Respiratory Muscle Strength and Quality of Life in Patients With Heart Failure and Their Main Correlated Factors: A Cross-sectional Study.

BACKGROUND: Heart failure may cause peripheral and respiratory muscle alterations, dyspnea, fatigue, and exercise intolerance, worsening the quality of life of patients. OBJECTIVES: The aims of this study were to analyze respiratory muscle strength and quality of life of patients with heart failure and correlate them with clinical variables and functional classification. METHODS: This cross-sectional study involved patients with heart failure. A manovacuometer assessed maximum inspiratory and expiratory pressures, and quality of life was assessed using the Minnesota Living with Heart Failure Questionnaire. Functional classification was categorized according to the New York Heart Association (NYHA) class in I, II, III, or IV. RESULTS: We included 60 patients (66.7% male) with a mean age of 62.0 years and mean left ventricular ejection fraction of 42.0%. Maximum inspiratory pressure and maximum expiratory pressure were close to normal (>70% of predicted) in most patients; however, a subgroup composed mostly of patients with dilated heart failure and NYHA class III (n = 21) presented low maximum inspiratory pressure values (59.2%; 95% confidence interval, 55.7%-62.8%). The mean total score of the Minnesota Living with Heart Failure Questionnaire was 44.4 points, being negatively correlated with left ventricular ejection fraction (r = -0.29, P = .02). Patients with NYHA class III and disease duration longer than 120 months presented higher total (P < .01) and physical dimension scores. CONCLUSIONS: Most patients had respiratory muscle strength close to normal; however, those with dilated heart failure and NYHA class III presented low maximum inspiratory pressure values. Quality of life was moderately compromised, mainly because of long disease duration, NYHA class III, and low left ventricular ejection fraction.

Efficacy of a rehabilitation protocol on pulmonary and respiratory muscle function and ultrasound evaluation of diaphragm and quadriceps femoris in patients with post-COVID-19 syndrome: a series of cases.

This study assessed the efficacy of a pulmonary rehabilitation (PR) on pulmonary and respiratory muscle function and thickness of quadriceps femoris and diaphragm of patients with post-COVID-19 syndrome. This series of cases followed nine patients who performed PR twice a week for six weeks. Patients received the following PR program: lung expansion therapy; respiratory muscle training; upper limb strength exercises; aerobic exercises on a treadmill. After the program, we observed increased peak expiratory flow (26.03%), forced vital capacity (FVC) (7.14%), forced expiratory volume in the first second (FEV1) (9.55%), and ratio between FEV1/FVC (6.19%). All parameters of respiratory muscle strength and endurance were improved. Diaphragmatic thickening fraction and thickness of quadriceps femoris also improved, whereas echo intensity of quadriceps reduced. Thus, RP protocol improved pulmonary function, respiratory muscle strength and endurance, and thickness of diaphragm and quadriceps femoris, and reduced echo intensity of quadriceps in patients with post-COVID-19 syndrome.

Modeling of covariates predicting renal allograft failure within six months after transplantation / Modelagem das covariáveis preditivas para falência do enxerto renal até seis meses do transplante

INTRODUCTION: Kidney transplantation (KT) is the renal replacement therapy (RRT) of choice for patients with chronic kidney disease (CKD). However, not every KT is successful and some patients persist on RRT. OBJECTIVE: To model a logistic regression with pre- and post-KT risk covariates capable of predicting secondary allograft dysfunction in need of RRT or reaching stage V of CKD until the first six months post-KT. METHODS: Cohort with KT recipients from Northeastern Brazil. Medical records of KT performed between 2011-2018 were analyzed. KT-recipients with insufficient data or who abandoned follow-up were excluded. The covariables analyzed were: demographic; infectious; pre- and post-KT comorbidities; panel reactive-antibodies; number of HLA mismatches; acute rejection episodes mediated by T-cell (ACR) or antibodies (AAR) six months after KT; and laboratory tests six months after KT. RESULTS: Covariates with higher risk for the analyzed outcomes six months after KT were: elderly KT recipients (OR:1.41; CI95%:1.01-1.99), time between onset of RRT and KT (ΔT-RRT&KT)>10years (OR:3.54; CI95%:1.27-9.87), diabetes mellitus (DM) pre-KT (OR:3.35; CI95%:1.51-7.46), pyelonephritis (OR:2.45; CI95%:1.24-4.84), polyomavirus nephropathy (OR:4.99; CI95%:1.87-13.3), AAS (OR:4.82; CI95%:1.35-17.2), 24h-proteinuria ≥300mg/24h (OR:5.05; CI95%:2.00-12.7) and serum calcium (Ca) <8.5mg/dL (OR:4.72; CI95%:2.00-11.1). The multivariate model presented an accuracy of 88.1% and the mean variance inflation factor is 1.81. CONCLUSION: Elderly-recipients, ΔT-RRT&KT>10 years, pre-KT DM, and post-KT aggressions until six months (pyelonephritis, polyomavirus nephropathy, ABMR, 24h-proteinuria≥300mg/24h, and Ca<8.5mg/dL) are associated with high predictive power for secondary allograft dysfunction in need of RRT or reaching CKD stage V until the first six months post-KT.

