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Previous issue date: 2016-06-30 / Introdu??o: Sabe-se que ventila??o n?o invasiva (VNI) ? capaz de aumentar capacidade funcional em pacientes com insufici?ncia card?aca (IC) cr?nica. Contudo, ainda h? diverg?ncias quanto ao modo ventilat?rio mais ben?fico para essa popula??o. Al?m disso, ? poss?vel que haja influencia entre os n?veis press?ricos ajustados na VNI e a magnitude dos seus efeitos. Objetivo: 1) testar se h? diferen?a entre os efeitos agudos da VNI na toler?ncia ao exerc?cio de indiv?duos com IC, quando aplicada modo CPAP ou modo Bi-n?vel; e 2) verificar se h? discrep?ncias nos efeitos agudos do modo Bi-n?vel sobre o desempenho f?sico desses indiv?duos, quando aplicado em n?veis press?ricos distintos. Metodologia: Ensaio cl?nico controlado, randomizado, duplo-cego e cross-over, composto por 14 volunt?rios, portadores de IC cr?nica, com classe funcional II e III (New York Heart Association), em situa??o de estabilidade cl?nica. O experimento ocorreu em quatro visitas distintas, com intervalo m?nimo de 48 horas entre elas. Na primeira visita, houve a triagem dos volunt?rios, em seguida a aplica??o de um SWT sem interven??o pr?via. Em cada uma das 3 visitas seguintes, obedecendo sequ?ncia randomizada, os volunt?rios utilizaram um modo diferente de VNI por 30 minutos, imediatamente antes do SWT. Foram utilizados os seguintes modos: Bi-n?vel com par?metros m?nimos (EPAP = 6 cmH2O e IPAP = 12 cmH2O), Bi-n?vel com par?metros m?ximos (EPAP = 8 cmH2O e IPAP = 14 cmH2O) e CPAP (6 cmH2O). Durante os testes foram analisados a dist?ncia caminhada, n?veis percebidos de fadiga e dispneia, resposta afetiva, bem como outras vari?veis fisiol?gicas. Para a an?lise estat?stica foi utilizado o teste ANOVA para medidas repetidas, seguido do p?s-teste de Bonferroni, considerando-se o p-valor menor ou igual a 0,05 como estatisticamente significante. Resultados: N?o foi encontrada diferen?a entre a DSP obtida no SWT ap?s CPAP (440,4+72,4m) e ap?s o Bi-n?vel m?nimo (441,6+79,4m). Contudo, a DSP foi maior ap?s o uso da VNI em rela??o ?quela observada no SWT sem interven??o pr?via (381,2+79,8m). Conclus?o: O uso de um suporte ventilat?rio n?o invasivo, independentemente do modo, promove melhora na toler?ncia ao exerc?cio em pessoas com IC, o que pode permitir que essa popula??o alcance, mais amplamente, os benef?cios oriundos do exerc?cio f?sico sobre a sua funcionalidade e qualidade de vida. / Introduction: Dyspnea and fatigue are the main clinical symptoms of heart failure and primarily responsible for exercise intolerance found in this syndrome. Now, It is known that the use of NIV in CPAP mode applied before exercise increases exercise tolerance in people with heart failure; however, it's not yet known if the bi-level mode is able to generate similar or even better results, due to pressure increase of the ventilatory support in this modality. Moreover, it is possible that there is influence between the pressure levels set in the NIV and the magnitude of its effect on the exercise in this population Objective:1) test for differences between the acute effects of NIV on exercise tolerance in patients with HF, when applied CPAP or bi-level mode; and 2) check for discrepancies in the acute effects of Bi-level mode on the physical performance of these individuals, when applied at different pressure levels. Methodology: This is a controlled, randomized, double-blind and cross-over clinical trial, composed of 14 volunteers (age 63 ? 9 years), with chronic heart failure, functional class II and III (New York Heart Association) in clinical stability. The experiment took place in four different visits, with an minimum interval of 48 hours between them. At the first visit, the volunteers were screened and performed a SWT without prior intervention. Following a randomized sequence, In each of the 3 subsequent visits, the volunteers received a different mode of NIV for 30 minutes immediately before the SWT. The following modes were used: Bi-level with minimal parameters (EPAP = 6 cm H2O and IPAP = 12 cm H2O), Bi-level with maximum parameters (EPAP = 8 cm H2O and IPAP = 14 cm H2O) and CPAP (6 cm H2O). In the tests were observed walking distance (WD), perceived levels of fatigue and dyspnea, affective response and other physiological variables. Statistical analysis was performed using ANOVA for repeated measures followed by Bonferroni post-test, considering p-value less than or equal to 0.05 as statistically significant. Results: No difference was found between the WD obtained in T-CP (440.4 + 72,4m) and T-Bi (441.6 + 79,4m) (p = 1.00). However, the WD was higher after the use of NIV in both the T-CP, as in T-Bi compared to that observed in T-Co (381.2 + 79,8m) (p = 0.004 and p = 0.007, respectively). Conclusion: The use of a non-invasive ventilatory support, regardless of mode, promotes improvement in exercise tolerance in people with heart failure, which can allow this population range, more broadly, the benefits from the exercise of its functionality and quality of life.
| Identifer | oai:union.ndltd.org:IBICT/oai:repositorio.ufrn.br:123456789/22452 |
| Date | 30 June 2016 |
| Creators | Melo, Fl?vio Emanoel Souza de |
| Contributors | 02545172421, http://lattes.cnpq.br/1788918737416095, Reis, Michel Silva, 04502885606, http://lattes.cnpq.br/1889922526777364, Vieira, Wouber H?rickson de Brito, 97028169472, http://lattes.cnpq.br/7943769688281372, Nogueira, Patricia Ang?lica de Miranda Silva |
| Publisher | PROGRAMA DE P?S-GRADUA??O EM FISIOTERAPIA, UFRN, Brasil |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
| Source | reponame:Repositório Institucional da UFRN, instname:Universidade Federal do Rio Grande do Norte, instacron:UFRN |
| Rights | info:eu-repo/semantics/openAccess |
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