RESUMO
Introducción: La artroplastia total de rodilla es el recurso terapéutico para pacientes con artrosis severa y gran incapacidad física. Sin embargo, muchos evolucionan con dolor y déficit funcional. En este estudio, se utiliza un tratamiento con movilización pasiva continua a partir de los 10 días de la cirugía. Materiales y Métodos: Se incluyó a 60 pacientes que fueron asignados, en forma aleatoria, a 2 grupos (30 en cada grupo). Al grupo 1 (G1, 23 mujeres) se le aplicó un protocolo de tratamiento convencional y, al grupo 2 (G2, 17 mujeres), el mismo programa y la adicción de un equipo de movimiento pasivo continuo a los 10 días de la intervención. Se evaluaron el dolor, la movilidad articular, la fuerza muscular y la función (WOMAC y prueba TUG). Resultados: No se observaron diferencias estadísticamente significativas en los parámetros estudiados, aunque sí una tendencia a la mejoría en el G2. En este grupo, la fuerza de extensión de la rodilla fue mayor y también hubo una correlación basal entre la fuerza y la prueba TUG. Conclusiones: El uso diferido de la movilización pasiva continua mejoró la fuerza de extensión de la rodilla y el rendimiento en la prueba TUG, aunque sin diferencias significativas entre ambos grupos. No se observaron efectos adversos. Nivel de Evidencia: I
Introduction: Total knee arthroplasty (TKA) is a valid therapeutic option for patients with severe arthritis and physical disability. However, many TKA patients develop pain and functional impairment. In our study, we used a continuous passive motion (CPM) device for exercise starting 10 days after surgery. Materials and Methods: The study population consisted of 60 patients, who were randomized into 2 groups. Group I (GI: 30 patients, 23 females) underwent the standard treatment and group II (GII, 30 patients, 17 females) underwent the standard treatment plus CPM starting 10 days after surgery. We evaluated pain, range of motion (ROM), extension muscle strength, and function (WOMAC and TUG tests). Results: All compared parameters yielded no statistically significant differences. A greater trend toward improvement was observed in GII regarding some parameters: greater extension muscle strength and a baseline correlation between flexion strength and the TUG test. Conclusions: The use of CPM starting 10 days after of surgery improved the extension muscle strength and produced better TUG test results, although without any statistically significant difference with the standard procedure. No adverse effects were observed. Level of Evidence: I
Assuntos
Adulto , Terapia Passiva Contínua de Movimento , Amplitude de Movimento Articular , Resultado do Tratamento , Artroplastia do JoelhoRESUMO
Early mobilization is beneficial for critically ill patients because it reduces muscle weakness acquired in intensive care units. The objective of this study was to assess the effect of functional electrical stimulation (FES) and passive cycle ergometry (PCE) on the nitrous stress and inflammatory cytometry in critically ill patients. This was a controlled, randomized, open clinical trial carried out in a 16-bed intensive care unit. The patients were randomized into four groups: Control group (n=10), did not undergo any therapeutic intervention during the study; PCE group (n=9), lower-limb PCE for 30 cycles/min for 20 min; FES group (n=9), electrical stimulation of quadriceps muscle for 20 min; and FES with PCE group (n=7), patients underwent PCE and FES, with their order determined randomly. The serum levels of nitric oxide, tumor necrosis factor alpha, interferon gamma, and interleukins 6 and 10 were analyzed before and after the intervention. There were no differences in clinical or demographic characteristics between the groups. The results revealed reduced nitric oxide concentrations one hour after using PCE (P<0.001) and FES (P<0.05), thereby indicating that these therapies may reduce cellular nitrosative stress when applied separately. Tumor necrosis factor alpha levels were reduced after the PCE intervention (P=0.049). PCE and FES reduced nitric oxide levels, demonstrating beneficial effects on the reduction of nitrosative stress. PCE was the only treatment that reduced the tumor necrosis factor alpha concentration.
