The lack of knowledge on acute stroke in Brazil: A cross-sectional study with children, adolescents, and adults from public schools.

OBJECTIVE: Stroke is an important cause of disability and death in adults worldwide. However, it is preventable in most cases and treatable as long as patients recognize it and reach capable medical facilities in time. This community-based study investigated students' stroke knowledge, Emergency Medical Services (EMS) activation, associated risk factors, warning signs and symptoms, and prior experience from different educational levels in the KIDS SAVE LIVES BRAZIL project. METHODS: The authors conducted the survey with a structured questionnaire in 2019‒2020. RESULTS: Students from the elementary-school (n = 1187, ∼13 y.o., prior experience: 14%, 51% women), high-school (n = 806, ∼17 y.o., prior experience: 13%, 47% women) and University (n = 1961, ∼22 y.o., prior experience: 9%, 66% women) completed the survey. Among the students, the awareness of stroke general knowledge, associated risk factors, and warning signs and symptoms varied between 42%‒66%. When stimulated, less than 52% of the students associated stroke with hypercholesterolemia, smoking, diabetes, and hypertension. When stimulated, 62%‒65% of students recognized arm weakness, facial drooping, and speech difficulty; only fewer identified acute headache (43%). Interestingly, 67% knew the EMS number; 81% wanted to have stroke education at school, and ∼75% wanted it mandatory. Women, higher education, and prior experience were associated with higher scores of knowing risk factors (OR = 1.28, 95% CI: 1.10‒1.48; OR = 2.12, 95% CI: 1.87‒2.40; OR = 1.46, 95% CI: 1.16‒1.83; respectively), and warning signs- symptoms (OR = 2.22, 95% CI: 1.89‒2.60; OR = 3.30, 95% CI: 2.81‒3.87; OR = 2.04, 95% CI: 1.58‒2.63; respectively). CONCLUSION: Having higher education, prior experience, and being a woman increases stroke-associated risk factors, and warning signs and symptoms identification. Schoolchildren and adolescents should be the main target population for stroke awareness.

The lack of knowledge on acute stroke in Brazil: A cross-sectional study with children, adolescents, and adults from public schools

Abstract Objective: Stroke is an important cause of disability and death in adults worldwide. However, it is preventable in most cases and treatable as long as patients recognize it and reach capable medical facilities in time. This community-based study investigated students' stroke knowledge, Emergency Medical Services (EMS) activation, associated risk factors, warning signs and symptoms, and prior experience from different educational levels in the KIDS SAVE LIVES BRAZIL project. Methods: The authors conducted the survey with a structured questionnaire in 2019‒2020. Results: Students from the elementary-school (n = 1187, ~13 y.o., prior experience: 14%, 51% women), high-school (n = 806, ~17 y.o., prior experience: 13%, 47% women) and University (n = 1961, ~22 y.o., prior experience: 9%, 66% women) completed the survey. Among the students, the awareness of stroke general knowledge, associated risk factors, and warning signs and symptoms varied between 42%‒66%. When stimulated, less than 52% of the students associated stroke with hypercholesterolemia, smoking, diabetes, and hypertension. When stimulated, 62%‒65% of students recognized arm weakness, facial drooping, and speech difficulty; only fewer identified acute headache (43%). Interestingly, 67% knew the EMS number; 81% wanted to have stroke education at school, and ~75% wanted it mandatory. Women, higher education, and prior experience were associated with higher scores of knowing risk factors (OR = 1.28, 95% CI: 1.10‒1.48; OR = 2.12, 95% CI: 1.87‒2.40; OR = 1.46, 95% CI: 1.16‒1.83; respectively), and warning signs- symptoms (OR = 2.22, 95% CI: 1.89‒2.60; OR = 3.30, 95% CI: 2.81‒3.87; OR = 2.04, 95% CI: 1.58‒2.63; respectively). Conclusion: Having higher education, prior experience, and being a woman increases stroke-associated risk factors, and warning signs and symptoms identification. Schoolchildren and adolescents should be the main target population for stroke awareness. HIGHLIGHTS Higher education, prior experience, and being women improved the odds of identifying stroke warning signs and symptoms as associated risk factors Improving knowledge, skills, and attitude on acute stroke in the school community may represent a significant advance in public health management Future stroke awareness campaigns and educational efforts should focus on schoolchildren and adolescents, especially in low-income countries

Pre-frailty status increases the risk of rehospitalization in patients after elective cardiac surgery without complication.

