Search

RESUMO Este estudo teve como objetivo traduzir e adaptar culturalmente o questionário Canadian survey of mobilization of intensive care unit patients para a língua portuguesa falada no Brasil. Este instrumento avalia profissionais de unidade de terapia intensiva (UTI) em relação aos conhecimentos sobre a mobilização precoce (MP) e sua importância, as percepções sobre barreiras e as práticas de reabilitação com o paciente crítico. O protocolo incluiu as etapas: autorização e cessão de direitos de uso; tradução do instrumento para a língua portuguesa; reconciliação; retrotradução para a língua original; revisão e harmonização da retrotradução; aprovação da autora principal do questionário original; revisão da versão em português; desdobramento cognitivo; e reconciliação e elaboração da versão final. Devido a algumas diferenças conceituais e culturais entre os dois países, algumas dúvidas foram discutidas com a autora principal do instrumento, a qual concordou com as alterações sugeridas. No desdobramento cognitivo, os 10 profissionais selecionados testaram a clareza, compreensão e aceitabilidade do questionário, e demonstraram suas dificuldades quanto ao conteúdo deste. Muitos entrevistados evidenciaram que o instrumento desperta reflexões importantes sobre as práticas diárias e os benefícios com a realização da MP. O questionário intitulado Pesquisa de mobilização de pacientes em unidade de terapia intensiva: conhecimento, perspectivas e práticas atuais encontra-se traduzido e adaptado culturalmente para a língua portuguesa falada no Brasil, podendo ser utilizado para avaliar aspectos da MP por profissionais que participam deste processo em UTIs adulto e pediátricas. Estudos futuros utilizando esta versão serão necessários para verificar se o questionário fornece medidas reprodutíveis e válidas. RESUMEN Este estudio tuvo como objetivo traducir y adaptar culturalmente el cuestionario Canadian survey of mobilization of intensive care unit patients al portugués de Brasil. Este instrumento evalúa a los profesionales de la unidad de cuidados intensivos (UCI) en cuanto al conocimiento sobre la movilización temprana (MT) y su importancia, las percepciones sobre las barreras y las prácticas de rehabilitación con pacientes críticos. El protocolo incluyó las siguientes etapas: autorización y cesión de derechos de uso; traducción del instrumento al portugués brasileño; reconciliación; retrotraducción al idioma original; revisión y armonización de la retrotraducción; aprobación de la autora principal al cuestionario original; revisión de la versión al portugués; despliegue cognitivo; y reconciliación y preparación de la versión final. Debido a algunas diferencias conceptuales y culturales entre los dos países, se discutieron algunas dudas con la autora principal del instrumento, quien estuvo de acuerdo con los cambios sugeridos. En el despliegue cognitivo, los 10 profesionales seleccionados probaron la claridad, la comprensión y la aceptabilidad del cuestionario, y demostraron las dificultades de los contenidos. Numerosos entrevistados manifestaron que el instrumento suscita importantes reflexiones sobre las prácticas cotidianas y beneficios de llevar a cabo la MT. El cuestionario titulado Investigación en movilización de pacientes en unidades de cuidados intensivos: conocimientos, perspectivas y prácticas actuales está traducido y adaptado culturalmente al portugués de Brasil, y puede ser utilizado para evaluar aspectos de MT por parte de profesionales que participan en este proceso en UCI de adultos y pediátrica. Se necesitarán estudios futuros que utilicen esta versión para verificar que el cuestionario proporciona la reproducibilidad y la validez de las medidas. ABSTRACT This study aimed to translate and culturally adapt the “Canadian survey of mobilization of intensive care unit patients” questionnaire to Brazilian Portuguese. This instrument evaluates intensive care unit (ICU) professionals’ knowledge about early mobilization and its importance, their perceptions about barriers and rehabilitation practices with critically ill patients. The protocol includes the following steps: authorization and assignment of rights of use; translation of the instrument into Portuguese; reconciliation; back-translation to the original language; revision and harmonization of back-translation; approval from the main author of the original questionnaire; revision of the Portuguese version; cognitive debriefing; reconciliation; and preparation of the final version. Due to some conceptual and cultural differences between the two countries, some questions were discussed with the author of the original instrument, who agreed with the suggested alterations. During cognitive debriefing, the 10 selected professionals tested the questionnaire’s clarity, understanding, and acceptability, indicating any difficulties they had regarding its content. Many interviewees reported that the instrument raises important reflections on daily practices and the benefits of early mobilization. The questionnaire entitled “Pesquisa de mobilização de pacientes em unidade de terapia intensiva: conhecimento, perspectivas e práticas atuais” was translated and culturally adapted to Brazilian Portuguese and can be used to evaluate aspects of early mobilization by professionals who participate in this process in adult and pediatric ICUs. Future studies using this version will be necessary to verify that the questionnaire provides reproducible and valid measurements.

