Question: Can Respiratory therapy alter the lung mechanics in patients with invasive mechanical ventilation? The data available in the literature remain controversial. This study aims to assess the changes of pulmonary mechanics in patients with invasive mechanical ventilation, comparing hemodynamic and ventilatory parameters one hour prior to application of the service, immediately after and one hour after the service. Design: Participants: Patients on mechanical ventilation for at least 48 hours with oro-tracheal tube. Intervention: Patients underwent a protocol of respiratory therapy and hemodynamic variables were recorded at different times. Outcome measures: The following variables were measured one hour before, immediately after and one hour after application of the protocol of respiratory therapy. Dynamic lung compliance (Cdyn), respiratory system resistance (Rsr), Tidal Volume (Vt), Positive End Expiratory Pressure (PEEP), Peak inspiratory pressure (PIP), Heart Rate (HR), Respiratory frequency (RF), and Saturation peripheral oxygen (SpO2). Results: The variables obtained the following mean and standard deviation: HR 88.9 ± 18.7 an hour before the service, presented an increase to 93.7 ± 19.2 immediately after the service, which fell one hour after the service, 88.5 ± 17.1. So we can conclude that heart rate showed an increase after treatment of respiratory therapy and one hour after this variable had a value less than the obtained in the beginning. SpO2 96.5 ± 2.29 one hour before the service, with an increase to 98.2 ± 1.62 immediately after the service, and a slight decrease to 97.8 ± 1.79 one hour after the service. We can conclude that the oxygen saturation showed a significant improvement one hour after the service, not returning to the value obtained one hour before the service. RF 20.8 ± 5.40 one hour before the service, increasing to 21.9 ± 5.89 immediately after the service and presenting a decrease of 19.4 ± 1.79 one hour after the service, when compared to one hour before the service. Rsr 14.2 ± 4.63 one hour before the service, down immediately after the service 11.0 ± 3.43 and a small increase one hour after the service, but did not return to baseline. Vt 550± 134 one hour before the service, increasing significantly to 698 ± 155 and presenting a decrease 672 ± 146, although it remained higher than the value obtained one hour before the service. PIP 22.2 ± 5.54 one hour before the service, with a slowdown that does not differ from the Bonferroni test with the value immediately after the service, and decreased to 21.5 ± 5.24, when compared with the previous two times . Cdyn 52.3 ± 16.1 one hour before the service, increased significantly immediately after the service 65.1 ± 19.1 and decreased to 64.7 ± 20.2 one hour after the service, with no significant difference if compared to the second time, and significant difference if compared with the first time. Peep 5.93 ± 1.80 one hour before the service, 5.89 ± 1.71 immediately after the service and 5.91 ± 1.70 one hour after the service. This was the only variable that showed no significant difference in any of the times compared. In Conclusion: The variables HR, SpO2, RF, Rsr, Vt and Cdyn obtained significance p < 0,01.Variable PIP gained significance with p <0, 013.

Question: Can Respiratory therapy alter the lung mechanics in patients with invasive mechanical ventilation? The data available in the literature remain controversial. This study aims to assess the changes of pulmonary mechanics in patients with invasive mechanical ventilation, comparing hemodynamic and ventilatory parameters one hour prior to application of the service, immediately after and one hour after the service. Design: Participants: Patients on mechanical ventilation for at least 48 hours with oro-tracheal tube. Intervention: Patients underwent a protocol of respiratory therapy and hemodynamic variables were recorded at different times. Outcome measures: The following variables were measured one hour before, immediately after and one hour after application of the protocol of respiratory therapy. Dynamic lung compliance (Cdyn), respiratory system resistance (Rsr), Tidal Volume (Vt), Positive End Expiratory Pressure (PEEP), Peak inspiratory pressure (PIP), Heart Rate (HR), Respiratory frequency (RF), and Saturation peripheral oxygen (SpO2). Results: The variables obtained the following mean and standard deviation: HR 88.9 ± 18.7 an hour before the service, presented an increase to 93.7 ± 19.2 immediately after the service, which fell one hour after the service, 88.5 ± 17.1. So we can conclude that heart rate showed an increase after treatment of respiratory therapy and one hour after this variable had a value less than the obtained in the beginning. SpO2 96.5 ± 2.29 one hour before the service, with an increase to 98.2 ± 1.62 immediately after the service, and a slight decrease to 97.8 ± 1.79 one hour after the