Impact of whole-body rehabilitation in patients receiving chronic mechanical ventilation

Martin, Ubaldo J.; Hincapié, Luis Alberto; Nimchuk, Mark; Gaughan, John; Criner, Gerard J.

doi:10.1097/01.ccm.0000181730.02238.9b

Cited by 156 publications

(211 citation statements)

References 21 publications

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“…Martin et al 7 sugeriram que a força da musculatura periférica está proporcionalmente ligada com a força da musculatura respiratória 7 . Indivíduos submetidos a exercícios físicos bem elaborados, que promovam aumento da força muscular em membros, podem apresentar acréscimo na função pulmonar, melhora do desempenho respiratório e aperfeiçoar as atividades de vida diária, fatores que reduzem o tempo de internamento.…”

Section: Discussionunclassified

“…Contrapondo o que foi observado neste estudo e no estudo de Martin et al 7 , Viana et al 11 avaliaram o efeito do exercício neuromuscular em 14 indivíduos submetidos à cirurgia de revascularização miocárdica ou valvoplastia, recém-admitidos em enfermaria cardiológica. Nesse, que foi um estudo prospectivo controlado, o grupo que foi submetido aos exercícios neuromusculares em membros inferiores não apresentou aumento significativo da força no momento da alta hospitalar comparado ao grupo controle.…”

Section: Discussionunclassified

“…Já os neuromusculares são realizados contra resistência externa (pesos livres) e visam ao ganho de força, resistência e massa muscular 6 . Dentre as vantagens dos exercícios funcionais e neuromusculares, destaca-se a redução na utilização de medicações, quando associados a hábitos saudáveis de vida, como reeducação alimentar e redução da ingestão de sódio 7 . Outra vantagem é que os exercícios neuromusculares realizados de forma exclusiva ou associados a outros exercícios podem melhorar de forma aguda ou crônica a pressão arterial 8 .…”

Section: Efeito Dos Exercícios Neuromusculares Funcionais Introduçãounclassified

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Efeitos dos exercícios funcionais e neuromusculares no tempo de internação e controle pressórico de pacientes hospitalizados

Costa¹,

Petto²,

Gomes

et al. 2015

ABCS Health Sci.

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Exercícios funcionais e neuromusculares são importantes ferramentas em centros de reabilitação, porém são pouco explorados em protocolos hospitalares. objetivo: Verificar se exercícios funcionais e neuromusculares são mais eficazes na redução do tempo de internamento e controle da pressão arterial (PA) dos indivíduos hospitalizados do que a fisioterapia hospitalar de rotina. Métodos: Foram incluídos pacientes hospitalizados por enfermidades não cardiológicas e sem hipertensão arterial sistêmica, sendo estes randomizados para grupo controle (GC), que realizou exercícios respiratórios, exercícios ativo-livres para membros superiores/ inferiores e caminhada no corredor, ou grupo de reabilitação funcional (GRF), submetido a exercícios neuromusculares para membros superiores/inferiores, cicloergômetro e treino de subir/descer degraus. Ambos os grupos receberam intervenção 2x/dia. A PA foi aferida na admissão, durante o internamento e na alta hospitalar. O tratamento estatístico foi realizado adotando-se intervalo de confiança de 95% e nível de significância de 5%. resultados: Avaliados 42 voluntários, dos quais 26 atenderam aos critérios de elegibilidade. Porém, seis foram excluídos, quatro por permanência hospitalar inferior a três dias e dois por não completarem o protocolo de tratamento. A média de idade no GC foi de 72±11 versus 73±8 no GRF. Não houve diferenças estatísticas da PA na admissão. Evidenciou-se redução da PA apenas no GRF durante o internamento (p<0,01), assim como na alta hospitalar (p<0,01). O GC apresentou maior tempo (dias) de internação 7,2±1,8 versus 5,5±1,3 do GRF (p<0,05). Conclusão: Exercícios funcionais e neuromusculares parecem mais eficazes na redução do tempo de internamento e controle da PA dos indivíduos hospitalizados do que a fisioterapia hospitalar de rotina.Palavras-chave: serviço hospitalar de fisioterapia; pressão arterial; terapia por exercício; medicina física e reabilitação; tempo de internação. ABStrACt introduction:Functional and neuromuscular exercises are important tools in rehabilitation centers, however they are little explored in hospital protocols. objective: To determine whether functional and neuromuscular exercises are more effective in reducing hospital stay and controlling blood pressure (BP) of hospitalized individuals than routine hospital physiotherapy. Methods: Hospitalized patients for non-cardiac illnesses and without hypertension were included, which were randomized to the control group (CG), who performed breathing exercises, active-free exercises for upper/lower limbs and walk in the hallway, or to functional rehabilitation group (FRG), which underwent neuromuscular exercises for upper/lower limbs, cycle ergometer and up/down stairs training. Both groups received intervention 2x/day. BP was measured at admission, during hospitalization and at discharge. Statistical analysis was performed by adopting a confidence interval of 95% and a 5% significance level. results: Forty-two volunteers were evaluated, of which 26 met the eligibility criteria. However, six...

