Physiotherapy management in patients with pleural effusion: a systematic review

Pleural effusion is the accumulation of fluid in between the parietal and visceral pleura, which is called the pleural cavity. It can occur by itself or can be the result of surrounding parenchymal disease like infection, malignancy, or inflammatory conditions. Pleural effusion is one of the major causes of pulmonary mortality and morbidity. With the aim to review the physiotherapy management in pleural effusion till date A Systematic review was done according to PRISMA guidelines was conducted on 15 articles through different databases like PubMed, google scholar which were identified, sorted, and screened according to the inclusion criteria and exclusion criteria post which the studies were assessed for quality. In this review the result data from the selected studies were extracted under the headings of title/author, type of study design, intervention /device /technique elaborated in the study, and key highlights of the study and was tabulated systematically. Following the discussion of results about the methods, effects of the protocols along with the biases in research it was concluded that Physiotherapy management increases pulmonary function, chest expansion and oxygenation in patients with pleural effusion.

Fisioterapia respiratória em crianças com pneumonia: revisão sistemática da literatura / Chest physiotherapy in children with pneumonia: a systematic literature review / Fisioterapia respiratoria en niños con neumonía: revisión sistemática de la literatura

Objetivo: Avaliar a atuação da fisioterapia respiratória no tratamento da pneumonia em crianças. Métodos: Trata-se de uma revisão sistemática baseada no método Preferred Reporting Items for Sistematic Reviews and Meta-Análises (PRISMA). Neste estudo foram incluídos artigos originais relacionados com objetivo que aplicaram a fisioterapia respiratória no tratamento de crianças com pneumonia, escritos na língua portuguesa e inglesa, publicados no site da Biblioteca Virtual em Saúde (BVS), nas bases de dados Literatura Latino-Americana e do caribe em ciências da saúde (LILACS), Scientific-Electronic-Library-Online (SciELO), no Physioterapia Evidence Database (PEDro) e PubMed, utilizando os descritores (pneumonia, respiratory physiotherapy, chest therapy, pediatric e child*). Resultados: Inicialmente foram identificados 273 artigos publicados e, de acordo com os critérios de inclusão, exclusão e elegibilidade, ao final cinco foram selecionados para análise qualitativa. Dos artigos selecionados para o estudo, três mostraram que fisioterapia respiratória proporcionou melhorias significativas entre os pacientes de grupo de controle e intervenção, usando técnicas e equipamentos que auxiliavam na desobstrução das vias aéreas e diminuição das internações decorrentes da pneumonia. Contudo, não houve estudos que qualificassem as intervenções fisioterapêuticas como principal recurso para o tratamento dessa doença. Conclusão: Dessa forma, conclui-se que a utilização da fisioterapia respiratória pode ser um adjuvante importante para a melhora dos quadros e funções respiratórias de crianças com pneumonia.

Objective: To evaluate the performance of respiratory physical therapy in the treatment of pneumonia in children. Methods: This is a systematic review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. This study included original articles related to the objective that applied respiratory physiotherapy in the treatment of children with pneumonia, written in Portuguese and English, published on the Virtual Health Library (VHL) site, in the Latin American and Caribbean Health Sciences Literature (LILACS), Scientific-Electronic-Library-Online (SciELO), Physiotherapy Evidence Database (PEDro) and PubMed databases, using the descriptors (pneumonia, respiratory physiotherapy, chest therapy, pediatric and child*). Results: Initially 273 published articles were identified and according to the inclusion, exclusion and eligibility criteria, at the end five were selected for qualitative analysis. Of the articles selected for the study, three showed that respiratory physiotherapy provided significant improvements among control and intervention group patients using techniques and equipment that aided in airway clearance and decreased hospitalizations due to pneumonia. However, there were no studies qualifying physical therapy interventions as the main resource for the treatment of this disease. Conclusion: Therefore, we concluded that chest physiotherapy can be an important adjuvant for the improvement of respiratory function in children with pneumonia.

