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Objective. Understanding a patient's respiratory effort and mechanics is essential for the provision of individualized care during mechanical ventilation. However, measurement of transpulmonary pressure (the difference between airway and pleural pressures) is not easily performed in practice. While airway pressures are available on most mechanical ventilators, pleural pressures are measured indirectly by an esophageal balloon catheter. In many cases, esophageal pressure readings take other phenomena into account and are not a reliable measure of pleural pressure.Approach.A system identification approach was applied to provide accurate pleural measures from esophageal pressure readings. First, we used a closed pressurized chamber to stimulate an esophageal balloon and model its dynamics. Second, we created a simplified version of an artificial lung and tried the model with different ventilation configurations. For validation, data from 11 patients (five male and six female) were used to estimate respiratory effort profile and patient mechanics.Main results.After correcting the dynamic response of the balloon catheter, the estimates of resistance and compliance and the corresponding respiratory effort waveform were improved when compared with the adjusted quantities in the test bench. The performance of the estimated model was evaluated using the respiratory pause/occlusion maneuver, demonstrating improved agreement between the airway and esophageal pressure waveforms when using the normalized mean squared error metric. Using the corrected muscle pressure waveform, we detected start and peak times 130 ± 50 ms earlier and a peak amplitude 2.04 ± 1.46 cmH2O higher than the corresponding estimates from esophageal catheter readings.Significance.Compensating the acquired measurements with system identification techniques makes the readings more accurate, possibly better portraying the patient's situation for individualization of ventilation therapy.

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BACKGROUND: Patient-ventilator asynchronies are usually detected by visual inspection of ventilator waveforms but with low sensitivity, even when performed by experts in the field. Recently, estimation of the inspiratory muscle pressure (Pmus) waveforms through artificial intelligence algorithm has been proposed (Magnamed®, São Paulo, Brazil). We hypothesized that the display of these waveforms could help healthcare providers identify patient-ventilator asynchronies. METHODS: A prospective single-center randomized study with parallel assignment was conducted to assess whether the display of the estimated Pmus waveform would improve the correct identification of asynchronies in simulated clinical scenarios. The primary outcome was the mean asynchrony detection rate (sensitivity). Physicians and respiratory therapists who work in intensive care units were randomized to control or intervention group. In both groups, participants analyzed pressure and flow waveforms of 49 different scenarios elaborated using the ASL-5000 lung simulator. In the intervention group the estimated Pmus waveform was displayed in addition to pressure and flow waveforms. RESULTS: A total of 98 participants were included, 49 per group. The sensitivity per participant in identifying asynchronies was significantly higher in the Pmus group (65.8 ± 16.2 vs. 52.94 ± 8.42, p < 0.001). This effect remained when stratifying asynchronies by type. CONCLUSIONS: We showed that the display of the Pmus waveform improved the ability of healthcare professionals to recognize patient-ventilator asynchronies by visual inspection of ventilator tracings. These findings require clinical validation. TRIAL REGISTRATION: ClinicalTrials.gov: NTC05144607. Retrospectively registered 3 December 2021.

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BACKGROUND: Veno-venous extracorporeal membrane oxygenation (ECMO) provides blood oxygenation and carbon dioxide removal in acute respiratory distress syndrome. However, during ECMO support, the native lungs still play an important role in gas exchange, functioning as a second oxygenator in series with ECMO. The hypoxic vasoconstriction mechanism diverts regional blood flow within the lungs away from regions with low oxygen levels, optimizing ventilation/perfusion matching. ECMO support has the potential to reduce this adaptive pulmonary response and worsen the ventilation/perfusion mismatch by raising venous oxygen partial pressure. Thus, the objective of this study was to evaluate the effect of ECMO on regional pulmonary perfusion and pulmonary hemodynamics during unilateral ventilation and posterior lung collapse. METHODS: Five Agroceres pigs were instrumented, monitored and submitted to ECMO. We used the Electrical Impedance Tomography (EIT) to evaluate lung ventilation and perfusion in all protocol steps. Effects of ECMO support on pulmonary hemodynamics and perfusion involving two different scenarios of ventilation/perfusion mismatch: (1) right-lung selective intubation inducing collapse of the normal left lung and (2) dorsal lung collapse after repeated lung lavage. Data including hemodynamics, respiratory, lung perfusion/ventilation, and laboratory data over time were analyzed with a mixed generalized model using the subjects as a random factor. RESULTS: The initiation of ECMO support provided a significant reduction in Mean Pulmonary Artery Pressure (PAPm) in both situations of ventilation/perfusion mismatch. However, distribution of lung perfusion did not change with the use of ECMO support. CONCLUSIONS: We found that the use of ECMO support with consequent increase in venous oxygen pressure induced a significant drop in PAPm with no detectable effect on regional lung perfusion in different scenarios of ventilation/perfusion mismatch.