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Estado Terminal/terapia , Citocinas/sangue , Terapia Passiva Contínua de Movimento/métodos , Estresse Nitrosativo/fisiologia , Respiração Artificial/métodos , Adulto , Idoso , Biomarcadores/sangue , Estado Terminal/reabilitação , Estimulação Elétrica/métodos , Feminino , Humanos , Inflamação/imunologia , Inflamação/metabolismo , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Estresse Oxidativo/fisiologia , Músculo Quadríceps/fisiopatologiaRESUMO
Early mobilization is beneficial for critically ill patients because it reduces muscle weakness acquired in intensive care units. The objective of this study was to assess the effect of functional electrical stimulation (FES) and passive cycle ergometry (PCE) on the nitrous stress and inflammatory cytometry in critically ill patients. This was a controlled, randomized, open clinical trial carried out in a 16-bed intensive care unit. The patients were randomized into four groups: Control group (n=10), did not undergo any therapeutic intervention during the study; PCE group (n=9), lower-limb PCE for 30 cycles/min for 20 min; FES group (n=9), electrical stimulation of quadriceps muscle for 20 min; and FES with PCE group (n=7), patients underwent PCE and FES, with their order determined randomly. The serum levels of nitric oxide, tumor necrosis factor alpha, interferon gamma, and interleukins 6 and 10 were analyzed before and after the intervention. There were no differences in clinical or demographic characteristics between the groups. The results revealed reduced nitric oxide concentrations one hour after using PCE (P<0.001) and FES (P<0.05), thereby indicating that these therapies may reduce cellular nitrosative stress when applied separately. Tumor necrosis factor alpha levels were reduced after the PCE intervention (P=0.049). PCE and FES reduced nitric oxide levels, demonstrating beneficial effects on the reduction of nitrosative stress. PCE was the only treatment that reduced the tumor necrosis factor alpha concentration.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Respiração Artificial/métodos , Terapia Passiva Contínua de Movimento/métodos , Citocinas/sangue , Estado Terminal/terapia , Estresse Nitrosativo/fisiologia , Biomarcadores/sangue , Estado Terminal/reabilitação , Estresse Oxidativo/fisiologia , Estimulação Elétrica/métodos , Músculo Quadríceps/fisiopatologia , Inflamação/imunologia , Inflamação/metabolismo , Unidades de Terapia IntensivaRESUMO
OBJECTIVE:: To evaluate the addition of blood flow restriction to passive mobilization in patients in the intensive care unit. DESIGN:: The study was a within-patient randomized trial. SETTING:: Two intensive care units in Belém, from September to October 2017. SUBJECTS:: In total, 34 coma patients admitted to the intensive care unit sector, and 20 patients fulfilled the study requirements. INTERVENTIONS:: All participants received the passive mobilization protocol for lower limbs, and blood flow restriction was added only for one side in a concurrent fashion. Intervention lasted the entire patient's hospitalization time. MAIN OUTCOME MEASUREMENT:: Thigh muscle thickness and circumference. RESULTS:: In total, 34 subjects were enrolled in the study: 11 were excluded for exclusion criteria, 3 for death, and 20 completed the intervention (17 men and 3 women; mean age: 66 ± 4.3 years). Despite both groups presented atrophy, the atrophy rate was lower in blood flow restriction limb in relation to the control limb (-2.1 vs. -2.8 mm, respectively, in muscle thickness; P = 0.001). In addition, the blood flow restriction limb also had a smaller reduction in the thigh circumference than the control limb (-2.5 vs. -3.6 cm, respectively; P = 0.001). CONCLUSION:: The use of blood flow restriction did not present adverse effects and seems to be a valid strategy to reduce the magnitude of the rate of muscle wasting that occurs in intensive care unit patients.
