Comportamento da mecânica ventilatória durante a realização de um atendimento de fisioterapia respiratória

Abstract

Question: Can Respiratory therapy alter the lung mechanics in patients with invasive mechanical ventilation? The data available in the literature remain controversial. This study aims to assess the changes of pulmonary mechanics in patients with invasive mechanical ventilation, comparing hemodynamic and ventilatory parameters one hour prior to application of the service, immediately after and one hour after the service. Design: Participants: Patients on mechanical ventilation for at least 48 hours with oro-tracheal tube. Intervention: Patients underwent a protocol of respiratory therapy and hemodynamic variables were recorded at different times. Outcome measures: The following variables were measured one hour before, immediately after and one hour after application of the protocol of respiratory therapy. Dynamic lung compliance (Cdyn), respiratory system resistance (Rsr), Tidal Volume (Vt), Positive End Expiratory Pressure (PEEP), Peak inspiratory pressure (PIP), Heart Rate (HR), Respiratory frequency (RF), and Saturation peripheral oxygen (SpO2). Results: The variables obtained the following mean and standard deviation: HR 88.9 ± 18.7 an hour before the service, presented an increase to 93.7 ± 19.2 immediately after the service, which fell one hour after the service, 88.5 ± 17.1. So we can conclude that heart rate showed an increase after treatment of respiratory therapy and one hour after this variable had a value less than the obtained in the beginning. SpO2 96.5 ± 2.29 one hour before the service, with an increase to 98.2 ± 1.62 immediately after the service, and a slight decrease to 97.8 ± 1.79 one hour after the service. We can conclude that the oxygen saturation showed a significant improvement one hour after the service, not returning to the value obtained one hour before the service. RF 20.8 ± 5.40 one hour before the service, increasing to 21.9 ± 5.89 immediately after the service and presenting a decrease of 19.4 ± 1.79 one hour after the service, when compared to one hour before the service. Rsr 14.2 ± 4.63 one hour before the service, down immediately after the service 11.0 ± 3.43 and a small increase one hour after the service, but did not return to baseline. Vt 550± 134 one hour before the service, increasing significantly to 698 ± 155 and presenting a decrease 672 ± 146, although it remained higher than the value obtained one hour before the service. PIP 22.2 ± 5.54 one hour before the service, with a slowdown that does not differ from the Bonferroni test with the value immediately after the service, and decreased to 21.5 ± 5.24, when compared with the previous two times . Cdyn 52.3 ± 16.1 one hour before the service, increased significantly immediately after the service 65.1 ± 19.1 and decreased to 64.7 ± 20.2 one hour after the service, with no significant difference if compared to the second time, and significant difference if compared with the first time. Peep 5.93 ± 1.80 one hour before the service, 5.89 ± 1.71 immediately after the service and 5.91 ± 1.70 one hour after the service. This was the only variable that showed no significant difference in any of the times compared. In Conclusion: The variables HR, SpO2, RF, Rsr, Vt and Cdyn obtained significance p < 0,01.Variable PIP gained significance with p <0, 013.