Navegando por Palavras-chave "Respiratory Mechanics"
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- ItemAcesso aberto (Open Access)Association of Oscillatory Ventilation during Cardiopulmonary Test to Clinical and Functional Variables of Chronic Heart Failure Patients(Soc Brasil Cirurgia Cardiovasc, 2018) Reis, Hugo Valverde; Sperandio, Priscila Abreu [UNIFESP]; Correa, Clynton Lourenco; Guizilini, Solange [UNIFESP]; Neder, Jose Alberto [UNIFESP]; Borghi-Silva, Audrey; Reis, Michel SilvaObjective: The aim of this study is to characterize the presence of exercise oscillatory ventilation (EOV) and to relate it with other cardiopulmonary exercise test (CET) responses and clinical variables. Methods: Forty-six male patients (age: 53.1 +/- 13.6 years old
- ItemSomente MetadadadosA cycle ergometer exercise program improves exercise capacity and inspiratory muscle function in hospitalized patients awaiting heart transplantation: a pilot study(Hospital Clinicas, Univ Sao Paulo, 2016) Forestieri, Patricia [UNIFESP]; Guizilini, Solange [UNIFESP]; Peres, Monique [UNIFESP]; Bublitz, Caroline [UNIFESP]; Bolzan, Douglas Willian [UNIFESP]; Rocco, Isadora Salvador [UNIFESP]; Santos, Vinicius Batista [UNIFESP]; Moreira, Rita Simone Lopes [UNIFESP]; Breda, João Roberto [UNIFESP]; Almeida, Dirceu Rodrigues de [UNIFESP]; Carvalho, Antonio Carlos de Camargo [UNIFESP]; Arena, Ross; Gomes, Walter José [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: The purpose of this study was to evaluate the effect of a cycle ergometer exercise program on exercise capacity and inspiratory muscle function in hospitalized patients with heart failure awaiting heart transplantation with intravenous inotropic support. METHODS: Patients awaiting heart transplantation were randomized and allocated prospectively into two groups: 1) Control Group (n=11) – conventional protocol; and 2) Intervention Group (n=7) – stationary cycle ergometer exercise training. Functional capacity was measured by the six-minute walk test and inspiratory muscle strength assessed by manovacuometry before and after the exercise protocols. RESULTS: Both groups demonstrated an increase in six-minute walk test distance after the experimental procedure compared to baseline; however, only the intervention group had a significant increase (P=0.08 and P=0.001 for the control and intervention groups, respectively). Intergroup comparison revealed a greater increase in the intervention group compared to the control (P<0.001). Regarding the inspiratory muscle strength evaluation, the intragroup analysis demonstrated increased strength after the protocols compared to baseline for both groups; statistical significance was only demonstrated for the intervention group, though (P=0.22 and P<0.01, respectively). Intergroup comparison showed a significant increase in the intervention group compared to the control (P<0.01). CONCLUSION: Stationary cycle ergometer exercise training shows positive results on exercise capacity and inspiratory muscle strength in patients with heart failure awaiting cardiac transplantation while on intravenous inotropic support.
- ItemSomente MetadadadosFatores Preditores Do Diagnóstico De Enfermagem Padrão Respiratório Ineficaz Em Pacientes De Uma Unidade De Terapia Intensiva(Universidade Federal de São Paulo (UNIFESP), 2017-11-30) Prado, Patricia Rezende Do [UNIFESP]; Lopes, Juliana De Lima [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: To identify the prevalence, the related factors (RF), the defining characteristics (DC), the accuracy measures and the predictive factors of the nursing diagnosis of ineffective breathing pattern (IBP) in adults and elderly patients of an intensive care unit). Method: this thesis consists of two articles, an integrative review of the literature and a cross sectional paper. The integrative review aimed to identify the DC and RF of the IBP diagnosis. Articles were used between the years 1980 and 2016, which presented these indicators in newborns, children, adults and the elderly. The research question was formulated using the PICOT (Patient, Intervention, Comparation, Outcomes and Time) strategy. The quality of the articles was evaluated by the New Castle Ottawa scale. The cross-sectional study aimed to identify the prevalence, RF, DC, accuracy measures and predictive factors of IBP. For this, the sample consisted of adults and elderly patients hospitalized in an ICU in the city of Rio Branco, Acre. To be considered as having IBP, patients should present three or more defining characteristics (DC), as well as having a low inspiratory pressure obtained by the manovacuometer test. The patients were divided into two groups, with and without the IBP diagnosis. The independent variables were identified in the NANDA International classification (NANDA-I), literature (bronchial secretion, cough, decreased vesicular murmurs, altered respiratory depth and auscultation with adventitious sounds) and included some variables of interest identified