Objetivo: Evaluar el papel de la fisioterapia respiratoria en el tratamiento de la neumonía en niños. Métodos: Esta es una revisión sistemática basada en el método Preferred Reporting Items for Sistematic Reviews and Meta-Análises (PRISMA). Este estudio incluyó artículos originales relacionados con el objetivo de aplicar la fisioterapia respiratoria en el tratamiento de niños con neumonía, escritos en portugués e inglés, publicados en el sitio web de la Biblioteca Virtual en Salud (BVS), en las bases de datos de Literatura Latinoamericana y del Caribe en ciencias de la salud. (LILACS), Scientific-Electronic-Library-Online (SciELO), no Physioterapia Evidence Database (PEDro) e PubMed, utilizando los descriptores (pneumonia, respiratory physiotherapy, chest therapy, pediatric e child*). Resultados: Inicialmente se identificaron 273 artículos publicados y, según los criterios de inclusión, exclusión y elegibilidad, finalmente se seleccionaron cinco para el análisis cualitativo. De los artículos seleccionados para el estudio, tres mostraron que la fisioterapia respiratoria proporcionó mejoras significativas entre los pacientes de los grupos de control e intervención, utilizando técnicas y equipos que ayudaron a despejar las vías respiratorias y reducir las hospitalizaciones por neumonía. Sin embargo, no hubo estudios que calificaran las intervenciones fisioterapéuticas como principal recurso para el tratamiento de esta enfermedad. Conclusíon: Por lo tanto, se concluye que el uso de fisioterapia respiratoria puede ser un coadyuvante importante para mejorar las condiciones y funciones respiratorias de los niños con neumonía.

Fisioterapia respiratoria en sujetos adultos cursando internación por neumonía adquirida en la comunidad. Revisión bibliográfica

Introducción: La neumonía adquirida en la comunidad (NAC) es una infección respiratoria en la cual es frecuente observar la indicación de fisioterapia respiratoria (FR). Sin embargo, en la actualidad las recomendaciones respecto a su uso en NAC son controvertidas, no existiendo evidencia que respalde su uso y permita conocer su real alcance. Objetivos: Revisar la evidencia respecto al impacto de la FR en pacientes adultos que cursan internación por NAC. Resultados: 5 estudios cumplieron los criterios de inclusión de esta revisión. Las maniobras de FR incluyeron ejercicios respiratorios, drenaje postural, percusión, vibración, espirometría incentivada, resistencia espiratoria, asistencia torácica durante movimientos respiratorios, tos dirigida y presión positiva intermitente. En los estudios incluidos la FR no disminuyó la mortalidad ni mejoró los valores espirométricos en los pacientes con NAC, así como tampoco los días hasta la curación ni la estadía hospitalaria. Respecto a los costos, el uso de FR en pacientes con NAC presentó un incremento significativo de los mismos. Conclusión: No hay evidencia que respalde el uso de manera rutinaria de FR en los pacientes adultos con NAC. Consideramos que se requieren de futuras investigaciones que permitan conocer el impacto de la FR en pacientes adultos con NAC, así como establecer consensos respecto a su indicación, selección de maniobras, estandarización de técnicas, tiempos y dosificación.

Introduction: Community-acquired pneumonia (CAP) is a respiratory infection in which the indication for respiratory physiotherapy (RF) is frequently observed. However, currently the recommendations regarding its use in CAP are controversial, and there is no evidence to support its use and allow us to know its real scope. Objectives: To review the evidence regarding the impact of RF in adult patients who are hospitalized for CAP. Results: 5 studies met the inclusion criteria of this review. RF maneuvers included breathing exercises, postural drainage, percussion, vibration, incentive spirometry, expiratory resistance, chest support during respiratory movements, directed cough, and intermittent positive pressure. In the included studies, RF did not reduce mortality or improve spirometric values in patients with CAP, nor did it improve days to cure or hospital stay. Regarding costs, the use of RF in patients with CAP presented a significant increase in costs. Conclusion: There is no evidence to support the routine use of RF in adult patients with CAP. We believe that future research is required to determine the impact of RF in adult patients with CAP, as well as to establish consensus regarding its indication, selection of maneuvers, standardization of techniques, times, and dosage.

Fisioterapia respiratoria en sujetos adultos cursando internación por neumonía adquirida en la comunidad. Revisión bibliográfica / Respiratory physiotherapy in adult subjects hospitalized for community-acquired pneumonia. Literature review

Introducción: La neumonía adquirida en la comunidad (NAC) es una infección respiratoria en la cual es frecuente observar la indicación de fisioterapia respiratoria (FR). Sin embargo, en la actualidad las recomendaciones respecto a su uso en NAC son controvertidas, no existiendo evidencia que respalde su uso y permita conocer su real alcance. Objetivos: Revisar la evidencia respecto al impacto de la FR en pacientes adultos que cursan internación por NAC. Resultados: 5 estudios cumplieron los criterios de inclusión de esta revisión. Las maniobras de FR incluyeron ejercicios respiratorios, drenaje postural, percusión, vibración, espirometría incentivada, resistencia espiratoria, asistencia torácica durante movimientos respiratorios, tos dirigida y presión positiva intermitente. En los estudios incluidos la FR no disminuyó la mortalidad ni mejoró los valores espirométricos en los pacientes con NAC, así como tampoco los días hasta la curación ni la estadía hospitalaria. Respecto a los costos, el uso de FR en pacientes con NAC presentó un incremento significativo de los mismos. Conclusión: No hay evidencia que respalde el uso de manera rutinaria de FR en los pacientes adultos con NAC. Consideramos que se requieren de futuras investigaciones que permitan conocer el impacto de la FR en pacientes adultos con NAC, así como establecer consensos respecto a su indicación, selección de maniobras, estandarización de técnicas, tiempos y dosificación.

