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
References
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