INTRODUÇÃO: Transplante renal (TR) é a terapia renal substitutiva (TRS) de escolha para pacientes com doença renal crônica (DRC). Entretanto, nem todo TR é bem-sucedido e alguns pacientes persistem em TRS. OBJETIVO: Modelar uma regressão logística com covariáveis de risco pré e pós-TR preditora da disfunção secundária do aloenxerto com necessidade de TRS ou alcance ao estágio V da DRC até os primeiros seis meses pós-TR. MÉTODOS: Coorte com receptores transplantados realizado em hospital no Nordeste brasileiro. Analisou-se registros médicos dos TR realizados entre 2011-2018. Receptores com dados insuficientes ou que abandonaram seguimento foram excluídos. Foram analisadas covariáveis: demográficas; infecciosas; comorbidades pré e pós-TR; painel de reatividade; incompatibilidades de HLA; episódios de rejeições agudas mediadas por células-T ou por anticorpos; exames laboratoriais seis meses pós-TR. RESULTADOS: Receptores idosos (OR:1,41; IC95%:1,01-1,99), tempo entre início da TRS e TR (∆T-TRS&TR)>10 anos (OR:3,54; IC95%:1,27-9,87), diabetes mellitus (DM) pré-TR (OR:3,35; IC95%:1,51-7,46), pielonefrite (OR:2,45; IC95%:1,24-4,84), nefropatia por poliomavírus (OR:4,99; IC95%:1,87-13,3), RAMA (OR:4,82; IC95%:1,35-17,2), proteinúria de 24h (Pt24h) ≥300mg/24h (OR:5,05; IC95%:2,00-12,7) e cálcio sérico (Ca)<8,5mg/dL (OR:4,72; IC95%:2,00-11,1) foram identificadas como covariáveis de maior risco para os desfechos analisados até seis meses pós-TR. O modelo multivariado apresentou acurácia de 88,1% e fator de inflação da variância médio de 1,81. CONCLUSÃO: Receptores idosos, ∆T-TRS&TR>10anos, DM pré-TR e agressões até seis meses pós-TR (pielonefrite, nefropatia por poliomavírus, RAMA, Pt24h≥300mg/24h e Ca<8,5mg/dL), apresentam alto poder preditivo para disfunção secundária do aloenxerto com necessidade de TRS ou alcance ao estágio V da DRC até os primeiros seis meses pós-TR.

Distinct phenotypes in COVID-19 may require distinct pulmonary rehabilitation strategies.

The novel coronavirus (SARS-CoV-2) has distinct clinical manifestations that can vary from an asymptomatic condition to severe acute respiratory failure. Phenotypes are attributable to different pathophysiological mechanisms and require different treatment strategies. The assessment and identification of different phenotypes can guide therapy configurations such as oxygen therapy, non-invasive ventilation, airway management, and tracheal intubation. Further studies are essential to provide information on the influence of phenotypes in the decision of rehabilitation strategies. The sequelae left in the respiratory system of COVID-19 survivors and its limitations will be a challenge for rehabilitation services worldwide. Lung injuries are directly related to the phenotypes presented, and depending on the degree of these injuries, rehabilitation strategies can be targeted. We believe that differentiating patients, according to their respective phenotypes, can improve decision-making in treatment and individualized rehabilitation.

Análise ultrassonográfica do quadríceps femoral de pacientes críticos sob ventilação mecânica / Ultrasound analysis of the quadricepsfemoris of critically ill patients on mechanical ventilation

Resumo Introdução: Devido aos diversos danos gerados pela imobilidade no leito, faz-se necessária uma avaliação precoce do estado muscular dos pacientes críticos. Objetivo: Comparar as imagens ultrassonográficas e correlacionar a espessura muscular com a ecointensidade do músculo reto femoral (RF) e vasto intermédio (VI) em 48 horas e com 7 dias de ventilação mecânica invasiva (VMI). Métodos: Trata-se de um estudo observacional prospectivo, com 53 imagens obtidas numa Unidade de Terapia Intensiva. Resultados: Houve redução na espessura muscular de RF, VI e espessura total. Observamos uma correlação negativa entre a espessura muscular e ecointensidade do RF nas primeiras 48 horas e 7 dias após a VMI. Já em relação ao VI, não observamos associação da espessura do VI com a ecointensidade nesse mesmo período. Conclusão: Evidenciamos uma relevante redução na espessura muscular do RF, VI e espessura total do quadríceps. Observamos uma alteração na composição da fibra muscular do RF, entretanto este comportamento não foi evidenciado no músculo VI.