service. We can conclude that the oxygen saturation showed a significant improvement one hour after the service, not returning to the value obtained one hour before the service. RF 20.8 ± 5.40 one hour before the service, increasing to 21.9 ± 5.89 immediately after the service and presenting a decrease of 19.4 ± 1.79 one hour after the service, when compared to one hour before the service. Rsr 14.2 ± 4.63 one hour before the service, down immediately after the service 11.0 ± 3.43 and a small increase one hour after the service, but did not return to baseline. Vt 550± 134 one hour before the service, increasing significantly to 698 ± 155 and presenting a decrease 672 ± 146, although it remained higher than the value obtained one hour before the service. PIP 22.2 ± 5.54 one hour before the service, with a slowdown that does not differ from the Bonferroni test with the value immediately after the service, and decreased to 21.5 ± 5.24, when compared with the previous two times . Cdyn 52.3 ± 16.1 one hour before the service, increased significantly immediately after the service 65.1 ± 19.1 and decreased to 64.7 ± 20.2 one hour after the service, with no significant difference if compared to the second time, and significant difference if compared with the first time. Peep 5.93 ± 1.80 one hour before the service, 5.89 ± 1.71 immediately after the service and 5.91 ± 1.70 one hour after the service. This was the only variable that showed no significant difference in any of the times compared. In Conclusion: The variables HR, SpO2, RF, Rsr, Vt and Cdyn obtained significance p < 0,01.Variable PIP gained significance with p <0, 013.

Question: Can Respiratory therapy alter the lung mechanics in patients with invasive mechanical ventilation? The data available in the literature remain controversial. This study aims to assess the changes of pulmonary mechanics in patients with invasive mechanical ventilation, comparing hemodynamic and ventilatory parameters one hour prior to application of the service, immediately after and one hour after the service. Design: Participants: Patients on mechanical ventilation for at least 48 hours with oro-tracheal tube. Intervention: Patients underwent a protocol of respiratory therapy and hemodynamic variables were recorded at different times. Outcome measures: The following variables were measured one hour before, immediately after and one hour after application of the protocol of respiratory therapy. Dynamic lung compliance (Cdyn), respiratory system resistance (Rsr), Tidal Volume (Vt), Positive End Expiratory Pressure (PEEP), Peak inspiratory pressure (PIP), Heart Rate (HR), Respiratory frequency (RF), and Saturation peripheral oxygen (SpO2). Results: The variables obtained the following mean and standard deviation: HR 88.9 ± 18.7 an hour before the service, presented an increase to 93.7 ± 19.2 immediately after the service, which fell one hour after the service, 88.5 ± 17.1. So we can conclude that heart rate showed an increase after treatment of respiratory therapy and one hour after this variable had a value less than the obtained in the beginning. SpO2 96.5 ± 2.29 one hour before the service, with an increase to 98.2 ± 1.62 immediately after the service, and a slight decrease to 97.8 ± 1.79 one hour after the service. We can conclude that the oxygen saturation showed a significant improvement one hour after the service, not returning to the value obtained one hour before the service. RF 20.8 ± 5.40 one hour before the service, increasing to 21.9 ± 5.89 immediately after the service and presenting a decrease of 19.4 ± 1.79 one hour after the service, when compared to one hour before the service. Rsr 14.2 ± 4.63 one hour before the service, down immediately after the service 11.0 ± 3.43 and a small increase one hour after the service, but did not return to baseline. Vt 550± 134 one hour before the service, increasing significantly to 698 ± 155 and presenting a decrease 672 ± 146, although it remained higher than the value obtained one hour before the service. PIP 22.2 ± 5.54 one hour before the service, with a slowdown that does not differ from the Bonferroni test with the value immediately after the service, and decreased to 21.5 ± 5.24, when compared with the previous two times . Cdyn 52.3 ± 16.1 one hour before the service, increased significantly immediately after the service 65.1 ± 19.1 and decreased to 64.7 ± 20.2 one hour after the service, with no significant difference if compared to the second time, and significant difference if compared with the first time. Peep 5.93 ± 1.80 one hour before the service, 5.89 ± 1.71 immediately after the service and 5.91 ± 1.70 one hour after the service. This was the only variable that showed no significant difference in any of the times compared. In Conclusion: The variables HR, SpO2, RF, Rsr, Vt and Cdyn obtained significance p < 0,01.Variable PIP gained significance with p <0, 013.

