared with matched healthy subjects.

BACKGROUND: High-flow nasal cannula (HFNC) oxygen therapy has been broadly used. However, no consensus has been achieved on the practical implementation of HFNC and how to provide aerosol delivery during HFNC therapy in adult patients. METHODS: An online anonymous questionnaire survey endorsed by 4 academic societies from America, Europe, mainland China, and Taiwan was administered from May to December 2019. Clinicians who had worked in adult ICUs for > 1 year and had used HFNC to treat patients within 30 days were included. RESULTS: A total of 2,279 participants clicked on the survey link, 1,358 respondents completed the HFNC section of the questionnaire, whereas 1,014 completed the whole survey. Postextubation hypoxemia and moderate hypoxemia were major indications for HFNC. The initial flow was mainly set at 40–50 L/min. Aerosol delivery via HFNC was used by 24% of the participants (248/1,014), 30% (74/248) of whom reported reducing flow during aerosol delivery. For the patients who required aerosol treatment during HFNC therapy, 40% of the participants (403/1,014) reported placing a nebulizer with a mask or mouthpiece while pursuing HFNC (a method shown to reduce inhaled dose), whereas 33% (331/1,014) discontinued HFNC to use conventional aerosol devices. A vibrating mesh nebulizer was the most commonly used nebulizer (40%) and was mainly placed at the inlet of the humidifier. CONCLUSIONS: The clinical utilization of HFNC was variable, as were indications, flow settings, and criteria for adjustment. Many practices associated with concomitant aerosol therapy were not consistent with available evidence for optimal use. More efforts are warranted to close the knowledge gap.

Background The classification of health problems of persons with Mucopolysaccharidosis (MPS) based on the International Classification of Functioning, Disability and Health (ICF) may contribute to better understanding the disease impacts. The ICF is a useful tool to describe disabilities and functioning, especially in diseases with multisystemic involvement. Aim To identify and classify the health needs of persons with non-neuronopathic MPS according to the ICF. Design A cross-sectional study. Setting Department of Physical Therapy (Federal University, Brazil). Population Persons with non-neuronopathic MPS. Methods Semi-structured interviews covering all components of the ICF were conducted to know the patients' perspectives of their health problems (patient-reported outcomes). The speeches were transcribed verbatim and analyzed by researchers to identifying meaningful concepts. Then, the concept units were linked to ICF components and the magnitude of the problem to ICF qualifiers. Data are shown by descriptive statistics and separated into two groups: children and adolescents, and adults. Results A total of 60 different ICF categories were used to classify participants' functioning. A total of 28 and 51 categories was necessary to classify the health problems of children and adults, respectively. Additionally, 16 categories related to contextual factors were used, of which eight and 12 were identified as facilitators by children, adolescents, and adults, respectively. The main problems were related to supportive functioning of arms or legs (b7603), pain in the body part (b2801), respiratory functions (b440), and voice functions (b310). Limitations in the activity and participation component were related to walking (d450), fine hand use (d440), washing oneself (d510), and dressing (d540). Recreation and leisure (d920) was restricted to approximately half of the studied population. Conclusions People with MPS face impairments of body structures and functions, activity limitations and restrictions to participation. Environmental factors may be act as facilitators of these problems. Clinical rehabilitation impact The ICF is a useful tool to classify the health problems of people with non-neuropathic MPS. The planning of rehabilitation programs needs to covers all components of functioning to provide a biopsychosocial model of care. The ICF categories may direct health professionals to more effective targets.

Objective To outline the epidemiological profile of surgical patients treated at the peripheral-nerve outpatient clinic of a public hospital in the state of Pernambuco, Brazil, from 2008 (the year this service was implemented in the hospital ) to 2016. Material and Methods A cross-sectional study with data collection from the medical records. A descriptive analysis was performed with the qualitative variables presented as relative and absolute frequencies, and the quantitative variables, as means and standard deviations. The studied variables were gender, age, diagnosis, and surgical techniques. Results In total, 506 medical records were analyzed. Of these, 269 were of male patients (53%), and 238 were of female patients (46%). The age of the sample ranged from 5 to 84 years (41 ± 14 years). The most prevalent diagnoses were: carpal tunnel syndrome (38.9%) followed by traumatic brachial plexus injury (33.2%). The first diagnosis was more frequent among women, while the second, among men. This collaborates with the predominant findings of upper-limb lesions (91%), in which men accounted for 52,75% (244) and women, for 47,25% (217). Conclusion The present study provided relevant information regarding the reality of peripheral-nerve surgeries performed at a public hospital in the state of Pernambuco, Brazil. Public health issues increasingly require the continuity of public policies and government incentive.