Introduction: Community-acquired pneumonia (CAP) is a respiratory infection in which the indication for respiratory physiotherapy (RF) is frequently observed. However, currently the recommendations regarding its use in CAP are controversial, and there is no evidence to support its use and allow us to know its real scope. Objectives: To review the evidence regarding the impact of RF in adult patients who are hospitalized for CAP. Results: 5 studies met the inclusion criteria of this review. RF maneuvers included breathing exercises, postural drainage, percussion, vibration, incentive spirometry, expiratory resistance, chest support during respiratory movements, directed cough, and intermittent positive pressure. In the included studies, RF did not reduce mortality or improve spirometric values in patients with CAP, nor did it improve days to cure or hospital stay. Regarding costs, the use of RF in patients with CAP presented a significant increase in costs. Conclusion: There is no evidence to support the routine use of RF in adult patients with CAP. We believe that future research is required to determine the impact of RF in adult patients with CAP, as well as to establish consensus regarding its indication, selection of maneuvers, standardization of techniques, times, and dosage.

Técnicas Instrumentales en Kinesiología Respiratoria: Principios y Orientación para la Práctica Clínica / Instrumental respiratory physiotherapy: principles and guidance for clinical practice

Introducción. La kinesiología respiratoria cuenta con una amplia variedad de estrategias terapéuticas para el tratamiento de pacientes con disfunción respiratoria, entre las cuales se pueden mencionar las técnicas instrumentales. En la actualidad, existe una amplia variedad de ellas, la gran mayoría frecuentemente utilizadas en la práctica clínica. No obstante, la literatura que respalda su uso es heterogénea al igual que sus protocolos de aplicación. El objetivo de esta revisión es describir las técnicas kinesiológicas instrumentales más utilizadas en la práctica clínica teniendo como base una propuesta de clasificación. Se incluyen los siguientes dispositivos: Threshold PEP, Mascarilla PiPEP, TheraPEP, Flutter, Acapella, RC-Cornet, chaleco oscilatorio/compresivo torácico de alta frecuencia, ventilación percusiva intrapulmonar e incentivador volumétrico y flujométrico. Estas se describen de acuerdo a sus características principales, principios fisiológicos, protocolos de aplicación y evidencia disponible en la literatura.

Background. Respiratory physiotherapy has various therapeutic strategies for treating patients with respiratory dysfunction, including mechanical devices. Currently, a wide variety of these devices exist, and many are frequently used in clinical practice. However, the literature supporting their use is heterogeneous, as well as their application protocols. This paper aims to provide an overview of the most used devices in respiratory physiotherapy at clinical practice based on a proposed classification. The following devices were included: Threshold PEP, PiPEP mask, TheraPEP, Flutter, Acapella, RC-Cornet, High frequency chest wall compression/oscillation, Intrapulmonary Percussive Ventilation, flow and volume spirometer. They were described according to their main characteristics, physiological mechanisms, application protocols and evidence from literature.

Use of Intrapulmonary Percussive Ventilation as Mechanical Bronchial Hygiene Therapy in Critical Pediatric Patients / Utilización de ventilación percusiva intrapulmonar como terapia de higiene bronquial mecánica en pacientes pediátricos críticos

ABSTRACT Intrapulmonary percussive ventilation (IPV) is a high-frequency mechanical bronchial hygiene technique (MBHT) that favors secretion clearance and is considered an alternative to the resolution of atelectasis. This is a prospective, observational and descriptive case series study conducted between August 1st, 2019 and December 31st, 2019. The study included patients younger than 18 years on ventilatory support who received at least one session of IPV in the intensive care unit. The primary objective of our study was to describe the characteristics of the population in whom we used a home IPV device as MBHT in the PICU. On a secondary level, we will describe the methodology for using this device and its results. Results: 18 patients were included; 48 IPV sessions were done. The main reason for doing IPV was the atelectasis diagnosis (83.3%). The treatment was carried out both in patients on IMV (invasive mechanical ventilation) (55.6%) and in patients with non-invasive support (44.4%), whether it was NIMV (non-invasive mechanical ventilation) or HFNC (high-flow nasal cannula). 53.3% of the patients showed radiographic resolution of atelectasis, where 75% only required between one and two sessions to resolve it. No severe complications were observed. Conclusion: This study allows us to describe the population receiving IPV and presents a tool that could be useful for the resolution of atelectasis.

