Efeitos do exercício passivo precoce em cicloergômetro na espessura muscular do quadríceps femoral de pacientes críticos: estudo-piloto randomizado controlado
DOI:
https://doi.org/10.1590/1809-2950/17025126032019Palavras-chave:
Modalidades de Fisioterapia, Unidades de Terapia Intensiva, Ultrassonografia, Terapia por Exercício, Deambulação PrecoceResumo
O objetivo deste estudo foi avaliar os efeitos do exercício passivo precoce em cicloergômetro na espessura muscular (EM) do quadríceps femoral (EMQ) de pacientes críticos admitidos em uma Unidade de Terapia Intensiva (UTI) de um hospital universitário terciário. O método utilizado foi um estudo-piloto randomizado controlado conduzido em uma amostra de 24 pacientes (51±18,11 anos, 16 do sexo masculino), com 24 a 48 horas de ventilação mecânica (VM), aleatoriamente divididos em dois grupos: grupo-controle (n=12), que recebeu a fisioterapia convencional; e grupo-intervenção (n=12), que recebeu o exercício passivo em cicloergômetro, uma vez ao dia, durante o período de sete dias do protocolo, em adição à fisioterapia convencional. A EMQ foi mensurada através da ultrassonografia. A primeira medida ultrassonográfica foi realizada entre as primeiras 48 horas de VM e a segunda ao término do protocolo. Não houve diferenças significativas na EMQ esquerda (27,29±5,86mm vs. 25,95±10,89mm; p=0,558) e direita (24,96±5,59mm vs 25,9±9,21mm; p=0,682) do grupocontrole e na EMQ esquerda (27,2±7,38mm vs 29,57±7,89mm; p=0,299) e direita (26,67±8,16mm vs 28,65±8,04mm; p=0,381) do grupo-intervenção. Na comparação entre os grupos, não houve alterações significativas em relação à EMQ esquerda (3,61±1,07mm; p=0,248) e a EMQ direita (2,75±0,85mm; p=0,738). Os resultados deste estudo-piloto demonstraram que a aplicação precoce do exercício passivo em cicloergômetro não promoveu mudanças significativas na espessura da camada muscular avaliada. No entanto, nossos achados sinalizam que a fisioterapia convencional foi capaz de preservar a EMQ de pacientes críticos admitidos em UTI.
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Referências
Turton P, Hay R, Taylor J, McPhee J, Welters I. Human limb
skeletal muscle wasting and architectural remodeling during
five to ten days intubation and ventilation in critical care:
an observational study using ultrasound. BMC Anesthesiol.
;16(1):119. doi: 10.1186/s12871-016-0269-z
Puthucheary ZA, Rawal J, McPhail M. Acute skeletal muscle
wasting in critical illness. JAMA. 2013;310(15):1591-600. doi:
1001/jama.2013.278481
Files DC, Sanchez MA, Morris PE. A conceptual framework:
the early and late phases of skeletal muscle dysfunction in the
acute respiratory distress syndrome. Crit Care. 2015;19(1):266.
doi: 10.1186/s13054-015-0979-5
Parry SM, El-Ansary D, Cartwright MS, Sarwal A, Berney S,
Koopman R, et al. Ultrasonography in the intensive care setting
can be used to detect changes in the quality and quantity of
muscle and is related to muscle strength and function. J Crit
Care. 2015;30(5):9-14. doi: 10.1016/j.jcrc.2015.05.024
Sarwal A, Parry SM, Berry MJ, Hsu FC, Lewis MT, Justus NW, et
al. Interobserver reliability of quantitative muscle sonographic
analysis in the critically ill population. J Ultrasound Med.
;34(7):1191-200. doi: 10.7863/ultra.34.7.1191
Hadda V, Khilnani GC, Kumar R, Dhunguna A, Mittal S, Khan MA,
et al. Intra- and inter-observer reliability of quadriceps muscle
thickness measured with bedside ultrasonography by critical
care physicians. Indian J Crit Care Med. 2017;21(7):448-52. doi:
4103/ijccm.IJCCM_426_16
Santos LJ, Lemos FA, Bianchi T, Sachetti A, Dall’Acqua AM, Naue
WS, et al. Early rehabilitation using a passive cycle ergometer
on muscle morphology in mechanically ventilated critically ill
patients in the Intensive Care Unit (MoVe-ICU study): study
protocol for a randomized controlled trial. Trials. 2015;16:383.
doi: 10.1186/s13063-015-0914-8
Kho ME, Martin RA, Toonstra AL, Zanni JM, Mantheiy EC,
Nelliot A, et al. Feasibility and safety of in-bed cycling for
physical rehabilitation in the intensive care unit. J Crit Care.
;30(6):1-5. doi: 10.1016/j.jcrc.2015.07.025
Machado AS, Pires-Neto RC, Carvalho MTX, Soares JC, Cardoso
DM, Albuquerque IM. Effects that passive cycling exercise have
on muscle strength, duration of mechanical ventilation, and
length of hospital stay in critically ill patients: a randomized
clinical trial. J Bras Pneumol. 2017;43(2):134-9. doi: 10.1590/
s1806-37562016000000170
Ely EW, Truman B, Shintani A, Thomason JW, Wheeler AP,
Gordon S, et al. Monitoring sedation status over time in ICU
patients: reliability and validity of the Richmond AgitationSedation Scale (RASS). JAMA. 2003;289(22):2983-91. doi:
1001/jama.289.22.2983
Knaus WA, Zimmermann JE, Wagner DP, Draper EA, Lawrence
DE. APACHE-acute physiology and chronic health evaluation:
a physiologically based classification system. Crit Care Med.