BACKGROUND: Patients with decreased consciousness are prone to prolonged bed rest and respiratory complications. If effective in reducing atelectasis, lung expansion maneuvers could be used to prevent these complications. In comatose, bedridden subjects, we aimed to assess the acute effect on regional lung aeration of 2 lung expansion techniques: expiratory positive airway pressure and the breath-stacking maneuver. Our secondary aim was to evaluate the influence of these lung expansion techniques on regional ventilation distribution, regional ventilation kinetics, respiratory pattern, and cardiovascular system. METHODS: We enrolled 10 subjects status post neurosurgery, unable to follow commands, and with prolonged bed rest. All subjects were submitted to both expansion techniques in a randomized order. Regional lung aeration, ventilation distribution, and regional ventilation kinetics were measured with electrical impedance tomography. RESULTS: Lung aeration increased significantly during the application of both expiratory positive airway pressure and breath-stacking (P < .001) but returned to baseline values seconds afterwards. The posterior lung regions had the largest volume increase (P < .001 for groups). Both maneuvers induced asynchronous inflation and deflation between anterior and posterior lung regions. There were no significant differences in cardiovascular variables. CONCLUSIONS: In comatose subjects with prolonged bed rest, expiratory positive airway pressure and breath-stacking promoted brief increases in lung aeration. (ClinicalTrials.gov registration NCT02613832.)

Objective The purpose of this pilot study was to evaluate the feasibility of testing an intervention protocol and measuring the immediate effects of a rib mobilization technique (RMT) and a diaphragm release technique (DRT) on the autonomic nervous system of patients with chronic obstructive pulmonary disease (COPD). Methods This was a pilot study of a randomized controlled trial. Fourteen individuals were evaluated. Eligibility criteria were being a sedentary person with a diagnosis of COPD, age between 50 and 72 years, and being clinically stable. Exclusion criteria were heart disease, other respiratory comorbidities, and body mass index above 30kg/m2. Participants first underwent cardiorespiratory evaluation and were then allocated into 2 groups: the RMT + DRT group and the DRT group. Clinical assessments were performed immediately before and after the intervention. Statistical analysis was carried out through a paired-sample Wilcoxon test, and the comparison between groups was performed using the Mann-Whitney test. Results All randomized participants completed the assessment and intervention protocol. Sample size was estimated at 24 individuals per group. The DRT group decreased resting heart rate by 5 bpm (P = .03) and increased variance (P = .04) and mean R-R interval (P = .03). The RMT + DRT group decreased mean R-R interval (P = .02). Conclusion The design for this study appears to be feasible for evaluating manual-therapy intervention in the nonmusculoskeletal function of patients with COPD. It was possible to determine the sample size for future studies. Preliminary data show that the diaphragm release technique may reduce mean resting heart rate and increase heart-rate variability immediately after the intervention.

Endothelial dysfunction is associated with increased cardiovascular risk and death in heart transplant recipients (HTx). Although the measurement of peripheral endothelial function is considered a significant predictor of cardiovascular events in several populations, few studies have investigated this outcome after therapeutic strategies, including different exercise types, duration, and intensity. This systematic review and meta-analysis aimed to investigate the effects of continuous moderate exercise (CON) or high-intensity interval training (HIIT) to improve endothelial function (EF) in HTx. The search was conducted in Cochrane Central Registry of Controlled Trials (CENTRAL), MEDLINE (via PubMed), Web of Science and Scopus/Elsevier, CINAHL/Ebsco, Physiotherapy Evidence Database (PEDro), LILACS/BIREME, and SciELO databases. Quality of the evidence was assessed using the Grading of Recommendations Assessment Development and Evaluation (GRADE). The search strategy retrieved 5192 titles. A total of four articles met the inclusion criteria and were included for the qualitative analysis. Meta-analysis showed that exercises improved EF ([mean difference-MD] 3.48 95% CI - 0.29 to 7.25, p = 0.007) when compared with the control. However, there was a poor quality of evidence to demonstrate that CON or HIIT is better than usual care to improve EF. Exercise training provides benefits to patients, but the poor quality of evidence does not allow us to state that exercise is related to endothelial function improvement in HTx.

OBJECTIVE To determine reference values of sniff nasal inspiratory pressure (SNIP) in healthy children. METHODS This cross-sectional observational study included healthy children aged 6 to 11 years of both sexes. The volunteers underwent a pulmonary function test to rule out respiratory disorders. Respiratory muscle strength was measured using maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP), respectively, with MIP close to functional residual capacity (FRC) and residual volume, while MEP to total lung capacity. SNIP was performed through the nostril contralateral to the occlusion, close to FRC. Two 6-minute walk tests were performed to assess functional exercise capacity. RESULTS The sample comprised 121 healthy children (62 girls); 54% presented body mass index (BMI) percentile less than 85th and 46% more than equal to 85th percentile, higher than expected. SNIP values were similar between sexes (91.1 ± 21.0 cmH2 O in girls and 87.7 ± 19.4 cmH2 O in boys; P = .36) as well as the means of lower limits of normal (56.88 cmH2 O for girls and 56.66 cmH2 O for boys). Girls presented SNIP measurements larger than those of the MIP of FRC (P