RESUMEN La ventilación percusiva intrapulmonar (VPI) es una técnica de higiene bronquial mecánica (THBM) de alta frecuencia, que favorece la movilización de secreciones y es considerada como alternativa para la resolución de atelectasias. Estudio de serie de casos, prospectivo, observacional y descriptivo que se llevó a cabo entre el 1 de agosto del 2019 y el 31 de diciembre del 2019. Se incluyeron todos los pacientes menores de 18 años, con soporte ventilatorio que recibieron al menos una sesión de VPI dentro de terapia intensiva. El objetivo primario de nuestro estudio es describir las características de la población en la que se utilizó un equipo domiciliario de VPI como THBM en la UCIP. De manera secundaria describiremos la metodología de implementación del dispositivo y sus resultados. Resultados: Se incluyeron 18 pacientes y se realizaron 48 sesiones de VPI. El principal motivo para la realización de VPI fue el diagnóstico de atelectasia (83,3%). El tratamiento se realizó tanto en pacientes con VMI (ventilación mecánica invasiva) (55,6%) como en pacientes con soporte no invasivo (44,4%), ya sea VMNI (ventilación mecánica no invasiva) o CNAF (cánula nasal de alto flujo). En el 53,3% de los pacientes, se evidenció resolución radiográfica de la atelectasia, entre los cuales, el 75% solo requirió entre una y dos sesiones para resolverlas. No se observaron complicaciones graves. Conclusión: Este estudio permite describir la población en la cual se implementa VPI a la vez que presenta una herramienta que podría ser de utilidad para la resolución de atelectasias.

Utilización de ventilación percusiva intrapulmonar como terapia de higiene bronquial mecánica en pacientes pediátricos críticos / Use of Intrapulmonary Percussive Ventilation as Mechanical Bronchial Hygiene Therapy in Critical Pediatric Patients

La ventilación percusiva intrapulmonar (VPI) es una técnica de higiene bronquial mecánica (THBM) de alta frecuencia, que favorece la movilización de secreciones y es considerada como alternativa para la resolución de atelectasias. Estudio de serie de casos, prospectivo, observacional y descriptivo que se llevó a cabo entre el 1 de agosto del 2019 y el 31 de diciembre del 2019. Se incluyeron todos los pacientes menores de 18 años, con soporte ventilatorio que recibieron al menos una sesión de VPI dentro de terapia intensiva. El objetivo primario de nuestro estudio es describir las características de la población en la que se utilizó un equipo domiciliario de VPI como THBM en la UCIP. De manera secundaria describiremos la metodología de implementación del dispositivo y sus resultados. Resultados: Se incluyeron 18 pacientes y se realizaron 48 sesiones de VPI. El principal motivo para la realización de VPI fue el diagnóstico de atelectasia (83,3%). El tratamiento se realizó tanto en pacientes con VMI (ventilación mecánica invasiva) (55,6%) como en pacientes con soporte no invasivo (44,4%), ya sea VMNI (ventilación mecánica no invasiva) o CNAF (cánula nasal de alto flujo). En el 53,3% de los pacientes, se evidenció resolución radiográfica de la atelectasia, entre los cuales, el 75% solo requirió entre una y dos sesiones para resolverlas. No se observaron complicaciones graves. Conclusión: Este estudio permite describir la población en la cual se implementa VPI a la vez que presenta una herramienta que podría ser de utilidad para la resolución de atelectasias.

Intrapulmonary percussive ventilation (IPV) is a high-frequency mechanical bronchial hygiene technique (MBHT) that favors secretion clearance and is considered an alterna tive to the resolution of atelectasis. This is a prospective, observational and descriptive case series study conducted be tween August 1st, 2019 and December 31st, 2019. The study included patients younger than 18 years on ventilatory support who received at least one session of IPV in the intensive care unit. The primary objective of our study was to describe the characteristics of the population in whom we used a home IPV device as MBHT in the PICU. On a secondary level, we will describe the methodology for using this device and its results. Results: 18 patients were included; 48 IPV sessions were done. The main reason for doing IPV was the atelectasis diagnosis (83.3%). The treatment was carried out both in patients on IMV (invasive mechanical ventilation) (55.6%) and in patients with non-invasive support (44.4%), whether it was NIMV (non-invasive mechanical ventilation) or HFNC (high-flow nasal cannula). 53.3% of the patients showed radiographic resolution of atelectasis, where 75% only required between one and two sessions to resolve it. No severe complications were observed. Conclusion: This study allows us to describe the population receiving IPV and presents a tool that could be useful for the resolution of atelectasis.

Fisioterapia respiratoria en pacientes post Covid-19

RESUMEN La pandemia de Covid-19 ha modificado pautas en la práctica clínica de especialidades como la Medicina Física y Rehabilitación. Se realizó esta comunicación con el objetivo de abordar las principales técnicas de fisioterapia respiratoria en convalecientes de Covid-19 y la evidencia generada de sus resultados.