BACKGROUND AND AIM: It has been demonstrated that patients with pre-frailty have more adverse outcomes after cardiac surgery; however, data on prognosis and long-term evolution in patients with pre-frailty after elective cardiac surgery without postoperative complications are still scarce. To evaluate the impact of pre-frailty status on functional survival in patients after elective cardiac surgery without surgical complications. METHODS: This was a retrospective study with 141 patients over 65 years old, with an established diagnosis of myocardial infarction or valve disease. Patients were evaluated by Clinical Frailty Scale (CFS) before surgery, according to the hospital protocol, and allocated into two groups: non-frail (CFS, 1-3) and pre-frail (CFS = 4). Patients with adverse cardiovascular events during surgery or at intensive care unit (ICU), mechanical ventilation more than 24 hours, ICU length of stay more than 48 hours, and in-hospital complications were excluded. For all analyses, the statistical significance was set at 5% (P < .05). RESULTS: There were no differences in demographic, anthropometric, surgical procedure, or baseline data on ICU. Pre-frail patients had more adverse events during the 3-year follow-up period with rehospitalization compared to non-frail (39.4% vs 14.3%, respectively). Rehospitalizations in pre-frail patients were in the first year after cardiac surgery (P < .05), and higher cumulative events in pre-frail have occurred with increased odds ratio (OR) (2.828, 95% confidence interval [CI]: 1.298-6.160; P = .001) and hazard ratio (HR) (3.560, 95% CI: 1.508-84.04; P = .004). The OR and HR for stroke or death were similar between groups when analyzed separately. CONCLUSION: Pre-frail patients have more adverse events after elective cardiac surgery without complications when compared to non-frail patients.

Pre-frailty status increases the risk of rehospitalization in patients after elective cardiac surgery without complication

ABSTRACT: background and aim: It has been demonstrated that patients with pre­frailty have more adverse outcomes after cardiac surgery; however, data on prognosis and long­ term evolution in patients with pre­frailty after elective cardiac surgery without postoperative complications are still scarce. To evaluate the impact of pre­frailty status on functional survival in patients after elective cardiac surgery without surgical complications. METHODS: This was a retrospective study with 141 patients over 65 years old, with an established diagnosis of myocardial infarction or valve disease. Patients were evaluated by Clinical Frailty Scale (CFS) before surgery, according to the hospital protocol, and allocated into two groups: non­frail (CFS, 1­3) and pre­frail (CFS = 4). Patients with adverse cardiovascular events during surgery or at intensive care unit (ICU), mechanical ventilation more than 24 hours, ICU length of stay more than 48 hours, and in­hospital complications were excluded. For all analyses, the statistical significance was set at 5% (P < .05). RESULTS: There were no differences in demographic, anthropometric, surgical procedure, or baseline data on ICU. Pre­frail patients had more adverse events during the 3­year follow­up period with rehospitalization compared to non­frail (39.4% vs 14.3%, respectively). Rehospitalizations in pre­frail patients were in the first year after cardiac surgery (P < .05), and higher cumulative events in pre­frail have occurred with increased odds ratio (OR) (2.828, 95% confidence interval [CI]: 1.298­6.160; P = .001) and hazard ratio (HR) (3.560, 95% CI: 1.508­84.04; P = .004). The OR and HR for stroke or death were similar between groups when analyzed separately. CONCLUSION: Pre­frail patients have more adverse events after elective cardiac surgery without complications when compared to non­frail patients.

Safety and Efficacy of Aerobic Exercise Training Associated to Non-Invasive Ventilation in Patients with Acute Heart Failure / Segurança e Eficácia do Treinamento Aeróbio Combinado à Ventilação Não-Invasiva em Pacientes com Insuficiência Cardíaca Aguda