RESUMO O objetivo deste estudo foi descrever características de sucesso e insucesso do uso da ventilação não invasiva (VNI) na unidade de terapia intensiva (UTI) de um hospital universitário. Trata-se de um estudo observacional prospectivo no qual foram incluídos 75 pacientes, com idade média de 58,3±18,8 anos. Desses, doze necessitaram do uso da VNI por mais de uma vez, totalizando 92 utilizações. Evidenciou-se que, delas, a taxa de sucesso foi de 60,9% (56). O grupo insucesso apresentou mais indivíduos do sexo masculino (p=0,006) e número maior de pacientes com diagnóstico de infecção extrapulmonar (p=0,012). Não foram encontradas diferenças entre os grupos de sucesso e insucesso nos quesitos de modo, modelo, máscara, tempo total de permanência e razões para a instalação da VNI. No grupo insucesso, a pressão positiva inspiratória nas vias aéreas (Ipap) e o volume corrente (VC) foram superiores (p=0,029 e p=0,011, respectivamente). A saturação periférica de oxigênio (p=0,047), o pH (p=0,004), base excess (p=0,006) e o bicarbonato (p=0,013) apresentaram valores inferiores. Concluiu-se que os indivíduos do sexo masculino com diagnóstico de infecção extrapulmonar e que evoluíram com acidose metabólica evoluíram com mais insucesso na utilização da VNI. Esses, necessitaram de parâmetros elevados de Ipap e VC. RESUMEN El objetivo de este estudio fue desarrollar las características del éxito y del fracaso con el uso de la ventilación no invasiva (VNI) en la unidad de terapia intensiva (UTI) de un hospital universitario. Se trata de un estudio observacional prospectivo en el cual fueron incluidos 75 pacientes, con edad media de 58,3±18,8 años. De estos, 12 necesitaron utilizar la VNI por más de una vez, que totalizó 92 utilizaciones. Se evidenció que, de estas, el índice de éxito fue del 60,9% (56). El grupo que no obtuvo el éxito esperado presentó más individuos del sexo masculino (p=0,006) y número mayor de pacientes con diagnóstico de infecciones extrapulmonares (p=0,012). No fueron encontradas diferencias entre los grupos con éxito y sin éxito en las cuestiones de modo, modelo, máscara, tiempo total de permanencia y razones para la instalación de la VNI. En el grupo sin éxito, la presión positiva inspiratoria en las vías aéreas (Ipap) y el volumen corriente (VC) fueron superiores (p=0,029 y p=0,011, respectivamente). La saturación periférica de oxígeno (p=0,047), el pH(p=0,004), base excess (p=0,0006) y el bicarbonato (p=0,013) presentaron valores inferiores. De este modo, se concluye que los individuos del sexo masculino con diagnóstico de infecciones extrapulmonares y que progresaron con acidose metabólica avanzaron más sin tener éxito en la utilización de la VNI. Además, necesitaron de parámetros elevados de Ipap y VC. ABSTRACT The objective of this study was to describe the aspects of success and failure of the use of non-invasive ventilation (NIV) in the intensive care unit (ICU) of a university hospital. This is a prospective observational study that included 75 patients, with 58.3±18.8 years as the mean age. Of these, 12 required the use of NIV more than once, for 92 uses in total. Among these, the success rate was 60.9% (56). The failure group had more males (p=0.006) and a higher number of patients diagnosed with extrapulmonary infection (p=0.012). No differences were found between success and failure groups for the variables mode, model, mask, total length of stay and reasons for NIV installation. In the failure group, inspiratory positive airways pressure (Ipap) and flow volume (FV) were higher (p=0.029 and p=0.011, respectively). Peripheral oxygen saturation (p=0.047), pH (p=0.004), base excess (p=0.006) and bicarbonate (p=0.013) presented lower values. This study concluded that male individuals diagnosed with extrapulmonary infection and whose picture evolved with metabolic acidosis evolved with more failure in NIV use. These patients required higher Ipap and FV parameters.

