Effects of manual chest compression and descompression maneuver on lung volumes, capnography and pulse oximetry in patients receiving mechanical ventilation / Efeitos da manobra de compressão e descompressão torácica nos volumes pulmonares, capnografia e oximetria de pulso em pacientes submetidos à ventilação mecânica

OBJECTIVES: The aims of this study were to evaluate whether there are changes in lung volumes, capnography, pulse oximetry and hemodynamic parameters associated with manual chest compression-decompression maneuver (MCCD) in patients undergoing mechanical ventilation (MV). Method: A prospective study of 65 patients undergoing to MV after 24 hours. All patients received bronchial hygiene maneuvers and after 30 minutes they were submitted to ten repetitions of the MCCD during 10 consecutive respiratory cycles in the right hemithorax and than in the left hemithorax. The data were collected before the application of the maneuver and after 1, 5, 10, 15, 20, 25, 30, 35 and 40 minutes following application of the maneuver. RESULTS: There were statistical significant (p<0.0001) improvements in the following parameters after MCCD maneuver during all phases of data collection until 40 minutes: inspiratory tidal volume (baseline: 458.2±132.1 ml; post 1 min: 557.3±139.1; post 40 min: 574.4±151), minute volume (baseline: 7.0±2.7 L/min; post 1 min: 8.7±3.3; post 40 min: 8.8±3.8), and pulse oximetry (baseline: 97.4±2.2%; post 1 min: 97.9±1,8; post 40 min: 98.2±1.6; p<0.05). There was a reduction in CO2 expired (baseline: 35.1±9.0 mmHg; post 1 min: 31.5±8.2; post 40 min: 31.5±8.29; p<0.0001). There was no statically significant changes in heart rate (baseline: 94.5±20.5 mmHg; post 1 min: 94.7±20.5; post 40 min: 94.92±20.20; p=1) and mean arterial pressure (baseline: 91.2±19.1 bpm; post 1 min: 89.5±17.7; post 40 min: 89.01±16.88; p=0.99). The variables were presented in terms of means and standard deviations. CONCLUSION: The MCCD maneuver had positive effects by increasing lung volume and pulse oximetry and reducing CO2 expired, without promoting hemodynamic changes in patients undergoing mechanical ventilation.

OBJETIVOS: Avaliar a presença de alterações nos volumes pulmonares, oximetria de pulso, capnografia e alterações hemodinâmicas associadas à intervenção da manobra de compressão e descompressão torácica (MCDT) nos pacientes submetidos à ventilação mecânica (VM). Método: Tratou-se de um estudo prospectivo em que foram incluídos 65 pacientes em VM há mais de 24 horas. O protocolo consistiu na aplicação de manobras de higiene brônquica e, após 30 minutos, os pacientes eram submetidos a dez repetições da MCDT em dez respirações consecutivas no hemitórax direito e, posteriormente, no hemitórax esquerdo, coletando os dados antes e após a aplicação da manobra nos tempos 1, 5, 10, 15, 20, 25, 30, 35 e 40 minutos. RESULTADOS: Constatou-se aumento significante (p<0,001) do volume corrente inspiratório (pré: 458,2±132,1 ml; pós 1 minuto: 557,3±139,1; pós 40 minutos: 574,4±151), volume minuto corrente (pré: 7,0±2,7 L/min; pós 1 minuto: 8,7±3,3; pós 40 minutos: 8,8±3,8) e oximetria de pulso (pré: 97,4±2,2%; pós 1 minuto: 97,9±1,8; pós 40 minutos: 98,2±1,6; p<0,05). Ocorreu redução no CO2 expirado (pré: 35,1±9,0 mmHg; pós 1 minuto: 31,5±8,2; pós 40 minutos: 31,5±8,29; p<0.0001). Não houve alteração significante da frequência cardíaca (pré: 94,5±20,5 mmHg; pós 1 minuto: 94,7±20,5 e pós 40 minutos: 94,9±20,2; p=1) e pressão arterial média (pré: 91,2±19,1 bpm; pós 1 minuto: 89,5±17,7 e pós 40 minutos: 89,0±16,8; p=0,99). As variáveis foram expressas em média e desvio-padrão. CONCLUSÃO: A MCDT possibilita a otimização dos volumes pulmonares, da oximetria de pulso e a redução do CO2 expirado sem promover alterações hemodinâmicas significantes nos pacientes submetidos à ventilação mecânica.