Abstract Background: Exercise training (ET) improves functional capacity in chronic heart failure (HF). However, ET effects in acute HF are unknown. Objective: To investigate the effects of ET alone or combined with noninvasive ventilation (NIV) compared with standard medical treatment during hospitalization in acute HF patients. Methods: Twenty-nine patients (systolic HF) were randomized into three groups: control (Control - only standard medical treatment); ET with placebo NIV (ET+Sham) and ET+NIV (NIV with 14 and 8 cmH2O of inspiratory and expiratory pressure, respectively). The 6MWT was performed on day 1 and day 10 of hospitalization and the ET was performed on an unloaded cycle ergometer until patients' tolerance limit (20 min or less) for eight consecutive days. For all analyses, statistical significance was set at 5% (p < 0.05). Results: None of the patients in either exercise groups had adverse events or required exercise interruption. The 6MWT distance was greater in ET+NIV (Δ120 ± 72 m) than in ET+Sham (Δ73 ± 26 m) and Control (Δ45 ± 32 m; p < 0.05). Total exercise time was greater (128 ± 10 vs. 92 ± 8 min; p < 0.05) and dyspnea was lower (3 ± 1 vs. 4 ± 1; p < 0.05) in ET+NIV than ET+Sham. The ET+NIV group had a shorter hospital stay (17 ± 10 days) than ET+Sham (23 ± 8 days) and Control (39 ± 15 days) groups (p < 0.05). Total exercise time in ET+Sham and ET+NIV had significant correlation with length of hospital stay (r = -0.75; p = 0.01). Conclusion: Exercise training in acute HF was safe, had no adverse events and, when combined with NIV, improved 6MWT and reduce dyspnea and length of stay.

Resumo Fundamento: O exercício físico melhora a capacidade funcional em pacientes com insuficiência cardíaca (IC) crônica. Entretanto, os efeitos do exercício na IC aguda são desconhecidos. Objetivo: Investigar os efeitos do exercício físico isolado ou associado à ventilação não-invasiva (VNI) em comparação ao tratamento convencional em pacientes com IC durante internação. Métodos: Vinte e nove pacientes (IC sistólica) foram randomizados em três grupos: Controle (tratamento clínico convencional); exercício com ventilação placebo (EX+Sham) e EX+VNI (VNI com 14 e 8 cmH2O de pressão inspiratória e expiratória, respectivamente).O TC6M foi realizado no primeiro e no décimo dia de internação e o exercício realizado em cicloergômetro até o limite de tolerância (20 minutos ou menos) por oito dias consecutivos. Para todas as análises, foi considerado p < 0,05 estatisticamente significante. Resultados: Nenhum paciente dos grupos EX+Sham e EX+VNI apresentou complicações ou necessitou interromper o exercício. O grupo EX+VNI apresentou melhor desempenho no TC6M (Δ120 ± 72 m) que os grupos EX+Sham (Δ73 ± 26 m) e Controle (Δ45 ± 32 m; p < 0,05). O tempo total de exercício foi maior (128 ± 10 vs. 92 ± 8 min; p < 0,05) e a dispneia menor (3 ± 1 vs. 4 ± 1; p < 0,05) no EX+VNI em relação ao EX+Sham. O grupo EX+VNI apresentou menor tempo de internação (17 ± 10 dias) comparado ao EX+Sham (23 ± 8 dias) e Controle (39 ± 15 dias; p < 0,05). O tempo total de exercício nos grupos EX+Sham e EX+VNI correlacionou-se com o tempo de internação hospitalar (r = -0,75; p = 0,01). Conclusão: O exercício físico foi seguro em pacientes com IC aguda, não houve complicações hospitalares e, quando associada à VNI, melhorou o desempenho no TC6M, dispneia e o tempo de internação.

Safety and Efficacy of Aerobic Exercise Training Associated to Non-Invasive Ventilation in Patients with Acute Heart Failure.

BACKGROUND: Exercise training (ET) improves functional capacity in chronic heart failure (HF). However, ET effects in acute HF are unknown. OBJECTIVE: To investigate the effects of ET alone or combined with noninvasive ventilation (NIV) compared with standard medical treatment during hospitalization in acute HF patients. METHODS: Twenty-nine patients (systolic HF) were randomized into three groups: control (Control - only standard medical treatment); ET with placebo NIV (ET+Sham) and ET+NIV (NIV with 14 and 8 cmH2O of inspiratory and expiratory pressure, respectively). The 6MWT was performed on day 1 and day 10 of hospitalization and the ET was performed on an unloaded cycle ergometer until patients' tolerance limit (20 min or less) for eight consecutive days. For all analyses, statistical significance was set at 5% (p < 0.05). RESULTS: None of the patients in either exercise groups had adverse events or required exercise interruption. The 6MWT distance was greater in ET+NIV (Δ120 ± 72 m) than in ET+Sham (Δ73 ± 26 m) and Control (Δ45 ± 32 m; p < 0.05). Total exercise time was greater (128 ± 10 vs. 92 ± 8 min; p < 0.05) and dyspnea was lower (3 ± 1 vs. 4 ± 1; p < 0.05) in ET+NIV than ET+Sham. The ET+NIV group had a shorter hospital stay (17 ± 10 days) than ET+Sham (23 ± 8 days) and Control (39 ± 15 days) groups (p < 0.05). Total exercise time in ET+Sham and ET+NIV had significant correlation with length of hospital stay (r = -0.75; p = 0.01). CONCLUSION: Exercise training in acute HF was safe, had no adverse events and, when combined with NIV, improved 6MWT and reduce dyspnea and length of stay.