The association between chronic kidney disease (CKD) and pulmonary pathophysiological changes is well stablished. Nevertheless, the effects of aerobic exercise (AE) on lungs of CKD need further clarification. Thus, Swiss mice were divided in control, AE, CKD, and CKD + AE groups. CKD was induced by 0.2% adenine intake during 8 weeks (4 weeks of CKD induction and 4 weeks of AE). AE consisted in running on treadmill, at moderate intensity, 30 min/day, 5 days/week, during 4 weeks. Twenty-four hours after the last training day, functional capacity test was performed, and 48 h after the test, mice were euthanized. CKD mice showed a significant increase in urine output, serum urea, and creatinine concentrations, and decreased body weight and urine density, besides oxidative damage (p = 0.044), edema area (p 0.001), leukocyte infiltration (p = 0.040), and collagen area in lung tissue (p = 0.004). AE resulted in an increase of distance traveled (p = 0.049) and maximum speed (p = 0.046), increased activity of catalase (p = 0.031) and glutathione peroxidase (p = 0.048) in lungs, increased levels of nitric oxide (NOx) in serum (p = 0.001) and bronchoalveolar lavage fluid (p = 0.047), and decreased kidney histological injury (p = 0.018) of CKD mice. However, AE also increased oxidative damage (p = 0.003) and did not change collagen content or perivascular edema in lungs (p 0.05) of CKD mice. Therefore, AE attenuated kidney injury and improved antioxidants defenses in lungs. Despite no significant changes in pulmonary damage, AE significantly improved physical performance in CKD mice.

To the Editor: We read and appreciate the interesting article entitled “Impact of Early Passive Exercise With Cycle Ergometer on Ventilator Interaction” by Silva et al.[1][1] The study aimed to assess the patient-ventilator interaction during passive mobilization performed with a cycle

Background and objective Sepsis is a potentially deadly organic dysfunction, and one of the main causes of mortality in intensive care units (ICU). Aerobic exercise (AE) is a preventive intervention in the establishment of inflammatory conditions, such as chronic lung diseases, but its effects on sepsis remain unclear. Therefore, this study aimed to evaluate the effects of AE on health condition, mortality, inflammation, and oxidative damage in an experimental model of pneumosepsis induced by Klebsiella pneumoniae (K.p). Methods Animals were randomly allocated to Control; Exercise (EXE); Pneumosepsis (PS) or Exercise + Pneumosepsis (EPS) groups. Exercised animals were submitted to treadmill exercise for 2 weeks, 30 min/day, prior to pneumosepsis induced by K.p tracheal instillation. Results PS produced a striking decrease in the health condition leading to massive death (85%). AE protected mice, as evidenced by better clinical scores and increased survival (70%). AE alleviated sickness behavior in EPS mice as evaluated in the open field test, and inflammation (nitrite + nitrate, TNF-α and IL-1β levels) in broncoalveolar fluid. Catalase activity, oxidative damage to proteins and DNA was increased by sepsis and prevented by exercise. Conclusion Overall, the beneficial effects of exercise in septic animals encompassed a markedly improved clinical score and decreased mortality, along with lower inflammation markers, less DNA and protein damage, as well as preserved antioxidant enzyme activity. Neural network risk analysis revealed exercise had a considerable effect on the overall health condition of septic mice.

We performed a systematic review to identify and summarize the effects of distinctive aerobic exercise (AE) protocols on chronic allergic lung inflammation reported in asthma animal models. We identified 255 preclinical studies of asthma and AE protocols by comprehensive searches in PubMed, ScienceDirect and LILACS for peer-reviewed journals, using the search components "exercise," "lung inflammation," and "asthma," without restrictions on publication date. Twenty-two studies were selected that met all eligibility criteria. Most studies used an ovalbumin experimental model and performed experiments with BALB/c mice. Most studies performed treadmill AE, using protocols of 30 to 60 minutes, 3 to 5 times/week, for 4 to 8 weeks. The results showed that the effects of AE on lungs were protocol dependent, but generaly, there was a decrease in inflammatory cell influx and Th2 cytokines, as well as an increase in anti-inflammatory defenses. However, the immunoregulation of globulins and nitric oxide levels in asthma seemed to be associated with the onset of AE. The results suggest that AE plays an important immunoregulatory role in animal models of asthma, with effects mainly mediated by increased anti-inflammatory defenses and reduced Th2 response. In parallel, prophylactic and therapeutic AE also played important roles in decreasing bronchial responsiveness and attenuating lung remodeling in animal models of asthma, secondary outcomes in this systematic review. The review protocol was published for free access in October 2017 on the Systematic Review Facility (SyRF) platform (http://syrf.org.uk/protocols/).

Aerobic exercise (AE) reduces lung function decline and risk of exacerbations in asthmatic patients. However, the inflammatory lung response involved in exercise during the sensitization remains unclear. Therefore, we evaluated the effects of exercise for 2 weeks in an experimental model of sensitization and single ovalbumin-challenge. Mice were divided into 4 groups: mice non-sensitized and not submitted to exercise (Sedentary, n=10); mice non-sensitized and submitted to exercise (Exercise, n=10); mice sensitized and exposed to ovalbumin (OVA, n=10); and mice sensitized, submitted to exercise and exposed to OVA (OVA+Exercise, n=10). 24 h after the OVA/saline exposure, we counted inflammatory cells from bronchoalveolar fluid (BALF), lung levels of total IgE, IL-4, IL-5, IL-10 and IL-1ra, measurements of OVA-specific IgG1 and IgE, and VEGF and NOS-2 expression via western blotting. AE reduced cell counts from BALF in the OVA group (p

