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- ItemAcesso aberto (Open Access)Empilhamento de ar e compressão torácica aumentam o pico de fluxo da tosse em pacientes com distrofia muscular de Duchenne(Sociedade Brasileira de Pneumologia e Tisiologia, 2009-10-01) Brito, Magneide Fernandes [UNIFESP]; Moreira, Gustavo Antonio [UNIFESP]; Pradella-Hallinan, Márcia Lurdes de Cássia [UNIFESP]; Tufik, Sergio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To evaluate cough efficiency using two manually-assisted cough techniques. METHODS: We selected 28 patients with Duchenne muscular dystrophy. The patients were receiving noninvasive nocturnal ventilatory support and presented FVC values < 60% of predicted. Peak cough flow (PCF) was measured, with the patient seated, at four time points: at baseline, during a spontaneous maximal expiratory effort (MEE); during an MEE while receiving chest compression; during an MEE after air stacking with a manual resuscitation bag; and during an MEE with air stacking and compression (combined technique). The last three measurements were conducted in random order. The results were compared using Pearson's correlation test and ANOVA with repeated measures, followed by Tukey's post-hoc test (p < 0.05). RESULTS: The mean age of the patients was 20 ± 4 years, and the mean FVC was 29 ± 12%. Mean PCF at baseline, with chest compression, after air stacking and with the use of the combined technique was 171 ± 67, 231 ± 81, 225 ± 80, and 292 ± 86 L/min, respectively. The results obtained with the use of the combined technique were significantly better than were those obtained with the use of either technique alone (F[3.69] = 67.07; p < 0.001). CONCLUSIONS: Both chest compression and air stacking techniques were efficient in increasing PCF. However, the combination of these two techniques had a significant additional effect (p < 0.0001).
- ItemAcesso aberto (Open Access)Hiperinsuflacao manual para desobstrucao das vias aereas em pediatria: revisao sistematica(Associação de Medicina Intensiva Brasileira - AMIB, 2013-09-01) Godoy, Vanessa Cristina Waetge Pires De; Zanetti, Nathalia Mendonca; Johnston, Cintia; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE:To perform an assessment of the available literature on manual hyperinflation as a respiratory physical therapy technique used in pediatric patients, with the main outcome of achieving airway clearance.METHODS:We reviewed articles included in the Lilacs (Latin American and Caribbean Literature on Health Sciences/Literatura Latino Americana e do Caribe em Ciências da Saúde), Cochrane Library, Medline (via Virtual Health Library and PubMed), SciELO (Scientific Electronic Library), and PEDro (Physiotherapy Evidence Database) databases from 2002 to 2013 using the following search terms: physiotherapy (techniques), respiratory therapy, intensive care, and airway clearance. The selected studies were classified according to the level of evidence and grades of recommendation (method of the Oxford Centre for Evidence-Based Medicine) by two examiners, while a third examiner repeated the search and analysis and checked the classification of the articles.RESULTS:Three articles were included for analysis, comprising 250 children (aged 0 to 16 years). The main diagnoses were acute respiratory failure, recovery following heart congenital disease and upper abdominal surgery, bone marrow transplantation, asthma, tracheal reconstruction, brain injury, airway injury, and heterogeneous lung diseases. The studies were classified as having a level of evidence 2C and grade of recommendation C.CONCLUSIONS:Manual hyperinflation appeared useful for airway clearance in the investigated population, although the evidence available in the literature remains insufficient. Therefore, controlled randomized studies are needed to establish the safety and efficacy of manual hyperinflation in pediatric patients. However, manual hyperinflation must be performed by trained physical therapists only.
- ItemAcesso aberto (Open Access)Ressecção laparoscópica dos cistoadenomas pancreáticos(Colégio Brasileiro de Cirurgia Digestiva, 2012-09-01) Farah, José Francisco De Mattos [UNIFESP]; Lupinacci, Renato Micelli; Apodaca-Torrez, Franz Robert [UNIFESP]; Hospital do Servidor Público Estadual de São Paulo Departamento de Cirurgia Geral e Oncológica; Universidade Federal de São Paulo (UNIFESP); Hôpital de la Pitié-Salpetrière - APHP Service de Chirurgie Général, Digestive et EndocrinienneBACKGROUND: Laparoscopic pancreatic resections have become increasingly frequent with good results reported by several centers. However, few studies have focused on laparoscopic treatment of pancreatic cystic lesions. AIM: To analyze the results of minimally invasive treatment of pancreatic cystic lesions. METHODS: Were included all laparoscopic pancreatic resections performed at three centers. Surgical procedures included resection of the pancreas and left enucleations (with or without splenectomy). The post-operative complications were classified according to the classification proposed by Clavien and Dindo6. The diagnosis of pancreatic fistula was confirmed if the amylase dosage of the drainage liquid in the third postoperative day was more than three times the amount of serum amylase. RESULTS: Were performed 44 laparoscopic pancreatic resections. Fifteen patients underwent surgery for suspected pancreatic cystadenoma and 13 had this diagnosis confirmed. There were 12 women (92%), and the average age of patients was 50 years. Six patients had minor postoperative complications. There were five (38%) pancreatic fistulas, neither considered as severe (C), and only one patient required hospital readmission and radiological drainage. In this series, there were no conversions, reoperations, or mortality. CONCLUSIONS: The laparoscopic approach is a safe and effective option for the treatment of pancreatic cystic lesions. The incidence of pancreatic fistula has good evolution and not diminishes the benefits of minimally invasive surgery.