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FMA – PICS Estratégias terapêuticas e inovações Professor Rodrigo Santos de Queiroz (rofisio@gmail.com) Aula disponível em: mobilidadefuncional.blogspot.com / https://www.facebook.com/mobfuncional/ Aula revisada em: 24/08/2018 A mobilização e reabilitação ativa na UTI melhoram a mobilidade, força muscular, dias vivos e fora do hospital em até 180 dias. TIPPING, Claire J. et al. The effects of active mobilisation and rehabilitation in ICU on mortality and function: a systematic review. Intensive care medicine, p. 1-13, 2016. Polineuromiopatia do doente crítico Dificuldades com marcadores (Eletrofisiologia e histologia) Fisiopatologia Microcirculação Edema endoneural e Hipóxia Proteólíse e bioenergética mitocondrial Canaliculopatia CALLAHAN LA, Supinski GS. Sepsis-induced myopathy. Crit Care Med. 2009; 37 (10): (suppl) S354-S367. JOLLEY SE, Bunnell A, Hough CL, Intensive Care Unit Acquired Weakness, CHEST (2016). Nem neuro, nem miopatia... BOUGLÉ, Adrien et al. Muscle regeneration after sepsis. Critical Care, v. 20, n. 1, p. 1, 2016. Fraqueza Muscular Adquirida na UTI HODGSON, Carol L. et al. The impact of disability in survivors of critical illness. Intensive Care Medicine, p. 1-10, 2017. Postintensive care syndrome (PICS) Estratégias 1 2 3 4 5 6 STILLER, Kathy. Physiotherapy in Intensive CarePhysiotherapy in Intensive Care An Updated Systematic Review. CHEST Journal, v. 144, n. 3, p. 825-847, 2013. Se eu não medir, como pode ser progressiva? STILLER, Kathy. Physiotherapy in intensive care: an updated systematic review. CHEST Journal, v. 144, n. 3, p. 825-847, 2013. Conclusions Dose Intensidade, duração e frequência FITT: frequência, intensidade, tipo e tempo SOMMERS, Juultje et al. Physiotherapy in the intensive care unit: an evidence-based, expert driven, practical statement and rehabilitation recommendations. Clinical rehabilitation, v. 29, n. 11, p. 1051-1063, 2015. American College of Sports Medicine. ACSM's guidelines for exercise testing and prescription. Lippincott Williams & Wilkins. 2013. FITT -VP Qual a dose? FITT-VP movimento QUEIROZ, Rodrigo Santos et al. Evaluation of the description of active mobilisation protocols for mechanically ventilated patients in the intensive care unit: A systematic review of randomized controlled trials. Heart & Lung, 2018. QUEIROZ, Rodrigo Santos et al. Evaluation of the description of active mobilisation protocols for mechanically ventilated patients in the intensive care unit: A systematic review of randomized controlled trials. Heart & Lung, 2018. VERCELES, Avelino C.; HAGER, Erin R. Use of accelerometry to monitor physical activity in critically ill subjects: a systematic review. Respiratory care, v. 60, n. 9, p. 1330-1336, 2015. The selected literature demonstrates that accelerometry correlates well with direct observation in reporting frequency and duration of various types of physical activity (rolling, sitting up, transferring, walking), but cannot differentiate various intensities of activity or whether movements are voluntary or involuntary with respect to effort. Beach LJ, Fetterplace K, Edbrooke L, et al. Measurement of physical activity levels in the Intensive Care Unit and functional outcomes: An observational study. Journal of Critical Care. 2017;40: 89-196. Sensewear armband mini-fly motion sensor (SWA-MF) strong correlation between active energy expenditure and the highest level of mobility (r=0.76, p=0.00) Measuring Patient Mobility in the ICU Using a Novel Noninvasive Sensor MA, Andy J. et al. Measuring Patient Mobility in the ICU Using a Novel Noninvasive Sensor. Critical care medicine, v. 45, n. 4, p. 630-636, 2017. Microsoft Kinect sensors (Microsoft, Beijing, China) PARRY, Selina M.; NYDAHL, Peter; NEEDHAM, Dale M. Implementing early physical rehabilitation and mobilisation in the ICU: institutional, clinician, and patient considerations. Intensive Care Medicine, p. 1-4, 2017. HODGSON, Carol L.; DENEHY, Linda. Measuring physical function after ICU: one step at a time. Intensive Care Medicine, p. 1-3, 2017. Journal of Emergency and Critical Care Medicine 2018 