Pre-Frailty Increases the Risk of Adverse Events in Older Patients Undergoing Cardiovascular Surgery / Pré-Fragilidade Aumenta o Risco de Eventos Adversos em Idosos Submetidos à Cirurgia Cardiovascular

Abstract Background: Frailty is identified as a major predictor of adverse outcomes in older surgical patients. However, the outcomes in pre-frail patients after cardiovascular surgery remain unknown. Objective: To investigate the main outcomes (length of stay, mechanical ventilation time, stroke and in-hospital death) in pre-frail patients in comparison with no-frail patients after cardiovascular surgery. Methods: 221 patients over 65 years old, with established diagnosis of myocardial infarction or valve disease were enrolled. Patients were evaluated by Clinical Frailty Score (CFS) before surgery and allocated into 2 groups: no-frailty (CFS 1~3) vs. pre-frailty (CFS 4) and followed up for main outcomes. For all analysis, the statistical significance was set at 5% (p < 0.05). Results: No differences were found in anthropometric and demographic data between groups (p > 0.05). Pre-frail patients showed a longer mechanical ventilation time (193 ± 37 vs. 29 ± 7 hours; p<0.05) than no-frail patients; similar results were observed for length of stay at the intensive care unit (5 ± 1 vs. 3 ± 1 days; p < 0.05) and total time of hospitalization (12 ± 5 vs. 9 ± 3 days; p < 0.05). In addition, the pre-frail group had a higher number of adverse events (stroke 8.3% vs. 3.9%; in-hospital death 21.5% vs. 7.8%; p < 0.05) with an increased risk for development stroke (OR: 2.139, 95% CI: 0.622-7.351, p = 0.001; HR: 2.763, 95%CI: 1.206-6.331, p = 0.0001) and in-hospital death (OR: 1.809, 95% CI: 1.286-2.546, p = 0.001; HR: 1.830, 95% CI: 1.476-2.269, p = 0.0001). Moreover, higher number of pre-frail patients required homecare services than no-frail patients (46.5% vs. 0%; p < 0.05). Conclusion: Patients with pre-frailty showed longer mechanical ventilation time and hospital stay with an increased risk for cardiovascular events compared with no-frail patients.

Resumo Fundamentos: A fragilidade é reconhecida como um importante preditor de eventos adversos em pacientes cirúrgicos idosos. Entretanto, os desfechos em pacientes com pré-fragilidade após a cirurgia cardiovascular ainda permanecem desconhecidos. Objetivos: Investigar os principais desfechos (tempo de internação, tempo de ventilação mecânica, incidência de acidente vascular cerebral e óbito intra-hospitalar) após cirurgia cardiovascular em pacientes com pré-fragilidade em comparação a pacientes sem fragilidade. Métodos: 221 pacientes acima de 65 anos de idade, com diagnóstico de infarto do miocárdio ou doença valvar foram recrutados no estudo. Os pacientes foram avaliados pela escala de fragilidade clínica (CFS, Clinical Frailty Score) antes da cirurgia e separados em 2 grupos: sem-fragilidade (CFS 1~3) vs. pré-fragilidade (CFS 4). Para todas as análises, foi considerada diferença significativa quando p < 0,05. Resultados: Não foram observadas diferenças nos dados antropométricos e demográficos entre os grupos. Os pacientes com pré-fragilidade apresentaram maior tempo de ventilação mecânica em comparação a pacientes sem fragilidade (193 ± 37 vs. 29 ± 7 horas; p < 0,05); resultados similares foram observados para tempo de permanência na unidade de terapia intensiva (5 ± 1 vs. 3 ± 1 days; p < 0,05) e tempo total de internação hospitalar (12 ± 5 vs. 9 ± 3 dias; p < 0,05). Além disso, os pacientes com pré-fragilidade apresentaram maior número de eventos adversos (acidente vascular cerebral-AVC 8,3% vs. 3,9%; óbito intra-hospitalar 21,5% vs. 7,8%; p<0,05) com risco aumentado para AVC (OR: 2,139, IC 95%: 0,622-7,351, p = 0,001; HR: 2,763, IC 95%: 1,206-6,331, p = 0,0001) e morte intra-hospitalar (OR: 1,809, IC 95%: 1,286-2,546, p = 0,001; HR: 1,830, IC 95%: 1,476-2,269, p = 0,0001). Além disso, um maior número de pacientes com pré-fragilidade necessitaram de fisioterapia domiciliar que pacientes sem fragilidade (46,5% vs. 0%; p< 0,05). Conclusão: Pacientes com pré-fragilidade apresentaram maior tempo de ventilação mecânica e maior tempo de internação hospitalar, com maior risco de desenvolverem eventos cardiovasculares adversos em comparação a pacientes sem fragilidade.