Background Beneficial effects from non-invasive ventilation (NIV) in acute COPD are well-established, but the impact of nebulization during NIV has not been well described. Aim To compare pulmonary deposition and distribution across regions of interest with administration of radiolabeled aerosols generated by vibrating mesh nebulizers (VMN) and jet nebulizer (JN) during NIV. Methods A crossover single dose study involving 9 stable subjects with moderate to severe COPD randomly allocated to receive aerosol administration by the VMN Aerogen and the MistyNeb jet nebulizer operating with oxygen at 8 lpm during NIV. Radiolabeled bronchodilators (fill volume of 3 mL: 0.5 mL salbutamol 2.5 mg + 0.125 mL ipratropium 0.25 mg and physiologic saline up to 3 mL) were delivered until sputtering during NIV (pressures of 12 cmH2O and 5 cmH2O - inspiratory and expiratory, respectively) using an oro-nasal facemask. Radioactivity counts were performed using a gamma camera and regions of interest (ROIs) were delimited. Aerosol mass balance based on counts from the lungs, upper airways, stomach, nebulizer, circuit, inspiratory and expiratory filters, and mask were determined and expressed as a percentage of the total. Results Both inhaled and lung doses were greater with VMN (22.78 ± 3.38% and 12.05 ± 2.96%, respectively) than JN (12.51 ± 6.31% and 3.14 ± 1.71%; p = 0.008). Residual drug volume was lower in VMN than in JN (3.08 ± 1.3% versus 46.44 ± 5.83%, p = 0.001). Peripheral deposition of radioaerosol was significantly lower with JN than VMN. Conclusions VMN deposited > 3 fold more radioaerosol into the lungs of moderate to severe COPD patients than JN during NIV.

RESUMO O objetivo deste trabalho foi avaliar o perfil e a prevalência da síndrome de Burnout em fisioterapeutas intensivistas das redes públicas da cidade do Recife, comparando-os entre unidades adultas, pediátricas e neonatais. Realizou-se um estudo descritivo de corte transversal em cinco hospitais públicos portadores de Unidade de Terapia Intensiva, por meio de um questionário sociodemográfico para fatores estressantes e do Maslach Burnout Inventory (MIB) para avaliar a prevalência da síndrome. Os resultados indicaram um percentual de 48,72% de Burnout para profissionais de UTI de cuidado adulto e 47,06% para unidades pediátricas e neonatais, considerando-se nível grave em apenas uma dimensão. Foram encontrados escores elevados nos indicadores de exaustão emocional, com 56,42% em UTI adulto e 64,71% em unidades pediátricas e neonatais. O indicador despersonalização apresentou 12,82% em UTI adulto e 29,41% nas demais. Já realização profissional obteve valores de 17,65% em UTI pediátricas e neonatais e de 33,33% em cuidado adulto. A prevalência da síndrome de Burnout se mostrou elevada entre os fisioterapeutas avaliados. Diante disso, observa-se a necessidade do desenvolvimento de medidas preventivas e modelos de intervenção para que tal efeito seja minimizado. RESUMEN En este trabajo se propone evaluar el perfil y la prevalencia del síndrome de Burnout entre los fisioterapias de cuidados intensivos en las redes públicas en Recife (Brasil), comparándolos entre las unidades pediátricas, neonatales y de adultos. Se trata de un estudio descriptivo de cohorte transversal, del cual participaron cinco hospitales públicos con Unidades de Cuidados Intensivos, por medio de un cuestionario sociodemográfico para factores de estrés y del Maslach Burnout Inventory (MIB) para evaluar la prevalencia del síndrome. Los resultados desvelan un porcentaje del 48,72 % de Burnout a profesionales de UCI de atención a adultos, y un 47,06 % en unidades pediátricas y neonatales, con nivel grave sólo en una dimensión. Se encontraron puntuaciones más altas en los indicadores de agotamiento emocional, con un 56,42 % en UCI de adultos, y un 64,71 % en unidades pediátricas y neonatales. El indicador despersonalización presentó un 12,82 % en UCI de adultos, y un 29,41 % en las demás. Ya la satisfacción profesional obtuvo valor de un 17,65 % en UCI pediátricas y neonatales, y un 33,33 % en la atención a adultos. La prevalencia del síndrome de Burnout fue elevada entre los fisioterapeutas evaluados. Lo que demuestra la necesidad de desarrollar medidas preventivas y modelos de intervención para minimizar este efecto. ABSTRACT The objective of this study was to evaluate the profile and prevalence of Burnout syndrome in physical therapists of public hospitals with intensive care units (ICU) in Recife, comparing them between adult, pediatric and neonatal units. A cross-sectional descriptive study was carried out in five public hospitals with intensive care units in the city of Recife. A sociodemographic questionnaire, a questionnaire for stressors and the Maslach Burnout Inventory (MIB) were used to assess the prevalence of the syndrome. The results indicated a percentage of Burnout of 48.72% for adult ICU professionals and 47.06% for pediatric and neonatal ICUs, considering a serious level in only one dimension. High scores were found in the Emotional Exhaustion indicators, with 56.42% in the adult ICU and 64.71% in the pediatric and neonatal ICUs. For Depersonalization 12.82% in adult ICU and 29.41% in other ICUs. As for Professional Realization, values of 17.65% in pediatric and neonatal ICUs and 33.33% in adults. The prevalence of Burnout syndrome was high among the evaluated physiotherapists. Given this, it is observed the need to develop preventive measures and intervention models, so that this effect is minimized.

Protocol withdrawn as authors were unable to progress the review.