Glasgow outcome scale at hospital discharge as a prognostic index in patients with severe traumatic brain injury.

OBJECTIVE: Evaluate the Glasgow outcome scale (GOS) at discharge (GOS-HD) as a prognostic indicator in patients with traumatic brain injury (TBI). METHOD: Retrospective data were collected of 45 patients, with Glasgow coma scale <8, age 25±10 years, 36 men, from medical records. Later, at home visit, two measures were scored: GOS-HD (according to information from family members) and GOS LATE (12 months after TBI). RESULTS: At discharge, the ERG showed: vegetative state (VS) in 2 (4%), severe disability (SD) in 27 (60%), moderate disability (MD) in 15 (33%) and good recovery (GR) in 1 (2%). After 12 months: death in 5 (11%), VS in 1 (2%), SD in 7 (16%), MD in 9 (20%) and GR in 23 (51%). Variables associated with poor outcome were: worse GOS-HD (p=0.03), neurosurgical procedures (p=0.008) and the kind of brain injury (p=0.009). CONCLUSION: The GOS-HD was indicator of prognosis in patients with severe TBI.

Glasgow outcome scale at hospital discharge as a prognostic index in patients with severe traumatic brain injury / Escala de resultados de Glasgow por ocasião da alta hospitalar como indicador prognóstico em pacientes com traumatismo cranioencefálico grave

OBJECTIVE: Evaluate the Glasgow outcome scale (GOS) at discharge (GOS-HD) as a prognostic indicator in patients with traumatic brain injury (TBI). METHOD: Retrospective data were collected of 45 patients, with Glasgow coma scale <8, age 25±10 years, 36 men, from medical records. Later, at home visit, two measures were scored: GOS-HD (according to information from family members) and GOS LATE (12 months after TBI). RESULTS: At discharge, the ERG showed: vegetative state (VS) in 2 (4%), severe disability (SD) in 27 (60%), moderate disability (MD) in 15 (33%) and good recovery (GR) in 1 (2%). After 12 months: death in 5 (11%), VS in 1 (2%), SD in 7 (16%), MD in 9 (20%) and GR in 23 (51%). Variables associated with poor outcome were: worse GOS-HD (p=0.03), neurosurgical procedures (p=0.008) and the kind of brain injury (p=0.009). CONCLUSION: The GOS-HD was indicator of prognosis in patients with severe TBI.

OBJETIVO: Avaliar a escala de resultados de Glasgow (ERG) à alta hospitalar (ERG-ALTA) como indicador prognóstico em pacientes com traumatismo cranioencefálico (TCE). MÉTODO: Dados retrospectivos de 45 pacientes (36 homens), com escala de coma de Glasgow <8, idade 25±10 anos, foram coletados do prontuário médico. Posteriormente, em visita domiciliar, foram pontuadas duas medidas: ERG-ALTA (de acordo com informações de familiares) e ERG TARDIA (após 12 meses do TCE). RESULTADOS: Por ocasião da alta hospitalar, a ERG evidenciou: estado vegetativo (EV) em 2 (4%); incapacidade grave (IG) em 27 (60%), incapacidade moderada (IM) em 15 (33%) e boa recuperação (BR) em 1 (2%). Após 12 meses: morte em 5 (11%), EV em 1 (2%), IG em 7 (16%), IM em 9 (20%) e BR em 23 (51%). Variáveis associadas com má evolução foram: pior ERG-ALTA (p=0,03); procedimentos neurocirúrgicos (p=0,008) e o tipo de lesão cerebral (p=0,009). CONCLUSÃO: A ERG-ALTA foi indicador adequado de prognóstico tardio em pacientes com TCE grave.

Effects of manual chest compression and descompression maneuver on lung volumes, capnography and pulse oximetry in patients receiving mechanical ventilation.