Pre-Frailty Increases the Risk of Adverse Events in Older Patients Undergoing Cardiovascular Surgery.

BACKGROUND: Frailty is identified as a major predictor of adverse outcomes in older surgical patients. However, the outcomes in pre-frail patients after cardiovascular surgery remain unknown. OBJECTIVE: To investigate the main outcomes (length of stay, mechanical ventilation time, stroke and in-hospital death) in pre-frail patients in comparison with no-frail patients after cardiovascular surgery. METHODS: 221 patients over 65 years old, with established diagnosis of myocardial infarction or valve disease were enrolled. Patients were evaluated by Clinical Frailty Score (CFS) before surgery and allocated into 2 groups: no-frailty (CFS 1~3) vs. pre-frailty (CFS 4) and followed up for main outcomes. For all analysis, the statistical significance was set at 5% (p < 0.05). RESULTS: No differences were found in anthropometric and demographic data between groups (p > 0.05). Pre-frail patients showed a longer mechanical ventilation time (193 ± 37 vs. 29 ± 7 hours; p<0.05) than no-frail patients; similar results were observed for length of stay at the intensive care unit (5 ± 1 vs. 3 ± 1 days; p < 0.05) and total time of hospitalization (12 ± 5 vs. 9 ± 3 days; p < 0.05). In addition, the pre-frail group had a higher number of adverse events (stroke 8.3% vs. 3.9%; in-hospital death 21.5% vs. 7.8%; p < 0.05) with an increased risk for development stroke (OR: 2.139, 95% CI: 0.622-7.351, p = 0.001; HR: 2.763, 95%CI: 1.206-6.331, p = 0.0001) and in-hospital death (OR: 1.809, 95% CI: 1.286-2.546, p = 0.001; HR: 1.830, 95% CI: 1.476-2.269, p = 0.0001). Moreover, higher number of pre-frail patients required homecare services than no-frail patients (46.5% vs. 0%; p < 0.05). CONCLUSION: Patients with pre-frailty showed longer mechanical ventilation time and hospital stay with an increased risk for cardiovascular events compared with no-frail patients.

Hemodynamics and tissue oxygenation effects after increased in positive end expiratory pressure in coronary artery bypass surgery

BACKGROUND: Cardiac surgery is widely used in the treatment of cardiovascular diseases. However, several complications can be observed during the postoperative period. Positive end expiratory pressure (PEEP) improves gas exchange, but it might be related to decreased cardiac output and possible impairment of tissue oxygenation. The aim of this study was to investigate the hemodynamic effects and oxygen saturation of central venous blood (ScvO2) after increasing PEEP in hypoxemic patients after coronary artery bypass (CAB) surgery. METHODS: Seventy post-cardiac surgery patients (CAB), 61 ± 7 years, without ventricular dysfunction (left ventricular ejection fraction 57 ± 2%), with hypoxemia (PaO2/FiO2 ratio <200) were enrolled. Heart rate, mean arterial pressure, arterial and venous blood samples were measured at intensive care unit and PEEP was increased to 12 cmH2O for 30min. RESULTS: As expected, PEEP12 improved arterial oxygenation and PaO2/FiO2 ratio (p < 0.0001). Reduction in ScvO2 was observed between PEEP5 (63 ± 2%) and PEEP12 (57 ± 1%; p = 0.01) with higher values of blood lactate in PEEP12 (p < 0.01). No hemodynamic effects (heart rate, mean arterial pressure, SpO2; p > 0.05) were related. CONCLUSION: Increased PEEP after cardiac surgery decreased ScvO2 and increased blood lactate, even with higher O2 delivery. PEEP did not interfere in hemodynamics status in CAB patients, suggesting that peripheral parameters must be controlled and measured during procedures involving increased PEEP in post-cardiac surgery patients in the intensive care unit.