Objective. This study aimed to summarize the accuracy of the different methods for detecting trigger asynchrony at the bedside in mechanically ventilated patients. Method. A systematic review was conducted from 1990 to 2020 in PubMed, Lilacs, Scopus, and ScienceDirect databases. The reference list of the identified studies, reviews, and meta-analyses was also manually searched for relevant studies. The reference standards were esophageal pressure catheter and/or electrical activity of the diaphragm. Studies were assessed following the QUADAS-2 recommendations, while the review was prepared according to the PRISMA criteria. Results. One thousand one hundred and eleven studies were selected, and four were eligible for analysis. Esophageal pressure was the predominant reference standard, while visual inspection and algorithms/software comprised index tests. The trigger asynchrony, ineffective expiratory effort, double triggering, and reverse triggering were analyzed. Sensitivity and specificity ranged from 65.2% to 99% and 80% to 100%, respectively. Positive predictive values reached 80.3 to 100%, while the negative predictive values reached 92 to 100%. Accuracy could not be calculated for most studies. Conclusion. Algorithms/software validated directly or indirectly using reference standards present high sensitivity and specificity, with a diagnostic power similar to visual inspection of experts.

José Carlos Nogueira Nóbrega-Júnior,1 Armèle Dornelas de Andrade,2 Erika Alves Marinho de Andrade,2 Maria do Amparo Andrade,2 Alice Santana Valadares Ribeiro,3 Rodrigo Pinto Pedrosa,4 Ana Paula de Lima Ferreira,2 Anna Myrna Jaguaribe de Lima2,5 1Department of Physical Therapy, Facottur Faculty, Olinda, Pernambuco, Brazil; 2Department of Physical Therapy Federal University of Pernambuco, Recife, Pernambuco, Brazil; 3Department of Rehabilitation, Hospital Otávio de Freitas, Recife, Pernambuco, Brazil; 4Sleep and Heart Laboratory, Pronto Socorro Cardiológico de Pernambuco (PROCAPE)- University of Pernambuco, Recife, Pernambuco, Brazil; 5Department of Morphology and Animal Physiology, Federal Rural University of Pernambuco, Recife, Pernambuco, BrazilCorrespondence: Anna Myrna Jaguaribe de LimaFederal Rural University of Pernambuco, Rua Manoel de Medeiros, s/n - Dois Irmãos, Recife, PE 52171-900, Brazil+55 81 3320-6475Email anna.myrna@ufrpe.brPurpose: Exercise programs have been considered as an adjuvant treatment in obstructive sleep apnea (OSA). However, few studies have focused on the effects of the inspiratory muscle training (IMT) in reducing the severity and the symptoms of OSA.Patients and Methods: A randomized controlled trial was conducted and approved by the local Ethics Committee. All subjects signed the informed consent form and were randomized into 2 groups: a) IMT group (n = 8), 8 weeks of IMT with 75% of maximal inspiratory pressure (MIP) and b) placebo group (n = 8): subjects performed IMT without load.Results: IMT group showed reduction in the apnea–hypopnea index (AHI) (p = 0.01), in the Berlin questionnaire score (p = 0.001) and an increase in inspiratory muscle strength (p = 0.018). IMT group demonstrated a reduction in the AHI (31.7 ± 15.9 events/h vs 29.9 ± 15.8 events/h; p < 0.001), in the Berlin questionnaire scores (2.6 ± 0.5 vs 1.2 ± 0.5; p = 0.016), Pittsburgh Sleep Quality Index (PSQI) score (7.2 ± 3.6 vs 3.7 ± 1.3; p = 0.008), in the Epworth Sleepiness Scale (ESS) (12.5 ± 4.0 vs 7.7 ± 3.0; p = 0.008) and increase in MIP (83.6 ± 26.5 cmH2O and 127.9 ± 32.5 cmH2O; p = 0.010).Conclusion: The IMT promotes discrete changes in the AHI and improves sleep quality and excessive daytime sleepiness in OSA. Moreover, IMT is a cheap, useful and simple home-based training program and can be considered as an adjunct therapy for OSA patients.Keywords: adjuvant therapy, respiratory exercises, obstructive sleep apnea symptoms, exercise training