in the clinical practice of researchers (age, medical diagnosis and smoking). Data were analyzed descriptively by means of absolute and relative frequencies. For all defining characteristics and related factors of dichotomous nature, accuracy measurements were presented through sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). In order to evaluate the simultaneous effects of the defining characteristics and related factors (predictor variables), on the presence of IBP (dependent variable), logistic regressions were adjusted. For the final model, having as predictors the related factors, the fitting adequacy of the final model was evaluated by Hosmer and Lemeshow test. Sensitivity and specificity were calculated from the ROC curve. Results: In the integrative literature review, the main RF identified in children was bronchial secretion (81.8%), followed by hyperventilation (22.4%). The main DC were: dyspnea (97,9%), tachypnea (82,9%), cough (74,3%), use of accessory breathing muscles (70,3 %), orthopnea (69,9%) and adventitious noise (67,5%). In adults, the main RF were fatigue (28.8%), pain (17.5%) and obesity (16.7%). The main DC were dyspnea (40.3%), tachypnea (16.7%) and orthopnea (15.6%). In the cross-sectional study, of the 120 patients, 67.5% presented IBP. In the univariate analysis, the variables that were associated with this nursing diagnosis were: group of disease (p = 0.008), RFs fatigue (p <0.001), obesity (p = 0.01) and secretion in the bronchi (p = 0.01), and the DC were changes in respiratory depth, auscultation with adventitious sounds, dyspnea, decreased vesicular murmurs, tachypnea, cough and use of accessory musculature to breathe, all with p-value <0.001. The DC decreased vesicular murmurs had high sensitivity (92.6%), specificity (97.4%), negative predictive value (86.4%) and positive (98.7%) and mean age of patients with positive IBP was higher than those with negative PRI (p = 0.003). The predictive factors of IBP in this ICU were: fatigue (OR = 61.96, p <0.001), age (OR = 1.06, p = 0.001) and group of diseases as the cardiocirculatory system (OR=0,07; p=0,02), trauma (OR=1; p=0,013) and other diagnoses (OR=0,15; p=0,009). Conclusion: Fatigue, age and group of diseases were predictors of IBP nursing diagnosis in this intensive care unit. Decreased vesicular murmurs, auscultation with adventitious sounds, and cough may be defining characteristics to be added in the NANDA-I classification, as well as secretion in the bronchi and group of disease as a related factor. It is emphasized the importance of investigating and identifying early these predictive factors with the intention of planning and implementing a care to improve the prognosis of patients with this nursing diagnosis.
- ItemAcesso aberto (Open Access)Impacto da técnica de expiração lenta e prolongada na mecânica respiratória de lactentes sibilantes(Sociedade Brasileira de Pneumologia e Tisiologia, 2013-02-01) Lanza, Fernanda de Cordoba [UNIFESP]; Wandalsen, Gustavo Falbo [UNIFESP]; Cruz, Carolina Lopes da [UNIFESP]; Solé, Dirceu [UNIFESP]; Universidade Nove de Julho Programa de Pós Graduação em Ciências da Reabilitação; Universidade Federal de São Paulo (UNIFESP); Hospital Israelita Albert Einstein Setor de Pediatria e NeonatologiaOBJECTIVE: To evaluate changes in respiratory mechanics and tidal volume (V T) in wheezing infants in spontaneous ventilation after performing the technique known as the prolonged, slow expiratory (PSE) maneuver. METHODS: We included infants with a history of recurrent wheezing and who had had no exacerbations in the previous 15 days. For the assessment of the pulmonary function, the infants were sedated and placed in the supine position, and a face mask was used and connected to a pneumotachograph. The variables of tidal breathing (V T and RR) as well as those of respiratory mechanics-respiratory system compliance (Crs), respiratory system resistance (Rrs), and the respiratory system time constant (prs)-were measured before and after three consecutive PSE maneuvers. RESULTS: We evaluated 18 infants. The mean age was 32 ± 11 weeks. After PSE, there was a significant increase in V T (79.3 ± 15.6 mL vs. 85.7 ± 17.2 mL; p = 0.009) and a significant decrease in RR (40.6 ± 6.9 breaths/min vs. 38.8 ± 0,9 breaths/min; p = 0.042). However, no significant differences were found in the variables of respiratory mechanics (Crs: 11.0 ± 3.1 mL/cmH2O vs. 11.3 ± 2.7 mL/cmH2O; Rrs: 29.9 ± 6.2 cmH2O mL-1 s-1 vs. 30.8 ± 7.1 cmH2O mL-1 s-1; and prs: 0.32 ± 0.11 s vs. 0.34 ±0.12 s; p > 0.05 for all). CONCLUSIONS: This respiratory therapy technique is able to induce significant changes in V T and RR in infants with recurrent wheezing, even in the absence of exacerbations. The fact that the variables related to respiratory mechanics remained unchanged indicates that the technique is safe to apply in this group of patients. Studies involving symptomatic infants are needed in order to quantify the functional effects of the technique.