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Extremidade Inferior/irrigação sanguínea , Terapia Passiva Contínua de Movimento/métodos , Sarcopenia/prevenção & controle , Idoso , Cuidados Críticos , Feminino , Hospitalização , Humanos , Unidades de Terapia Intensiva , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: The aim of this case series is to describe the experience of using the non-pneumatic anti-shock garment (NASG) in the management of severe Postpartum hemorrhage (PPH) and shock, and the value of implementing this concept in high-complexity obstetric hospitals. METHODS: Descriptive case series of 77 women that received NASG in the management of PPH with severe hypovolemic shock from June 2014 to December 2015. Vital signs, shock index (SI), the lactic acid value and the base deficit were compared before and after NASG application. RESULTS: Fifty-six (77%) women had an SI > 1.1 at the time shock management was initiated; 96% had uterine atony. All women received standard does of uterotonics. The average time between the birth and NASG applications was 20 min. Forty-eight percent of women recovered haemodynamic variables in the first hour and 100% within the first 6 h; 100% had a SI < 1.0 in the first hour. The NASG was not removed until definitive control of bleeding was achieved, with an average time of use of 24 h. There were no mortalities. CONCLUSIONS: In this case series of women in severe shock, the NASG was an effective management device for the control of severe hypovolemic shock. It should be considered a first-line option for shock management.
Assuntos
Vestuário , Trajes Gravitacionais , Hipovolemia/terapia , Procedimentos Cirúrgicos Obstétricos/instrumentação , Hemorragia Pós-Parto/terapia , Choque/terapia , Adolescente , Adulto , Colômbia/epidemiologia , Emergências , Feminino , Humanos , Hipovolemia/epidemiologia , Terapia Passiva Contínua de Movimento/instrumentação , Terapia Passiva Contínua de Movimento/métodos , Procedimentos Cirúrgicos Obstétricos/métodos , Hemorragia Pós-Parto/epidemiologia , Gravidez , Resultado da Gravidez/epidemiologia , Estudos Retrospectivos , Choque/epidemiologia , Adulto JovemRESUMO
OBJECTIVE:: The passive cycle ergometer aims to prevent hypotrophy and improve muscle strength, with a consequent reduction in hospitalization time in the intensive care unit and functional improvement. However, its effects on oxidative stress and immune system parameters remain unknown. The aim of this study is to analyze the effects of a passive cycle ergometer on the immune system and oxidative stress in critical patients. METHODS:: This paper describes a randomized controlled trial in a sample of 19 patients of both genders who were on mechanical ventilation and hospitalized in the intensive care unit of the Hospital Agamenom Magalhães. The patients were divided into two groups: one group underwent cycle ergometer passive exercise for 30 cycles/min on the lower limbs for 20 minutes; the other group did not undergo any therapeutic intervention during the study and served as the control group. A total of 20 ml of blood was analysed, in which nitric oxide levels and some specific inflammatory cytokines (tumour necrosis factor alpha (TNF-α), interferon gamma (IFN-γ) and interleukins 6 (IL-6) and 10 (IL-10)) were evaluated before and after the study protocol. RESULTS:: Regarding the demographic and clinical variables, the groups were homogeneous in the early phases of the study. The nitric oxide analysis revealed a reduction in nitric oxide variation in stimulated cells (p=0.0021) and those stimulated (p=0.0076) after passive cycle ergometer use compared to the control group. No differences in the evaluated inflammatory cytokines were observed between the two groups. CONCLUSION:: We can conclude that the passive cycle ergometer promoted reduced levels of nitric oxide, showing beneficial effects on oxidative stress reduction. As assessed by inflammatory cytokines, the treatment was not associated with changes in the immune system. However, further research in a larger population is necessary for more conclusive results.