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Section: Discussionunclassified

Section: Efeito Dos Exercícios Neuromusculares Funcionais Introduçãounclassified

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Efeitos dos exercícios funcionais e neuromusculares no tempo de internação e controle pressórico de pacientes hospitalizados

Costa¹,

Petto²,

Gomes

et al. 2015

ABCS Health Sci.

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“…3,11,12 In particular, patients may receive a prompt and dedicated physiotherapy rehabilitation program in chronic ventilator facilities, 1,3,13 and transfer from an ICU to a chronic ventilator facility substantially improved patients' ambulation and activities of daily life irrespective of the underlying pathophysiology, avoiding unnecessary immobilization 14 . To date, the role of comprehensive rehabilitation in critically ill adults still remains controversial 13 or not fully established 15 : patients who have survived a recent acute respiratory failure (ARF) event can benefit from an individually tailored physiotherapy rehabilitation program that improves clinical indices, respiratory and peripheral muscle strength, activities of daily life, exercise tolerance, and disability scores. 14,[16][17][18][19][20][21][22][23][24] Once the precipitating cause of the ARF episode has been solved, these chronically ill patients still require care due to their huge motor disabilities, clinical dependence (oxygen, mechanical ventilation, nutritional, and communication device needs), and nursing necessities, 3 which the care team (physiotherapist, doctor, and nurse) must measure to better guide the daily care of the patient. No study has been performed with a large patient sample to investigate patient needs with these 3 different perspectives combined.…”

Section: Introductionmentioning

confidence: 99%

Effects of a Multidisciplinary Care Program on Disability, Autonomy, and Nursing Needs in Subjects Recovering From Acute Respiratory Failure in a Chronic Ventilator Facility