The purpose of the study is to systematically review about alveolar recruitment maneuvers followed by mechanical ventilation with PEEP guided by electrical impedance tomography (EIT) in laparoscopic bariatric surgery. Metodology: The primary outcomes were: regional pulmonary ventilation (regional impedance variation), end-expiratory lung impedance, and end-expiratory lung volume. Results: The survey identified three eligible studies. The sample consisted of 136 participants of both genders. The alveolar recruitment maneuver (ARM) was performed through the mechanical ventilator and using the EIT in the patient’s chest. The studies showed moderate to high risk of bias, and the quality of the evidence was classified as very low quality due to the methodological limitations found and absence of directionality. Conclusion: ARM with PEEP guided by EIT does not significantly improve the respiratory system mechanics in the intraoperative period in obese patients undergoing laparoscopic bariatric surgery. El objetivo del estudio es revisar sistemáticamente las manos de reclutamiento alveolar seguidas de ventilación mecánica con PEEP guiada por tomografía de impedancia eléctrica (TIE) en cirurgia bariátrica laparoscópica. Metodologia: Os desfechos primários foram: ventilación pulmonar regional (variação regional da impedância), impedância pulmonar expiratória final y volumen pulmonar expiratório final. Resultados: A pesquisa identificou três estudos elegíveis. A mostra foi composta por 136 participantes de ambos sexos. Una manobra de recrutamento alveolar (MRA) para realizar a través de un ventilador mecánico y utilizando-se o TIE no tórax do paciente. Os estudos apresentaram risco de viés de moderado a alto, e a qualidade da evidência foi classificada como qualidade muito baixa devido às limitações metodológicas encontradas e ausência de directionamento adequado. Conclusión: A MRA com PEEP guiada pela TIE não melhora significativamente a mecânica do system respiratório no period intraoperatório em pacientes obesos submetidos à cirurgia bariátrica laparoscopic. O objetivo do estudo é revisar sistematicamente sobre as manobras de recrutamento alveolar seguidas de ventilação mecânica com PEEP guiada por tomografia de impedância elétrica (TIE) em cirurgia bariátrica laparoscópica. Metodologia: Os desfechos primários foram: ventilação pulmonar regional (variação regional da impedância), impedância pulmonar expiratória final e volume pulmonar expiratório final. Resultados: A pesquisa identificou três estudos elegíveis. A amostra foi composta por 136 participantes de ambos os sexos. A manobra de recrutamento alveolar (MRA) foi realizada através do ventilador mecânico e utilizando-se o TIE no tórax do paciente. Os estudos apresentaram risco de viés de moderado a alto, e a qualidade da evidência foi classificada como qualidade muito baixa devido às limitações metodológicas encontradas e ausência de direcionamento adequado. Conclusão: A MRA com PEEP guiada pela TIE não melhora significativamente a mecânica do sistema respiratório no período intraoperatório em pacientes obesos submetidos à cirurgia bariátrica laparoscópica.

Introduction: Cardiac allograft vasculopathy (CAV) is the main cause of chronic graft failure in cardiac transplant patients and plays a significant role in overall morbimortality of the post-transplantation population. In spite of the many available exams currently able to detect CAV subclinical development, they generally display important clinical limitations and lack early diagnosis sensibility. Therefore, the investigation of alternative technologies is essential for the better recognition and prevention of such condition. Methods: Exploratory study on the use of peripheral arterial tonometry as assessment of endothelial health of post-transplant patients. Patients were enrolled from Brazil’s 3rd largest heart transplant center, Instituto de Medicina Integral Professor Fernando Figueira, and subsequently evaluated with EndoPAT2000 between August 2019 and February 2020, when COVID-19 pandemic prematurely concluded the study. Eligible patients had at least 2 years of transplant afterlife and were regularly hospital monitored. The patients’ cardiac catheterism records were collected for more accurate comparison with endothelial results. Medications, preexisting conditions, and transplant information were acquired from medical records. The main outcomes consisted of peripheral arterial tonometry detection capability of endothelial abnormality degree and CAV. Results: Sample size of 22 patients (mean age 50.9, 90.9% men) submitted for EndoPAT2000 exam. Of these, 14 had prior catheterism records (3 had confirmed CAV, 2 coronary fistulas, 9 no abnormalities) and 9 didn′t. When compared with the non catheterism group (2.25 ± 0.41, 0.80 ± 0.19, 8.13 ± 12.21, 16.49 ± 13.87) patients who underwent the procedure (1.89 ± 0.56, 0.60 ± 0.28, 0.72 ± 10.78, 8.54 ± 12.69) had reasonably lower RHI, LnRHI, AI, and AI@75 respectively. CAV confirmed patients (1.99 ± 0.69, 0.65 ± 0.34, -2.07 ± 3.72, 4.40 ± 6.74) had no significant RHI differences, yet displayed slightly lower AI values. Conclusion: The findings of this study suggest there was no significant difference of endothelial health per peripheral arterial tonometry examination between the average catheterism population and CAV patients. Larger studies are needed to confirm such findings.

Imbalance in autonomic modulation can occur after a cardiac event, which can lead to deleterious consequences. Exercise has proven to be a therapy which affects this modulation and can be assessed through heart rate variability (HRV).The objective of this systematic review was to investigate the effects of physical exercise on heart rate variability in individuals with coronary artery disease (CAD). The PubMed, PEDro, Scielo, Lilacs and Cochrane databases were systematically searched, for articles which performed supervised exercises in phase II of cardiac rehabilitation in patients with CAD.Given the differences between studies on interventions and population characteristics, it is difficult to justify similarities or divergences in terms of results. In addition to the variation in sample size, intervention duration, carrying out an additional program at home, and patients with different clinical presentations, it can be inferred that responses to exercise may vary for certain types/clinical profile of individuals with CAD. Thus, it is necessary to carry out more studies with greater methodological rigor, greater standardization of the variables studied and the evaluation forms, in order to increase the veracity of the results and the consequent clinical relevance and therapeutic application.

