Treinamento muscular inspiratório em crianças sob ventilação mecânica: revisão da literatura
Inspiratory muscle training in children under mechanical ventilation: literature review
PINTO, Ana Carolina Pereira Nunes; BARBOSA, José Luis Rodrigues; JOHNSTON, Cintia
Resumo
Introdução: Apesar de salvar inúmeras vidas, a ventilação mecânica, por períodos prolongados, está frequentemente associada a vários riscos e efeitos adversos. Várias intervenções, visando à otimização do desmame de pacientes sob ventilação mecânica, têm sido propostas. Objetivo: Realizar uma revisão da literatura para identificar os efeitos do treinamento muscular inspiratório (TMI) em crianças sob ventilação pulmonar mecânica. Métodos: Revisão bibliográfica realizada em cinco bases de dados eletrônicas: PubMed/Medline, Lilacs, PEDro, SciELO e Cochrane Library, utilizando os descritores “respiration, artificial”, “breathing exercises” “ventilator weaning” e “child”, em inglês, espanhol e português. Foram incluídos estudos que utilizavam o TMI, em pacientes na faixa etária pediátrica, sob ventilação pulmonar mecânica, publicados até o mês de janeiro de 2017. A pesquisa não impôs data mínima de publicação. Os estudos encontrados foram classificados por nível de evidência, mediante o método GRADE. Resultados: Após a análise dos títulos, resumos e conteúdo, dos 832 artigos encontrados, 830 foram excluídos, por não estarem de acordo com os critérios de inclusão, restando dois artigos. Os estudos incluíram três crianças com média de idade de 5,5 meses + 2,02, que foram submetidas ao TMI. Todas as crianças evoluíram com o sucesso do desmame da ventilação mecânica, não tendo apresentado efeitos adversos durante o treinamento. Conclusão: Há evidências de muito baixa qualidade de que o TMI pode ser aplicado em crianças sob ventilação mecânica prolongada, com critérios de inclusão/exclusão, avaliação e interrupção determinadas, individualmente, por um fisioterapeuta treinado. O assunto precisa ser melhor investigado, por meio de ensaios clínicos randomizados que utilizem dispositivos terapêuticos desenvolvidos, especificamente, para essa população.
Palavras-chave
Abstract
Introduction: Despite saving countless lives, prolonged mechanical ventilation is often associated with several risks and adverse effects. Several interventions aiming to optimize the weaning of patients under mechanical ventilation have been proposed. Objective: To perform a literature review to identify the effects of inspiratory muscle training in children under mechanical ventilation. Methods: Bibliographic review in five electronic databases: PubMed / Medline, Lilacs, PEDro, SciELO and Cochrane Library, using the descriptors “respiration, artificial”, “breathing exercises” and “ventilator weaning” and “child”, in English, Spanish and Portuguese. We included studies that used inspiratory muscle training (IMT) in pediatric patients under pulmonary mechanical ventilation published until January 2017. The research did not impose a minimum publication date. The studies found were classified by level of evidence using the GRADE method. Results: After analyzing the titles, abstracts and content, of the 832 articles found, 830 were excluded because they did not meet the inclusion criteria, with two articles remaining. The studies included 3 children with mean age of 5.5 ± 2.02 months who underwent IMT. All children evolved with successful weaning from mechanical ventilation and did not present adverse effects during training. Conclusions: There is very low quality of evidence that IMT can be applied to children under prolonged mechanical ventilation, with inclusion/exclusion criteria, assessment and interruption individually determined by a trained physiotherapist. The subject needs to be better investigated through randomized clinical trials using therapeutic devices specifically developed for this population.
Keywords
Referências
1. Moodie LH, Reeve JC, Vermeulen N, Elkins MR. Inspiratory muscle training to facilitate weaning from mechanical ventilation: protocol for a systematic review. BMC Research Notes. 2011 Aug 11;4:283.
2. Gizzi C, Moretti C, Agostino R. Weaning from mechanical ventilation. J Matern Fetal Neonatal Med. 2011 Oct;24 (Suppl 1):61-3.
3. Jaber S, Petrof BJ, Jung B, Chanques G, Berthet JP, Rabuel C, et al. Rapidly progressive diaphragmatic weakness and injury during mechanical ventilation in humans. Am J Respir Crit Care Med. 2011 Feb 1;183(3):364–71.
4. Bancalari E, Claure N. Strategies to accelerate weaning from respiratory support. Early Hum Dev. 2013 Jun;89(Suppl 1):S4-6.