Treinamento muscular respiratório em idosos: estudo de revisão / Respiratory muscle training in older adults: review article

OBJECTIVE: Respiratory muscle training has been considered one of the main strategies to alleviate sarcopenia in older adults. Therefore, the present study aimed to verify which respiratory muscle training protocols are most used in this population and their main benefits described in the literature. METHODS: A literature search was performed in the electronic databases PubMed, Latin American and Caribbean Health Sciences Literature (LILACS) and Scientific Electronic Library Online (SciELO). For this, we used the terms: respiratory muscle training, older adults, and muscle weakness. A total of 80 articles were studied, of which only 8 met the inclusion criteria of this study, whose methodology, variables studied, and outcome were analyzed. RESULTS: Among the 8 articles analyzed, we can observe an important diversity of the studied protocols; and all articles showed the most varied gains possible with respiratory muscle training. CONCLUSION: The protocols used in the various studies depend directly on the objective to be achieved with respiratory muscle training; and the main outcomes were improvements in strength, lung function, physical fitness level, quality of life, inflammatory markers and glucose intake.

OBJETIVO: O treinamento muscular respiratório vem sendo considerado uma das principais estratégias para amenizar a sarcopenia em idosos, portanto, o presente estudo teve por objetivo verificar quais protocolos de treinamento muscular respiratório são mais utilizados em idosos e os seus principais benefícios encontrados na literatura. MÉTODOS: Foi realizada pesquisa bibliográfica nas bases de dados eletrônicas PubMed, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Scientific Electronic Library Online (SciELO). Para tanto, foram utilizados os termos: treinamento muscular respiratório, idosos e fraqueza muscular. Foi estudado um total de 80 artigos, dos quais apenas 8 preencheram os critérios de inclusão deste estudo, cuja metodologia, variáveis estudadas e desfecho foram analisados. RESULTADOS: Dos oito artigos analisados, podemos observar uma importante diversidade dos protocolos estudados; e em todos os artigos foram encontrados ganhos dos mais variados possíveis com o treinamento muscular respiratório. CONCLUSÃO: Os protocolos utilizados nos diversos estudos dependem diretamente do objetivo a ser alcançado com o treinamento muscular respiratório; e os principais desfechos foram a melhora na força, na função pulmonar, no nível de aptidão física, na qualidade de vida, em marcadores inflamatórios e no consumo da glicose.

The effect of inspiratory muscle training on the quality of life, immune response, inspiratory and lower limb muscle strength of older adults: a randomized controlled trial / O efeito do treinamento muscular inspiratório em idosos sobre a qualidade de vida, resposta imune, força muscular inspiratória e de membros inferiores: um ensaio clínico randomizado

Abstract Objective: To evaluate the impact of inspiratory muscle training (IMT) on the quality of life, immune response, inspiratory and lower limb muscle strength of older adults. Method: A randomized clinical trial was conducted with 30 institutionalized older adults. They were allocated into two groups: the IMT group (n=15), which underwent IMT with PowerBreathe Classic, using a load of 60% of maximal inspiratory pressure (MIP). This was performed using a 30 repetition protocol, three times a week, for six weeks. The second group was the control group (n=15) which did not perform any type of therapeutic intervention. In both groups, MIP, lower limb strength by sit-up test, quality of life by the SF-36 questionnaire and C-reactive protein (CRP) were evaluated. Results: The results demonstrated the homogeneity between the groups regarding the demographic and clinical variables. The IMT group showed an increase in the variation of MIP (9.20±7.36 cmH2O) compared to the control (0.93±8.79 cmH2O). Improvement was also observed in the sitting and standing test (p<0.05) (Tukey Test) in the difference between the values ​​before and after the IMT. In terms of quality of life, two of the eight SF-36 domains were influenced by the IMT, namely: functional capacity and limitations due to physical factors. There were no changes in CRP in either group. Conclusion: IMT improved the inspiratory muscle strength, lower limb strength and quality of life of institutionalized older adults. These findings reinforce the contribution of this therapy to reducing the deleterious effects of aging.

Resumo Objetivo: Avaliar o impacto do treinamento muscular inspiratório (TMI) sobre a qualidade de vida, resposta imune, força muscular inspiratória e de membros inferiores de idosos. Método: Trata-se de um ensaio clínico randomizado, realizado com 30 idosos institucionalizados. Eles foram alocados em dois grupos, Grupo TMI (n=15): TMI com o PowerBreathe Classic, usando carga de 60% da pressão inspiratória máxima (PIM). O TMI foi realizado através de um protocolo de 30 repetições, três vezes por semana, durante seis semanas; e Grupo controle (n=15): não realizavam nenhum tipo de intervenção terapêutica. Em ambos os grupos foram avaliadas a PIM, a força de membros inferiores pelo teste de sentar-levantar, a qualidade de vida pelo questionário SF-36 e a proteína C reativa (PCR). Resultados: Os resultados demonstraram a homogeneidade entre os grupos em relação às variáveis demográficas e clínicas. O grupo TMI apresentou um aumento da variação da PIM (9,20±7,36cmH2O) comparado ao controle (0,93±8,79 cmH2O). Foi observada ainda melhora no teste de sentar e levantar (p<0,05) (teste de Tukey) na diferença entre os valores antes e após o TMI. Em relação à qualidade de vida, dois dos oito domínios do SF-36 sofreram influência do TMI, são eles: capacidade funcional e limitações por aspectos físicos. Não ocorreram mudanças na PCR em nenhum dos grupos. Conclusão: o TMI foi capaz de melhorar a força muscular inspiratória, a força de membros inferiores, e a qualidade de vida de idosos institucionalizados. Estes achados reforçam a contribuição desta terapêutica em reduzir os efeitos deletérios do envelhecimento.