OBJECTIVES: The aims of this study were to evaluate whether there are changes in lung volumes, capnography, pulse oximetry and hemodynamic parameters associated with manual chest compression-decompression maneuver (MCCD) in patients undergoing mechanical ventilation (MV). METHOD: A prospective study of 65 patients undergoing to MV after 24 hours. All patients received bronchial hygiene maneuvers and after 30 minutes they were submitted to ten repetitions of the MCCD during 10 consecutive respiratory cycles in the right hemithorax and than in the left hemithorax. The data were collected before the application of the maneuver and after 1, 5, 10, 15, 20, 25, 30, 35 and 40 minutes following application of the maneuver. RESULTS: There were statistical significant (p<0.0001) improvements in the following parameters after MCCD maneuver during all phases of data collection until 40 minutes: inspiratory tidal volume (baseline: 458.2±132.1 ml; post 1 min: 557.3±139.1; post 40 min: 574.4±151), minute volume (baseline: 7.0±2.7 L/min; post 1 min: 8.7±3.3; post 40 min: 8.8±3.8), and pulse oximetry (baseline: 97.4±2.2%; post 1 min: 97.9±1,8; post 40 min: 98.2±1.6; p<0.05). There was a reduction in CO2 expired (baseline: 35.1±9.0 mmHg; post 1 min: 31.5±8.2; post 40 min: 31.5±8.29; p<0.0001). There was no statically significant changes in heart rate (baseline: 94.5±20.5 mmHg; post 1 min: 94.7±20.5; post 40 min: 94.92±20.20; p=1) and mean arterial pressure (baseline: 91.2±19.1 bpm; post 1 min: 89.5±17.7; post 40 min: 89.01±16.88; p=0.99). The variables were presented in terms of means and standard deviations. CONCLUSION: The MCCD maneuver had positive effects by increasing lung volume and pulse oximetry and reducing CO2 expired, without promoting hemodynamic changes in patients undergoing mechanical ventilation.

Continuous positive airway pressure increases inspiratory capacity of COPD patients.

BACKGROUND AND OBJECTIVE: Hyperinflation with a decrease in inspiratory capacity (IC) is a common presentation for both unstable and stable COPD patients. As CPAP can reduce inspiratory load, possibly secondary to a reduction in hyperinflation, this study examined whether CPAP would increase IC in stable COPD patients. METHODS: Twenty-one stable COPD patients (nine emphysema, 12 chronic bronchitis) received a trial of CPAP for 5 min at 4, 7 and 11 cmH(2)O. Fast and slow VC (SVC) were measured before and after each CPAP trial. In patients in whom all three CPAP levels resulted in a decreased IC, an additional trial of CPAP at 2 cmH(2)O was conducted. For each patient, a 'best CPAP' level was defined as the one associated with the greatest IC. This pressure was then applied for an additional 10 min followed by spirometry. RESULTS: Following application of the 'best CPAP', the IC and SVC increased in 15 patients (nine emphysema, six chronic bronchitis). The mean change in IC was 159 mL (95% CI: 80-237 mL) and the mean change in SVC was 240 mL (95% CI: 97-386 mL). Among these patients, those with emphysema demonstrated a mean increase in IC of 216 mL (95% CI: 94-337 mL). Six patients (all with chronic bronchitis) did not demonstrate any improvement in IC. CONCLUSIONS: The best individualized CPAP can increase inspiratory capacity in patients with stable COPD, especially in those with emphysema.

Syndromes related to sodium and arginine vasopressin alterations in post-operative neurosurgery.

BACKGROUND: Cerebral salt wasting syndrome (CSWS), syndrome of inappropriate antidiuretic hormone secretion (SIADH) and diabetes insipidus (DI) are frequently found in postoperative neurosurgery. PURPOSE: To identify these syndromes following neurosurgery. METHOD: The study included 30 patients who had been submitted to tumor resection and cerebral aneurysm clipping. Sodium levels in serum and urine and urine volume were measured daily up to the 5th day following surgery. Plasma arginine vasopressin (AVP) was measured on the first, third and fifth days post-surgery. RESULTS: CSWS was found in 27/30 patients (90%), in 14 (46.7%) of whom it was associated with a reduction in the levels of plasma AVP (mix syndrome). SIADH was found in 3/30 patients (10%). There was no difference between the two groups of patients. CONCLUSION: CSWS was the most common syndrome found, and in half the cases it was associated with DI. SIADH was the least frequent syndrome found.