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Made available in DSpace on 2015-07-22T20:50:54Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-03-31 / Objetivo: Avaliar a efetividade e segurança do treinamento proprioceptivo na melhora da capacidade funcional em pacientes com artrite reumatóide. Métodos: Revisão Sistemática utilizando a metodologia da Colaboração Cochrane. Estratégia de busca: As bases pesquisadas foram: Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 4), MEDLINE (1966 to 2008) via PubMed, EMBASE (1980 to 2008), LILACS (1982 to 2008), CINAHL (1982 to 2008), PEDro e Scirus. Também realizamos busca manual em anais de congressos, listas de referências de artigos publicados e contatos com especialistas. Não houve restrição de idioma. Critérios de Seleção: ensaios clínicos randomizados ou ensaios clínicos controlados comparando o treinamento proprioceptivo com alguma outra intervenção ou com nenhuma intervenção, em pacientes com artrite reumatóide, de acordo com os critérios do Colégio Americano de Reumatologia (ACR).de 1987 Coleta de dados e análise: Dois revisores independentemente avaliaram títulos e/ou resumos para critérios de inclusão e para risco de viés. Resultados: A pesquisa eletrônica identificou 864 estudos. Para esta busca, 17 estudos descreveram exercícios gerais em pacientes com artrite reumatóide como o principal tópico. Após analisá-los, observamos que o principal desfecho foi a melhora na força muscular, resistência, e exercícios dinâmicos (natação, caminhada, etc). Portanto nós não encontramos nenhum estudo investigando os efeitos do treinamento proprioceptivo isolado em pacientes com artrite reumatóide, não foi possível incluir nenhum dado em relação ao tópico escolhido em nossa revisão sistemática. Conclusão: Não houve nenhum estudo disponível avaliando a eficácia do treinamento proprioceptivo em pacientes com artrite reumatóide. A efetividade e segurança do treinamento proprioceptivo em melhorar a capacidade funcional destes pacientes permanece desconhecido. / Objective: To assess the effectiveness and safety of balance training (proprioceptive training) to improve functional capacity in patients with rheumatoid arthritis. Methods: Systematic review with Cochrane methodology. Search strategy: Databases Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 4), MEDLINE (1966 to 2008) via PubMed, EMBASE (1980 to 2008), LILACS (1982 to 2008), CINAHL (1982 to 2008), PEDro e Scirus. We also carried out a handsearching and contact professional associates of the eligible studies when necessary. There was no language restriction. Selection criteria: All eligible randomised controlled trials or controlled clinical trials comparing balance training (proprioceptive training) with any other intervention or with no intervention, in patients with rheumatoid arthritis of according to the 1987 American College of Rheumatology (ACR) criteria. Data collection e analysis: Two reviewers independently assessed titles and/or abstracts for inclusion criteria and for risk of bias. Results: The electronic search identified 864 studies. From this search, 17 studies described general exercises in rheumatoid arthritis patients as the main topic. After analysing them, we observed that the main outcomes were improvement in muscle strength, endurance, and dynamic exercises (swimming, walking, etc). As we did not find any studies investigating the effects of proprioceptive training alone in patients with rheumatoid arthritis, it was not possible to include any data regarding the chosen topic in our systematic review. Conclusion: There is no research available examining the efficacy of balance training in patients with rheumatoid arthritis. The effectiveness and safety of balance training to improve functional capacity of these patients remains unclear, however, it is suggested that future research should give more importance to the balance training by either increasing the number and duration of sessions or investigating its efficacy alone. / TEDE / BV UNIFESP: Teses e dissertações