Vitacca¹,

Paneroni²,

Peroni

et al. 2014

Respir Care

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BACKGROUND:The aim of this study was to analyze the effects of a multidisciplinary program carried out in a chronic ventilator facility on disability, autonomy, and nursing needs of patients after a prolonged ICU stay. Secondary outcome measures were survival, weaning rate, chronic ventilator facility stay, and discharge destination. METHODS: Multidisciplinary assessment, clinical stabilization, weaning attempts, and a new Disabled Patients Autonomy Planning tool to assess daily care needs were investigated in 240 subjects in a chronic ventilator facility (52 subjects after cardiovascular surgery, 60 subjects with acute respiratory failure, 71 subjects with COPD, and 57 subjects with neurological disease). RESULTS: At admission, nursing needs, disability, and autonomy differed according to diagnosis (P < .001); weaned subjects had greater nursing needs (P < .001) and disability (P ‫؍‬ .0014) than unweaned subjects. During the stay, 13.8% of the subjects died irrespective of diagnosis (P ‫؍‬ .12); 47% (P < .001) were weaned with significant differences (P <.007) by diagnosis. In the 207 surviving subjects, nursing needs increased as disability increased (r ‫؍‬ 0.59, P < .001) and autonomy decreased (r ‫؍‬ ؊0.66, P < .001); disability and autonomy were interrelated (r ‫؍‬ 0.61, P < .001). Oxygen saturation, hypercapnia, dyspnea, disability, autonomy, and nursing needs significantly improved (all, P < .001). Fifty-nine percent of the subjects were discharged home. Subjects discharged to nursing homes presented mainly neurological diseases, being more disabled and less autonomous, with higher nursing needs (all, P < .04). Mechanical ventilation use and tracheostomy increased the probability of being discharged to a nursing home (odds ratio [OR] of 1.84, P ‫؍‬ .04; OR 2.47, P ‫؍‬ .003, respectively). Mortality was higher in subjects who were ventilated (OR 8.44, P < .001), male (OR 2.64, P ‫؍‬ .01), elderly (P < .001), or malnourished (P ‫؍‬ .01) and in subjects with low autonomy (P < .001), greater nursing needs (P ‫؍‬ .002), and more severe disabilities (P ‫؍‬ .04). CONCLUSIONS: A specialized tailored multidisciplinary program in subjects after an ICU stay contributed to recovery from disability, autonomy, and fewer nursing needs irrespective of diagnosis. Subjects discharged to a nursing home were the most severely disabled.

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“…There are no proven, widely implemented treatments for PICS, although there are recent promising initial results (8,(12)(13)(14)(15)(16)(17). In the absence of specific therapies, many other patient populations routinely use peer support groups, often with evidence of efficacy (18,19).…”

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confidence: 99%

Issues of Survivorship Are Rarely Addressed during Intensive Care Unit Stays. Baseline Results from a Statewide Quality Improvement Collaborative

et al. 2014

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Rationale/Objective: In the context of increasing survivorship from critical illness, many studies have documented persistent sequelae among survivors. However, few evidence-based therapies exist for these problems. Support groups have proven efficacy in other populations, but little is known about their use after an intensive care unit (ICU) stay. Therefore, we surveyed critical care practitioners regarding their hospital's practice regarding discussing post-ICU problems for survivors with patients and their loved ones, communicating with primary care physicians, and providing support groups for current or former patients and families.Methods: A written survey was administered to 263 representatives of 73 hospitals attending the January 2013 annual meeting of the Michigan Health and Hospitals Association Keystone ICU initiative, a quality improvement collaborative focused on enhancing outcomes across Michigan ICUs.Results: There were 174 completed surveys, a 66% response rate. Representatives included staff nurses, nursing leadership, physicians, hospital administrators, respiratory therapists, and pharmacists. Sixty-nine percent of respondents identified at least one issue facing ICU survivors after discharge. The concerns most commonly identified by these ICU practitioners were weakness, psychiatric pathologies, cognitive dysfunction, and transitions of care. However, most respondents did not routinely discuss post-ICU problems with patients and families, and only 20% had a mechanism to formally communicate discharge information to primary care providers. Five percent reported having or being in the process of creating a support group for ICU survivors after discharge.Conclusions: Despite growing awareness of the problems faced by ICU survivors, in this statewide quality improvement collaborative, hospital-based support groups are rarely available, and deficiencies in transitions of care exist. Practice innovations and formal research are needed to provide ways to translate awareness of the problems of survivorship into improved outcomes for patients.

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Impact of whole-body rehabilitation in patients receiving chronic mechanical ventilation

Cited by 156 publications

References 21 publications

Efeitos dos exercícios funcionais e neuromusculares no tempo de internação e controle pressórico de pacientes hospitalizados

Efeitos dos exercícios funcionais e neuromusculares no tempo de internação e controle pressórico de pacientes hospitalizados

Effects of a Multidisciplinary Care Program on Disability, Autonomy, and Nursing Needs in Subjects Recovering From Acute Respiratory Failure in a Chronic Ventilator Facility

Issues of Survivorship Are Rarely Addressed during Intensive Care Unit Stays. Baseline Results from a Statewide Quality Improvement Collaborative

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