Oxidative stress and immune system analysis after cycle ergometer use in critical patients.

OBJECTIVE:: The passive cycle ergometer aims to prevent hypotrophy and improve muscle strength, with a consequent reduction in hospitalization time in the intensive care unit and functional improvement. However, its effects on oxidative stress and immune system parameters remain unknown. The aim of this study is to analyze the effects of a passive cycle ergometer on the immune system and oxidative stress in critical patients. METHODS:: This paper describes a randomized controlled trial in a sample of 19 patients of both genders who were on mechanical ventilation and hospitalized in the intensive care unit of the Hospital Agamenom Magalhães. The patients were divided into two groups: one group underwent cycle ergometer passive exercise for 30 cycles/min on the lower limbs for 20 minutes; the other group did not undergo any therapeutic intervention during the study and served as the control group. A total of 20 ml of blood was analysed, in which nitric oxide levels and some specific inflammatory cytokines (tumour necrosis factor alpha (TNF-α), interferon gamma (IFN-γ) and interleukins 6 (IL-6) and 10 (IL-10)) were evaluated before and after the study protocol. RESULTS:: Regarding the demographic and clinical variables, the groups were homogeneous in the early phases of the study. The nitric oxide analysis revealed a reduction in nitric oxide variation in stimulated cells (p=0.0021) and those stimulated (p=0.0076) after passive cycle ergometer use compared to the control group. No differences in the evaluated inflammatory cytokines were observed between the two groups. CONCLUSION:: We can conclude that the passive cycle ergometer promoted reduced levels of nitric oxide, showing beneficial effects on oxidative stress reduction. As assessed by inflammatory cytokines, the treatment was not associated with changes in the immune system. However, further research in a larger population is necessary for more conclusive results.

Oxidative stress and immune system analysis after cycle ergometer use in critical patients

OBJECTIVE: The passive cycle ergometer aims to prevent hypotrophy and improve muscle strength, with a consequent reduction in hospitalization time in the intensive care unit and functional improvement. However, its effects on oxidative stress and immune system parameters remain unknown. The aim of this study is to analyze the effects of a passive cycle ergometer on the immune system and oxidative stress in critical patients. METHODS: This paper describes a randomized controlled trial in a sample of 19 patients of both genders who were on mechanical ventilation and hospitalized in the intensive care unit of the Hospital Agamenom Magalhães. The patients were divided into two groups: one group underwent cycle ergometer passive exercise for 30 cycles/min on the lower limbs for 20 minutes; the other group did not undergo any therapeutic intervention during the study and served as the control group. A total of 20 ml of blood was analysed, in which nitric oxide levels and some specific inflammatory cytokines (tumour necrosis factor alpha (TNF-α), interferon gamma (IFN-γ) and interleukins 6 (IL-6) and 10 (IL-10)) were evaluated before and after the study protocol. RESULTS: Regarding the demographic and clinical variables, the groups were homogeneous in the early phases of the study. The nitric oxide analysis revealed a reduction in nitric oxide variation in stimulated cells (p=0.0021) and those stimulated (p=0.0076) after passive cycle ergometer use compared to the control group. No differences in the evaluated inflammatory cytokines were observed between the two groups. CONCLUSION: We can conclude that the passive cycle ergometer promoted reduced levels of nitric oxide, showing beneficial effects on oxidative stress reduction. As assessed by inflammatory cytokines, the treatment was not associated with changes in the immune system. However, further research in a larger population is necessary for more conclusive results.

Quality of life and physical activity in intensive care professionals from middle São Francisco.

OBJECTIVE: The objective was to assess the level of physical activity (LPA) and the quality of life QL of the professionals who work in ICU. METHOD: This was a cross-sectional study carried out in Adult ICUs. LPA was assessed by the International Questionnarie of Physical Activity--short form (IQPA-SF) and the QL by the Medical Outcomes Study 36 (SF-36) questionnaire. RESULTS: It was classified active 50.89% out of a total of 59 professionals. Nursing technicians were considered the most active with 60.6%. The QL of the professionals who were considered active were better when compared to inactives, with statistical differences to the category of physical aspects limitation, social aspects and mental health. The working hours were higher than recommend, the physicians were higher than the physical therapist, nurses and technicians nurses (p = 0.046). CONCLUSION: Physically active professionals who work in ICU had higher quality of life probably why have lower hours of work and consequently more free time to engage in physical activity.