ABSTRACT The Covid-19 pandemic has modified guidelines in the clinical practice of specialties such as Physical Medicine and Rehabilitation. This communication was carried out with the aim of addressing the main respiratory physiotherapy techniques in convalescents from Covid-19 and the evidence generated from their results.

RESUMO A pandemia de Covid-19 modificou as diretrizes na prática clínica de especialidades como Medicina Física e Reabilitação. Esta comunicação foi realizada como objetivo de abordar as principais técnicas de fisioterapia respiratória em convalescentes da Covid-19 e as evidências geradas a partir dos seus resultados.

Use of High-Flow Nasal Cannula in Users with acute Respiratory Diseases Receiving Hospital at Home / Uso de cánula nasal de alto flujo en usuarios con patologías respiratorias agudas en hospitalizacion domiciliaria

Introduction: Hospital at Home (HAH) is considered an extremely important service, showing great efficacy in the treatment of respiratory diseases. Objectives: To evaluate the effects of high-flow nasal cannulas (HFNCs), describe the experience of patients treated with this therapy as HC and propose a protocol that standardizes the use of this equipment in the context of acute respiratory diseases as home care. Materials and Methods: This was done by means of a quasi-experimental study with patients admitted to HAH between May and September 2019. For the statistical analysis we used Minitab 17.0. Results: 11 subjects met the inclusion criteria, with a mean age of 73 ± 7.8 years. 100% of them (N = 11) had been referred from the emergency service with oxygen requirements. 73.2% (N = 8) were admitted with diseases classified as J15 and J44; 18.1% (N = 2) had diagnosis code J84 and 9% (N = 1) had diagnosis code J46, according to the ICD-10 (International Classification of DiseasesTenth Edition). The mean duration of the HFNC connection was 7.5 ± 5.1 days. We used a mean flow of 35 ± 5.2 L/min, FiO2 of 33 ± 6.1% and a temperature of 32.3 ± 5.1 Degrees Celsius (°C). The clinical signs with statistically significant changes were (Kruskal Wallis, p < 0.05) the BORG Scale, UAM, RR and the SAFI Index. The SpO2 and HR didn't show statistically significant differences. Conclusion: Despite the fact that the number of patients under treatment was low, there are potentially significant effects in parameters of relevance for this type of diseases, and this may serve as a basis for future studies.

Recomendaciones para la implementación de soporte respiratorio pediátrico en COVID-19. Kinesiología Intensiva y Terapia Respiratoria Pediátrica de Chile / Recommendations for the implementation of pediatric respiratory support in COVID-19. Intensive Kinesiology and Respiratory Therapy Chilean

Resumen: De acuerdo a la información disponible, los pacientes pediátricos con COVID-19 tendrían una me nor frecuencia, se presentarían en su mayoría con un cuadro clínico de leve a moderado, y con una baja tasa de morbimortalidad asociada5. Sin embargo, es incierto el comportamiento real que tendrá el SARS-CoV-2 en Chile, así como tampoco sabemos el impacto que tendrá su interacción con otros virus respiratorios en el desenlace clínico. Asumiendo que los pacientes pediátricos que requieran hospitalización por sospecha o confirmación de COVID-19 necesitarán de diferentes niveles de so porte respiratorio, hemos elaborado recomendaciones transversales fundamentadas en el óptimo manejo del apoyo respiratorio pediátrico, basados en los principios de calidad y eficiencia en la en trega del soporte, en parámetros de bioseguridad y en el uso apropiado de recursos6. Estos elementos que se encuentran relacionados al armado y filtrado de los aerosoles producidos por algunos equipos de soporte ventilatorio, son recomendados en esta guía con el fin de unificar criterios técnicos que permitan entregar un apoyo óptimo al paciente pediátrico, manteniendo la mayor bioseguridad po sible para el paciente y el equipo de salud.

Abstract: According to the available information, pediatric cases of COVID-19 would present less frequently, most of them with mild to moderate clinical picture, and low associated morbidity and mortality5. However, we do not know the actual behavior that SARS-CoV-2 will have in Chile, nor the impact that its interaction with other respiratory viruses will have on the clinical outcome. On the assump tion that pediatric patients requiring hospitalization due to suspicion or confirmation of COVID-19 will need different levels of respiratory support, we have developed wide-range recommendations based on the optimal management of pediatric respiratory support according to the principles of quality and efficiency in the delivery of support, biosafety parameters, and appropriate use of resou rces6. These elements, which are related to assembling and filtering the aerosols produced by some respiratory support equipment, are recommended in this guide in order to unify technical criteria that allow optimal support for the pediatric patient while maintaining the highest possible biosafety for the patient and the health team.

