ABSTRACT
Introdução: O derrame pleural define-se como a acumulação anormal de líquido no espaço pleural, podendo ser causado por um significativo número de situações patológicas e originar importantes complicações, dependendo o seu tratamento da causa e da dimensão do derrame. A reeducação funcional respiratória, levada a efeito pelos enfermeiros especialistas em enfermagem de reabilitação, ao englobar um conjunto de técnicas que atuam na respiração com implicações diretas na mecânica alveolar, é vista como uma intervenção potenciadora da redução dos sintomas e otimização da funcionalidade. Neste contexto, o objetivo deste estudo pretende determinar de que forma a reeducação funcional respiratória tem impacto nas pessoas com derrame pleural. Métodos: Foi realizada uma revisão sistemática da literatura sobre estudos que avaliavam o impacto da reeducação funcional respiratória no derrame pleural. Fez-se pesquisa na PUBMED, EBSCO, Google Académico e SciELO de estudos publicados entre janeiro de 2008 e maio de 2017 que foram posteriormente avaliados, respeitando os critérios de inclusão e exclusão previamente estabelecidos. Resultados: Três estudos preencheram os critérios de inclusão, cujos resultados revelam que em pessoas com derrame pleural pretende-se, com a reeducação funcional respiratória, impedir a formação de aderências pleurais, evitar a limitação da mobilidade toraco-pulmonar e diafragmática; impedir ou corrigir as posições antiálgicas defeituosas e as suas consequências, impedir as deformações posturais como a retração do hemitórax comprometido e limitação da articulação escápulo-umeral; incentivar a expansão pulmonar e promover a reabsorção do derrame pleural com a finalidade de melhorar a performance pulmonar. Também as evidências encontradas nos permitiram elaborar um plano de intervenção direccionado à pessoa com derrame pelural. Conclusão: O programa de reeducação funcional respiratória é uma mais-valia como tratamento coadjuvante, trazendo benefícios significativos para as pessoas ao nível da performance pulmonar, assim como na diminuição do tempo de internamento.
Introduction: Pleural effusion is defined as the abnormal accumulation of fluid in the pleural space, which can be caused by a significant number of pathological conditions and cause major complications, depending on the treatment of the cause and size of the effusion. Respiratory functional reeducation, carried out by nurses specialized in rehabilitation nursing, encompassing a set of breathing techniques with direct implications in alveolar mechanics, is seen as an intervention that enhances the reduction of symptoms and optimization of functionality. In this context, the aim of this study is to determine how functional respiratory reeducation affects people with pleural effusion. Methods: A systematic review of the literature on studies evaluating the impact of respiratory functional reeducation on pleural effusion was carried out. PUBMED, EBSCO, Google Scholar and SciELO were searched for studies published between January 2008 and May 2017 that were subsequently evaluated, respecting the previously established inclusion and exclusion criteria. RESULTS: Three studies fulfilled the inclusion criteria, and the results show that in people with pleural effusion it is intended, with functional respiratory reeducation, to prevent the formation of pleural adhesions, to avoid the limitation of thoroco-pulmonary and diaphragmatic mobility; preventing or correcting defective analgesic positions and their consequences, preventing postural deformations such as compromised hemithorax retraction and limitation of the sputum-humeral joint; encourage lung expansion and promote the reabsorption of pleural effusion in order to improve pulmonary performance. Also the evidences found allowed us to elaborate a plan of intervention directed to the person with pelural effusion. Conclusion: The respiratory functional re-education program is an added value as an adjunct treatment, bringing significant benefits to patients in terms of pulmonary performance and decreased length of hospital stay.
Subject(s)
Pleural Effusion , Rehabilitation , Breathing Exercises , Review , Rehabilitation NursingABSTRACT
BACKGROUND: COPD is a high-mortality disease and projected to become the third leading cause of death worldwide by 2030. Our aim was to evaluate predictors of 3-y mortality and factors associated with early (1 y) and late (second and third year) mortality in subjects with severe COPD who completed a pulmonary rehabilitation program. METHODS: A historical cohort study was performed with subjects with COPD who were admitted to a day-hospital for chronic respiratory failure for a pulmonary rehabilitation program, from January 2008 to December 2010. The population was characterized based on sociodemographic factors, body mass index, smoking habits, lung function tests, respiratory failure, comorbidities, bacterial colonization, Modified Medical Research Council dyspnea index, 6-min walk test, mechanical ventilation, noninvasive ventilation, long-term oxygen therapy, hospital admissions, and mortality. RESULTS: From 183 patients who completed a pulmonary rehabilitation program, 93 had COPD. Our cohort had 78 male and 15 female subjects. The mean age ± SD was 68.6 ± 8.9 y, ranging from 43 to 85 y. After the pulmonary rehabilitation program, there were fewer, although not statistically significantly different hospital admissions (2.1 vs 1.7, P = .17). Three years after the pulmonary rehabilitation program, 34 subjects died (36.6%). Hypercapnic respiratory failure (P = .02), noninvasive ventilation (P = .002), lung cancer (P = .001), shorter 6-min walk distance (P = .03), and higher number of previous hospital admissions (P < .001) were associated with a higher mortality rate. CONCLUSION: There is a high mortality rate in late-stage patients with COPD. The most relevant factors associated with mortality were lung cancer, respiratory failure and noninvasive ventilation, severe exacerbations with hospitalization, and lower functional exercise capacity.
