Artículos de revistas
The Effects Of Orthostatism In Adult Intensive Care Unit Patients
Registro en:
Revista Brasileira De Terapia Intensiva. , v. 24, n. 1, p. 64 - 71, 2012.
0103507X
10.1590/S0103-507X2012000100010
2-s2.0-84873897136
Autor
Sibinelli M.
Maioral D.C.
Falcao A.L.E.
Kosour C.
Dragosavac D.
Lima N.M.F.V.
Institución
Resumen
Objective: To assess the consciousness level, pulmonary and hemodynamic effects of orthostatic position in intensive care patients. Methods: This study was conducted from April 2008 to July 2009 in the Adult Intensive Care Unit, Hospital das Clínicas, Universidade Estadual de Campinas, São Paulo, Brazil. Fifteen patients were included who were mechanically ventilated for more than seven days and had the following characteristics: tracheotomized; receiving intermittent nebulization; maximal inspiratory pressure of less than -25 cm H2O; Tobin score less than 105; preserved respiratory drive; not sedated; partial arterial oxygen pressure greater than 70 mm Hg; oxygen saturation greater than 90%; and hemodynamically stable. With inclinations of 0̈, 30̈ and 50̈, the following parameters were recorded: consciousness level; blinking reflex; thoracoabdominal cirtometry; vital capacity; tidal volume; minute volume; respiratory muscle strength; and vital signs. Results: No neurological level changes were observed. Respiratory rate and minute volume (VE) decreased at 30% and later increased at 50%; however, these changes were not statistically significant. Abdominal cirtometry and maximal expiratory pressure increased, but again, the changes were not statistically significant. Regarding maximal inspiratory pressure and vital capacity, statistically significant increases were seen in the comparison between the 50̈ and 0̈ inclinations. However, tidal volume increased with time in the comparisons between 30̈ and 0̈ and between 50̈ and 0̈. Mean blood pressure increased only for the comparison of 50̈ versus 0̈. Heart rate increased with time for the comparisons between 30̈ and 0̈, between 50̈ and 0̈ and between 50̈ and 30̈. Conclusion: Passive orthostatism resulted in improved tidal volume and vital capacity, maximal inspiratory pressure and increased heart rate and mean blood pressure in critically ill patients. 24 1 64 71 Adam, S., Forrest, S., ABC of intensive care: Other supportive care (1999) BMJ, 319 (7203), pp. 175-178. , Review Perme, C., Chandrashekar, R., Early mobility and walking program for patients in intensive care units: Creating a standard of care (2009) Am J Crit Care., 18 (3), pp. 212-221 Jerre, G., Silva, T.J., Beraldo, M.A., Gastaldi, A., Kondo, C., Leme, F., Fisioterapia no paciente sob ventilação mecânica (2007) J Bras Pneumol., 33 (SUPPL. 2), pp. 142-150 Needham, D.M., Mobilizing patients in the intensive care unit: Improving neuromuscular weakness and physical function (2008) JAMA, 300 (14), pp. 1685-1690 Morris, P.E., Herridge, M.S., Early intensive care unit mobility: Future directions (2007) Crit Care Clin., 23 (1), pp. 97-110 Chang, A.T., Boots, R., Hodges, P.W., Paratz, J., Standing with assistance of a tilt table in intensive care: A survey of Australian physiotherapy practice (2004) Aust J Physiother., 50 (1), pp. 51-54 Luque, A., Martins, C.G.G., Silva, M.S.S., Lanza, F.C., Gazzotti, M.R., Prancha Ortostática Nas Unidades de Terapia Intensiva da Cidade de São Paulo, , Mundo Saúde Vellar, C.M., Forti Júnior, G., Ortostatismo passivo em pacientes comatosos na UTI- um estudo preliminar (2008) Rev Neurociênc., 16 (1), pp. 16-19 Chang, A.T., Boots, R.J., Hodges, P.W., Thomas, P.J., Paratz, J.D., Standing with the assistance of a tilt table improves minute ventilation in chronic critically ill patients (2004) Arch Phys Med Rehabil., 85 (12), pp. 1972-1976 Butler, J.E., McKenzie, D.K., Gandevia, S.C., Discharge frequencies of single motor units in human diaphragm and parasternal muscles in lying