Randomized and comparative study between two intra-hospital exercise programs for heart transplant patients / Estudo randomizado e comparativo entre dois programas de exercícios intra-hospitalares para pacientes de transplante de coração

OBJECTIVE: To compare the effects of two physical therapy exercise in-hospital programs in pulmonary function and functional capacity of patients in the postoperative period of heart transplantation. METHODS: Twenty-two heart transplanted patients were randomized to the control group (CG, n=11) and training group (TG, n=11). The control group conducted the exercise program adopted as routine in the institution and the training group has had a protocol consisting of 10 stages, with incremental exercises: breathing exercises, resistance training, stretching and walking. The programs began on the first day after extubation and stretched until hospital discharge. Assessed pulmonary function, distance walked in six minutes walk test (6MWT) and peripheral muscle strength by one repetition maximum test (1RM). RESULTS: Similar behavior was observed between the two groups treated, with statistically significant increases between the first and second test of the following variables: FVC (59% in CG and 35.2% in TG); MIP (8.6% in CG and 53.5% in TG), MEP (28.8% in CG and 40.7% in TG) and 6MWT (44.5% in CG and 31.4% in TG). There was an increase of peripheral strength by 1RM test, over time, to the muscle groups of the elbow flexors, shoulder flexors, hip abductors and knee flexors. CONCLUSION: Heart transplant patients benefit from exercise programs in hospital, regardless of the program type applied. A new training proposal did not result in superiority compared to routine programme applied. Exercise protocols provided improves in ventilatory variables and functional capacity of this population.

OBJETIVO: Comparar os efeitos de dois programas fisioterapêuticos de exercícios intra-hospitalares na função pulmonar e na capacidade funcional de pacientes no período pós-operatório de transplante cardíaco. MÉTODOS: Vinte e dois transplantados de coração foram randomizados em Grupo Controle (GC, n=11) e Grupo de Treinamento (GT, n=11). O GC realizou o programa de exercícios adotado como rotina na instituição e o GT realizou protocolo constituído de 10 fases, com exercícios incrementais: exercícios respiratórios, resistidos, alongamentos e caminhada. Os programas tiveram início no primeiro dia após a extubação e se estenderam até a alta hospitalar. Avaliou-se função pulmonar, distância percorrida no teste de caminhada dos seis minutos (TC6M) e força muscular periférica pelo teste de uma repetição máxima (1RM). RESULTADOS: Observou-se comportamento semelhante entre os dois grupos tratados, com aumentos estatisticamente significantes entre o primeiro e o segundo teste das variáveis: CVF (59% no GC; 35,2% no GT); PIMax (8,6% no GC; 53,5% no GT, PEMax (28,8% no GC; 40,7% no GT) e TC6M (44,5% no GC; 31,4% no GT). Houve aumento de força periférica pelo teste de 1RM para os músculos flexores de cotovelo, flexores de ombro, abdutores de quadril e flexores de joelho ao longo do tempo. CONCLUSÃO: Pacientes transplantados de coração se beneficiam da aplicação de programas de exercícios no período intra-hospitalar, independente do tipo de programa aplicado. Uma nova proposta de treinamento não resultou em superioridade em relação ao programa aplicado de rotina. Os protocolos de exercícios proporcionaram melhora das variáveis ventilatórias e da capacidade funcional dessa população.

Oxigenioterapia, pressäo positiva contínua em vias aéreas ou ventilaçäo näo invasiva em dois níveis de pressäo no tratamento do edema agudo de pulmäo cardiogênico / Oxygen therapy, continuous positive airway pressure, or noninvasive bilevel positive pressure ventilation in the treatment of acute cardiogenic pulmonary edema

OBJECTIVE: To compare the effects of 3 types of noninvasive respiratory support systems in the treatment of acute pulmonary edema: oxygen therapy (O2), continuous positive airway pressure, and bilevel positive pressure ventilation. METHODS: We studied prospectively 26 patients with acute pulmonary edema, who were randomized into 1 of 3 types of respiratory support groups. Age was 69±7 years. Ten patients were treated with oxygen, 9 with continuous positive airway pressure, and 7 with noninvasive bilevel positive pressure ventilation. All patients received medicamentous therapy according to the Advanced Cardiac Life Support protocol. Our primary aim was to assess the need for orotracheal intubation. We also assessed the following: heart and respiration rates, blood pressure, PaO2, PaCO2, and pH at begining, and at 10 and 60 minutes after starting the protocol. RESULTS: At 10 minutes, the patients in the bilevel positive pressure ventilation group had the highest PaO2 and the lowest respiration rates; the patients in the O2 group had the highest PaCO2 and the lowest pH (p<0.05). Four patients in the O2 group, 3 patients in the continuous positive pressure group, and none in the bilevel positive pressure ventilation group were intubated (p<0.05). CONCLUSION: Noninvasive bilevel positive pressure ventilation was effective in the treatment of acute cardiogenic pulmonary edema, accelerated the recovery of vital signs and blood gas data, and avoided intubation

Efeito da posiçäo de Trendelemburg sobre o estado hemodinâmico e a saturaçäo de oxigênio / Effect of the Trendelemburg position on hemodinamic state and the oxygen saturation

Vinte pacientes em pós-operatório de cirurgia cardíaca foram estudados com o objetivo de avaliar os efeitos da posiçäo de Trendelemburg sobre o estado hemodinâmico e a saturaçäo de oxigênio. Os pacientes foram divididos em dois grupos. No subgrupo A os pacientes estavam sob ventilaçäo mecânica, recebendo drogas vasoativas; no subgrupo B estavam respirando espontaneamente, sem uso de drogas vasoativas. Foram realizadas medidas hemodinâmicas e da saturaçäo de oxigênio (SaO2) em todos os pacientes nas posiçöes de decúbito dorsal e Trendelemburg. Os resultados obtidos comparados e analisados estatisticamente, demonstraram näo haver alteraçöes significativas nos parâmetros avaliados em ambos os grupos