Background Individuals affected by heart failure (HF) may present fatigue, dyspnea, respiratory muscle weakness, and sympathetic activity hyperstimulation of the myocardium, among other symptoms. Conducting cardiac rehabilitation (CR) programs can be associated with inspiratory muscle training. The aim of this study was to evaluate the efficacy of inspiratory muscular training (IMT) associated with a CR program on modulating myocardial sympathetic activity and maximal functional capacity, submaximal functional capacity, thickness, and mobility of the diaphragm muscle in patients with HF. Methods We will conduct a clinical, controlled, randomized, double-blind trial that will include sedentary men and women who are 21–60 years old and who have diagnosed systolic HF and a left ventricular ejection fraction of less than 45%. Participants will be randomly assigned to one of two groups: experimental and control. The control group will follow the conventional CR protocol, and the experimental group will follow the conventional CR protocol associated with IMT 7 days a week. The two proposed exercise protocols will have a frequency of three times a week for a period of 12 weeks. The sympathetic innervation of the cardiac muscle, the maximum and submaximal functional capacity, diaphragm mobility and thickness, and the quality of life of the participants will be evaluated before and after the intervention protocol. Discussion This clinical trial will be the first study to investigate the additional effects of IMT on CR in sympathetic hyperstimulation in the myocardium. The results of this study will contribute to developing therapeutic strategies collaborating to elucidate whether the association of IMT with CR can induce clinical benefits for patients with HF. Trial registration ClinicalTrials.gov identifier: NCT02600000. Registered November 9, 2015. Retrospectively registered.

Background: The Weber classification based on peak VO2 is a well-established method for categorizing patients with heart failure (HF) regarding severity. However, other submaximal tests such as the...

Made available in DSpace on 2021-06-25T11:13:47Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-01-28 Introduction and aim: Studies regarding asynchrony in patiients in the cardiac postoperative period are still only a few. The main objective of our study was to compare asynchronies incidence and its index (AI) in 3 different modes of ventilation (volume-controlled ventilation [VCV], pressure-controlled ventilation [PCV] and pressure-support ventilation [PSV]) after ICU admission for postoperative care. Methods: A prospective parallel randomised trialin the setting of a non-profitable hospital in Brazil. The participants were patients scheduled for cardiac surgery. Patients were randomly allocated to VCV or PCV modes of ventilation and later both groups were transitioned to PSV mode. Results: All data were recorded for 5 minutes in each of the three different phases: T1) in assisted breath, T2) initial spontaneous breath and T3) final spontaneous breath, a marking point prior to extubation. Asynchronies were detected and counted by visual inspection method by two independent investigators. Reliability, inter-rater agreement of asynchronies, asynchronies incidence, total and specific asynchrony indexes (AIt and AIspecific) and odds of AI ≥10% weighted by total asynchrony were analysed. A total of 17 patients randomly allocated to the VCV (n= 9) or PCV (n=8) group completed the study. High inter-rated agreement for AIt (ICC 0.978; IC95%, 0,963-0.987) and good reliability (r=0.945; p

Objective To evaluate the effect of a 12-week whole-body vibration (WBV) training program on quadriceps muscle strength, quadriceps thickness, the 6-min walk test (6MWT), respiratory muscle strength and quality of life in adults with a kidney transplant. Method Five renal transplant recipients (age: 43-52 years; body mass: 67.1 kg; height: 1.60 m) were examined individually before and after a 12-week WBV program (two weekly sessions, 35 Hz frequency, 2-4 mm amplitude) using quadriceps strength, quadriceps thickness, 6-min walking test, inspiratory muscle strength and quality of life. Results There were no complications during WBV protocol, and the program was considered safe. Two of the participants changed quadriceps muscle strength, and one increased muscle thickness. Inspiratory muscle strength improved in one participant. The distance covered on 6MWT increased for two participants. Most of the subjects (P3, P4 and P5) reported improved quality of life, mainly regarding pain and social aspects. Conclusion The protocol improved the physical function and quality of life in some of the patients. However, WBV training prescription should be adjusted according to individual needs. Thus, studying the use of WBV in this patient group is necessary to understand and apply the benefits for this population.

Background Whole-body vibration (WBV) may be an alternative of physical training for kidney transplant recipients. Objective To evaluate the effect of a training program on quadriceps muscle strength and thickness, distance walked in the 6-min walking test (6MWT), respiratory muscle strength and quality of life in adult kidney transplant recipients. Design Randomized controlled clinical trial. Method Twelve kidney transplant recipients of both genders who underwent WBV training (35 Hz) twice a week for 12 weeks on alternate days (WBVG), and training with a Sham Group (SG) were evaluated before and after intervention. Results No difference was observed in quadriceps muscle strength and thickness between groups, however a large (d = 0.81) and a small (d = 0.44) effect size were observed after the training, respectively. Both groups improved the execution time of Sit-to-Stand Test before and after analysis, but this effect did not show superiority between them, however there was a large effect size provided by training (d = 1.11). No changes were observed between groups in relation to inspiratory muscle strength, but training effects could be observed by the effect size after the study period (d = 0.59). No changes were observed regarding the distance walked in the 6MWT and the effect size was small (d = 0.31). Conclusion WBV program would induce physiological responses that must be taken into consideration in adults’ kidney transplant recipients. Our results show considerable effect sizes were observed for muscle strength and quadriceps thickness, inspiratory muscle strength, and 6MWT walking distance, although no difference was observed between groups at the end of the study.

