ObjectiveTo determine the efficacy of lung hyperinflation maneuvers via a mechanical ventilator compared to isolated tracheal aspiration for removing secretions, normalizing hemodynamics and improving lung mechanics in patients on mechanical ventilation.MethodsThis was a randomized crossover clinical trial including patients admitted to the intensive care unit and on mechanical ventilation for more than 48 hours. Patients were randomized to receive either isolated tracheal aspiration (Control Group) or lung hyperinflation by mechanical ventilator (MVH Group). Hemodynamic and mechanical respiratory parameters were measured along with the amount of aspirated secretions.ResultsA total of 50 patients were included. The mean age of the patients was 44.7 ± 21.6 years, and 31 were male. Compared to the Control Group, the MVH Group showed greater aspirated secretion amount (3.9g versus 6.4g, p = 0.0001), variation in mean dynamic compliance (-1.3 ± 2.3 versus -2.9 ± 2.3; p = 0.008), and expired tidal volume (-0.7 ± 0.0 versus -54.1 ± 38.8, p = 0.0001) as well as a significant decrease in peak inspiratory pressure (0.2 ± 0.1 versus 2.5 ± 0.1; p = 0.001).ConclusionIn the studied sample, the MVH technique led to a greater amount of aspirated secretions, significant increases in dynamic compliance and expired tidal volume and a significant reduction in peak inspiratory pressure.

Stroke often leads to abnormalities in muscle tone, posture, and motor control that may compromise voluntary motor function, thus affecting the motor control required for maintaining the synergy of both peripheral and respiratory muscles. Objective To evaluate respiratory muscle strength, pulmonary function, trunk control, and functional independence in patients with stroke and to correlate trunk control with the other variables. Methods This was a cross-sectional study of patients diagnosed with stroke. We assessed respiratory muscle strength, trunk control as assessed by the Trunk Impairment Scale, spirometric variables, and the Functional Independence Measure. Results Forty-four patients were included. Pulmonary function and respiratory muscle strength were significantly lower than predicted for the study population, and the mean Trunk Impairment Scale score was 14.3 points. The following significant correlations were found between the variables: trunk control vs. maximal inspiratory pressure (r = 0.26, p < 0.05); trunk control vs. forced vital capacity (r = 0.28, p < 0.05); trunk control vs. forced expiratory volume in one second (r = 0.29, p < 0.05), and trunk control vs. the Functional Independence Measure (r = 0.77, p < 0.05). Conclusion The present study showed that respiratory muscle strength, pulmonary function, functional independence, and trunk control are reduced in patients diagnosed with stroke.

ObjectiveTo assess the long-term, health-related quality of life of intensive care unit survivors by systematic review.MethodsThe search for, and selection and analysis of, observational studies that assessed the health-related quality of life of intensive care unit survivors in the electronic databases LILACS and MEDLINE® (accessed through PubMed) was performed using the indexed MESH terms "quality of life [MeSH Terms]" AND "critically illness [MeSH Terms]". Studies on adult patients without specific prior diseases published in English in the last 5 years were included in this systematic review. The citations were independently selected by three reviewers. Data were standardly and independently retrieved by two reviewers, and the quality of the studies was assessed using the Newcastle-Ottawa scale.ResultsIn total, 19 observational cohort and 2 case-control studies of 57,712 critically ill patients were included. The follow-up time of the studies ranged from 6 months to 6 years, and most studies had a 6-month or 1-year follow up. The health-related quality of life was assessed using two generic tools, the EuroQol and the Short Form Health Survey. The overall quality of the studies was low.ConclusionsLong-term, health-related quality of life is compromised among intensive care unit survivors compared with the corresponding general population. However, it is not significantly affected by the occurrence of sepsis, delirium, and acute kidney injury during intensive care unit admission when compared with that of critically ill patient control groups. High-quality studies are necessary to quantify the health-related quality of life among intensive care unit survivors.

OBJECTIVES:The aim of this study was to evaluate systemic inflammatory factors and their relation to success or failure in a spontaneous ventilation test.METHODS:This cross-sectional study included a sample of 54 adult patients. Demographic data and clinical parameters were collected, and blood samples were collected in the first minute of the spontaneous ventilation test to evaluate interleukin (IL)-1β, IL-6, IL-8, and IL-10, tumour necrosis factor alpha (TNFα) and C-reactive protein.RESULTS:Patients who experienced extubation failure presented a lower rapid shallow breathing index than those who passed, and these patients also showed a significant increase in C-reactive protein 48 hours after extubation. We observed, moreover, that each unit increase in inflammatory factors led to a higher risk of spontaneous ventilation test failure, with a risk of 2.27 (1.001 – 4.60, p=0.049) for TNFα, 2.23 (1.06 – 6.54, p=0.037) for IL-6, 2.66 (1.06 – 6.70, p=0.037) for IL-8 and 2.08 (1.01 – 4.31, p=0.04) for IL-10, and the rapid shallow breathing index was correlated with IL-1 (r=-0.51, p=0.04).CONCLUSIONS:C-reactive protein is increased in patients who fail the spontaneous ventilation test, and increased ILs are associated with a greater prevalence of failure in this process; the rapid shallow breathing index may not be effective in patients who present systemic inflammation.

Introdução: Os cânceres hematológicos afetam o organismo com diversas disfunções, e a fisioterapia tem o intuito de auxiliar na prevenção e no tratamento, proporcionando uma melhor qualidade de vida. Objetivo: Verificar os efeitos de um protocolo fisioterapêutico em indivíduos com câncer hematológico. Método: Trata-se de um estudo quase-experimental, com participantes de 18 a 50 anos de idade, de ambos os sexos, realizado no Complexo Hospitalar da Santa Casa de Misericórdia de Porto Alegre. Aplicou-se um protocolo fisioterapêutico por quatro semanas, conforme o estágio hematológico individual, no qual foram avaliados força, bem-estar geral e performance, além de fadiga, respectivamente, com as escalas: Medical Research Council (MRC), Karnofsky, Eastern Cooperative Oncology Group Performance Status (ECOG) e Multidimensional Fatigue Inventory (MFI) 20 - versão brasileira. Resultados: Foram incluídos 11 indivíduos. Verificou-se um aumento significativo da força muscular (p=0,024). Na avaliação do bem-estar geral e performance, não houve diferença significativa (p=0,192) e (p=0,368), assim como nos exames sanguíneos (p>0,05). Na análise dos sinais vitais, apenas a frequência respiratória apresentou aumento significativo no pré e pós-protocolo (p=0,04). Houve correlações significativas entre as escalas de Karnofsky e ECOG (r=-0,81;), MFI e ECOG (r=0,64) e MFI e de Borg (r=0,67), com p<0,05. Conclusão: Os resultados mostraram que é possível utilizar um protocolo fisioterapêutico que se adapte ao perfil hematológico e às condições clínicas do paciente nessa área, existindo correlações entre diversas variáveis funcionais avaliadas, contudo mais estudos são necessários.