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RESUMO O objetivo deste trabalho foi avaliar o perfil e a prevalência da síndrome de Burnout em fisioterapeutas intensivistas das redes públicas da cidade do Recife, comparando-os entre unidades adultas, pediátricas e neonatais. Realizou-se um estudo descritivo de corte transversal em cinco hospitais públicos portadores de Unidade de Terapia Intensiva, por meio de um questionário sociodemográfico para fatores estressantes e do Maslach Burnout Inventory (MIB) para avaliar a prevalência da síndrome. Os resultados indicaram um percentual de 48,72% de Burnout para profissionais de UTI de cuidado adulto e 47,06% para unidades pediátricas e neonatais, considerando-se nível grave em apenas uma dimensão. Foram encontrados escores elevados nos indicadores de exaustão emocional, com 56,42% em UTI adulto e 64,71% em unidades pediátricas e neonatais. O indicador despersonalização apresentou 12,82% em UTI adulto e 29,41% nas demais. Já realização profissional obteve valores de 17,65% em UTI pediátricas e neonatais e de 33,33% em cuidado adulto. A prevalência da síndrome de Burnout se mostrou elevada entre os fisioterapeutas avaliados. Diante disso, observa-se a necessidade do desenvolvimento de medidas preventivas e modelos de intervenção para que tal efeito seja minimizado.

RESUMEN En este trabajo se propone evaluar el perfil y la prevalencia del síndrome de Burnout entre los fisioterapias de cuidados intensivos en las redes públicas en Recife (Brasil), comparándolos entre las unidades pediátricas, neonatales y de adultos. Se trata de un estudio descriptivo de cohorte transversal, del cual participaron cinco hospitales públicos con Unidades de Cuidados Intensivos, por medio de un cuestionario sociodemográfico para factores de estrés y del Maslach Burnout Inventory (MIB) para evaluar la prevalencia del síndrome. Los resultados desvelan un porcentaje del 48,72 % de Burnout a profesionales de UCI de atención a adultos, y un 47,06 % en unidades pediátricas y neonatales, con nivel grave sólo en una dimensión. Se encontraron puntuaciones más altas en los indicadores de agotamiento emocional, con un 56,42 % en UCI de adultos, y un 64,71 % en unidades pediátricas y neonatales. El indicador despersonalización presentó un 12,82 % en UCI de adultos, y un 29,41 % en las demás. Ya la satisfacción profesional obtuvo valor de un 17,65 % en UCI pediátricas y neonatales, y un 33,33 % en la atención a adultos. La prevalencia del síndrome de Burnout fue elevada entre los fisioterapeutas evaluados. Lo que demuestra la necesidad de desarrollar medidas preventivas y modelos de intervención para minimizar este efecto.

ABSTRACT The objective of this study was to evaluate the profile and prevalence of Burnout syndrome in physical therapists of public hospitals with intensive care units (ICU) in Recife, comparing them between adult, pediatric and neonatal units. A cross-sectional descriptive study was carried out in five public hospitals with intensive care units in the city of Recife. A sociodemographic questionnaire, a questionnaire for stressors and the Maslach Burnout Inventory (MIB) were used to assess the prevalence of the syndrome. The results indicated a percentage of Burnout of 48.72% for adult ICU professionals and 47.06% for pediatric and neonatal ICUs, considering a serious level in only one dimension. High scores were found in the Emotional Exhaustion indicators, with 56.42% in the adult ICU and 64.71% in the pediatric and neonatal ICUs. For Depersonalization 12.82% in adult ICU and 29.41% in other ICUs. As for Professional Realization, values of 17.65% in pediatric and neonatal ICUs and 33.33% in adults. The prevalence of Burnout syndrome was high among the evaluated physiotherapists. Given this, it is observed the need to develop preventive measures and intervention models, so that this effect is minimized.

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Verificar as implicações da cirurgia derevascularização do miocárdio (CRVM) na qualidade de vidade pacientes após um período de três meses do procedimentocirúrgico, observando os aspectos físicos, emocionais esociais que podem estar alterados nesses indivíduos.Material e Métodos: Foram estudados 33 pacientes comdoença arterial coronariana, submetidos à CRVM e areabilitação cardiovascular fase I. A análise da qualidade devida dos pacientes ocorreu pela apuração, em dois momentos,do questionário padronizado, o SF-36 que tem o propósito deexaminar a percepção do estado de saúde pelo própriopaciente. Resultados: Quando comparado o momento do précirúrgicocom os três meses após a cirurgia foi observadoque houve melhora em todos os domínios do questionário dequalidade de vida SF-36, exceto no domínio de limitação poraspectos emocionais (p-valor = 0,920). A melhora foiespecialmente observada nos domínios da capacidadefuncional, da dor, do estado geral de saúde e da saúdemental (p-valor < 0,001), sendo também observada nosdomínios da limitação por aspectos físicos (p-valor = 0,020),da vitalidade (p-valor = 0,001) e dos aspectos sociais (0,039).Conclusões: Demonstrou-se que a CRVM cumpre o objetivode melhorar a qualidade de vida dos pacientes, porém nãose pode subestimar a influência da reabilitação fase I nessamelhora...