Kinesioterapia respiratoria en pediatría / Respiratory physiotherapy

La kinesiterapia respiratoria, es una especialidad terapéutica que tiene el rol principal de prevenir y tratar las complicaciones pulmonares de forma sencilla, sin incorporar recursos sofisticados en su ejecución. Su objetivo es optimizar la función respiratoria para lograr un adecuado intercambio de gases y mejorar la relación ventilación perfusión. Para esto se efectuan maniobras de permeabilización bronquiales, que cobran especial valor en la infancia, dado que este grupo etáreo, presenta mayor producción de secreciones y una VA de conducción muy estrecha, ambos elementos predisponen a obstrucciones que deben ser manejadas cuando se amerite. La kinesiterapia, también incluye otras técnicas como ejercicios respiratorios, movilización, posicionamientos, maniobras de reexpansión pulmonar asociados con dispositivos especialmente adaptados para este objetivo. En este escrito, se dan las bases de esta terapia física, con énfasis en la edad pediátrica, junto a la descripción global y específica de las principales técnicas, que el pediatra debiese conocer.

Chest physioterapy is a therapeutic specialty that aims to prevent and treat lung complications without adding sophisticated resources for his execution as its main role. Its goal is to optimize the pulmonary function to achieve appropriate gaseous exchange and to improve ventilation/perfusion ratio. To this end airway clearance techniques are performed, these techniques are of special value during childhood, since this age group present higher quantities of secretions and very narrow conducting airways, both elements predispose to obstructions that must be handle if the case merits. Chest physioterapy also include others techniques as deep breathing, early movilizations, lung recruitment maneuvers with specially adapted devices. This paper set the stage of this pshysical therapy with emphasis in pediatric age, adding a global and specific description of the main techniques that the pediatritian should know.

Fisioterapia respiratoria na pressao intracraniana de pacientes graves internados em unidade de terapia intensiva: revisao sistematica / Chest physiotherapy on intracranial pressure of critically ill patients admitted to the intensive care unit: a systematic review

Objetivo: Analisar os desfechos aumento/diminuição da pressão intracraniana e/ou queda da pressão de perfusão cerebral, proporcionados pela fisioterapia respiratória em pacientes graves assistidos em unidade de terapia intensiva. Métodos: Por meio de uma revisão sistemática da literatura, foram selecionados ensaios clínicos publicados entre 2002 e 2012. A busca envolveu as bases de dados LILACS, SciELO, MedLine e PEDro, usando os descritores "physical therapy", "physiotherapy", "respiratory therapy" e "randomized controlled trials" em cruzamento com o descritor "intracranial pressure". Resultados: Foram incluídos 5 estudos, que somaram 164 pacientes, com média de idade entre 25 e 65 anos, e que indicaram que as manobras de fisioterapia respiratória aumentaram significativamente a pressão intracraniana, sem alterar a pressão de perfusão cerebral. Os artigos abordaram as técnicas de vibração, vibrocompressão, tapotagem, drenagem postural, além da manobra de aspiração intratraqueal. Todos os pacientes estavam sob ventilação mecânica invasiva. Conclusão: A fisioterapia respiratória promove aumento da pressão intracraniana. Os estudos sugerem que não há repercussões hemodinâmicas e respiratórias a curto prazo ou alteração da pressão de perfusão cerebral. Entretanto, não há estudos que avaliem desfechos clínicos e que assegurem a segurança das manobras. .

Objective: To analyze the outcomes of increased or decreased intracranial pressure and/or the decrease in cerebral perfusion pressure resulting from respiratory physiotherapy on critically ill patients admitted to the intensive care unit. Methods: Through a systematic review of the literature, clinical trials published between 2002 and 2012 were selected. The search involved the LILACS, SciELO, MedLine and PEDro databases using the keywords "physical therapy", "physiotherapy", "respiratory therapy" and "randomized controlled trials" combined with the keyword "intracranial pressure". Results: In total, five studies, including a total of 164 patients between 25 and 65 years of age, reporting that respiratory physiotherapy maneuvers significantly increased intracranial pressure without changing the cerebral perfusion pressure were included. The articles addressed several techniques including vibration, vibrocompression, tapping, postural drainage, and the endotracheal aspiration maneuver. All patients required invasive mechanical ventilation. Conclusion: Respiratory physiotherapy leads to increased intracranial pressure. Studies suggest that there are no short-term hemodynamic or respiratory repercussions or changes in the cerebral perfusion pressure. However, none of the studies evaluated the clinical outcomes or ensured the safety of the maneuvers. .