Made available in DSpace on 2015-12-06T23:07:58Z (GMT). No. of bitstreams: 0 Previous issue date: 2006 / INTRODUÇÃO: A espirometria de incentivo tem permanecido uma técnica de fisioterapia cardiorrespiratória amplamente usada para profilaxia e tratamento de complicações respiratórias em pacientes pós-cirúrgicos. OBJETIVOS: Avaliar a efetividade da espirometria de incentivo na prevenção de complicações pulmonares pós-operatória em adultos submetidos à cirurgia de revascularização da artéria coronária. MÉTODOS: O tipo de estudo utilizado foi a revisão sistemática de ensaios clínicos aleatórios. Foram utilizadas oito bases de dados (Medline, Embase, Cinahl, Lilacs, CENTRAL - Cochrane Field Rehabilitation and related therapies, PeDro, AMED e DARE) com suas respectivas estratégias de busca, referências de artigos e revistas especializadas, sem restrição de idiomas na sua identificação. Foram incluídos estudos sobre o uso da espirometria de incentivo em pacientes submetidos à cirurgia de revascularização da artéria coronária. Os desfechos clínicos analisados foram atelectasia, pneumonia, capacidade vital, volume expiratório forçado no 1° segundo, pressão parcial de oxigênio arterial pela fração inspirada de oxigênio e tempo de permanência hospitalar. A qualidade dos métodos foi avaliada segundo a ocultação da alocação, conforme a metodologia da Colaboração Cochrane, e de acordo com a lista Delphi, por dois avaliadores independentes. Os dados dos estudos foram extraídos por meio de uma ficha padronizada. Para avaliar a concordância dos resultados da qualidade dos estudos, foi usado o teste Kappa. Para as variáveis contínuas, foi calculada a diferença da média ponderada (efeito fixo), e para as variáveis categóricas foi calculada a razão de chances de ocorrência dos eventos (Odds Ratio), ambos com intervalo de confiança de 95 por cento. RESULTADOS: Sete ensaios clínicos preencheram os critérios de inclusão, porém somente quatro estudos foram incluídos para metanálise, num total de 443 participantes (184 espirometria de incentivo; 259 controle). Nenhum dos estudos incluídos descreveu de forma adequada a ocultação de alocação. Não encontramos nenhuma evidência de diferença estatística significante de efeito estimado de risco (OR) a favor da espirometria de incentivo na prevenção de complicações pulmonares, quando comparada às outras técnicas de fisioterapia cardiorrespiratória ou ao grupo que não foi submetido à um programa sistematizado de fisioterapia. CONCLUSÃO: Evidências existentes não apóiam o uso da espirometria de incentivo para prevenir complicações pulmonares nos pacientes submetidos à cirurgia de revascularização da artéria coronária / Introduction: The Incentive spirometry remains the most widely used cardiorespiratory physiotherapy technique for the prevention and treatment of respiratory complications in post-operative patients. Objectives: To evaluate the effectiveness of incentive spirometry in the prevention of postoperative pulmonary complications in adults who underwent coronary artery bypass graft. Methods: A systematic review of random clinical trials was carried out, using information from nine data bases (Medline, Embase, Cinahl, Lilacs, CENTRAL, Cochrane Field Rehabilitation and related therapies, PeDro, AMED, and DARE) with their respective search strategies, as well as articles and specialized magazine references, with no restriction to language. Studies on the use of incentive spirometry in patients who underwent coronary artery bypass graft were included. Clinical outcomes were atelectasis, pneumonia, vital capacity, forced expiratory volume in 1 second, partial pressure of arterial oxygen per oxygen inspired fraction and the durations of total hospital stay. Method quality was assessed according of concealment of allocation, in agreement with the Cochrane Collaboration Method and the Delphi List, by two independent evaluators. Data were collected by a standardized record file. The Kappa Test was used to evaluate agreement among quality studies results. The difference between average means (fixed effect) was calculated for the continuous variables, and the Odds Ratio was used for the categorical variables, both with a reliability interval of 95%. Results: Seven clinical trials met the eligibility criteria, however only four studies were included for meta-analysed. In total 443 patients were enrolled (184 treatment group, 259 control group). None of the included studies described adequately the concealment allocation procedure. We did not find any evidence of statistical difference accompanied of estimated effect of risk (OR) and confidence interval of 95% in favor of incentive espirometry in the prevention of pulmonary complications when compared to other cardiorespiratory physical therapy techniques or the physiotherapy absence. Conclusion: The evidences do not support the use of incentive espirometry to prevent pulmonary complications in the patients undergoing coronary artery bypass graft. / BV UNIFESP: Teses e dissertações

