![]() Fonoaudiologia, Fisioterapia e Terapia Ocupacional da Faculdade de Medicina da. Fisioterapia respiratria e terapia intensiva.pdf. Guyton fisiologia medica pdf at. Anestesia e Rianimazione e terapia intensiva PROVA ESAME. Unidade de Terapia Intensiva do. Funo pulmonar, ventilao mecnica, pediatria, terapia intensiva, insuficincia respiratria. Fisioterapia Intensiva PDF - Free Ebook Download. Fisioterapia motora em pacientes internados na unidade de .. Fisioterapia motora em pacientes cr. A fraqueza muscular do paciente cr. Fisioterapia intensiva. Fisioterapia intensiva. Conclusiones: la fisioterapia respiratoria tie- ne indicaci. Fundamentos da terapia respiratria de Egan. Anestesia e Rianimazione e terapia intensiva PROVA. O paciente deve ser bem orientado quanto . Mo-Funcional e Fisioterapia Intensiva da Santa Casa de S. Download free pdf files. Fisioterapia Respiratoria. Na UTI, o principal objetivo dos cuidados no paciente neurol. I Recomenda. 2. 01. Quadro 1- Resumo dos estudos. Source: www. scielo. Fisioterapia em pacientes cr. Por conseguinte, o cap. Source: almoogaz. Thes. Source: sundayers. The Last Of The Angels. Other Files Available to Download . Lectures On Logic Studies In Continental Thought. Other Files Available to Download. Source: towardharmonywithnature. Pressure support versus T- tube for weaning from mechanical ventilation in adults - Ladeira - 2. The Cochrane Library. Summary of main results. The studies included here were conducted in various parts of the world, in Europe, South America, and Asia, although all of them were published in the English language. The results of this systematic review have external validity for adult patients, mostly intubated, who were on mechanical ventilation for at least 2. Despite the fact that the included studies had not defined respiratory failure, the causes of respiratory failure or reasons for the initiation of mechanical ventilation were described for eight studies. The criteria for interruption of ventilatory support were described by all authors. Pressure support (PS) ventilation and a T- tube were used directly as spontaneous breathing trials (SBTs) in four studies with 8. In 1. 86 (1. 5. 4%) included patients, both interventions were used along with a gradual weaning from mechanical ventilation; the PS was gradually decreased, twice a day, until the minimal PS was reached (PSmin) and periods with a T- tube were gradually increased to two hours (Brochard 1. Esteban 1. 99. 5) and eight hours (Vitacca 2. SBTs for patients with difficult and prolonged weaning. In two studies involving 1. PS was lowered to 2 to 4 cm H2. O (Mati. Two authors (Esteban 1. Perren 2. 00. 2) reported no statistical differences between 3. SBTs on the outcomes weaning success and reintubation. The results of this review apply to at least a two hour SBT. The nine included studies were classified according to the difficulty and length of the weaning process. Four studies presented patients who achieved simple weaning (Esteban 1. Haberthur 2. 00. 2; Koh 2. Koksal 2. 00. 4). In six studies (Brochard 1. Esteban 1. 99. 5; Esteban 1. Koh 2. 00. 0; Mati. They were classified as having a difficult weaning. Two studies (Brochard 1. Vitacca 2. 00. 1) presented patients with prolonged weaning. They had failed three attempted SBTs or required more than seven days of mechanical ventilation after their first SBT to finally achieve successful weaning. Four studies had patients classified into two weaning groups, and only Esteban 1. The classification of patients into three groups of weaning was based on expert opinion during the Fifth Conference of the International Consensus Intensive in 2. Boles 2. 00. 7). We classified the included studies into three categories of weaning based on information reported in the original articles and by contacting the authors. Further studies are being conducted to establish this classification and to evaluate how the outcomes of ICU mortality, reintubation, and length of stay in the ICU are affected in each category of weaning (Funk 2. Pe. Nine studies assessed this outcome in 9. PS and 7. 3% with a T- tube achieved weaning success, although this difference was statistically non- significant. The weaning success was 8. Boles 2. 00. 7 reported weaning success in 1. SBTs, population, and duration of the SBT differed among the studies. In this review, the percentages of patients in simple, difficult, and prolonged weaning groups were 6. In the Funk 2. 01. Our sample size for prolonged weaning was smaller (5. The ICU mortality rate was not statistically different among the patients who passed the SBTs using PS and T- tube, independent of the weaning process. The overall mortality rate was 1. The mortality rate was 7. The mortality rate was higher among the patients with difficult weaning. In the 2. 57 patients of an observational study, Funk 2. Our sample size for prolonged weaning was small (5. The duration of weaning from mechanical ventilation was analysed qualitatively, even though four studies (Brochard 1. Esteban 1. 99. 7; Mati. The data of three of these studies were reported as medians and interquartile ranges. The mean and standard deviation can be estimated from the median (Hozo 2. Based on the qualitative analysis of these three studies (Brochard 1. Mati. The weaning duration depends on the cause of the respiratory failure as, for example, COPD patients can spend up to 5. Esteban 1. 99. 4). Blackwood 2. 01. 0 reported that implementation of weaning protocols was related to the shorter duration of weaning, a reduction of 7. SBTs (PSV versus T- tube) that influenced weaning duration. In this review, the reintubation rate was higher among patients who used the T- tube (1. PS) but we did not find any statistically significant difference between them. The rate of reintubation within 4. Esteban 1. 