The Effects of Hospital Based Respiratory Physiotherapy an Intervention Study among COPD Patient in Al-Zawia City, Libya

Chronic obstructive pulmonary disease (COPD) is a one of the major cause of death and disability worldwide. This study aimed to compare the quality of life (QOL), Activity of Daily Living (ADL), Pulmonary Function Test (PFT) and general health symptoms pre and after hospital-based respiratory physiotherapy program among COPD patients. Pre and post intervention study was conducted between January and July 2010. A total of 54 subjects aged between 30 to 40 years old were recruited for this study using universal sampling method from Alzawia Teaching Hospital, Libya. Data collected were socio-demographic data, QOL (before and after the intervention) using the Short Form-36 (SF-36) questionnaire, ADL using the Barthel Index and the General Health Symptoms. The mean SF-36 score for QOL is 30.13 (SD = 8.06) and 63.46 (SD = 13.53) before and after the physiotherapy respectively (with the p <0.0001). Patients’ Activity of Daily Living mean scores are 70.18, (SD = 16.50) and mean = 88.89 (SD = 13.28) before and after program (p< 0.0001). The general medical condition mean score after respiratory physiotherapy is 3.72 as compared to 4.96 before the respiratory physiotherapy (p< 0.0001). Pulmonary Function Test shows improvement in actual/predicted FEV1 ratio in all 54 cases with mean improvement from 55.85 before to 81.67 after the pulmonary physiotherapy (with the p <0.0001). Hospital based respiratory physiotherapy program had significantly improved QOL, pulmonary function and activities of daily living among the subjects.

Relación entre la aplicación de un protocolo de tratamiento kinésico y la variación de parámetros hemodinámicos en pacientes con patología cardiovascular recientemente operados / Hemodynamic profile of patients was undergoing cardiac surgery and their relationships with the application of a respiratory physical therapy protocol

Objetivo: Analizar el perfil hemodinámico de pacientesoperados de cirugía cardiaca y su relación con la aplicaciónde un protocolo de tratamiento kinésico. La hipótesis detrabajo establece que no existe relación entre la aplicación deun protocolo de tratamiento kinésico y la generación decambios hemodinámicos deletéreos...

Background: This study proposes to analyze the profilehemodynamic of patients was undergoing cardiac surgeryand their relationships with the application of a respiratoryphysical therapy protocol. The hypothesis was that there isnot a relation between the application of a respiratoryphysiotherapy protocol and the generation of changes hemodynamicsdeleterious...

Fisioterapia respiratória na fibrose cística / Respiratory physiotherapy in cystic fibrosis

A fisioterapia torácica convencional (FTC) foi introduzida na década de 1950 como padrão-ouro nos cuidados dos pacientes com fibrose cística (FC), no entanto há poucas evidências para que seu uso seja mantido na rotina diária. Neste trabalho, revisamos a evolução das condutas fisioterapêuticas em pacientes portadores de FC, bem como as novas opções de tratamento, com base nas evidências descritas na literatura nos últimos anos. Na últimas décadas, a fisioterapia respiratória modificou-se consideravelmente introduziu-se novas abordagens, tais como técnicas ativas, os pacientes são mantidos em posições mais confortáveis, que se mostram mais eficazes do que as convencionais. Entre elas, destacamos a pressão expiratória positiva (PEP), PEP oscilatória, ciclo ativo da respiração, aumento do fluxo expiratório, drenagem autógena e drenagem autógena modificada. O paciente deve conhecer e eventualmente participar, juntamente ao profissional, da definição da técnica mais apropriada a seu caso. Para tal, uma boa relação fisioterapeuta-paciente é de fundamental importância.

Conventional chest physiotherapy (CCP) started to be used in the 1950s as the gold standard in the care of patients with cystic fibrosis (CF). However, there is little evidence that its use is maintained in the daily routine. The present review of the literature presents the evolution of the practice of physical therapy in patients with CF, as well as new treatment options based on the evidence described in recent years. In the last decades respiratory physiotherapy has changed considerably. By means of new approaches, such as active techniques, patients are offered more comfortable positions, which are more effective than the conventional ones. Among these techniques, the following are highlighted: positive expiratory pressure (PEP), oscillatory PEP, active cycle of breathing, expiratory flow increase, autogenic drainage, and modified autogenic drainage. Patients must understand the therapy and help the physical therapist to define the most appropriate technique for their cases. A good physical therapistpatient relationship is crucial so that such objective can be achieved.

