Força muscular respiratória e periférica de pacientes pós-COVID-19
Data
2024
Autores
Saldanha, Maria Fernanda Lima Souza 
Orientadores
Sperandio, Priscila Cristina de Abreu
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: a persistência de dispneia e fadiga, com consequente intolerância ao exercício, tem sido os sintomas mais frequentes em pacientes pós-COVID-19. Apesar dos avanços científicos, sua causa ainda não é totalmente compreendida. Objetivo: avaliar a força muscular respiratória e periférica de pacientes diagnosticados com COVID-19 após a alta hospitalar, a fim de identificar a porcentagem de pacientes que apresentam fraqueza dessas musculaturas. Método: A avaliação foi realizada após 90 dias do início dos sintomas e incluiu avaliação da força muscular respiratória, força de preensão palmar, teste da caminhada de seis minutos, teste do degrau de quatro minutos e função pulmonar. Resultados: foram incluídos 264 pacientes, dos quais 27% apresentaram PImáx <80%prev e 53% apresentaram força de preensão palmar máxima <80% previsto. O grupo PImáx <80%prev, além de menor PImáx, apresentou menor PImáx absoluta, PImáx %prev, PImáx sustentada, SIndex, PEmáx absoluta e PEmáx %prev (p<0,001), menor valor de força de preensão palmar no membro dominante, menor VEF1 (%), menor número de degraus no TD4M e menor distância percorrida no TC6M (p=0,022; p=0,045; p=0,025; p=0,047, respectivamente). O grupo com PImáx ≥80%prev apresentou maior porcentagem de pacientes que foram internados em UTI (p=0,003) e fizeram uso de ventilação mecânica não invasiva (p=0,012). A PImáx <80% está associada a menor PEmáx, menor força de preensão palmar e menor distância no TC6M (x2=30,817, p<0,001; x2=10,305, p<0,05; x2=25,186, p<0,0001, respectivamente). Conclusão: Dos pacientes avaliados, 27% apresentam fraqueza muscular inspiratória e 53% apresentam força de preensão palmar máxima <80% previsto após a alta hospitalar pós-COVID-19. Menor PEmáx, menor força de preensão palmar e menor distância percorrida no TC6M estão associadas à fraqueza muscular inspiratória quando comparadas com pacientes sem fraqueza.
Introduction: Persistent dyspnea and fatigue, with consequent exercise intolerance, have been the most frequent symptoms in post-COVID-19 patients. Despite scientific advances, its cause is still not fully understood. Objective: To assess the respiratory and peripheral muscle strength of patients diagnosed with COVID-19 after hospital discharge, to identify the percentage of patients who have weakness in these muscles. Method: The evaluation was carried out 90 days after the onset of symptoms and included assessment of respiratory muscle strength, handgrip strength, six-minute walk test, four-minute step test and pulmonary function. Results: 264 patients were included, 27% of whom had MIP <80% predicted and 53% had maximum handgrip strength <80% predicted. The MIP <80% predicted group, in addition to lower MIP, had lower absolute MIP, MIP % predicted, sustained MIP, SIndex, absolute MEP and MEP % predicted (p<0.001), lower grip strength in the dominant limb, lower FEV1 (%), lower number of steps in the 4MWT and lower distance covered in the 6MWT (p=0.022; p=0.045; p=0.025; p=0.047, respectively). The group with MIP ≥80%prev had a higher percentage of patients who were admitted to the ICU (p=0.003) and used non-invasive mechanical ventilation (p=0.012). MIP <80% is associated with lower MEP, lower handgrip strength and lower 6MWT distance (x2=30.817, p<0.001; x2=10.305, p<0.05; x2=25.186, p<0.0001, respectively). Conclusion: Of the patients evaluated, 27% had inspiratory muscle weakness and 53% had maximum handgrip strength <80% predicted after hospital discharge post-COVID-19. Lower MEP, lower handgrip strength and lower distance covered in the 6MWT are associated with inspiratory muscle weakness when compared to patients without weakness.
Introduction: Persistent dyspnea and fatigue, with consequent exercise intolerance, have been the most frequent symptoms in post-COVID-19 patients. Despite scientific advances, its cause is still not fully understood. Objective: To assess the respiratory and peripheral muscle strength of patients diagnosed with COVID-19 after hospital discharge, to identify the percentage of patients who have weakness in these muscles. Method: The evaluation was carried out 90 days after the onset of symptoms and included assessment of respiratory muscle strength, handgrip strength, six-minute walk test, four-minute step test and pulmonary function. Results: 264 patients were included, 27% of whom had MIP <80% predicted and 53% had maximum handgrip strength <80% predicted. The MIP <80% predicted group, in addition to lower MIP, had lower absolute MIP, MIP % predicted, sustained MIP, SIndex, absolute MEP and MEP % predicted (p<0.001), lower grip strength in the dominant limb, lower FEV1 (%), lower number of steps in the 4MWT and lower distance covered in the 6MWT (p=0.022; p=0.045; p=0.025; p=0.047, respectively). The group with MIP ≥80%prev had a higher percentage of patients who were admitted to the ICU (p=0.003) and used non-invasive mechanical ventilation (p=0.012). MIP <80% is associated with lower MEP, lower handgrip strength and lower 6MWT distance (x2=30.817, p<0.001; x2=10.305, p<0.05; x2=25.186, p<0.0001, respectively). Conclusion: Of the patients evaluated, 27% had inspiratory muscle weakness and 53% had maximum handgrip strength <80% predicted after hospital discharge post-COVID-19. Lower MEP, lower handgrip strength and lower distance covered in the 6MWT are associated with inspiratory muscle weakness when compared to patients without weakness.
Descrição
Citação
SALDANHA, Maria Fernanda Lima Souza. Força muscular respiratória e periférica de pacientes pós-COVID-19. 2024. 56 f. Dissertação (Mestrado em Pneumologia) - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2024.