;9(8):591-7. doi: 10.1097/00003246-198108000-00008
Fivez T, Hendrickx A, Van Herpe T, Vlasselaers D, Desmet L,
Van den Berghe G, et al. An analysis of reliability and accuracy
of muscle thickness ultrasonography in critically ill children
and adults. J Parenter Enteral Nutr. 2016;40(7):944-9. doi:
1177/0148607115575033
Lindenau JD, Guimarães LSP. Calculando o tamanho de efeito
no SPSS. Rev HCPA. 2012;32(3):363-81.
Lodeserto F, Yende S. Understanding skeletal muscle
wasting in critically ill patients. Crit Care. 2014;18(6):617. doi:
1186/s13054-014-0617-7
Gruther W, Kainberger F, Fialka-Moser V, Paternostro-Sluga
T, Quittan M, Spiss C, et al. Effects of neuromuscular electrical
stimulation on muscle layer thickness of knee extensor muscles
in intensive care unit patients: a pilot study. J Rehabil Med.
;42(6):593-7. doi: 10.2340/16501977-0564
Renaud G, Llano-Diez M, Ravara B, Gorza L, Feng HZ, Jin
JP, et al. Sparing of muscle mass and function by passive
loading in an experimental intensive care unit model. J Physiol.
;591(5):1385-402. doi: 10.1113/jphysiol.2012.248724
Llano-Diez M, Renaud G, Andersson M, Marrero HG, Cacciani
N, Engquist H, et al. Mechanisms underlying ICU muscle
wasting and effects of passive mechanical loading. Crit Care.
;16(5):209. doi: 10.1186/cc11841
Pavlov VA, Tracey KJ. The cholinergic anti-inflammatory
pathway. Brain Behav Immun. 2005;19(6):493-9. doi: 10.1016/j.
bbi.2005.03.015
Strasser EM, Stättner S, Karner J, Klimpfinger M, Freynhofer
M, Zaller V, et al. Neuromuscular electrical stimulation reduces
skeletal muscle protein degradation and stimulates insulinlike growth factors in an age and current dependent manner:
a randomized, controlled clinical trial in major abdominal
surgical patients. Ann Surg. 2009;249(5):738-43. doi:
1097/SLA.0b013e3181a38e71
Maffiuletti NA, Roig M, Karatzanos E, Nanas S. Neuromuscular
electrical stimulation for preventing skeletal-muscle weakness
and wasting in critically ill patients: a systematic review. BMC
Med. 2013;11:137. doi: 10.1186/1741-7015-11-137
Burtin C, Clerckx B, Robbeets C, Ferdinande P, Langer
D, Troosters T, et al. Early exercise in critically ill patients
enhances short-term functional recovery. Crit Care Med.
;37(9):2499-505. doi: 10.1097/CCM.0b013e3181a38937
Puthucheary ZA, Montgomery H, Moxham J, Harridge S, Hart
N. Structure to function: muscle failure in critically ill patients. J
Physiol. 2010;588(23):4641-8. doi: 10.1113/jphysiol.2010.197632
Sarwal A, Parry SM, Berry MJ, Hsu FC, Lewis MT, Justus NW, et
al. Interobserver reliability of quantitative muscle sonographic
analysis in the critically ill population. J Ultrasound Med.
;34(7):1191-200. doi: 10.7863/ultra.34.7.1191
Paris M, Mourtzakis M. Assessment of skeletal muscle
mass in critically ill patients: considerations for the utility
of computed tomography imaging and ultrasonography.
Curr Opin Clin Nutr Metab Care. 2016;19(2):125-30. doi:
1097/MCO.0000000000000259
Segers J, Hermans G, Charususin N, Fivez T, Vanhorebeek I, Van
den Berghe G, et al. Assessment of quadriceps muscle mass
with ultrasound in critically ill patients: intra- and inter-observer
agreement and sensitivity. Intensive Care Med. 2015;41(3):562-3.
doi: 10.1007/s00134-015-3668-6
Tillquist M, Kutsogiannis DJ, Wischmeyer PE, Kummerlen C,
Leung R, Stollery D, et al. Bedside ultrasound is a practical and
reliable measurement tool for assessing quadriceps muscle
layer thickness. J Parenter Enteral Nutr. 2014;38(7):886-90.
doi: 10.1177/0148607113501327
Paris MT, Mourtzakis M, Day A, Leung R, Watharkar S,
Kozar R, et al. Validation of bedside ultrasound of muscle
layer thickness of the quadriceps in the critically ill patient
(VALIDUM study). J Parenter Enteral Nutr. 2017;41(2):171-80.
doi: 10.1177/0148607116637852
Hermans G, Wilmer A, Meersseman W, Milants I, Wouters
PJ, Bobbaers H, et al. Impact of intensive insulin therapy on
neuromuscular complications and ventilator-dependency
in the Medical Intensive Care Unit. Am J Respir Crit Care
Med. 2007;175(5):480-9. doi: https://doi.org/10.1164/
rccm.200605-665OC
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