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Estado Terminal/terapia , Exercício Físico/fisiologia , Terapia Passiva Contínua de Movimento/métodos , Estresse Oxidativo/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Citocinas/sangue , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Unidades de Terapia Intensiva , Lipopolissacarídeos/uso terapêutico , Masculino , Pessoa de Meia-Idade , Força Muscular/fisiologia , Atrofia Muscular/prevenção & controle , Óxido Nítrico/imunologia , Óxido Nítrico/metabolismo , Estresse Oxidativo/imunologia , Reprodutibilidade dos Testes , Respiração Artificial/métodos , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVE: The passive cycle ergometer aims to prevent hypotrophy and improve muscle strength, with a consequent reduction in hospitalization time in the intensive care unit and functional improvement. However, its effects on oxidative stress and immune system parameters remain unknown. The aim of this study is to analyze the effects of a passive cycle ergometer on the immune system and oxidative stress in critical patients. METHODS: This paper describes a randomized controlled trial in a sample of 19 patients of both genders who were on mechanical ventilation and hospitalized in the intensive care unit of the Hospital Agamenom Magalhães. The patients were divided into two groups: one group underwent cycle ergometer passive exercise for 30 cycles/min on the lower limbs for 20 minutes; the other group did not undergo any therapeutic intervention during the study and served as the control group. A total of 20 ml of blood was analysed, in which nitric oxide levels and some specific inflammatory cytokines (tumour necrosis factor alpha (TNF-α), interferon gamma (IFN-γ) and interleukins 6 (IL-6) and 10 (IL-10)) were evaluated before and after the study protocol. RESULTS: Regarding the demographic and clinical variables, the groups were homogeneous in the early phases of the study. The nitric oxide analysis revealed a reduction in nitric oxide variation in stimulated cells (p=0.0021) and those stimulated (p=0.0076) after passive cycle ergometer use compared to the control group. No differences in the evaluated inflammatory cytokines were observed between the two groups. CONCLUSION: We can conclude that the passive cycle ergometer promoted reduced levels of nitric oxide, showing beneficial effects on oxidative stress reduction. As assessed by inflammatory cytokines, the treatment was not associated with changes in the immune system. However, further research in a larger population is necessary for more conclusive results.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Estado Terminal/terapia , Exercício Físico/fisiologia , Terapia Passiva Contínua de Movimento/métodos , Estresse Oxidativo/fisiologia , Citocinas/sangue , Ensaio de Imunoadsorção Enzimática , Unidades de Terapia Intensiva , Lipopolissacarídeos/uso terapêutico , Força Muscular/fisiologia , Atrofia Muscular/prevenção & controle , Óxido Nítrico/imunologia , Óxido Nítrico/metabolismo , Estresse Oxidativo/imunologia , Reprodutibilidade dos Testes , Respiração Artificial/métodos , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do TratamentoRESUMO
INTRODUCTION: Early mobilization can be performed in critically ill patients and improves outcomes. A daily cycling exercise started from day 5 after ICU admission is feasible and can enhance functional capacity after hospital discharge. In the present study we verified the physiological changes and safety of an earlier cycling intervention (< 72 hrs of mechanical ventilation) in critical ill patients. METHODS: Nineteen hemodynamically stable and deeply sedated patients within the first 72 hrs of mechanical ventilation were enrolled in a single 20 minute passive leg cycling exercise using an electric cycle ergometer. A minute-by-minute evaluation of hemodynamic, respiratory and metabolic variables was undertaken before, during and after the exercise. Analyzed variables included the following: cardiac output, systemic vascular resistance, central venous blood oxygen saturation, respiratory rate and tidal volume, oxygen consumption, carbon dioxide production and blood lactate levels. RESULTS: We enrolled 19 patients (42% male, age 55 ± 17 years, SOFA = 6 ± 3, SAPS3 score = 58 ± 13, PaO2/FIO2 = 223 ± 75). The median time of mechanical ventilation was 1 day (02), and 68% (n=13) of our patients required norepinephrine (maximum concentration = 0.47 µg.kg(-1).min(-1)). There were no clinically relevant changes in any of the analyzed variables during the exercise, and two minor adverse events unrelated to hemodynamic instability were observed. CONCLUSIONS: In our study, this very early passive cycling exercise in sedated, critically ill, mechanically ventilated patients was considered safe and was not associated with significant alterations in hemodynamic, respiratory or metabolic variables even in those requiring vasoactive agents.
