Este documento tem por objetivo trazer informações sobre a utilização da posição prona no tratamento da insuficiência respiratória aguda (IRpA) secundária à COVID-19, bem como alertar para contraindicações e possíveis complicações do seu uso no ambiente da terapia intensiva. Embora a posição prona seja um recurso terapêutico que pode melhorar o processo de oxigenação de pacientes com SDRA, sugerimos cautela na indicação deste posicionamento durante a pandemia do COVID-19, especialmente em UTIs improvisadas, com time reduzido e não treinado. Nesse sentido, reforçamos a necessidade de treinamento dos fisioterapeutas e colegas das equipes multiprofissionais que atuam nas UTIs para que possam empregar com segurança esse recurso, sempre que houver necessidade e condições de segurança para sua realização.

CONTEXT AND OBJECTIVE: Methylphenidate is the most widely used drug for treating attention deficit hyperactivity disorder. However, it has important side effects, such as abdominal pain, insomnia, anorexia and loss of appetite, and also some cases of early severe emphysema after drug abuse have been reported. Our aim was to investigate the development of pulmonary emphysema in rats that were subjected to different doses of methylphenidate. DESIGN AND SETTING: Experimental study carried out at the laboratory of a public university. METHODS: Eighteen male Wistar rats were divided into three groups: control (0.9% saline solution); MP 0.8 (methylphenidate, 0.8 mg/kg); MP 1.2 (methylphenidate, 1.2 mg/kg). After 90 days of daily gavage, the animals were sacrificed and lung tissue samples were prepared for analysis on the mean alveolar diameter (Lm). RESULTS:The Lm was greater in MP 0.8 (47.91 ± 3.13; P < 0.01) and MP 1.2 (46.36 ± 4.39; P < 0.05) than in the control group (40.00 ± 3.48). CONCLUSION: Methylphenidate caused an increase in the alveolar diameter of rats, which was compatible with human pulmonary emphysema. RESUMO

In this small representative group of patients with COPD, inspiratory muscle weakness was not a determining factor of performance during CPAP or PAV-supported aerobic exercise.

Objective: To look for correlations between lung function and cardiac dimension variables in morbidly obese patients, in order to test the hypothesis that the relative size of the small airways is independently correlated with left ventricular hypertrophy. Methods: This was a retrospective study involving 192 medical records containing a clinical protocol employed in candidates for bariatric surgery between January of 2006 and December of 2010. Results: Of the 192 patients evaluated, 39 (10 males and 29 females) met the inclusion criteria. The mean BMI of the patients was 49.2 ± 7.6 kg/m2, and the mean age was 35.5 ± 7.7 years. The FEF25-75/FVC, % correlated significantly with left ventricular posterior wall thickness and relative left ventricular posterior wall thickness, those correlations remaining statistically significant (r = −0.355 and r = −0.349, respectively) after adjustment for weight, gender, and history of systemic arterial hypertension. Stepwise multivariate linear regression analysis showed that FVC and FEV1 were the major determinants of left ventricular mass (in grams or indexed to body surface area). Conclusions: A reduction in the relative size of the small airways appears to be independently correlated with obesity-related cardiac hypertrophy, regardless of factors affecting respiratory mechanics (BMI and weight), gender, or history of systemic arterial hypertension. However, FEV1 and FVC might be important predictors of left ventricular mass in morbidly obese individuals.

ResumoObjetivos: Verificar a importância da medida da independência funcional (MIF) nos desfechos clínicos de idosos mecanicamente ventilados e analisar os fatores de risco associados à mortalidade. Métodos: Coorte prospectiva de pacientes submetidos a VMI, divididos em dois grupos: Grupo não sobrevivente -óbito na internação e Grupo sobrevivente -alta hospitalar. Resultados: A MIF antes da internação na UTI foi em média para o grupo não sobrevivente 94,8 e para o grupo sobrevivente 113,4 pontos (p=0,0062) e se relacionou com maior risco de óbito (p<0,0001; RR=2,37; IC 95%=1,43 a 3,93). Nos 27 pacientes avaliados após 6 meses houve recuperação da MIF a valores próximos (103,0 pontos) comparados ao momento antes da internação na UTI (113,4). Conclusões: A redução da MIF relacionou-se com maior risco de óbito. A mortalidade observada na internação foi alta com 59,0%. A MIF sofreu redução significativa após a internação na UTI e 6 meses após a alta da UTI recuperou-se a valores semelhantes se comparada a antes da internação.Descritores: Idosos; Atividades cotidianas; Unidades de terapia intensiva; Fatores de risco. AbstractObjectives: To verify the importance of Functional Independence Measure (FIM) on clinical outcomes in mechanically ventilated elderly and analyze risk factors associated with mortality. Methods: A prospective cohort of patients receiving IMV, divided into two groups: non survivor group -Hospital death and survivor Group -discharge. Results: FIM before admission to the ICU was on average for the non-survivor group 94.8 and for the surviving group 113.4 points (p=0.0062) and was associated with increased risk of death (p<0.0001, RR=2.37, 95% CI=1.43-3.93). In the 27 patients evaluated after 6 months there was recovery of the FIM at approximate values (103.0 points) when compared to the moment before ICU admission (113.4). Conclusions: The reduction in FIM was associated with an increased risk of death. Mortality observed at admission was high at 59.0%. FIM suffered a significant reduction after admission to the ICU and 6 months after discharge from the ICU recovered to similar values when compared to before hospitalization.