ABSTRACT
BACKGROUND AND OBJECTIVES: Cardiopulmonary and skeletal muscle impairment and poor physical activity are potential contributors to reduced functional capacity in cystic fibrosis (CF). The Glittre-ADL test (TGlittre) has great potential for clinical use in adult CF adults, as it meets the need for a comprehensive assessment of physical function using tasks similar to activities of daily living. This study aimed to evaluate the performance of TGlittre in CF adults compared to the 6-min walk test (6MWT) and, secondarily, to quantify the associations of their results with pulmonary function, muscle strength, and health-related quality of life (HRQoL). METHODS: This cross-sectional study evaluated 34 CF adults and compared them with 34 subjects from a control group. The participants underwent the following assessments: functional capacity using TGlittre and 6MWT; spirometry; respiratory muscle strength; handgrip strength (HGS); and HRQoL using the Cystic Fibrosis Questionnaire-Revised (CFQ-R). RESULTS: While CF patients showed a longer time to perform TGlittre compared to controls (134 (119-150) versus 107 (95-126) % of the predicted time p = 0.0002), no difference between these groups was observed in the 6MWT. When the second TGlittre was compared to the first TGlittre, there was a significant decrease in total time for both CF patients (p < 0.0001) and controls (p = 0.0001). TGlittre time correlated with 6MWT distance (6MWD) (rs = -0.641, p < 0.0001), HGS (rs = -0.364, p = 0.034), peripheral oxygen saturation at the end of the test (rs = -0.463, p = 0.006) and the "digestive symptoms" domain of CFQ-R (rs = 0.376, p = 0.028). TGlittre time was shorter in patients who engaged in regular physical activity (3.10 (2.49-3.39) min versus 3.28 (2.95-3.53) min, p = 0.016). CONCLUSIONS: TGlittre is more effective than the 6MWT in detecting limitations during exercise. There is an important learning effect of TGlittre in adult CF patients. TGlittre time was correlated with 6MWD, HGS, oxygen saturation level, and the patient's level of physical activity.
Subject(s)
Cystic Fibrosis , Exercise Test , Adult , Humans , Exercise Test/methods , Activities of Daily Living , Hand Strength , Cystic Fibrosis/diagnosis , Cross-Sectional Studies , Quality of LifeABSTRACT
The development of less invasive ventilatory strategies in very-low-birth-weight (VLBW) preterm newborns has been a growing concern in recent decades. This study aimed to measure differences in the clinical progression of preterm newborns using two distinct periods in a university hospital: before and after using underwater bubble continuous positive airway pressure (ubCPAP). This is a retrospective study of VLBW preterm newborns with gestational ages less than or equal to 32 weeks admitted to the neonatal intensive care unit. The time series was divided into two groups: a pre-CPAP group ( n = 45) and a post-CPAP group ( n = 40). The post-CPAP group had fewer resuscitations, required fewer surfactant doses, spent fewer days on mechanical ventilation, and demonstrated less of a need for fraction of inspired oxygen > 30%. UbCPAP is an easy to use, minimally invasive, and effective ventilatory strategy for VLBW preterm newborns that can be used in environments with limited resources. Thus, adopting this simple strategy as part of a service organization and health policy can positively impact outcomes.