Análise fisioterapêutica em pacientes portadores de fibrose cística / Physiotherapeutic analysis in patients with cystic fibrosis

analisar os pacientes com Fibrose Cística em acompanhamento no Programa de Assistência Multidisciplinar aos Portadores de Fibrose Cística do Hospital Universitário João de Barros Barreto pela verificação de volumes pulmonares e sinais vitais. Método: estudo transversal, com base nos dados coletados por meio de questionários aplicados em 26 pacientes de ambos os sexos, de 6 a 46 anos de idade, selecionados a partir de amostragem aleatória simples, de maio a outubro 2008. Resultados: observou-se que 57,7% dos pacientes encontravam-se na adolescência; 26,9% na fase adulta e 15,4% na infância. Quanto à espirometria, 34,62% dos pacientes apresentaram prova de função ventilatória normal; 42,31% distúrbio ventilatório obstrutivo leve; 3,85% distúrbio ventilatório restritivo e 7,7% distúrbio ventilatório misto. A média PImáx foi de -91,92 cmH2O, da PEmáx 60,77 cmH2O e do Pico de Fluxo Expiratório 335,58 L/min. Conclusão: os resultados indicam que a maioria dos pacientes avaliados encontravam-se em um quadro estável desta doença, obtendo resultados nos testes de função pulmonar semelhantes a indivíduos saudáveis.

analyse a profile of patients with Cystic Fibrosis who attended to the Multidisciplinary Assistance Program to the Patients with Cystic Fibrosis of the Hospital Hospital Universitário João de Barros Barreto through the verification of lung capacities and vital signs. Method: transverse study, based on collected data through questionnaries applied in 26 patients from both sexes, from 6 to 46 years old, select through simple aleatory model. Results: it has been observed that 57,7% of the patients were adolescents; 26,9% were adults and 15,4% were children. About the spirometry, 34,62% of the patients have had normal pulmonary function test; 42,31% obstructive ventilatory defect; 3,85% restrictive ventilatory defect and 7,7% mixed ventilatory defect. The measurement of maximum inspiratory pressure (MIP) was -91,92 cmH2O, the maximum expiratory pressure was 60,77 cmH2O and the measurement peak expiratory flow was 335,58 L/min. Conclusion: The results indicate that the majority of the patients that were evaluated are in a stable condition of this disease, achieving results in the lung function tests similar to healthy people.

Relationship of BODE Index to functional tests in chronic obstructive pulmonary disease

OBJECTIVE: To determine if there is a correlation between the BODE Index and variables assessed during the Activities of Daily Living assessment, performance on lower limber tests, and peripheral muscle impairment of the upper limb in patients with chronic obstructive pulmonary disease. MATERIALS AND METHODS: Ten men (aged 58 to 80 years old) with moderate to very severe obstruction were evaluated and classified by the BODE Index. They were evaluated by pulmonary ventilation (V•E), oxygen consumption (V•O2), and carbonic gas production (V•CO2) on the ADL assessment; Distance Walking (DW) in the Six Minute Walking Test (6MWT) and the Six Minute Walking Test on Treadmill (6MWTT); number of repetitions in the Sit-to-Stand Test; and the Hand Grip Strength Test. Correlations were evaluated between the classification and the tests performed (Pearson and Spearman test, p<0.05). RESULTS: The mean of the total score for the BODE Index was 2.80 (±1.03), with three patients scoring in the first quartile (Q1) and seven scoring in the second quartile (Q2). This Index showed a negative correlation with the 6MWTT (r=-0.86), the Sit-to-Stand Test (r=-0.66), and the Hand Grip Strength Test (r=-0.83). CONCLUSIONS: Our results show that there is no correlation between the BODE Index and the ventilatory and metabolic responses in the Activities of Daily Living assessment. On the other hand, a correlation was observed between the BODE Index and the variables assessed in the 6MWTT, Sit-to-Stand Test, and Hand Grip Strength Test in moderate to very severe Chronic Obstructive Pulmonary Disease patients. This suggests that these tests can be employed as predictors of physical exercise capacity, perhaps as complementary tests to the BODE Index.

Fisioterapia respiratória em pacientes sob ventilação mecânica / Respiratory physiotherapy for patients under mechanical ventilation

O avanço tecnológico tem favorecido o aparecimento de complicações clínicas,as quais são, entretanto, passíveis de serem prevenidas, principalmente quando se atua de forma interdisciplinar. Junto aos pacientes acamados, sedados, dependentes de ventilação mecânica e que necessitam recuperar suas funções respiratórias, o enfermeiro e o fisioterapeuta podem atuar como objetivo de melhorar a ventilação pulmonar e, conseqüentemente, a oxigenação. Uma das ações preventivas que evitam complicações pulmonares é a fisioterapiarespiratória. Esta revisão bibliográfica enfoca e descreve as conseqüências daaspiração de resíduos orofaríngeos e gástricos, como um dos fatores predisponentes ao aparecimento da pneumonia aspirativa, além de expor as manobras de fisioterapia respiratória, cuja aplicação pode preservar a oxigenação e a ventilação pulmonar, favorecendo a recuperação do paciente. Este trabalho de revisão antecedeu o trabalho depois realizado com este tipo de pacientes, em que a atividade do fisioterapeuta veio complementar o cuidado oferecido pela equipe de enfermagem