Syndromes related to sodium and arginine vasopressin alterations in post-operative neurosurgery

BACKGROUND: Cerebral salt wasting syndrome (CSWS), syndrome of inappropriate antidiuretic hormone secretion (SIADH) and diabetes insipidus (DI) are frequently found in postoperative neurosurgery. PURPOSE: To identify these syndromes following neurosurgery. METHOD: The study included 30 patients who had been submitted to tumor resection and cerebral aneurysm clipping. Sodium levels in serum and urine and urine volume were measured daily up to the 5th day following surgery. Plasma arginine vasopressin (AVP) was measured on the first, third and fifth days post-surgery. RESULTS: CSWS was found in 27/30 patients (90 percent), in 14 (46.7 percent) of whom it was associated with a reduction in the levels of plasma AVP (mix syndrome). SIADH was found in 3/30 patients (10 percent). There was no difference between the two groups of patients. CONCLUSION: CSWS was the most common syndrome found, and in half the cases it was associated with DI. SIADH was the least frequent syndrome found.

INTRODUÇÃO: A síndrome perdedora de sal (SPS), síndrome da secreção inapropriada do hormônio antidiurético (SIADH) e diabetes insipidus (DI) são freqüentemente encontradas no pós-operatório de neurocirurgia. OBJETIVO: Identificar essas síndromes relacionadas à neurocirurgia. MÉTODO: Foram estudados 30 pacientes submetidos à ressecção de tumor (n=19) e clipagem de aneurisma (n=11) cerebral durante os primeiros cinco dias do pós-operatório. Os pacientes foram submetidos a dosagens diárias de sódio sérico e urinário até o 5° dia pós-operatório, com controle de volume urinário neste período e dosagem de arginina-vasopressina (AVP) plasmática no 1°, 3° e 5° dias pós-operatórios. RESULTADOS: A SPS foi encontrada em 27/30 pacientes (90 por cento), em 14/27 (46,7 por cento) associada à diminuição dos níveis de AVP plasmática (síndrome mista). A SIADH foi encontrada em 3/30 pacientes (10 por cento). Não houve diferença entre os dois grupos de pacientes. CONCLUSÃO: A SPS foi a síndrome mais freqüente, em metade de casos associada ao DI. A SIADH foi a menos freqüente.

[Influence of the respiratory physiotherapy on intracranial pressure in severe head trauma patients]. / Influência da fisioterapia respiratória na pressão intracraniana em pacientes com traumatismo craniencefálico grave.

OBJECTIVE: To evaluate influence of the respiratory physiotherapy on intracranial pressure (ICP) in patients with severe head trauma. METHOD: Thirty five patients with severe head trauma were included in the study. The patients were divided into three groups: ICP 0-10, 11-20 and 21-30 mmHg. The following variables were measured: ICP and mean arterial pressure. Cerebral perfusion pressure was calculated as the difference between mean arterial and intracranial pressure. RESULTS: Endotracheal aspiration increased ICP in all patients. The mean arterial pressure didn't change and cerebral perfusion pressure decreased, but remaining normal value. CONCLUSION: Respiratory physiotherapy maneuvers can be safely applied in patients with severe head trauma with ICP below 30 mmHg. More attention should be taken during endotracheal aspiration.

Influência da fisioterapia respiratória na pressão intracraniana em pacientes com traumatismo craniencefálico grave / Influence of the respiratory physioterapy on intracranial pressure in severe head trauma patients

OBJETIVO: Estudar a influência das manobras de fisioterapia respiratória na pressão intracraniana (PIC) dos pacientes com trauma craniencefálico grave. MÉTODO: Trinta e cinco pacientes com trauma craniencefálico grave foram incluídos no estudo, sendo divididos em três grupos: com PIC < 10, 11-20 e 21-30 mmHg. As variáveis monitorizadas foram: PIC e pressão arterial média. A pressão de perfusão cerebral foi calculada pela diferença de pressão arterial média e PIC. RESULTADOS: A manobra de aspiração traqueal causou aumento de PIC em todos os grupos. A pressão arterial média não teve alterações e a pressão de perfusão cerebral diminuiu pouco, porém mantendo valores normais. CONCLUSÃO: As manobras de fisioterapia respiratória podem ser usadas com segurança em pacientes com traumatismo craniencefálico grave, com PIC abaixo de 30 mmHg.Certo cuidado deve ser tomado durante a aspiração traqueal.