Qualidade de vida e atividade física em profi ssionais de terapia intensiva do sub médio São Francisco / Calidad de vida y actividad física de la profesionales en cuidados intensivos del promedio San Francisco / Quality of life and physical activity in intensive care professionals from middle São Francisco

Objetivo: o objetivo deste estudo foi avaliar o nível de atividade física (NAF) e a qualidade de vida (QV) dos profissionais que trabalham em Unidade de Terapia Intensiva (UTI). Método: tratou-se de um estudo transversal realizado em UTIs clínicas adultos, onde o NAF foi avaliado pelo questionário internacional de atividade física (IPAQ) e a QV através do questionário Medical Outcomes Study 36 (SF-36). Resultados: estavam ativos 50,85% de 59 profissionais, sendo os técnicos de enfermagem considerados os mais ativos (60,6%). A QV dos profissionais ativos foi melhor quando comparados aos inativos, com diferenças estatísticas para os domínios limitação por aspectos físicos, aspecto social e saúde mental. A jornada de trabalho estava acima do recomendado, sendo a dos médicos maiores que as dos fisioterapeutas, enfermeiros e técnicos de enfermagem (p = 0,04). Conclusão: profissionais de UTI fisicamente ativos apresentaram maior qualidade de vida provavelmente por possuírem uma menor jornada de trabalho e consequentemente mais tempo livre para realizar atividades físicas. .

Objetivo: el objetivo de este estudio fue evaluar el nivel de actividad física (NAF) y la calidad de vida (QOL) de los profesionales que trabajan en la unidad de cuidados intensivos (UCI). Método: este fue un estudio transversal realizado en clínicas UCI de adultos, donde el NAF fue evaluado por el Cuestionario Internacional de Actividad Física (IPAQ) y la calidad de vida a través del Medical Outcomes Study 36 (SF-36). Resultados: los activos fueron 50,85% de 59 profesionales, técnicos y enfermeras consideran los más activos (60,6%). La calidad de vida de los profesionales en activo fue mejor en comparación con los inactivos, con diferencias estadísticas para los dominios limitados por aspecto físico, social y de salud mental. La jornada de trabajo estaba por encima de los niveles recomendados, son más grandes que las de los fisioterapeutas médicos, enfermeras y auxiliares de enfermería (p = 0,04). Conclusión: profesionales físicamente activos en la UCI ha mejorado la calidad de vida, probablemente porque tienen una carga de trabajo más pequenos y por lo tanto más tiempo libre para participar en actividades físicas. .

Objective: the objective was to assess the level of physical activity (LPA) and the quality of life QL of the professionals who work in ICU. Method: this was a cross-sectional study carried out in Adult ICUs. LPA was assessed by the International Questionnarie of Physical Activity - short form (IQPA-SF) and the QL by the Medical Outcomes Study 36 (SF-36) questionnaire. Results: it was classified active 50.89% out of a total of 59 professionals. Nursing technicians were considered the most active with 60.6%. The QL of the professionals who were considered active were better when compared to inactives, with statistical differences to the category of physical aspects limitation, social aspects and mental health. The working hours were higher than recommend, the physicians were higher than the physical therapist, nurses and technicians nurses (p = 0.046). Conclusion: physically active professionals who work in ICU had higher quality of life probably why have lower hours of work and consequently more free time to engage in physical activity. .

Implicações da Revascularização do Miocárdiona Qualidade de Vida: Três meses de pós-operatório / Implications of Myocardial Revascularization on Quality Of Life: A Three-Month Postoperative Follow-Up

Verificar as implicações da cirurgia derevascularização do miocárdio (CRVM) na qualidade de vidade pacientes após um período de três meses do procedimentocirúrgico, observando os aspectos físicos, emocionais esociais que podem estar alterados nesses indivíduos.Material e Métodos: Foram estudados 33 pacientes comdoença arterial coronariana, submetidos à CRVM e areabilitação cardiovascular fase I. A análise da qualidade devida dos pacientes ocorreu pela apuração, em dois momentos,do questionário padronizado, o SF-36 que tem o propósito deexaminar a percepção do estado de saúde pelo própriopaciente. Resultados: Quando comparado o momento do précirúrgicocom os três meses após a cirurgia foi observadoque houve melhora em todos os domínios do questionário dequalidade de vida SF-36, exceto no domínio de limitação poraspectos emocionais (p-valor = 0,920). A melhora foiespecialmente observada nos domínios da capacidadefuncional, da dor, do estado geral de saúde e da saúdemental (p-valor < 0,001), sendo também observada nosdomínios da limitação por aspectos físicos (p-valor = 0,020),da vitalidade (p-valor = 0,001) e dos aspectos sociais (0,039).Conclusões: Demonstrou-se que a CRVM cumpre o objetivode melhorar a qualidade de vida dos pacientes, porém nãose pode subestimar a influência da reabilitação fase I nessamelhora...

