RESUMO
Introducción: La neumonía adquirida en la comunidad (NAC) es una infección respiratoria en la cual es frecuente observar la indicación de fisioterapia respiratoria (FR). Sin embargo, en la actualidad las recomendaciones respecto a su uso en NAC son controvertidas, no existiendo evidencia que respalde su uso y permita conocer su real alcance. Objetivos: Revisar la evidencia respecto al impacto de la FR en pacientes adultos que cursan internación por NAC. Resultados: 5 estudios cumplieron los criterios de inclusión de esta revisión. Las maniobras de FR incluyeron ejercicios respiratorios, drenaje postural, percusión, vibración, espirometría incentivada, resistencia espiratoria, asistencia torácica durante movimientos respiratorios, tos dirigida y presión positiva intermitente. En los estudios incluidos la FR no disminuyó la mortalidad ni mejoró los valores espirométricos en los pacientes con NAC, así como tampoco los días hasta la curación ni la estadía hospitalaria. Respecto a los costos, el uso de FR en pacientes con NAC presentó un incremento significativo de los mismos. Conclusión: No hay evidencia que respalde el uso de manera rutinaria de FR en los pacientes adultos con NAC. Consideramos que se requieren de futuras investigaciones que permitan conocer el impacto de la FR en pacientes adultos con NAC, así como establecer consensos respecto a su indicación, selección de maniobras, estandarización de técnicas, tiempos y dosificación.
Introduction: Community-acquired pneumonia (CAP) is a respiratory infection in which the indication for respiratory physiotherapy (RF) is frequently observed. However, currently the recommendations regarding its use in CAP are controversial, and there is no evidence to support its use and allow us to know its real scope. Objectives: To review the evidence regarding the impact of RF in adult patients who are hospitalized for CAP. Results: 5 studies met the inclusion criteria of this review. RF maneuvers included breathing exercises, postural drainage, percussion, vibration, incentive spirometry, expiratory resistance, chest support during respiratory movements, directed cough, and intermittent positive pressure. In the included studies, RF did not reduce mortality or improve spirometric values in patients with CAP, nor did it improve days to cure or hospital stay. Regarding costs, the use of RF in patients with CAP presented a significant increase in costs. Conclusion: There is no evidence to support the routine use of RF in adult patients with CAP. We believe that future research is required to determine the impact of RF in adult patients with CAP, as well as to establish consensus regarding its indication, selection of maneuvers, standardization of techniques, times, and dosage.
Assuntos
Modalidades de FisioterapiaRESUMO
Introducción: La neumonía adquirida en la comunidad (NAC) es una infección respiratoria en la cual es frecuente observar la indicación de fisioterapia respiratoria (FR). Sin embargo, en la actualidad las recomendaciones respecto a su uso en NAC son controvertidas, no existiendo evidencia que respalde su uso y permita conocer su real alcance. Objetivos: Revisar la evidencia respecto al impacto de la FR en pacientes adultos que cursan internación por NAC. Resultados: 5 estudios cumplieron los criterios de inclusión de esta revisión. Las maniobras de FR incluyeron ejercicios respiratorios, drenaje postural, percusión, vibración, espirometría incentivada, resistencia espiratoria, asistencia torácica durante movimientos respiratorios, tos dirigida y presión positiva intermitente. En los estudios incluidos la FR no disminuyó la mortalidad ni mejoró los valores espirométricos en los pacientes con NAC, así como tampoco los días hasta la curación ni la estadía hospitalaria. Respecto a los costos, el uso de FR en pacientes con NAC presentó un incremento significativo de los mismos. Conclusión: No hay evidencia que respalde el uso de manera rutinaria de FR en los pacientes adultos con NAC. Consideramos que se requieren de futuras investigaciones que permitan conocer el impacto de la FR en pacientes adultos con NAC, así como establecer consensos respecto a su indicación, selección de maniobras, estandarización de técnicas, tiempos y dosificación.