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Estado Terminal/terapia , Terapia Passiva Contínua de Movimento/métodos , Adulto , Idoso , Gasometria , Débito Cardíaco , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Norepinefrina/uso terapêutico , Oximetria , Consumo de Oxigênio/fisiologia , Segurança do Paciente , Troca Gasosa Pulmonar/fisiologia , Respiração Artificial , Simpatomiméticos/uso terapêutico , Volume de Ventilação Pulmonar/fisiologia , Fatores de TempoRESUMO
El presente estudio tiene como objetivo principal determinar los efectos del Kinesio Taping en la funcionalidad manual de pacientes con hemiplejia post accidente cerebro vascular en el Hospital Nacional Dos de Mayo. Se aplicó la técnica Kinesio Taping, utilizando rollos de KIN TAPE (vendaje neuromuscular) a los pacientes seleccionados. El estudio fue de tipo analítico-observacional, sin grupo control, prospectivo, longitudinal. Se incluyeron 8 paciente de ambos sexos, cuyas edades oscilaban entre los 40 y 75 años, los cuales asistían al servicio de Terapia Ocupacional del Hospital Nacional Dos de Mayo, con una valoración inicial de Brunnstrom (Etapa 3, 4, y 5, según la escala de recuperación de la hemiplejia de Signe Brunnstrom). De las personas en estudio, el 50 por ciento (4 pacientes), corresponden a casos que tienen como diagnóstico hemiplejia, el resto pertenecen a hemiparesia; el 62,50 por ciento (5 pacientes) son de sexo masculino, mientras que el 37,50 por ciento (3 pacientes) mujeres. En relación al hemicuerpo afectado, el 63,5 por ciento (5 pacientes) tienen el lado derecho afectado, siendo el 100 por ciento (8 pacientes) diestros. Para la evaluación de la funcionalidad manual se utilizó el Test de Sollerman (versión adaptada), Para el análisis de los tipos o formas de prensión, se seleccionó del Test de Sollerman (versión adaptada), 8 subtest que representan dichas prensiones. Mientras que para evaluar en qué estadío en las etapas de Brunnstrom se encuentran los pacientes, se usó un formato de evaluación de Brunnstrom, luego se hizo un seguimiento de tres meses, obteniendo resultados iniciales (no hay aplicación de KIN TAPE) y finales (si hubo aplicación de KIN TAPE). De ésta manera se determinó: funcionalidad manual (antes), funcionalidad manual (después), tipos o formas de prensión (antes), tipos o formas de prensión (después), estadío en las etapas de Brunnstrom (antes) y estadío en las etapas de Brunnstrom (después). Los resultados que se...
This study aims to determine the effects of main Kinesio Taping on hand function of patients with hemiplegia post-stroke at Hospital Dos de Mayo. Technique was applied Kinesio Taping, using KIN TAPE rolls (Kinesio Taping) selected patients. The type of study was analytical-observational, no control group, prospective, longitudinal. We included eight patients of both sexes, aged between 40 and 75 years, who were attending the Occupational Therapy service at National Hospital Dos de Mayo, with an initial assessment of Brunnstrom (Phase 3, 4, and 5 as the scale recovery of Signe Brunnstrom hemiplegia). Of individuals in the study, 50 per cent of the cases had a diagnosis hemiplegia (4 patients), while the rest belongs to hemiparesis; 62.50 per cent (5 patients) are male with 37.50 per cent (3 patients) women. In relation to the affected side of the body, 63.5 per cent (5 patients) have the right affected, with 100 per cent (8 patients) skilled. For evaluating the manual functionality was used the Sollerman's test, to analyze the types or forms of grip, was selected of the Sollerman's test, 8 subtest representing these grips. While assessing that stage in Brunnstrom stages are patients, we used a Brunnstrom assessment format, then followed up three months, obtaining initial results (no application of KIN TAPE) and final (if there application KIN TAPE). Determined in this way: manual functionality (before), manual functionality (after), types or forms of grip (before), types or forms of grip (Iater) stage in the stages Brunnstrom (before) and stage in the stages Brunnstrom (after). The results obtained were: four patients who started with Brunnstrom 3 including three patients with poor manual dexterity (two Brunnstrom April evolved with regular manual dexterity, while one remained in Brunnstrom 3 and evolved to a poor manual dexterity), a patient with a poor manual dexterity Brunnstrom step 4 and evolved into a regular manual dexterity, four patients started with...