Objective: To verify the implications of myocardialrevascularization surgery (MRS) on patients’ quality of lifeafter a three-month postoperative follow-up, with a focus onphysical, emotional and social factors that may be altered inthese individuals. Material and Methods: A total of 33 patientswith coronary artery disease who underwent MRS and phaseI cardiovascular rehabilitation, were included in the study.The analysis of patients’ quality of life was carried out in twostages according to a standardized questionnaire (SF-36),which aims to examine the perception of patients on theirown health status. Results: When the preoperative periodwas compared to that of three months after surgery, therewas an improvement in all domains covered by the SF-36questionnaire, excepting for the incapability due to emotionalaspects (p-value = 0.920). The improvement was observedparticularly in the fields of functional capacity, pain, generalhealth and mental health (p-value < 0.001). Furthermore, therewas an improvement in the fields of incapability due tophysical aspects (p-value = 0.020), vitality (p-value = 0.001)and social aspects (p-value = 0.039). Conclusions: It wasdemonstrated that myocardial revascularization surgeryimproves patients’ quality of life. However, one cannotunderestimate the influence of phase I rehabilitation on suchimprovements...

Smoking as risk factor for chronic kidney disease: systematic review.

INTRODUCTION: Chronic kidney disease (CKD) and smoking are public health problems. OBJECTIVE: To assess smoking as a risk factor for progression of CKD. METHODS: We conducted a systematic review in Medline, LILACS, SciELO, Google Scholar, Embase and Trials.gov with articles published until February/2013. Were included: cohort, clinical trials and case-control. Performed in humans, aged ≥ 18 years with smoking as a risk factor for progression of CKD. We excluded studies that reported no smoking and CKD in the title or had proposed to reduce smoking. RESULTS: Among 94 citations, 12 articles were selected. Of these, six were multicenter conducted in developed countries, four were randomized. Males predominated 51-76%. There was associated with smoking progression in 11 studies. It was found that the consumption ≥ 15 packs/ year increases the risk of progression of CKD. CONCLUSION: Smoking is a risk factor for progression of CKD.

Tabagismo como fator de risco para a doença renal crônica: revisão sistemática / Smoking as risk factor for chronic kidney disease: systematic review

Introdução: A doença renal crônica (DRC) e o tabagismo são problemas de saúde pública. Objetivo: Analisar o tabagismo como fator risco para a progressão da DRC. Métodos: Realizou-se uma revisão sistemática nas bases Medline, LILACS, SciELO, Google Acadêmico, Trials.gov e Embase com artigos publicados até fevereiro de 2013. Incluíram-se estudos: tipo coorte, ensaios clínicos e caso-controle. Realizados em seres humanos com idade ≥ 18 anos tendo tabagismo como fator de risco para progressão da DRC. Excluíram-se estudos que não referiam tabagismo e DRC no título ou tinham proposta de combate ao fumo. Resultados: Das 94 citações, 12 artigos foram selecionados. Destes, seis eram multicêntricos realizados em países desenvolvidos e quatro foram aleatorizados. Predominou o sexo masculino 51%-76%. Houve progressão associada ao tabagismo em 11 estudos. Identificou-se que o consumo ≥ 15 maços/ ano aumenta o risco de progressão da DRC. Conclusão: Tabagismo é fator de risco para progressão da DRC. .

Introduction: Chronic kidney disease (CKD) and smoking are public health problems. Objective: To assess smoking as a risk factor for progression of CKD. Methods: We conducted a systematic review in Medline, LILACS, SciELO, Google Scholar, Embase and Trials.gov with articles published until February/2013. Were included: cohort, clinical trials and case-control. Performed in humans, aged ≥ 18 years with smoking as a risk factor for progression of CKD. We excluded studies that reported no smoking and CKD in the title or had proposed to reduce smoking. Results: Among 94 citations, 12 articles were selected. Of these, six were multicenter conducted in developed countries, four were randomized. Males predominated 51-76%. There was associated with smoking progression in 11 studies. It was found that the consumption ≥ 15 packs/ year increases the risk of progression of CKD. Conclusion: Smoking is a risk factor for progression of CKD. .

Effects of electrical muscle stimulation early in the quadriceps and tibialis anterior muscle of critically ill patients.