Introduction: Community-acquired pneumonia (CAP) is a respiratory infection in which the indication for respiratory physiotherapy (RF) is frequently observed. However, currently the recommendations regarding its use in CAP are controversial, and there is no evidence to support its use and allow us to know its real scope. Objectives: To review the evidence regarding the impact of RF in adult patients who are hospitalized for CAP. Results: 5 studies met the inclusion criteria of this review. RF maneuvers included breathing exercises, postural drainage, percussion, vibration, incentive spirometry, expiratory resistance, chest support during respiratory movements, directed cough, and intermittent positive pressure. In the included studies, RF did not reduce mortality or improve spirometric values in patients with CAP, nor did it improve days to cure or hospital stay. Regarding costs, the use of RF in patients with CAP presented a significant increase in costs. Conclusion: There is no evidence to support the routine use of RF in adult patients with CAP. We believe that future research is required to determine the impact of RF in adult patients with CAP, as well as to establish consensus regarding its indication, selection of maneuvers, standardization of techniques, times, and dosage.
RESUMO
Objetivo: Comparar a eficácia da Fisioterapia Torácica Convencional versus a Pressão Expiratória Positiva no tratamento de fibrocísticos internados para tratamento da exacerbação.Métodos: Ensaio clínico randomizado em 29 pacientes do Hospital de Clínicas de Porto Alegre, divididos em Grupo A (13 pacientes) e Grupo B (16 pacientes). Os pacientes do Grupo A foram tratados por meio de pressão expiratória positiva e, sentados, realizavam 15 ciclos respiratórios dentro da máscara, com pressão expiratória positiva final de 13 cmH2O seguidos de 2 a 3 huffing fora da máscara com tosse e expectoração; esta seqüência foi repetida 7 vezes durante 30 minutos. Os pacientes do Grupo B, tratados por meio de fisioterapia torácica convencional,assumiram 5 posições de drenagem postural, mantidas de 5 a 7 minutos,totalizando meia hora, 2 vezes ao dia. Em cada posição, o tórax foi submetido ata potagem associada à vibração, respiração profunda, huffing, tosse e expectoração por 3 minutos. Os pacientes eram avaliados antes e após o tratamento por meio das provas de função pulmonar, pico de fluxo expiratório, saturação da hemoglobina por oxigênio e escore radiológico de Shwachman. Resultados: Comparando-se as variáveis entre os grupos com o teste t Student e análise de covariância, não houve diferença estatisticamente significativa (p<0,05).Conclusão: Esses resultados não demonstraram diferença entre as técnicas avaliadas. A pressão expiratória positiva é um método que justifica estudos adicionais, pois propicia aos pacientes maior autonomia.
Objective: to compare the efficacy of Conventional Chest Physical Therapy with Positive Expiratory Pressure in the treatment of cystic fibrosis patients during hospital treatment of exacerbation. Methods Randomized clinical trial with 29 patients at the Hospital de Clínicas de Porto Alegre. Thirteen patients were randomly assigned to Group A (Positive ExpiratoryPressure) in which the seated patient went through 15 breathing cycles using a mask with a positive end-expiratory pressure of 13 cmH2O, followed by huffing without the mask along with coughing and expectoration. This sequence was repeated 7 times during 30 minutes. Sixteen patients were included in group B (Conventional Chest Physical Therapy) where patients assumed five postural drainage positions. In each position, the chest was submitted to manual clappingfor three minutes associated with vibration, deep breathing, huffing, coughing and expectoration. Each position was maintained for five to seven minutes for a total of 30 minutes, twice daily. The patients were evaluated before and after the treatment using pulmonary function tests, peak expiratory flow, measurement of the arterial oxyhemoglobin saturation and determination of the Shwachmannradiographic score. Results: In a comparison of the outcomes of the two groups using the Student t test andanalysis of covariance, there were no statistically significant differences between the two groups with respect to outcome (p<0.05). Conclusion: The results indicated no differences between the techniques evaluated. Further studies are necessary since PEP gives more autonomy to the patients.