Hemodynamics and tissue oxygenation effects after increased in positive end-expiratory pressure in coronary artery bypass surgery.

BACKGROUND: Cardiac surgery is widely used in the treatment of cardiovascular diseases. However, several complications can be observed during the postoperative period. Positive end expiratory pressure (PEEP) improves gas exchange, but it might be related to decreased cardiac output and possible impairment of tissue oxygenation. The aim of this study was to investigate the hemodynamic effects and oxygen saturation of central venous blood (ScvO2) after increasing PEEP in hypoxemic patients after coronary artery bypass (CAB) surgery. METHODS: Seventy post-cardiac surgery patients (CAB), 61 ± 7 years, without ventricular dysfunction (left ventricular ejection fraction 57 ± 2%), with hypoxemia (PaO2/FiO2 ratio <200) were enrolled. Heart rate, mean arterial pressure, arterial and venous blood samples were measured at intensive care unit and PEEP was increased to 12 cmH2O for 30 min. RESULTS: As expected, PEEP12 improved arterial oxygenation and PaO2/FiO2 ratio (p < 0.0001). Reduction in ScvO2 was observed between PEEP5 (63 ± 2%) and PEEP12 (57 ± 1%; p = 0.01) with higher values of blood lactate in PEEP12 (p < 0.01). No hemodynamic effects (heart rate, mean arterial pressure, SpO2; p > 0.05) were related. CONCLUSION: Increased PEEP after cardiac surgery decreased ScvO2 and increased blood lactate, even with higher O2 delivery. PEEP did not interfere in hemodynamics status in CAB patients, suggesting that peripheral parameters must be controlled and measured during procedures involving increased PEEP in post-cardiac surgery patients in the intensive care unit.

Alternatives to Aerobic Exercise Prescription in Patients with Chronic Heart Failure / Alternativas para Prescrição de Exercício Aeróbio a Pacientes com Insuficiência Cardíaca

Background: Exercise is essential for patients with heart failure as it leads to a reduction in morbidity and mortality as well as improved functional capacity and oxygen uptake (v̇O2). However, the need for an experienced physiologist and the cost of the exam may render the cardiopulmonary exercise test (CPET) unfeasible. Thus, the six-minute walk test (6MWT) and step test (ST) may be alternatives for exercise prescription. Objective: The aim was to correlate heart rate (HR) during the 6MWT and ST with HR at the anaerobic threshold (HRAT) and peak HR (HRP) obtained on the CPET. Methods: Eighty-three patients (58 ± 11 years) with heart failure (NYHA class II) were included and all subjects had optimized medication for at least 3 months. Evaluations involved CPET (v̇O2, HRAT, HRP), 6MWT (HR6MWT) and ST (HRST). Results: The participants exhibited severe ventricular dysfunction (ejection fraction: 31 ± 7%) and low peak v̇O2 (15.2 ± 3.1 mL.kg-1.min-1). HRP (113 ± 19 bpm) was higher than HRAT (92 ± 14 bpm; p < 0.05) and HR6MWT (94 ± 13 bpm; p < 0.05). No significant difference was found between HRP and HRST. Moreover, a strong correlation was found between HRAT and HR6MWT (r = 0.81; p < 0.0001), and between HRP and HRST (r = 0.89; p < 0.0001). Conclusion: These findings suggest that, in the absence of CPET, exercise prescription can be performed by use of 6MWT and ST, based on HR6MWT and HRST.

