Early mobilization in victims of traumatic brain injury / Mobilização precoce em vítimas de traumatismo cranioencefálico

INTRODUCTION: Several studies have shown that early mobilization is safe and beneficial for patients admitted to the intensive care units (ICUs), especially for those with mechanical ventilation (MV). OBJECTIVE: To investigate the benefits of early mobilization physiotherapeutic techniques applied to patients who suffered craniocerebral trauma (CCT). METHODS: This is an experimental study that evaluated clinical data from 27 patients. In sedated patients, mobilization and passive stretching were performed on the upper and lower limbs; in those without sedation, active-assisted, free and resisted exercises were included. RESULTS: The experimental group was composed of 51.8% of the participants and the control group by 48.2%, the majority being male (81.5%) with a median age of 43 years. The patients in the experimental group had an average of 9.5 days (2.2-14.7) of mechanical ventilation (MV), and those belonging to the control group, of 17 days (7-21.7) with MV (p=0.154). The patients in the experimental group had an average of 13.5 days in the ICU, against an average of 17 days in the control group (p=0.331), and an average of 20.5 days in hospital against 24 days in the control group (p=0.356). CONCLUSION: Early mobilization should be applied to critically ill patients as it can decrease the length of stay in the ICU and the hospital.

INTRODUÇÃO: Diversos estudos têm mostrado que a mobilização precoce é segura e benéfica para pacientes internados em unidades de terapia intensiva (UTIs), especialmente para aqueles com ventilação mecânica (VM). OBJETIVO: Investigar os benefícios das técnicas fisioterapêuticas de mobilização precoce aplicada aos pacientes que sofreram traumatismo cranioencefálico (TCE). MÉTODOS: Trata-se de um estudo quasi-randomizado, que incluiu 27 com TCE divididos em dois grupos: controle (n=13) e experimental (n=14) pacientes. No grupo experimental, os pacientes sedados foram submetidos à mobilização e alongamentos passivos nos membros superiores e inferiores; naqueles sem sedação, foram incluídos exercícios ativo-assistidos, livres e resistidos. RESULTADOS: O grupo experimental foi composto por 51,8% dos participantes da pesquisa e o grupo controle por 48,2%, sendo a maioria do sexo masculino (81,5%) com mediana de idade de 43 anos. Os pacientes do grupo experimental apresentaram média de 9,5 dias (2,2-14,7) de ventilação mecânica, e os pertencentes ao grupo controle, de 17 dias (7-21,7) com de VM (p=0,154). Os pacientes do grupo experimental apresentaram média de 13,5 dias de internação em UTI, contra média de 17 dias do grupo controle (p=0,331), e média de 20,5 dias de internação hospitalar contra 24 dias do grupo controle (p=0,356). CONCLUSÃO: A mobilização precoce é uma técnica que deve ser aplicada em pacientes críticos dentro das UTIs, pois pode diminuir o tempo de internação na UTI e hospitalar.

Bioprosthesis versus Mechanical Valve Heart Prosthesis: Assessment of Quality of Life

Abstract Background: The aim of this study was to evaluate the QoL of patients undergoing heart valve replacement using the SF-36 questionnaire, compare it between patients with mechanical prosthesis and patients with bioprosthesis, and correlate the results with sociodemographic variables. Objective: To assess the QoL of patients undergoing heart valve replacement and compare it between patients with bioprosthetic valves and patients with mechanical prosthetic valves. Methods: We included 36 consecutive patients (16 men) with a mean age of 51 years and six months, who underwent mitral or aortic valve replacement from September 2007 to December 2011. The study was conducted between March and May 2012 and involved the application of the SF-36 survey and a sociodemographic questionnaire. Statistical tests were performed, and data are expressed as absolute frequency and percentile, and median and interquartile range (P25 and P75) (Mann-Whitney test), considering a significance of 95%. Results: The average time of surgery was 32.5 months (8-61 months). Participants were asked about the practice of physical activity, and 41.7% were physically active. For the SF-36 domains, the highest scores were observed for the social domain whereas the lowest scores were found for mental health, with a mean of 89.25 and 54.44, respectively. In the statistical analysis, we found statistically higher values in emotional functional for patients with mechanical valve prosthesis (p = 0.0084). Conclusion: The QoL of the patients undergoing heart valve replacement improves considerably after the surgery, except for the mental health domain, probably due to the low practice of physical activity. The type of prosthesis seems not to influence the QoL or the patients in the late postoperative period.