Navegando por Palavras-chave "Intermittent positive-pressure ventilation"

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    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).
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    Safety in intrahospital transportation: evaluation of respiratory and hemodynamic parameters. A prospective cohort study
    (Associação Paulista de Medicina - APM, 2008-11-01) Mazza, Bruno Franco [UNIFESP]; Amaral, José Luiz Gomes do [UNIFESP]; Rosseti, Heloisa [UNIFESP]; Carvalho, Rosana Borges [UNIFESP]; Senna, Ana Paula Resque [UNIFESP]; Guimarães, Hélio Penna [UNIFESP]; Machado, Flávia Ribeiro [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    CONTEXT AND OBJECTIVE: Intrahospital transportation of mechanically ventilated patients is a high-risk situation. We aimed to determine whether transfers could be safely performed by using a transportation routine. DESIGN AND SETTING: Prospective cohort study with before and after evaluation. METHODS: Mechanically ventilated patients who needed transportation were included. Hemodynamic and respiratory parameters were measured before and after transportation. Statistical analysis consisted of variance analysis and paired Student's t test. Results were considered significant if P < 0.05. RESULTS: We studied 37 transfers of 26 patients (12 female) of mean age 46.6 ± 15.7. Patients with pulmonary diseases, positive end expiratory pressure > 5, FiO2 > 0.4 and vasoactive drug use comprised 42.4%, 24.3%, 21.6% and 33.0% of cases, respectively. Mean duration of transportation was 43.4 ± 18.9 minutes. Complications occurred in 32.4%. There was a significant increase in CO2 (before transportation, 29.6 ± 7.3 and after transportation, 34.9 ± 7.0; P = 0.000); a trend towards improved PO2/FiO2 ratio (before transportation, 318.0 ± 137.0 and after transportation, 356.8 ± 119.9; P = 0.053); increased heart rate (before transportation, 80.9 ± 18.7 and after transportation, 85.5 ± 17.6; P = 0.08); and no significant change in mean arterial blood pressure (P = 0.93). CONCLUSION: These results suggest that intrahospital transportation can be safely performed. Our low incidence of complications was possibly related to both the presence of a multidisciplinary transportation team and proper equipment.