BACKGROUND: Failure to wean can prolong ICU stay, increase complications associated with mechanical ventilation, and increase morbidity and mortality. The spontaneous breathing trial (SBT) is one method used to assess weaning. The aim of this study was to assess proportional assist ventilation plus (PAV؉) as an SBT by comparing its applicability, safety, and efficacy with T-tube and pressure support ventilation (PSV). METHODS: A randomized study was performed involving 160 adult subjects who remained on mechanical ventilation for > 24 h. Subjects were randomly assigned to the PAV؉, PSV, or T-tube group. When subjects were ready to perform the SBT, subjects in the PAV؉ group were ventilated in PAV؉ mode (receiving support of up to 40%), the pressure support was reduced to 7 cm H 2 O in the PSV group, and subjects in the T-tube group were connected to one T-piece with supplemental oxygen. Subjects were observed for signs of intolerance, whereupon the trial was interrupted. When the trial succeeded, the subjects were extubated and assessed until discharge. RESULTS: The subjects were predominantly male (66.5%), and the leading cause of admission was traumatic brain injury. The groups were similar with respect to baseline characteristics, and no significant difference was observed among the groups regarding extubation success or failure. Analysis of the specificity and sensitivity revealed good sensitivity for all groups; however, the PAV؉ group had higher specificity (66.6%) and higher sensitivity (97.6%), with prediction of ϳ92.1% of the success and failure events. CONCLUSIONS: No significant differences in the groups was observed regarding the rate of extubation failure, duration of mechanical ventilation, and ICU and hospital stay, indicating that PAV؉ is an alternative for use as an SBT.

Background Deep and respiratory muscle disorders are commonly observed in critically ill patients. Neuromuscular electrical stimulation (NMES) is an alternative to mobilize and to exercise that does not require active patient participation and can be used on bedridden patients. Objective Evaluate the effectiveness of the NMES therapy in quadriceps versus diaphragm subjects in mechanical ventilation (MV). Methods Sixty-seven subjects in MV were included, divided into 3 groups: (a) control group (CG, n=26), (b) stimulation of quadriceps (quadriceps group–QG, n=24), and (c) stimulation of diaphragm (diaphragm group–DG, n=17). The QG and DG patients received consecutive daily electrical stimulation sessions at specific points from the first day of randomization until ICU discharge. Respiratory and peripheral muscle strength, MV time, length of hospitalization, and functional independence score (the Functional Status Score-ICU) were recorded. Results There were studied n=24 (QG), n=17 (DG), and n=26 (CG) patients. Peripheral muscle strength improved significantly in the QG (p=0.030). Functional independence at ICU discharge was significantly better in QG (p=0.013), and the QG presented a better Barthel Index compared to DG and CG (p=0.0049) and also presented better FSS compared to CG (p=0.001). Conclusions Electrical stimulation of quadriceps had best outcomes for peripheral muscle strength compared with controls or electrical stimulation of diaphragm among mechanically ventilated critically ill subjects and promoted functional independence and decreased length of hospitalization.

OBJETIVO: Identificar os principais estressores ambientais, conforme a percepção de familiares de pacientes internados em uma UTI-G de adultos de um hospital público universitário. MÉTODO: Estudo transversal descritivo com familiares de pacientes gravemente enfermos internados na UTI de um hospital escola. Para a coleta de dados, utilizou-se uma escala contendo 25 itens relacionados a eventos da referida UTI. Para análise dos resultados, as respostas foram classificadas como estressores ambientais, referentes à equipe, ao paciente e à visita. RESULTADOS: Participaram 53 familiares, 67,9% mulheres, com média de idade de 39,7 anos. Os fatores relacionados ao paciente foram mais estressantes do que aqueles referentes à equipe e ao ambiente (p < 0,005). Os eventos mais estressantes para os familiares estiveram relacionados à insegurança e ao medo quanto ao estado clínico do paciente, dentre esses, o motivo e o tempo de internação e ver o paciente em coma. CONCLUSÃO: A internação de um parente próximo na UTI foi considerada pelos familiares que efetivamente participaram desse processo um evento estressante. Todos os participantes indicaram pelo menos um evento causador de estresse capaz de provocar diferentes reações emocionais. Conhecer tais eventos pode facilitar as estratégias de humanização hospitalar, propiciando alternativas para reduzir os níveis de estresse e alterações psiquiátricas subsequentes.

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Objective This study sought to assess the influence of prone positioning on the stress of newborn premature infants through the measurement of the salivary cortisol concentration and the evaluation of physiological and behavioral responses before and after changes in body positioning.Methods Saliva samples were collected from newborn infants at two different times: the first (corresponding to the baseline) after a period of 40 minutes during which the infants were not subjected to any manipulation and were placed in the lateral or supine position, and the second 30 minutes after placement in the prone position. Variables including heart rate, respiratory rate, peripheral oxygen saturation, and the Brazelton sleep score were recorded before, during, and at the end of the period in the prone position.Results The sample comprised 16 newborn premature infants (56.3% male) with a gestational age between 26 and 36 weeks, postnatal age between 1 and 33 days, birth weight of 935 to 3,050g, and weight at the time of intervention of 870 to 2,890g. During the intervention, six participants breathed room air, while the remainder received oxygen therapy. The median salivary cortisol concentration was lower in the prone position compared to baseline (0.13 versus 0.20; p=0.003), as was the median Brazelton sleep score (p=0.02). The average respiratory rate was lower after the intervention (54.88±7.15 versus 60±7.59; p=0.0004). The remainder of the investigated variables did not exhibit significant variation.Conclusion Prone positioning significantly reduced the salivary cortisol level, respiratory rate, and Brazelton sleep score, suggesting a correlation between prone positioning and reduction of stress in preterm infants.