5. Moodie L, Reeve J, Elkins M. Inspiratory muscle training increases inspiratory muscle strength in patients weaning from mechanical ventilation: a systematic review. J Physiother. 2011;57(4):213-21.
6. Elkins M, Dentice R. Inspiratory muscle training facilitates weaning from mechanical ventilation among patients in the intensive care unit: a systematic review. J Physiother. 2015 Jul;61(3):125–134.
7. Smith BK, Bleiweis MS, Neel CR, Martin AD. Inspiratory muscle strength training in infants with congenital heart disease and prolonged mechanical ventilation: a case report. Phys Ther. 2013 Feb;93(2): 229-36.
8. Hill K, Cecins NM, Eastwood PR, Jenkins SC. Inspiratory muscle training for patients with chronic obstructive pulmonary disease: a practical guide for clinicians. Arch Phys Med Rehabil. 2010 Sep;91(9):1466-70.
9. Yensen, J. PICO Search Strategies. Online J Nurs Inform. 2013;17(3).
10. Schünemann H, Brożek J, Guyatt G, Oxman A (editors). GRADE Handbook [Internet]. 2013. Available from: https://gdt.gradepro.org/app/handbook/handbook.html
11. Brunherotti MA, Bezerra PP, Bachur CK, Jacometti CR. Inspiratory muscle training in a newborn with anoxia who was chronically ventilated. Phys Ther. 2012 Jun;92(6):865-71.
12. Lima AV, Muniz LS, Libório SC. Anatomia e fisiologia respiratória funcional. In: Johnston C, Zanetti NM. Fisioterapia Pediátrica Hospitalar. 1. ed. São Paulo: Atheneu; 2012. p. 1-17.
13. American Thoracic Society/European Respiratory Society (ATS/ERS). ATS/ERS statement on respiratory muscle testing. Am J Respir Crit Care Med. 2002 Aug 15;166(4):518-624.
14. Cader S, Vale E, Dantas E. Effect of inspiratory muscle training on weaning success in critically ill intubated patients. In: Bettany-Saltikov J (editor). Physical Therapy Perspectives in 21st century – Challenges and possibillities. [Rijeka, Croatia]: IntechOpen; 2012. p. 283-304. Available from: https://www.intechopen.com/books/physical-therapy-perspectives-in-the-21st-century-challenges-andpossibilities/effect-of-inspiratory-muscle-training-on-weaning-success-in-critically-ill-intubatedpatients
15. Harikumar G, Egderongbe Y, Nadel S, Wheatley E, Moxham J, Greenough A, et al. Tension-time index as a predictor of extubation outcome in ventilated children. Am J Respir Crit Care Med. 2009 Nov 15;180(10):982-8.
16. Bisset B, Leditschke A, Green M. Specific inspiratory muscle training is safe in selected patients who are ventilator-dependent: A case series. Intensive Crit Care Nurs. 2012 Apr;28(2):98-104.
17. Dixit A, Prakash S. Effects of threshold inspiratory muscle training versus conventional physiotherapy on the weaning period of mechanically ventilated patients: A comparative study. Int J Physiother Res. 2014 Apr;2(2):424-8.
18. Cader AS, Vale RGS, Castro JC, Bacelar SC, Biehl C, Gomes MC, et al. Inspiratory muscle training improves maximal inspiratory pressure and may assist weaning in older intubated patients: a randomised trial. J Physiother. 2010;56(3):171-7.
19. Cader AS, Vale RGS, Zamora VE, Costa CH, Dantas EHM. Extubation process in bed-ridden elderly intensive care patients receiving inspiratory muscle training: a randomized clinical trial. Clin Interv Aging. 2012;7:437-43.
20. Pires VA, Costa D, Jamami M, Oishi J, Baldissera V. Comparação de duas técnicas de treinamento muscular respiratório em pacientes sob ventilação mecânica com insucesso de desmame. Rev Bras Fisioter/Braz J Phys Ther. 2000 Jan-Jun;4(2):93-104.
21. Caruso P, Denari SDC, Ruiz SAL, Bernal KG, Manfrin GM, Friedrich C, et al. Inspiratory muscle training is ineffective in mechanically ventilated critically ill patients. Clinics (São Paulo). 2005 Dec;60(6):479-84.
22. Cancelliero-Gaiad KM, Ike D, Costa D. Efeito da estimulação diafragmática elétrica transcutânea em parâmetros respiratórios de pacientes com Doença Pulmonar Obstrutiva Crônica. Fisioter Pesq. 2013 Out-Dec;20(4):322-9.
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email