99. 9 and Boles 2. SBTs. From the subgroup analysis on two categories of the weaning process, the reintubation rate was higher among the patients with simple rather than difficult weaning: 1. Again, there was not any statistically significant difference between PSV and the T- tube. According to Mac. Intyre 2. 01. 2, reintubation rates of 5% to 2. The rates of reintubation with simple and difficult weaning in two observational studies (Funk 2. Pe. In this review, the reintubation rate was lower in the difficult weaning group. The successful SBT (PSV or T- tube) is used as a predictor of weaning success from mechanical ventilation, so this outcome was added to the systematic review. Data were available from four included studies. A statistically significantly percentage (7. PS passed the SBT and were extubated. A greater number of patients undergoing T- tube trials failed the two hours of SBT, and these patients returned to mechanical ventilation for at least 2. After pooling the data on 9. SBT. Weaning success or successful extubation is the absence of ventilatory support (Brochard 1. Vitacca 2. 00. 1) 4. In all studies included here, the intolerance criteria or tolerance criteria for SBTs were similar: respiratory rate and pattern, gas exchange (arterial oxygen saturation), and haemodynamic stability (heart rate and systolic blood pressure) (see Table 2). Ezingeard 2. 00. 6 observed that the intubated patients who failed the SBT through the T- tube but continued the SBT with PS of 7 or 1. H2. 0 were successfully extubated. Several studies showed that work of breathing is significantly higher during T- tube trials compared with PSV trials (Cabello 2. Koh 2. 00. 0; Kuhlen 2. Patel 1. 99. 6). The ICU and long- term weaning unit (LWU) lengths of stay were evaluated by five authors (Brochard 1. Esteban 1. 99. 7; Mati. The mean difference of 7. PSV, in our meta- analysis of two studies (Brochard 1. Vitacca 2. 00. 1) with 1. Three studies (Esteban 1. Mati. The results reported by two studies (Mati. Blackwood 2. 01. 0 reported a 1. ICU length of stay in studies that adopted a weaning protocol. All studies included in this review followed the criteria for the interruption of mechanical ventilation, an initial T- tube test, and SBTs. The physiologic parameters planned for this review were evaluated by seven studies, and these parameters were measured in an initial T- tube test between two to five minutes before the SBTs. Only two studies (Haberthur 2. Koh 2. 00. 0) evaluated RR, VT, and rapid shallow breathing index (RSBI) during SBTs; for two outcomes, RR and VT, the PS was statistically superior to the T- tube in a meta- analysis of two studies with 9. We did not find any differences between PS and T- tube SBTs among the 9. RSBI. The RSBI was used as a weaning predictor test before trials of extubation (SBTs) as recommended by Boles 2. Mac. Intyre 2. 01. In this review, the PSV was not statistically different from T- tube, and some studies (Cabello 2. Gon. Although at least two studies evaluated the total duration of mechanical ventilation and hospital length of stay, the data from three studies were reported as the median and interquartile range but we chose not to perform meta- analysis with estimated data. Patients in difficult weaning who submitted to PSV spent less time on mechanical ventilation (median of - 4. T- tube. Vitacca 2. T- tube (see Appendix 1. Appendix 1. 4). Only the study by Esteban 1. There was not any statistical difference between PSV and T- tube for these outcomes (see Table 3). Adverse effects were reported by three studies (Brochard 1. Mati. New episodes of pneumonia and arrhythmia were diagnosed in 1. SBTs presented with ischaemic heart failure during weaning. Agitation needing low dose sedative was found in 1. PSV versus three in T- tube SBTs), and life- threatening complications during the procedure were reported in 6. PSV versus three (1. T- tube SBTs). The studies did not find any significant statistical difference between patients who underwent PS and T- tube SBTs. Costa 2. 00. 5 reported a higher frequency of arrhythmias in cardiac patients compared to patients without heart disease, regardless of SBTs (PSV versus T- tube). The SBTs appear to be safe for weaning patients from mechanical ventilation. Subgroup analysis was conducted in accordance with the weaning process (simple, difficult, and prolonged) for the three outcomes ICU mortality, weaning success and reintubation. Four studies compared the PSV versus T- tube techniques in two weaning groups; only Esteban 1. Brochard 1. 99. 4; Koh 2. Haberthur 2. 00. 2 evaluated and reported the data for weaning success in patients in the simple and difficult weaning groups. However, the study design was cross- over. We thus collected the results of the first study moment, that is, prior to cross- over. None of the studies evaluated comfort, quality of life, or costs. The agitation during SBTs may be associated with patient discomfort. Overall completeness and applicability of evidence. The results from this systematic review applied to adult patients with at least 2. The patients were clinically and biogenically stable, their weaning was either simple or difficult, and they underwent SBTs through PS and the T- tube. The results were favourable towards PS but were non- statistically significant for weaning success, ICU mortality, reintubation and other factors. The RR and VT were statistically significant in favour of PS. The patients who underwent PS for 1.
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