BACKGROUND: Electrical muscle stimulation (EMS) is applied to critically ill patients in order to improve their muscle strength, thereby preventing hypotrophy and promoting functional recovery. OBJECTIVE: To assess the effects of early EMS on the range of movement of the ankle joint, and on thigh and leg circumference in critically ill patients. METHODS: This is a prospective randomized clinical trial comprising 11 patients undergoing mechanical ventilation. Before and after EMS the thigh and leg circumference in both lower limbs and the goniometry of the tibiotarsal joint were measured. The angle of 90° on the goniometer was taken as the standard neutral position (NP), with the arm fixed on the lateral malleolus of the ankle joint. Other measurements, namely dorsiflexion and plantar flexion, referred to as mobile arm, were taken from the NP. These recordings were obtained following an active contraction of the patients' muscles. RESULTS: Compared with the electrostimulated limb, a difference in dorsiflexion of the control limb was observed (96.2 ± 24.9 versus 119.9 ± 14.1°; p = 0.01). A girth of 10 cm of the leg was found in limb reduction when compared to the electrostimulated one (24.7 ± 3.1 versus 26.4 ± 4.0 cm; p = 0.03). CONCLUSIONS: EMS used at low current intensity and for a short duration failed to prevent muscle atrophy in critically ill patients. However, we did find a significant improvement in active dorsiflexion of the ankle joint suggesting that it could help to prevent against stance plantar flexion in these patients.

Avaliação da Capacidade Funcional e daLimitação Física em SujeitosPós-Revascularização Miocárdica / Assessment of Functional Capacity and Physical Limitation in Subjects Submitted to Myocardial Revascularization

Objetivo: Avaliar a capacidade funcional e a limitação física,em pacientes submetidos à cirurgia de revascularização domiocárdio (CRVM) com seis meses do pós-operatório.Material e Métodos: Foram estudados 28 pacientes comdoença arterial coronariana, submetidos à CRVM entrenovembro de 2008 e abril de 2009. Foram avaliadas acapacidade funcional e a limitação por aspectos físicos pelaapuração dos respectivos domínios presentes noquestionário padronizado Medical Outcomes Study - shortform 36 (MOS-SF), e o nível de atividade física, por meio doInternational Physical Activity Questionnaire (IPAQ).Resultados: Houve diferenças significantes entre o pré e opós-operatório para os domínios “capacidade funcional”(41,79 vs. 70,18; p < 0,001) e “limitação por aspectos físicos”(3,57 vs. 35,71; p < 0,001). Foi evidenciado que os pacientesclassificados como “ativos” pelo IPAQ tiveram pontuaçãosignificativamente maior do que o classificado com“sedentário” para o domínio “capacidade funcional” (81,07vs. 45,00; p = 0,012) e que os classificados como“insuficientemente ativo” (58,93 vs. 11,11; p = 0,006) e“sedentário” (58,93 vs. 15,00; p = 0,006) no domínio “limitaçãopor aspectos físicos”. Conclusão: Foi observado acréscimona pontuação dos domínios “capacidade funcional” e“limitação por aspectos físicos” após seis meses da CRVM,o que traduz em aumento da capacidade de realizar atividadesque no pré-operatório não eram possíveis. A melhora destesdomínios foi mais expressiva em indivíduos que praticaramatividade física regularmente após o procedimento cirúrgico...

Objective: To evaluate the functional capacity and physicallimitation in patients submitted to coronary artery bypass graft(CABG) at six months after surgery. Material and Methods:28 patients with coronary artery disease who underwentCABG between November 2008 and April 2009 were includedin this study. Their functional capacity and physical limitationwere approached considering the respective domains presentin the standardized questionnaire Medical Outcomes StudyShort Form (MOS-SF), as well as the level of physical activitythrough the International Physical Activity Questionnaire(IPAQ), in the period of six months after the CABG. Results:There were significant differences before and after surgeryfor the domains “functional capacity” (41.79 vs. 70.18; p<0.001) and “limited by physical aspects” (3.57 vs. 35.71 p<0.001). It was shown that patients classified as “active” byIPAQ had significantly higher scores than those rated as“sedentary” for the domain “functional capacity” (81.07 vs.45.00; p = 0.012) and also higher than those classified as“insufficiently active” (58.93 vs. 11.11; p = 0.006) and“sedentary” (58.93 vs. 15.00; p = 0.006) for the domain “limitedby physical aspects.” Conclusion: There was an increase inthe scores of the domains “functional capacity” and “limitationby physical aspects” six months after CABG, which translatesinto increased ability to perform activities that could not beperformed preoperatively. The improvement of these areaswas more significant in subjects who practiced regularphysical activity after surgery...

