RESUMO
BACKGROUND: Inspiratory muscle training (IMT) strategies can reduce ICU length of stay and optimize recovery in critically ill patients. Our objective was to compare IMT combined with spontaneous breathing with T-piece in tracheostomized subjects. METHODS: Tracheostomized critically ill subjects who were ready to wean were selected and randomly allocated to one of 2 groups: electronically-assisted IMT (EIMT) or spontaneous breathing with T-piece. Electronically assisted IMT was delivered using 30% of maximal inspiratory pressure (manual EIMT or automatically adjusted loads). The following variables were analyzed: ICU length of stay, weaning time, maximal inspiratory pressure, rapid shallow breathing index, pressure (cm H2O), power (W), flow (L/s), volume (L), and energy (J). RESULTS: A total of 132 patients were assessed; 104 subjects were enrolled with EIMT, n = 51 (automatic EIMT, n = 25 and manual EIMT n = 26), or spontaneous breathing with T-piece group, n = 53. The Acute Physiology and Chronic Health Evaluation II score was significantly higher (P = .02) in subjects in the manual EIMT group. Weaning time did not differ significantly between groups (8.55 ± 6.48 d and 10.86 ± 6.48 d, EIMT and spontaneous breathing with T-piece group, respectively; P = .23). Weaning success rates (75%) were lower in the manual EIMT group. Invasive mechanical ventilation time was longer but not significantly different (P = .21) in the spontaneous breathing with T-piece group. Maximal inspiratory pressure was significantly higher in the spontaneous breathing with T-piece and the automatic EIMT groups (P < .001 and P = .007, respectively). Pressure, power, and energy values were significantly higher in the manual EIMT group (P < .001, P = .003, and P = .003, respectively). CONCLUSIONS: IMT modalities in this trial had no significant impacts on weaning time or successful weaning rates.
Assuntos
Estado Terminal , Modalidades de Fisioterapia , Músculos Respiratórios , Desmame do Respirador , Estado Terminal/terapia , Humanos , Respiração Artificial , Músculos Respiratórios/fisiologia , Resultado do TratamentoRESUMO
PURPOSE: Therapeutic strategies that modulate ventricular remodeling can be useful after acute myocardial infarction (MI). In particular, statins may exert effects on molecular pathways involved in collagen metabolism. The aim of this study was to determine whether treatment with atorvastatin for 4 weeks would lead to changes in collagen metabolism and ventricular remodeling in a rat model of MI. METHODS: Male Wistar rats were used in this study. MI was induced in rats by ligation of the left anterior descending coronary artery (LAD). Animals were randomized into three groups, according to treatment: sham surgery without LAD ligation (sham group, n = 14), LAD ligation followed by 10mg atorvastatin/kg/day for 4 weeks (atorvastatin group, n = 24), or LAD ligation followed by saline solution for 4 weeks (control group, n = 27). After 4 weeks, hemodynamic characteristics were obtained by a pressure-volume catheter. Hearts were removed, and the left ventricles were subjected to histologic analysis of the extents of fibrosis and collagen deposition, as well as the myocyte cross-sectional area. Expression levels of mediators involved in collagen metabolism and inflammation were also assessed. RESULTS: End-diastolic volume, fibrotic content, and myocyte cross-sectional area were significantly reduced in the atorvastatin compared to the control group. Atorvastatin modulated expression levels of proteins related to collagen metabolism, including MMP1, TIMP1, COL I, PCPE, and SPARC, in remote infarct regions. Atorvastatin had anti-inflammatory effects, as indicated by lower expression levels of TLR4, IL-1, and NF-kB p50. CONCLUSION: Treatment with atorvastatin for 4 weeks was able to attenuate ventricular dysfunction, fibrosis, and left ventricular hypertrophy after MI in rats, perhaps in part through effects on collagen metabolism and inflammation. Atorvastatin may be useful for limiting ventricular remodeling after myocardial ischemic events.
Assuntos
Anticolesterolemiantes/farmacologia , Atorvastatina/farmacologia , Colágeno/metabolismo , Remodelação Ventricular/efeitos dos fármacos , Animais , Anticolesterolemiantes/uso terapêutico , Atorvastatina/uso terapêutico , Ablação por Cateter , Modelos Animais de Doenças , Fibrose , Expressão Gênica/efeitos dos fármacos , Ventrículos do Coração/patologia , Hemodinâmica/efeitos dos fármacos , Interleucina-1/genética , Interleucina-1/metabolismo , Masculino , Metaloproteinase 1 da Matriz/metabolismo , Infarto do Miocárdio/tratamento farmacológico , Infarto do Miocárdio/patologia , Infarto do Miocárdio/cirurgia , Miocárdio/metabolismo , Miocárdio/patologia , Subunidade p50 de NF-kappa B/genética , Subunidade p50 de NF-kappa B/metabolismo , Ratos , Ratos Wistar , Inibidor Tecidual de Metaloproteinase-1/metabolismoRESUMO
PURPOSE: Several methods of myocardial protection have been used. The use of all-blood solutions modified with glutamate and aspartate has increased. Its use in situations of acute ischemia provides improved contractile function, "resuscitating" the previously lesioned muscle. The dilution preconized by literature is around 25% of the hematocrit. The present study evaluates an all-blood cardioplegia solution with tepid 1% dilution, denominated miniplegia. MATERIAL AND METHOD: Pigs of the Large-White breed were used with an isolated heart and perfused with blood of a support animal. Three groups (n = 7 per group) were designated with the following treatments: Control group (CO), St. Thomas solution (ST), continuous normothermic all-blood solutions (SG). After the stabilization period, systolic pressure (PS), diastolic pressure (PD), developed pressure (PD), stress of the wall, elastance, and passive stiffness were recorded. The hearts were submitted to 30 minutes of regional ischemia with the clamping of the anterior interventricular artery, and subsequently to 90 minutes of global ischemia with the use of the three different treatments during this period. At the beginning of global ischemia, the coronary clamp was removed. The hearts were again reperfused. Upon three minutes into reperfusion the hearts were defibrillated when necessary. Measurements were taken every 30 minutes to 90 minutes into reperfusion. RESULTS: The SG presented a better recovery of the ventricular function in several of the parameters recorded. The ST group was inferior to the SG group, which in turn was superior to the CO group in some of the parameters analyzed. A higher number of defibrillations were needed to reestablish coordinated heart beats in the ST and CO groups. There were no differences related to the percentage of wet weight between the SG and ST groups, and the percentage was higher in the CO group. CONCLUSION: The use of all-blood miniplegia provided superior protection when compared to global ischemia or crystalloid cardioplegia in acutely ischemic hearts. The model employed is very close to the clinical situation due to the use of blood as a perfusate.