Background Individuals affected by stroke present with changes in cardiovascular and respiratory functions. Cardiorespiratory training (CRT) is one of the classic intervention guidelines for cardiorespiratory fitness. CRT in association with the proprioceptive neuromuscular facilitation (PNF) technique for respiratory muscles could improve the quality of life, cardiorespiratory function and gait parameters of patients after stroke. Objective To assess the effects of respiratory and trunk patterns of CRT associated with PNF on the quality of life, gait, oxygen consumption, respiratory muscle strength and thoracic volumes. Methods/design A blind, randomized clinical trial with allocation confidentiality will be performed. Forty patients will be randomized into four groups: CRT-lower limb (LL) plus PNF; CRT-LL and respiration; CRT-upper limb (UL) plus PNF; or CRT-UL and respiration. Individuals will be evaluated at three different times (pretreatment, after 20 days of treatment and 1 month after the end of treatment). The treatment protocol consists of respiratory exercises, 30 min of CRT (cycle ergometer) and then repetition of the respiratory exercises, performed three times a week over a period of 20 days. Primary outcome measures are quality of life, gait, balance, peak oxygen uptake and rib cage compartment volumes. As secondary outcomes, respiratory function and maximal inspiratory and expiratory pressures will be measured. Discussion The association of PNF with CRT may be a viable and accessible alternative to increase cardiorespiratory function in patients with stroke. Trial registration ClinicalTrials.gov, NCT03171012. Registered on 6 June 2017.

Purpose The aim of this study was to verify if the association of hypertension and diabetes mellitus could lead to the differences on cardiorespiratory fitness and lipid profile in older adults. Methods 40 older adults were divided into two groups: Hypertensive (HTN) and Hypertensive-diabetic (HTN + T2DM). Maximum exercise test on a treadmill was conducted. Lipid profiles assessment was conducted before and after exercise. The cardiorespiratory fitness (CRF) variables were peak oxygen consumption (VO2peak), time to reach peak oxygen consumption (TVO2peak), carbon dioxide ventilatory equivalent (VE/VCO2) and carbon dioxide production (VCO2). To test intergroup and intragroup analyses independent and paired t-tests were used before and after acute exercise. Multiple linear regression was performed to test the influence of coexistence of HTN and T2DM on CRF. Results CRF measures such as VO2peak (β = -3.90), VCO2 (β = -3.87) and TVO2peak (β= -115.79) were significantly (p-value Conclusion HTN + T2DM older adults had poorer CRF. Acute changes in lipemia were similar in both groups.

Purpose. To assess the potential effectiveness or efficacy of early mobilization on respiratory and peripheral muscle strengths and functionality in nonintubated patients. Methods. For 40 nonintubated patients over 18 years of age with over 24-hour intensive care unit (ICU) stay allocated to a single intervention, an incremental mobilization protocol was initiated. Maximal inspiratory and expiratory pressures (MIP and MEP), peripheral muscle strength (handgrip strength (HGS) and Medical Research Council scale (MRC-s)), and functionality (FIM, ICF-BMS, PFIT-s, and FSS-ICU scales) were evaluated at ICU admission and discharge. Results. All outcomes were significantly improved (pre vs. post values): MIP (43.93 ± 21.95 vs. 54.12 ± 21.68 cmH2O; P<0.001), MEP (50.32 ± 28.65 vs. 60.30 ± 21.23; P=0.002), HGS (25.5 (9.58) vs. 27.5 (9.48); P=0.046), MRC-s (58.52 ± 2.84 vs. 59.47 ± 1.81; P=0.023), FIM (54.4 ± 22.79 vs. 69.48 ± 12.74), ICF-BMS (28.63 ± 16.19 vs. 14.03 ± 11.15), PFIT-s (9.55 ± 2.34 vs. 11.18 ± 1.32) (P<0.001), and FSS-ICU (28.7 ± 9.1 vs. 32.6 ± 5.0; P=0.001). The ceiling effect at admission/discharge was in MRC-s (60/82.5%), FSS-ICU (50/70%), and FIM (35/62.5%). The floor effect occurred at discharge in ICF-BMS (7.5/52.5%). Conclusions. The early mobilization protocol seemed effective at maintaining/increasing the respiratory muscle strength and functionality of nonintubated patients in critical care. Ceiling effect was high for MRC-s, FSS-ICU, and FIM scales.

Introduction: Mobilization is an effective therapy to combat the deleterious effects of immobility, but not all patients are in a condition to be moved; thus, knowledge about contraindication criteria is fundamental. Objective: To evaluate the knowledge of physiotherapists working in adult ICUs on contraindications to the mobilization of critical patients. Method: This was a cross-sectional study in which a survey was applied to physiotherapists working in an adult ICU in the city of Recife. Results: Out of the 36 criteria presented, only five were considered contraindication criteria. Clinical parameters were those that obtained higher frequency for not being considered criteria for contraindication, nor were there observed differences in the relation between the time of working in the ICU. Conclusion: Most physiotherapists did not consider the criteria presented as contraindications to mobilization, so that professional training in mobilization practices and the creation of protocols are necessary. Resumo Introdução: A mobilização é uma terapia eficaz para combater os efeitos deletérios do imobilismo, contudo, é sabido que nem todos os pacientes apresentam condições de saúde para recebê-la, sendo assim, é fundamental o conhecimento sobre os critérios de contraindicação. Objetivo: Avaliar o conhecimento dos fisioterapeutas atuantes em UTI adulto sobre as contraindicações à mobilização de pacientes críticos na cidade do Recife. Método: Este é um estudo transversal, no qual foi aplicado um inquérito aos fisioterapeutas atuantes em UTI adulto na cidade do Recife. Resultados: Dos 36 critérios expostos, apenas cinco foram considerados critérios de contraindicação. Os parâmetros clínicos foram os que obtiveram maior frequência como não sendo considerados critérios de contraindicação, também não foram observadas diferenças na relação entre grau acadêmico e o conhecimento dos critérios, assim como no tempo de atuação em UTI. Conclusão: Uma proporção significativa dos fisioterapeutas atuantes em UTI não considera os critérios expostos como contraindicações à prática da mobilização, sendo assim necessário o aperfeiçoamento profissional sobre as práticas da mobilização e a criação de protocolos.