Made available in DSpace on 2015-12-06T23:46:33Z (GMT). No. of bitstreams: 0 Previous issue date: 2013 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Objetivo: Comparar a funcao dos MAP entre nuliparas e multiparas, no terceiro trimestre de gravidez, analisando a relacao entre atividade eletrica (EMGs), palpacao vaginal (Escala Oxford odificada - EOM) e extensibilidade perineal (Epi-no®), alem de avaliar os fatores de risco (IMC, IUE, tosse seca, constipacao e peso estimado do concepto). Paciente e Metodos: Estudo transversal e observacional com amostra consecutiva de 60 mulheres higidas (30 nuliparas e 30 multiparas), feto unico, IG entre a 35ª a 40ª semana. Foram excluidas as pacientes com indicacao de cesarea eletiva ou com ausencia de contracao dos MAP durante o exame fisico. Paciente posicionada em litotomia realizou-se a avaliacao da atividade eletrica dos MAP atraves da EMGs que captou o sinal mioeletrico do terco externo no conduto vaginal. Em seguida, verificou-se a forca muscular atraves EOM, graduando a contracao muscular de 0 a 5. E por ultimo, o Epi-no® foi posicionado na vagina,sendo inflado ate o maximo de desconforto reportado pela paciente. Para correlacionar os tres metodos de avaliacao foram usados os testes estatisticos Correlacao de Pearson e Kruskall-Wallis, para as variaveis IMC, IU gestacional, constipacao, atividade fisica e tosse cronica foram utilizadas os testes Mann-Whitney, Qui-quadrado e Fisher com nivel alfa de 0,05. Resultados: Encontramos uma relacao positiva entre os valoresmedianos da EMGs e EOM (escore 1=31,31&#956;V; escore 2=37,09&#956;V; escore 3=49,98&#956;V p=0,008) e ausencia de correlacao entre os valores da EMGs com a extensibilidade perineal (r= -0,193 p=0,140) e da escala Oxford com o Epi-no® (escore 1=18,50, escore 2=18,75 e escore 3=18,75 p=0,785). Quanto aos fatores de risco, encontramos diferencas entre os grupos no IMC (N: 27,06 vs. M: 31,79 p<0,001), e nao nas demais variaveis (tosse cronica M: 10% vs. N: 20% p=0,471; constipacao M: 13,3% vs. N: 26,6% p=0,197; IUG M: 63,3% vs. N: 50% p=0,297) e atividade fisica M: 16,6% vs. N: 30% p= 0,222). Conclusao: A nuliparas apresentaram maior atividade eletrica e forca muscular, e menor extesnibilidade perineal comparada as multiparas. A correlacao entre os metodos evidenciou que a extensibilidade e uma variavel independente da forca muscular e atividade eletrica. Quanto aos fatores de risco, apenas o IMC foi significante entre nuliparas e multiparas / BV UNIFESP: Teses e dissertações

Submitted by Edileide Reis (leyde-landy@hotmail.com) on 2015-04-13T21:47:42Z No. of bitstreams: 1 Fabiana Marques Souza Daltro.pdf: 1179094 bytes, checksum: 0d526557803359f3d8e00c24963b0f66 (MD5) / Made available in DSpace on 2015-04-13T21:47:42Z (GMT). No. of bitstreams: 1 Fabiana Marques Souza Daltro.pdf: 1179094 bytes, checksum: 0d526557803359f3d8e00c24963b0f66 (MD5) Previous issue date: 2013 / As técnicas respiratórias de remoção de secreção pulmonar são bem descritas na literatura bem como as de expansão pulmonar, entretanto as técnicas amplamente recomendadas para o pós-operatório de revascularização do miocárdio utilizando pressão positiva nas vias aéreas parecem não restabelecer os volumes pulmonares até o quinto dia pós-operatório. Correlacionado a isso, não há evidência científica da utilização do PEP como terapia de expansão pulmonar em pós-operatório de pacientes revascularizados. Objetivos: Testar a eficácia do dispositivo de fisioterapia – PEP – aparelho de pressão positiva fluxo dependente a partir de sistema de orifício – e estimar o seu incremento sobre a capacidade vital (CV) no pós-operatório de pacientes revascularizados até o quinto dia pós-operatório. Delineamento: Ensaio Clínico Randomizado (ECR). Casuística, Material e Métodos: A amostra foi constituída por 52 pacientes, sendo 26 no grupo controle e 26 no grupo intervenção. A medida da CV foi realizada no pré-operatório antes da randomização. Após RM os pacientes foram submetidos à realização das respectivas técnicas, duas vezes ao dia, por cinco dias. A CV foi registrada antes e após a realização da técnica escolhida a partir do grupo em três dias: D1 – POI; D2 – 2°DPO; D3 – 4° DPO. A ocorrência de desfechos clínicos atelectasia, pneumonia e insuficiência respiratória aguda foram analisados na forma de ocorrência. Resultados: Os grupos controle (GC) e intervenção (GI) apresentaram características gerais e operatórias semelhantes. O GI obteve maior incremento da CV quando comparado ao GC, bem como maior número da amostra com otimização desse valor pulmonar, embora sem significância estatística. Não houve diferença estatística na incidência dos desfechos clínicos: atelectasia, pneumonia e insuficiência respiratória aguda na análise intergrupos. Conclusão: O dispositivo de fisioterapia PEP mostrou-se estatisticamente ineficaz para incremento da CV na amostra estudada até o 4° dia pós operatório.