Journal of Emergency and Critical Care Medicine 2018 The early mobilization in intervention group appeared to have positive influence on hospital outcomes with the LOS in ICU (MD =−1.75, 95% CI: −2.70 to −0.79; P=0.0003) and duration of mechanical ventilation (MD =−1.64, 95% CI: −2.41 to −0.87; P<0.0001) ZHANG, Gensheng et al. The effect of early mobilization for critical ill patients requiring mechanical ventilation: a systematic review and meta-analysis. Journal of Emergency and Critical Care Medicine, v. 2, n. 1, 2018. ZHANG, Gensheng et al. The effect of early mobilization for critical ill patients requiring mechanical ventilation: a systematic review and meta-analysis. Journal of Emergency and Critical Care Medicine, v. 2, n. 1, 2018. ZHANG, Gensheng et al. The effect of early mobilization for critical ill patients requiring mechanical ventilation: a systematic review and meta-analysis. Journal of Emergency and Critical Care Medicine, v. 2, n. 1, 2018. ZHANG, Gensheng et al. The effect of early mobilization for critical ill patients requiring mechanical ventilation: a systematic review and meta-analysis. Journal of Emergency and Critical Care Medicine, v. 2, n. 1, 2018. DOIRON, K. A.; HOFFMANN, T. C.; BELLER, E. M. Early intervention (mobilization or active exercise) for critically ill adults in the intensive care unit. The Cochrane database of systematic reviews, v. 3, 2018. Objetivo: Avaliar os efeitos da intervenção precoce (mobilização ou exercício ativo), iniciados na UTI, fornecidos a adultos gravemente doentes durante ou após o período de ventilação mecânica, em comparação com o atraso no exercício ou cuidados habituais, na melhoria da função física ou desempenho, força muscular e qualidade de vida relacionada DOIRON, K. A.; HOFFMANN, T. C.; BELLER, E. M. Early intervention (mobilization or active exercise) for critically ill adults in the intensive care unit. The Cochrane database of systematic reviews, v. 3, 2018. Resultados: Incluídos quatro RCTs (um total de 690 participantes) UTI geral, médica ou cirúrgica (cardíaca), com idade média ou mediana nos estudos variando de 56 a 62 anos Vieses e descrição da dose? DOIRON, K. A.; HOFFMANN, T. C.; BELLER, E. M. Early intervention (mobilization or active exercise) for critically ill adults in the intensive care unit. The Cochrane database of systematic reviews, v. 3, 2018. Principais conclusões: Não há evidências suficientes e de baixa qualidade sobre o efeito da intervenção precoce sobre os desfechos estudados (função física ou desempenho, força muscular e qualidade de vida) Fontes de Viés: pequeno tamanho amostral, à falta de cegamento dos participantes e dos pesquisadores, variação nas intervenções e desfechos usados para medir seu efeito, e inadequação das descrições das intervenções fornecidas como cuidados habituais nos estudos incluídos. http://thorax.bmj.com/content/early/2017/08/05/thoraxjnl-2016-209858.responses QUEIROZ, Rodrigo Santos et al. Evaluation of the description of active mobilisation protocols for mechanically ventilated patients in the intensive care unit: A systematic review of randomized controlled trials. Heart & Lung, 2018. Objectives: The aim of this review was to evaluate of the description of the active mobilisation protocols in patients on invasive mechanical ventilation at intensive care units (ICU). Methods: Systematic review of randomised controlled trials (RCTs) using the Consensus on Exercise Reporting Template. QUEIROZ, Rodrigo Santos et al. Evaluation of the description of active mobilisation protocols for mechanically ventilated patients in the intensive care unit: A systematic review of randomized controlled trials. Heart & Lung, 2018. Quais as novas tendências? Não é uma questão de ser fisio. Não é apenas uma questão de mexer nobraço e na perna do paciente... Não é apenas uma questão de amplitude de movimento... Devemos informar para cada unidade motora que ainda não é hora de parar de funcionar. Obrigado.... Aula e material complementar disponívéis em: mobilidadefuncional.blogspot.com / https://www.facebook.com/mobfuncional/
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