Subject(s)
Airway Management/instrumentation , Continuous Positive Airway Pressure/instrumentation , Intensive Care, Neonatal/methods , Noninvasive Ventilation/instrumentation , Respiration, Artificial/instrumentation , Airway Management/methods , Continuous Positive Airway Pressure/methods , Delivery Rooms , Female , Humans , Infant , Infant, Newborn , Infant, Premature , Infant, Very Low Birth Weight , Male , Noninvasive Ventilation/methods , Pregnancy , Respiration, Artificial/methods , Retrospective StudiesABSTRACT
Os avanços da assistência perinatal, em parceria com as inovações tecnológicas tem beneficiado o diagnóstico precoce e, consequentemente, o tratamento das patologias da prematuridade, principalmente as respiratórias. Atualmente são preconizadas estratégias ventilatórias menos invasivas, entre elas, o uso da pressão positiva contínua nas vias aéreas (CPAP) na Síndrome do desconforto respiratório (SDR) visando evitar a intubação orotraqueal ( IOT) e ventilação mecânica (VM ) nos recém-nascidos pré-termo ( RNPT) . Dentre as modalidades de oferecer CPAP tem se destacado o sistema de CPAP selo d'água , por apresentar simplicidade na execução e segurança para os RN. Objetivo Este estudo realizou uma análise retrospectiva de 6 anos em uma única UTIN do Hospital Universitário Pedro Ernesto de RNPT nascidos ≤ 32 semanas de idade gestacional ( IG ) e com peso ≤ 1500 com SDR de (2010-2015). Metodologia - Análise comparativa dos resultados respiratórios em duas séries temporais: - grupo Pré-CPAP selo d'água (2010-2012) e o grupo Pós-CPAP selo d'água (2013-2015). Foi realizado em um hospital universitário referência em maternidade de risco da rede pública do Estado do Rio de Janeiro.A amostra foi composta de 85 RNPT ,sendo que 45 alocados no grupo Pré-CPAP e 40 no grupo Pós-CPAP. O estudo foi aprovado pelo Comitê de Ética em Pesquisa (CEP), recebendo o número CAAE: 55021016.0.3001.5259. Os dados coletados durante os dois períodos foram analisados pelo programa estatístico SPSS 18.0. Foi utilizado o teste de Shapiro Wilk ,o teste de Mann Whitney e o teste de correlação de Spearman. O estudo adotou o valor de p<0,05 para o valor de significância estatística. As tabelas e gráficos foram plotados no programa Data Office Excel 2016. Resultados : Não foram encontradas diferenças significativas para os dados maternos revelando homogeneidade entre os grupos. Já nos dados referentes na sala de parto e no transporte neonatal foram encontradas diferenças significativas para as varíaveis : reanimação na sala de parto , dispositivos na reanimação e FiO2 na reanimação e transporte até a Unidade de terapia intensiva neonatal ( UTIN ) (onde o grupo Pós-CPAP utilizou-se mais CPAP em detrimento da VPP+TOT,utilizado no grupo Pré-CPAP). Quanto aos dados descritivos e inferenciais, das variáveis numéricas dos grupos, verifica-se que o grupo Pós-CPAP, com a utilização da CPAP selo d'água, obteve-se resultados satisfatórios e significativos, em relação ao grupo Pré-CPAP, nas variáveis: número de doses de surfactante (com menor dose no grupo Pós-CAP , p = 0,008 ); dias de ventilação mecânica invasiva -VMI (com menor número de dias de utilização no grupo Pós-CPAP, p = 0,000 ) e o uso de FiO2 ≤ 30% também foi estatisticamente significativa p = 0,043 (com menor necessidade de suporte de O2 do grupo Pós-CPAP, em relação ao grupo Pré-CPAP ). Conclusão: A CPAP selo d'água precoce pode ser recomendado como método menos invasivo e dispendioso na gestão da SDR de RNPT de muito baixo peso
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant, Very Low Birth Weight , Continuous Positive Airway Pressure/methods , Continuous Positive Airway Pressure/statistics & numerical data , Retrospective Studies , Continuous Positive Airway Pressure/nursingABSTRACT
Background. In the neonatal intensive care unit (NICU) environment, preterm newborns are subject to environmental stress and numerous painful interventions. It is known that hydrokinesiotherapy promotes comfort and reduces stress because of the physiological properties of water. Objective. To evaluate the short-term effects of hydrokinesiotherapy on reducing stress in preterm newborns admitted to the NICU. Materials and Methods. Fifteen preterm newborns underwent salivary cortisol measurement, pain evaluation using the Neonatal Infant Pain Scale (NIPS), and heart rate, respiratory rate, and peripheral oxygen saturation measurements before and after the application of hydrokinesiotherapy. Results. The mean gestational age of the newborns was 34.2 ± 1.66 weeks, and the mean weight was 1823.3 ± 437.4 g. Immediately after application of hydrokinesiotherapy, a significant reduction was observed in salivary cortisol (p = 0.004), heart rate (p = 0.003), and respiratory rate (p = 0.004) and a significant increase was observed in peripheral oxygen saturation (p = 0.002). However, no significant difference was observed in the NIPS score (p > 0.05). Conclusion. In the present study, neonatal hydrotherapy promoted short-term relief from feelings of stress. Neonatal hydrokinesiotherapy may be a therapeutic alternative. However, this therapy needs to be studied in randomized, crossover, and blinded trials. This trial is registered with NCT02707731.