Fundamento: O exercício físico é fundamental para pacientes com insuficiência cardíaca, pois reduz a morbimortalidade e melhora a capacidade funcional e o consumo de oxigênio (v̇O2). Entretanto, a realização do teste de exercício cardiopulmonar (TECP) pode se tornar inviável, devido à necessidade de médico capacitado e ao alto custo deste exame. Assim, o teste de caminhada de 6 minutos (TC6M) e o teste do degrau (TD) emergem como alternativas para a prescrição de exercício. Objetivo: Correlacionar a frequência cardíaca (FC) durante o TC6M e o TD com a FC no limiar aeróbio (FCLA) e a FC no pico do exercício (FCP), obtidas no TECP. Métodos: Foram incluídos 83 pacientes (58 ± 11 anos) com insuficiência cardíaca (NYHA classe II), com medicação otimizada por pelo menos 3 meses. Foram realizados TECP (v̇O2, FCLA e FCP), TC6M (FCTC6M) e TD (FCTD). Resultados: Os pacientes apresentavam disfunção ventricular grave (fração de ejeção: 31 ± 7%) e baixo v̇O2 pico (15,2 ± 3,1 ml.kg-1.min-1). A FCP (113 ± 19 bpm) foi maior que a FCLA (92 ± 14 bpm; p < 0,05) e a FCTC6M (94 ± 13 bpm; p < 0,05). Não houve diferença entre FCP e FCTD. Além disso, observou-se forte correlação entre a FCLA e a FCTC6M (r = 0,81; p < 0,0001) e entre a FCP e a FCTD (r = 0,89; p < 0,0001). Conclusão: Os resultados obtidos sugerem ser viável a prescrição de exercício através do TC6M e do TD, com base na FCTC6M e na FCTD, na ausência do TECP.

Alternatives to Aerobic Exercise Prescription in Patients with Chronic Heart Failure.

BACKGROUND: Exercise is essential for patients with heart failure as it leads to a reduction in morbidity and mortality as well as improved functional capacity and oxygen uptake (v̇O2). However, the need for an experienced physiologist and the cost of the exam may render the cardiopulmonary exercise test (CPET) unfeasible. Thus, the six-minute walk test (6MWT) and step test (ST) may be alternatives for exercise prescription. OBJECTIVE: The aim was to correlate heart rate (HR) during the 6MWT and ST with HR at the anaerobic threshold (HRAT) and peak HR (HRP) obtained on the CPET. METHODS: Eighty-three patients (58 ± 11 years) with heart failure (NYHA class II) were included and all subjects had optimized medication for at least 3 months. Evaluations involved CPET (v̇O2, HRAT, HRP), 6MWT (HR6MWT) and ST (HRST). RESULTS: The participants exhibited severe ventricular dysfunction (ejection fraction: 31 ± 7%) and low peak v̇O2 (15.2 ± 3.1 mL.kg-1.min-1). HRP (113 ± 19 bpm) was higher than HRAT (92 ± 14 bpm; p < 0.05) and HR6MWT (94 ± 13 bpm; p < 0.05). No significant difference was found between HRP and HRST. Moreover, a strong correlation was found between HRAT and HR6MWT (r = 0.81; p < 0.0001), and between HRP and HRST (r = 0.89; p < 0.0001). CONCLUSION: These findings suggest that, in the absence of CPET, exercise prescription can be performed by use of 6MWT and ST, based on HR6MWT and HRST.

Aplicabidade de um protocolo de interrupção da ventilação mecânica em pacientes no pós-operatório de cirurgia cardíaca

A cirurgia cardíaca tem sido o tratamento de escolha para diminuir a morbilidade de paciente com doenças diovarculares. Os anestésicos usados durante o ato cirúrgico deprimem o centro respiratório, impossibilitando a respitação espontânea. A autonomia respiratória desses pacientes retorna tão logo cesse o efeito anestésico, dando condições de rápida extubação. O objetivo do presente estudo foi avaliar a eficácia de um protocolo de interrupção da ventilação mecãnica em pacientes nos pós-operatório de cirurgia cardíaca do Instituto Dante Pazzanese de Cardiologia, para posteriormente discutir sua aplicabilidade e segurança. Participaram do estudo 175 pacientes num período de quatro meses, tendo como critério de inclusão a realização de cirurgia cardíaca sob assistência ventilatória mecânica, idade maior que 15 anos e intubação endotraqueal menor que 24 horas. O sucesso do protocolo consistia em autonomia ventilatória até 24 horas após a extubação. Dos 175 pacientes, 27 foram excluídos do trabalho, 107 foram extubados pelo protocolo e 41 tiveram que suspender o estudo por complicações respiratórias ou hemodinâmicas. Daqueles que concluíram o estudo, nenhum necessitou de reintubação, sendo o sucesso considerado de 100%. A PaCO2 e a pressão arterial média nos pacientes que falharam apresentaram diferença estatisticamente significante quando comparados aos pacientes do grupo sucesso. Conclui-se que a extubação rápida em pacientes no pós-operatório de cirurgia cardíaca foi segura e o protocolo foi eficaz para esse tipo de população.