and standing (2001) J Appl Physiol., 90 (1), pp. 147-154 Yoshizaki, H., Yoshida, A., Hayashi, F., Fukuda, Y., Effect of posture change on control of ventilation (1998) Jpn J Physiol., 48 (4), pp. 267-273 Chang, A.T., Boots, R.J., Brown, M.G., Paratz, J.D., Hodges, P.W., Ventilatory changes following head-up tilt and standing in healthy subjects (2005) Eur J Appl Physiol., 95 (5-6), pp. 409-417 Gisolf, J., Wilders, R., Immink, R.V., Van Lieshout, J.J., Karemaker, J.M., Tidal volume, cardiac output and functional residual capacity determine end-tidal CO2 transient during standing up in humans (2003) J Physiol., 554 (PART 2), pp. 579-590 Bourdin, G., Barbier, J., Burle, J.F., Durante, G., Passant, S., Vincent, B., The feasibility of early physical activity in intensive care unit patients: A prospective observational one-center study (2010) Respir Care., 55 (4), pp. 400-407 Porto, E.F., Castro, A.A.M., Leite, J.R.O., Miranda, S.V., Lancauth, A., Kumpel, C., Análise comparativa da complacência do sistema respiratório em três diferentes posições no leito (lateral, sentada e dorsal) em pacientes submetidos à ventilação mecânica invasiva prolongada (2008) Rev Bras ter Intensiva., 20 (3), pp. 213-219 Fiz, J.A., Aguilar, X., Carreres, A., Barbany, M., Formiguera, X., Izquierdo, J., Morera, J., Postural variation of the maximum inspiratory and expiratory pressures in obese patients (1991) Int J Obes., 15 (10), pp. 655-659 Roquejani, A.C., Araújo, S., Oliveira, R.A.R.A., Dragosavac, D., Falcão, A.L.E., Terzi, R.G.G., Kousour, C., Influência da posição corporal na medida da pressão inspiratória máxima (PImáx) e da pressão expiratória máxima (PEmáx) em voluntários adultos sadios (2004) Rev Bras ter Intensiva., 16 (4), pp. 215-218 Wilson, W.H., The Influence of posture on the volume of the reserve air (1927) J Physiol., 64 (1), pp. 54-64 Blair, E., Hickam, J.B., The effect of change in body position on lung volume and intrapulmonary gas mixing in normal subjects (1955) J Clin Invest., 34 (3), pp. 383-389 Druz, W.S., Sharp, J.T., Activity of respiratory muscles in upright and recumbent humans (1981) J Appl Physiol., 51 (6), pp. 1552-1561 Druz, W.S., Sharp, J.T., Electrical and mechanical activity of the diaphragm accompanying body position in severe chronic obstructive pulmonary disease (1982) Am Rev Respir Dis., 125 (3), pp. 275-280 Dean, E., Ross, J., Oxygen transport: The basis for contemporary cardiopulmonary physical therapy and its optimization with body positioning and mobilization (1992) Phys Ther Pract., 1, pp. 34-44 Miyamoto, Y., Tamura, T., Himura, T., Nakamura, T., Higuchi, J., Mikami, T., The dynamic response of the cardiopulmonary parameters to passive head-up tilt (1982) Jpn J Physiol., 32 (2), pp. 245-258 Rossiter, C.D., Hayden, N.L., Stocker, S.D., Yates, B.J., Changes in outflow to respiratory pump muscles produced by natural vestibular stimulation (1996) J Neurophysiol., 76 (5), pp. 3274-3284 Lee, C.M., Wood, R.H., Welsch, M.A., Influence of head-down and lateral decubitus neck flexion on heart rate variability (2001) J Appl Physiol., 90 (1), pp. 127-132 Duron, B., Postural and ventilatory functions of intercostals muscles (1973) Acta Neurobiol Exp (Wars)., 33 (1), pp. 355-380 Bechbache, R.R., Chow, H.H., Duffin, J., Orsini, E.C., The effects of hypercapnia, hypoxia, exercise and anxiety on the pattern of breathing in man (1979) J Physiol., 293, pp. 285-300 Nishino, T., Honda, Y., Changes in pattern of breathing following baroreceptor stimulation in cats (1982) Jpn J Physiol., 32 (2), pp. 183-195 László, Z., Rössler, A., Hinghofer-Szalkay, H.G., Cardiovascular and hormonal changes with different angles of head-up tilt in men (2001) Physiol Res., 50 (1), pp. 71-82 Toska, K., Walloe, L., Dynamic time course of hemodynamic responses after passive head-up tilt and tilt back to supine position (2002) J Appl Physiol., 92 (4), pp. 1671-1676