In this study, we evaluated the effects of high-intensity swimming in an experimental model of acute lung injury (ALI) induced by lipopolysaccharide (LPS) on lung inflammation and antioxidant defenses. Balb/C male mice were submitted to exercise (30 min/day, 5 days/week, for a period of 3 weeks) prior to LPS instillation in the lung. Twenty-four hours after delivery of LPS (10 μg/animal), mice were euthanized and bronchoalveolar fluid (BALF) was obtained for cell counting and analysis of cytokines by ELISA. Lung tissue was used to evaluate antioxidant defenses. LPS instillation resulted in an increase in total and mononuclear cells, IL-1β, TNF-α, and IL-6 in BALF. LPS instillation also altered IL-10 and IL-ra levels in BALF and induced antioxidant defenses (glutathione, superoxide dismutase, catalase, and glutathione peroxidase) in the lung. Protein carbonyl increased in the LPS-treated animals. High-intensity swimming prevented all these changes induced by LPS. Significance: Therefore, this experimental protocol of high-intensity swimming showed a protective effect on ALI, decreasing inflammatory processes and preventing disturbances in antioxidant defenses into the lungs.

Introduction: The purpose of this study was to verify the differences between fl exibility and body mass index (BMI) in contemporary dance and classical ballet ballerinas. Materials and Methods: The sample was of 22 ballet danc- ers of Thais Muller Studio Dance at Santa Maria city / RS, in the age bracket of 13 to 16 years, divided into 2 groups of 11 dancers, paired by age: contemporary dance practitioners and classical ballet practitioners. In the evaluation were the anthropometric data (stature, weight, lower limbs length measures) and the fl exibility indexes. The angular fl exibility was mea- sured through goniometric (fl exion, abduction and hip external rotation), and the linear, Sitting Reaching Box Weels, which evaluates the posterior muscle chain fl exibility. The BMI has been obtained by weight.stature -2 . Descriptive statistics (mean, standard deviation), test of normality of the data and t test for independent samples were used for the data analysis. 5% of Signifi cance was used. Results: Despite all the ranges of motion were higher in the classical ballet practitioners group, only the abduction movement had statistically signifi cant differences between the two groups. There were no differences in the BMI. Discussion: The groups were similar concerning BMI, and classical ballet practitioners are more fl exible.

Introduccion: El objetivo de ese estudio fue a verificar las diferencias entre la flexibilidad y el indice de masa corporal (IMC) en bailarines de danza contemporanea y ballet clasico. Materiales y Metodos: La muestra fue compuesta por 22 bailarines del Studio de Danca Thais Muller, de la ciudad de Santa Maria - RS, en la franja etaria de 13 a 16 anos, dividida en 2 grupos de 11 bailarinas, pareadas por edad: practicantes de danza contemporanea y practicantes de ballet clasico. La evaluacion constaban los datos antropometricos (estatura, peso, medidas de largo de los miembros inferiores) y los indices de flexibilidad. La flexibilidad angular fue mensurada a traves de la goniometria (flexion, abduccion y rotacion externa del cadera), y la lineal, por la Caja de Sentar y Alcanzar de Weels, que evalua la flexibilidad de la carcel muscular posterior. El IMC fue obtenido a traves de la formula masa.estatura-2. Para el analisis de los datos, se utilizo la estadistica descriptiva (media, desvio patron), test de normalidad de los datos y test t para muestras independientes. Se adopto acepcion de 5%. Resultados: A pesar de todas las amplitudes de movimiento evaluadas sean superiores en el grupo practicante de ballet clasico, solo el movimiento de abduccion presento diferencia estadisticamente significativa entre los 2 grupos. Tampoco hubo diferencia en el IMC. Discusion: Los grupos son semejantes cuanto al IMC y, las practicantes de ballet clasico son mas flexibles

A escoliose envolve uma modificação das vértebras e costelas com rotação vertebral, desvio lateral e lordose, o que gera transtornos, principalmente em crianças e adolescentes por seu caráter evolutivo. Muitos métodos têm sido propostos para o tratamento desse tipo de deformidade postural, com objetivo de controlar a evolução e prevenir complicações. Nesse trabalho aplicou-se a técnica de Iso-Streching e o uso de Bola Suíça para tratamento de um paciente portador de escoliose idiopática. As principais metas foram proporcionar o alongamento das cadeias musculares, aumentar a flexibilidade e melhorar o padrão postural. O paciente foi submetido a avaliação das cadeias musculares, avaliação postural, teste de Adams, mensuração da flexibilidade e do ângulo de Cobb. Após o tratamento, verificou-se melhora do padrão postural, diminuição da dor e diminuição das retrações musculares.