Influência da mobilização precoce na força muscular periférica e respiratória em pacientes críticos / Influence of early mobilization on respiratory and peripheral muscle strength in critically ill patients

OBJETIVO: Avaliar os efeitos de um protocolo de mobilização precoce na musculatura periférica e respiratória de pacientes críticos. MÉTODOS: Ensaio clínico, controlado e randomizado realizado em 59 pacientes de ambos os gêneros, em ventilação mecânica. Os pacientes foram divididos em grupo fisioterapia convencional - grupo controle, n=14, que realizou a fisioterapia do setor, e grupo mobilização precoce, n=14, que recebeu um protocolo sistemático de mobilização precoce. A força muscular periférica foi avaliada por meio do Medical Research Council e a força muscular respiratória (dada por pressão inspiratória máxima e pressão expiratória máxima) foi mensurada pelo manovacuômetro com uma válvula unidirecional. A mobilização precoce sistemática foi realizada em cinco níveis. RESULTADOS: Para os valores de pressão inspiratória máxima e do Medical Research Council, foram encontrados ganhos significativos no grupo mobilização precoce. Entretanto, a pressão expiratória máxima e o tempo de ventilação mecânica (dias), tempo de internamento na unidade de terapia intensiva (dias), e tempo de internamento hospitalar (dias) não apresentaram significância estatística. CONCLUSÃO: Houve ganho da força muscular inspiratória e periférica para a população estudada quando submetida a um protocolo de mobilização precoce e sistematizado.

OBJECTIVE:To evaluate the effects of an early mobilization protocol on respiratory and peripheral muscles in critically ill patients. METHODS: A randomized controlled clinical trial was conducted with 59 male and female patients on mechanical ventilation. The patients were divided into a conventional physical therapy group (control group, n=14) that received the sector's standard physical therapy program and an early mobilization group (n=14) that received a systematic early mobilization protocol. Peripheral muscle strength was assessed with the Medical Research Council score, and respiratory muscle strength (determined by the maximal inspiratory and expiratory pressures) was measured using a vacuum manometer with a unidirectional valve. Systematic early mobilization was performed on five levels. RESULTS: Significant increases were observed for values for maximal inspiratory pressure and the Medical Research Council score in the early mobilization group. However, no statistically significant improvement was observed for maximal expiratory pressure or MV duration (days), length of stay in the intensive care unit (days), and length of hospital stay (days). CONCLUSION: The early mobilization group showed gains in inspiratory and peripheral muscle strength.

Effects of controlled and pressure support mechanical ventilation on rat diaphragm muscle.

PURPOSE: The objective of this study was to analyze the effects of Pressure Controlled Ventilation mode (PCV-C) and PSV mode in diaphragm muscle of rats. METHODS: Wistar rats (n=18) were randomly assigned to the control group or to receive 6 hours of PCV and PSV. After this period, animals were euthanized and their diaphragms were excised, frozen in liquid nitrogen and stored in at -80º C for further histomorphometric analysis. RESULTS: Results showed a 15% decrease in cross-sectional area of muscle fibers on the PCV-C group when compared to the control group (p<0.001) and by 10% when compared to the PSV group (p<0.05). Minor diameter was decreased in PCV-C group by 9% when compared with the control group (p<0.001) and by 6% when compared to the PSV group (p<0.05). When myonuclear area was analyzed, a 16% decrease was observed in the PCV-C group when compared to the PSV group (p<0.05). No significant difference between the groups was observed in myonuclear perimeter (p>0.05). CONCLUSION: Short-term controlled mechanical ventilation seems to lead to muscular atrophy in diaphragm fibers. The PSV mode may attenuate the effects of VIDD.

Fisioterapia em pacientes críticos adultos: recomendações do Departamento de Fisioterapia da Associação de Medicina Intensiva Brasileira / Physical therapy in critically ill adult patients: recommendations from the Brazilian Association of Intensive Care Medicine Department of Physical Therapy

A incidência de complicações decorrentes dos efeitos deletérios da imobilidade na unidade de terapia intensiva contribui para o declínio funcional, aumento dos custos assistenciais, redução da qualidade de vida e mortalidade pós-alta. A fisioterapia é uma ciência capaz de promover a recuperação e preservação da funcionalidade, podendo minimizar estas complicações. Para nortear as condutas fisioterapêuticas nas unidades de terapia intensiva, um grupo de especialistas reunidos pela Associação de Medicina Intensiva Brasileira (AMIB), desenvolveu recomendações mínimas aplicáveis à realidade brasileira. Prevenção e tratamento de atelectasias, condições respiratórias relacionadas à remoção de secreção e condições relacionadas a falta de condicionamento físico e declínio funcional foram as três áreas discutidas. Além destas recomendações específicas, outro aspecto importante foi a consideração de que a prescrição e execução de atividades, mobilizações e exercícios físicos são do domínio específico do fisioterapeuta e o seu diagnóstico deve preceder qualquer intervenção.

Complications from immobility in intensive care unit patients contribute to functional decline, increased healthcare costs, reduced quality of life and higher post-discharge mortality. Physical therapy focuses on promoting recovery and preserving function, and it may minimize the impact of these complications. A group of Brazilian Association of Intensive Care Medicine physical therapy experts developed this document that contains minimal physical therapy recommendations appropriate to the Brazilian real-world clinical situation. Prevention and treatment of atelectasis, procedures related to the removal of secretions and treatment of conditions related to physical deconditioning and functional decline are discussed. Equally important is the consideration that prescribing and executing activities, mobilizations and exercises are roles of the physical therapist, whose diagnosis should precede any intervention.