A doença pulmonar obstrutiva crônica (DPOC) caracteriza-se por limitação crônica do fluxo aéreo, em muitos casos podendo ocorrer também disfunção muscular respiratória associada e déficit na capacidade de gerar força contrátil, resultando em fraqueza dessa musculatura. O objetivo desse estudo foi avaliar a eficácia do Treinamento Muscular Inspiratório (TMI) sobre a deposição de radioaerossol pulmonar em pacientes com DPOC e fraqueza muscular respiratória. Trata-se de um ensaio clínico randomizado e duplo cego que submeterá pacientes com DPOC de diferentes estadiamentos segundo os critérios da Global Initiative for Chronic Obstructive Lung Disease (GOLD) e com fraqueza muscular respiratória (PImax < 60cmH2O) ao TMI (Grupo TMI) e ao treino com carga sub-terapêutica (Grupo Controle). Os pacientes do Grupo TMI iniciarão o treinamento com 60% da PImax e a intensidade do treino será aumentada semanalmente em 50% sob os novos valores de PImax mensurados. O grupo controle realizará o protocolo de com 10% da PImax inicial e esse valor se manterá constante ao longo do treinamento. A deposição pulmonar de radioaerossol será mensurada através da cintilografia pelo índice de deposição pulmonar (IDP), obtido através da razão entre a quantidade de contagens de cada região de interesse (ROI) pela quantidade total de contagens do respectivo pulmão. Há uma escassez na literatura sobre o comportamento da distribuição pulmonar de radioaerossóis nessa população, até o momento, não foram encontrados estudos que estabeleçam relação entre o TMI em pacientes com DPOC e fraqueza muscular respiratória e a melhora da deposição de radioaerossol pulmonar. Tal constatação reafirma a importância do desenvolvimento do presente estudo que poderá contribuir para uma melhor perspectiva dos pacientes com DPOC.

To investigate whether whole body vibration (WBV) training increases the explosive force of the knee extensors in chronic kidney disease (CKD) patients. Fourteen CKD patients undergoing hemodialysis were randomly allocated in WBV training or Sham group. Explosive force parameters (contractile impulse [CImp] and relative rate of force development [RFDr]) obtained in early (30 and 50 msec) and late phases (100 and 200 msec) of the knee extensors force/time curve. CImp and RFDr obtained at the early phase of force/time curve reduced after the intervention period, with a smaller decline for WBV (CImp at 50 msec [~−15% and −51%, P=0.038], RFDr at 30 msec [~−22% and −52%, P=0.044] and RFDr at 50 msec [~−11% and −54%; P=0.008]). In the late phase there was a lower decline for WBV group compared to Sham group, respectively: CImp: 100 msec (~−8% and −55%, P=0.025), 200 msec (~−3% and −46%, P= 0.025); RFDr 100 msec (~0.01% and −56%, P=0.033), 200 msec (~−5% and −36%, P=0.004). Three months of WBV training may attenuate the explosive force reduction in CKD patients.

PURPOSE To evaluate the effects of a long-term pulmonary rehabilitation program (PRP) on functional capacity, maximal inspiratory pressure (MIP), quality of life, and plasma levels of tumor necrosis factor alpha (TNF-α), soluble tumor necrosis factor receptors 1 and 2 (sTNFR1 and sTNFR2, respectively), and cytokine interleukin 1beta (IL-1β) in elderly patients with chronic obstructive pulmonary disease (COPD). METHODS In a quasi-experimental study, PRP effectiveness was investigated in elderly patients with stage I-IV COPD undergoing a 6-mo training program. Participants took part in an 80-min PRP 3 times/wk. Before and after the intervention, the distance walked during a 6-min walk test (6MWD), MIP, St George's Respiratory Questionnaire (SGRQ), and plasma levels of TNF-α, sTNFR1, sTNFR2, and IL-1β were evaluated. RESULTS In 7 patients who completed the PRP and had markers evaluated, we observed improvement in 6MWD (range, 26-331 m) and MIP for most patients. There was an improvement in impact and total domains for all patients and in symptoms and activity for most patients on the SGRQ at the completion of the PRP. TNF-α, sTNFR1, sTNFR2, and IL-1β increased in some patients at the end of the PRP. The 6-mo PRP improved functional capacity, MIP, and quality of life for most patients. CONCLUSIONS Inflammatory markers showed various changes at the end of the study; however, only sTNFR2 levels improved after the PRP.