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JUSTIFICATIVA E OBJETIVOS: Em 2000, foi publicado o II Consenso Brasileiro de Ventilação Mecânica. Desde então, o conhecimento na área da ventilação mecânica avançou rapidamente, com a publicação de inúmeros estudos clínicos que acrescentaram importantes informações para o manuseio de pacientes críticos em ventilação artificial. Além disso, a expansão do conceito de Medicina Baseada em Evidências determinou a hierarquização das recomendações clínicas, segundo o rigor metodológico dos estudos que as embasaram. Essa abordagem explícita vem ampliando a compreensão e a aplicação das recomendações clínicas. Por esses motivos, a AMIB - Associação de Medicina Intensiva Brasileira - e a SBPT - Sociedade Brasileira de Pneumologia e Tisiologia - julgaram conveniente a atualização das recomendações descritas no Consenso anterior. Dentre os tópicos selecionados a Fisioterapia durante a Ventilação Mecânica foi um dos temas propostos. O objetivo foi descrever os pontos mais importantes relacionados à atuação do fisioterapeuta no ambiente da terapia Intensiva com ênfase na ventilação mecânica. MÉTODO: Objetivou-se chegar a um documento suficientemente sintético, que refletisse a melhor evidência disponível na literatura. A revisão bibliográfica baseou-se na busca de estudos através de palavras-chave e em sua gradação conforme níveis de evidência. As palavras-chave utilizadas para a busca foram: mechanical ventilation e physical therapy. RESULTADOS: São apresentadas recomendações quanto aos principais procedimentos fisioterápicos, as técnicas e suas aplicações. CONCLUSÕES: A fisioterapia ocupa hoje papel relevante no ambiente da terapia intensiva, principalmente para os pacientes sob ventilação mecânica invasiva ou não invasiva. BACKGROUND AND OBJECTIVES: The II Brazilian Consensus Conference on Mechanical Ventilation was published in 2000. Knowledge on the field of mechanical ventilation evolved rapidly since then, with the publication of numerous clinical studies with potential impact on the ventilatory management of critically ill patients. Moreover, the evolving concept of evidence - based medicine determined the grading of clinical recommendations according to the methodological value of the studies on which they are based. This explicit approach has broadened the understanding and adoption of clinical recommendations. For these reasons, AMIB - Associação de Medicina Intensiva Brasileira and SBPT - Sociedade Brasileira de Pneumologia e Tisiologia - decided to update the recommendations of the II Brazilian Consensus. Physical therapy during mechanical ventilation has been one of the updated topics. This objective was described the most important topics on the physical therapy during mechanical ventilation. METHODS: Systematic review of the published literature and gradation of the studies in levels of evidence, using the key words: mechanical ventilation and physical therapy. RESULTS: Recommendations on the most important techniques applied during mechanical ventilation. CONCLUSIONS: Physical therapy has a central role at the Intensive Care environment, mainly in patients submitted to a mechanical ventilatory support invasive or non invasive.

A Fisioterapia faz parte do atendimento multidisciplinar oferecido aos pacientes em Unidade de Terapia Intensiva (UTI). Sua atuacao e extensa e se faz presente em varios segmentos do tratamento intensivo, tais como o atendi-mento a pacientes criticos que nao necessitam de suporte ventilatorio; assistencia durante a recuperacao pos-cirur-gica, com o objetivo de evitar complicacoes respiratorias e motoras; assistencia a pacientes graves que necessitam de suporte ventilatorio. Nesta fase, o fisioterapeuta tem uma importante participacao, auxiliando na conducao da ventilacao mecânica, desde o preparo e ajuste do venti-lador artificial a intubacao, evolucao do paciente durante a ventilacao mecânica, interrupcao e desmame do suporte ventilatorio e extubacao. Neste Consenso, sera abordada exclusivamente a atuacao do fisioterapeuta no tratamento dos pacientes sob ventilacao mecânica invasiva e nao invasiva, baseando-se as recomendacoes em resultados de estudos clinicos e na opiniao dos especialistas, que aqui expoem sua experiencia na area de terapia intensiva.

The II Brazilian Consensus Conference on Mechanical Ventilation was published in 2000. Knowledge on the field of mechanical ventilation evolved rapidly since then, with the publication of numerous clinical studies with potential impact on the ventilatory management of critically ill patients. Moreover, the evolving concept of evidence - based medicine determined the grading of clinical recommendations according to the methodological value of the studies on which they are based. This explicit approach has broadened the understanding and adoption of clinical recommendations. For these reasons, AMIB - Associação de Medicina Intensiva Brasileira and SBPT - Sociedade Brasileira de Pneumologia e Tisiologia - decided to update the recommendations of the II Brazilian Consensus. Physical therapy during mechanical ventilation has been one of the updated topics. This objective was described the most important topics on the physical therapy during mechanical ventilation.Systematic review of the published literature and gradation of the studies in levels of evidence, using the key words: mechanical ventilation and physical therapy.Recommendations on the most important techniques applied during mechanical ventilation.Physical therapy has a central role at the Intensive Care environment, mainly in patients submitted to a mechanical ventilatory support invasive or non invasive.

Objective: To evaluate the quality of life in a group of patients with Chronic Renal Disease before and after a physiotherapy program during hemodialysis. Materials and Methods: This is a non controlled, before and after, clinical trial where the quality of life was measured using the questionary Medical Outcomes Study 36 – Item Short-Form Health Survey (SF-36), before and after a program of physical activities directed to patients submitted to hemodialysis. Twenty four sessions of physiotherapy were performed during eight weeks. The paired t-test was used for comparison of the results. For analyses of the relevant clinical differences, an increase of five or more points was considered for the domains of SF-36, and of 2.5 or more points for the components of Physical Components Summary (PCS) and Mental Components Summary (MCS). Results: For the 17 participants of this study, only the domain Functional Capacity (p=0.04) and the components Physical Components Summary (p=0.01) and Mental Components Summary (p=0.04) presented statistical relevance. In relation to the clinically relevant difference, the domains Functional Capacity, Physical Aspects, Vitality, Social Aspects and Emotional Aspects were considered (higher than 5 points), even as the components of Physical Components Summary and Mental Components Summary (higher than 2.5 points). Conclusions: This study suggests that physiotherapeutic assistance, performed during hemodyalisis, provided improvements in some dimensions of quality of life of the studied group, mainly functional capacity, where we found statistically significant and clinically relevant improvement.