Comparação de três protocolos de fisioterapia respiratória sobre a mecânica pulmonar e parâmetros cardiorrespiratórios de pacientes submetidos a ventilação mecânica invasiva

Abstract

In order to reduce pulmonary and systemic complications arising from invasive mechanical ventilation (IMV), physiotherapy becomes indispensable in intensive care units (ICUs). However it is still necessary to produce evidence on the effectiveness of the procedures used. The aim of this study is to compare three protocols for respiratory therapy in patients undergoing IMV: only aspiration; vibro-compression and aspiration; vibro-compression, aspiration and hyperventilation by mechanical ventilator and check the effects on pulmonary mechanics and cardio respiratory parameters. The variables investigated were: heart rate, respiratory rate, blood pressure, oxygen saturation, dynamic and static compliance and airway resistance, immediately after and 15 minutes after the procedures. A comparative analysis was performed by intra-group analysis of variance (ANOVA) for repeated measures followed by post hoc Bonferroni. The comparison between groups was performed by one-way ANOVA, significance level of 5%. Except in the aspiration group, the other showed clinic improvement in pulmonary resistance and compliance. The vibro-compresion and aspiration group had reduced resistance and increased compliance while the group that was associated with hyperinflation had better impact on compliance with no change in pulmonary resistance. There were no adverse hemodynamic, and oxygenation remained stable indicating safety of procedures. Hyperinflation seems to have been the indicator of positive impact on static and dynamic compliance.