Objective: To verify the implications of myocardialrevascularization surgery (MRS) on patients’ quality of lifeafter a three-month postoperative follow-up, with a focus onphysical, emotional and social factors that may be altered inthese individuals. Material and Methods: A total of 33 patientswith coronary artery disease who underwent MRS and phaseI cardiovascular rehabilitation, were included in the study.The analysis of patients’ quality of life was carried out in twostages according to a standardized questionnaire (SF-36),which aims to examine the perception of patients on theirown health status. Results: When the preoperative periodwas compared to that of three months after surgery, therewas an improvement in all domains covered by the SF-36questionnaire, excepting for the incapability due to emotionalaspects (p-value = 0.920). The improvement was observedparticularly in the fields of functional capacity, pain, generalhealth and mental health (p-value < 0.001). Furthermore, therewas an improvement in the fields of incapability due tophysical aspects (p-value = 0.020), vitality (p-value = 0.001)and social aspects (p-value = 0.039). Conclusions: It wasdemonstrated that myocardial revascularization surgeryimproves patients’ quality of life. However, one cannotunderestimate the influence of phase I rehabilitation on suchimprovements...

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Objetivo: Avaliar a capacidade funcional e a limitação física,em pacientes submetidos à cirurgia de revascularização domiocárdio (CRVM) com seis meses do pós-operatório.Material e Métodos: Foram estudados 28 pacientes comdoença arterial coronariana, submetidos à CRVM entrenovembro de 2008 e abril de 2009. Foram avaliadas acapacidade funcional e a limitação por aspectos físicos pelaapuração dos respectivos domínios presentes noquestionário padronizado Medical Outcomes Study - shortform 36 (MOS-SF), e o nível de atividade física, por meio doInternational Physical Activity Questionnaire (IPAQ).Resultados: Houve diferenças significantes entre o pré e opós-operatório para os domínios “capacidade funcional”(41,79 vs. 70,18; p < 0,001) e “limitação por aspectos físicos”(3,57 vs. 35,71; p < 0,001). Foi evidenciado que os pacientesclassificados como “ativos” pelo IPAQ tiveram pontuaçãosignificativamente maior do que o classificado com“sedentário” para o domínio “capacidade funcional” (81,07vs. 45,00; p = 0,012) e que os classificados como“insuficientemente ativo” (58,93 vs. 11,11; p = 0,006) e“sedentário” (58,93 vs. 15,00; p = 0,006) no domínio “limitaçãopor aspectos físicos”. Conclusão: Foi observado acréscimona pontuação dos domínios “capacidade funcional” e“limitação por aspectos físicos” após seis meses da CRVM,o que traduz em aumento da capacidade de realizar atividadesque no pré-operatório não eram possíveis. A melhora destesdomínios foi mais expressiva em indivíduos que praticaramatividade física regularmente após o procedimento cirúrgico...

Objective: To evaluate the functional capacity and physicallimitation in patients submitted to coronary artery bypass graft(CABG) at six months after surgery. Material and Methods:28 patients with coronary artery disease who underwentCABG between November 2008 and April 2009 were includedin this study. Their functional capacity and physical limitationwere approached considering the respective domains presentin the standardized questionnaire Medical Outcomes StudyShort Form (MOS-SF), as well as the level of physical activitythrough the International Physical Activity Questionnaire(IPAQ), in the period of six months after the CABG. Results:There were significant differences before and after surgeryfor the domains “functional capacity” (41.79 vs. 70.18; p<0.001) and “limited by physical aspects” (3.57 vs. 35.71 p<0.001). It was shown that patients classified as “active” byIPAQ had significantly higher scores than those rated as“sedentary” for the domain “functional capacity” (81.07 vs.45.00; p = 0.012) and also higher than those classified as“insufficiently active” (58.93 vs. 11.11; p = 0.006) and“sedentary” (58.93 vs. 15.00; p = 0.006) for the domain “limitedby physical aspects.” Conclusion: There was an increase inthe scores of the domains “functional capacity” and “limitationby physical aspects” six months after CABG, which translatesinto increased ability to perform activities that could not beperformed preoperatively. The improvement of these areaswas more significant in subjects who practiced regularphysical activity after surgery...

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