Vasopressin serum levels in patients with severe brain lesions and in brain-dead patients.

INTRODUCTION: Patients with severe brain lesions (SBL) and brain-dead patients (BD) frequently present with vasopressin (AVP) secretion disorders. OBJECTIVE: To evaluate AVP serum levels in SBL and BD patients. DESIGN: Prospective, open label, observational trial. SETTING: A general teaching hospital. METHOD: Three groups of adult subjects (age> 18y) of both sexes were included in this study: control group: 29 healthy volunteers; SBL group: 17 patients with Glasgow Coma Scale (GCS)< 8; and BD group: 11 brain-dead patients. Samples of venous blood were collected in the morning at rest from healthy volunteers and at 8 hourly intervals over a period of 24h from SBL and BD patients for AVP determinations. Concomitantly, some clinical and laboratorial variables were also recorded. RESULTS: AVP serum levels (pg/ml) were [mean (SD); median]: control [2.2(1.1); 2.0]; SBL [5.7(6.3); 2.9]; and BD [2.6(1.0); 2.8]. AVP serum levels varied greatly in SBL patients, but without statistically significant difference in relation to the other groups (p=0.06). Hypotension (p=0.02), hypernatremia (p=0.0001), serum hyperosmolarity (p=0.0001) and urinary hypoosmolarity (p=0.003) were outstanding in BD patients when compared with SBL. CONCLUSIONS: The AVP serum levels did not demonstrate significant statistical difference between the groups, only showing a greater variability in SBL patients (manifested as serum spike levels). Hypernatremia and hyperosmolarity were present in BD patients, indicating a failure of the hypothalamic-pituitary system in AVP production and release.

Vasopressin serum levels in patients with severe brain lesions and in brain-dead patients

INTRODUÇÃO: Pacientes com lesão cerebral grave (LCG) ou com morte encefálica (ME) freqüentemente apresentam alterações na secreção de vasopressina (AVP). OBJETIVO: Avaliar os níveis séricos de AVP em pacientes com LCG e ME. DESENHO: Estudo prospectivo, aberto, observacional. LOCAL: Um hospital geral universitário. MÉTODO: Sujeitos adultos (idade >18 anos), de ambos os sexos, foram divididos em três grupos: grupo controle: 29 voluntários sadios; grupo LCG: 17 pacientes com pontuação na Escala de Coma de Glasgow (ECG)<8; grupo ME: 11 pacientes com diagnóstico de ME. Amostras de sangue venoso foram colhidas pela manhã, em repouso, nos pacientes do grupo controle, e de 8/8h, por 24h, nos pacientes dos grupos LCG e ME, para dosagens de AVP. Variáveis clínicas e laboratoriais de interesse foram anotadas concomitantemente. RESULTADOS: Os valores da AVP (pg/ml) foram [média (DP); mediana]: grupo controle [2,2(1,1); 2,0]; grupo LCG [5,7(6,3); 2,9] e grupo ME [2,6(1,0); 2,8]. Observou-se maior variação dos níveis séricos de AVP no grupo LCG, mas sem diferença estatisticamente significativa em relação aos demais (p=0,06). Hipotensão (p=0,02), hipernatremia (p=0,0001), hiperosmolaridade sérica (p=0,0001) e hiposmolaridade urinária (p=0,003) foram proeminentes no grupo ME em relação ao grupo LCG. CONCLUSÃO: Não foram encontradas diferenças estatisticamente significativas nos níveis de AVP entre os grupos, notando-se apenas uma maior variação de seus níveis séricos no grupo LCG (expressa sob a forma de picos séricos isolados). Hipernatremia e hiperosmolalidade estiveram presentes no grupo ME, indicando uma deficiência do sistema hipotálamo-hipofisário na produção e/ou liberação de AVP.