Terapia rotacional: eixo longitudinal, em unidade de terapia intensiva
DOI:
https://doi.org/10.24220/2318-0897v20n1/2a823Palavras-chave:
Atelectasia pulmonar, Terapia passiva contínua de movimento, Terapia respiratória, Unidades de terapia intensivaResumo
Reunir e sumarizar os benefícios e protocolos da terapia rotacional na prevenção e no tratamento de complicações pulmonares de pacientes internados em terapia intensiva. Trata-se de uma revisão sistemática da literatura, na qual foram consultadas as bases de dados Lilacs, MedLine, Cochrane, Divisão Bibliotecária da Universidade de Stanford e o Banco de Dados de Evidência em Fisioterapia. Os ensaios clínicos randomizados e publicados entre 2000 e 2008 foram incluídos na análise. Sete estudos foram selecionados, sendo um multicêntrico, totalizando 573 pacientes. O objetivo da intervenção foi a prevenção e o tratamento de complicações pulmonares em três e quatro ensaios, respectivamente. A terapia rotacional foi adotada na forma de terapia cinética em dois estudos, e a terapia de rotação lateral contínua, nos demais. Dentre os principais desfechos, foram observados menor incidência de pneumonia (n=3), menor ocorrência e risco de desenvolver atelectasia lobar (n=1), melhora da razão PaO2/FiO2 em pacientes com lesão pulmonar aguda (n=1) e maior volume de escarro expelido (n=1). A terapia rotacional pode ser uma terapêutica coadjuvante no tratamento e na prevenção de complicações pulmonares, uma vez que se observou melhora clínica e fisiológica nos pacientes críticos. Outros estudos são necessários, entretanto, para confirmação desses resultados.
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Referências
Dock W. The evil sequelae of complete bed rest. JAMA. 1944; 125(16):1083-5.
Georgievskii VS, Mikhailov VM. Effect of confinement to bed for sixty days on the circulatory system. Hum Physiol. 1978; 4(5):703-7.
Goldhill DR, Imhoff M, McLean B, Waldmann C. Rotational bed therapy to prevent and treat respiratory complications: a review and meta-analysis. Am J Crit Care. 2007; 16(1):50-61.
Cardoso TC, Lopes LM, Carneiro AH. A case-control study on risk factors for early-onset respiratory tract infection in patients admitted in ICU. BMC Pulm Med. 2007; 7:7-12.
Dodek P, Keenan S, Cook D, Heyland D, Jacka M, Hand L, et al. Evidence-based clinical practice guideline for the prevention of ventilator-associated pneumonia. Ann Intern Med. 2004; 141(4):305-13.
Tablan OC, Anderson LJ, Besser R, Bridges C, Hajjeh R. Guidelines for preventing health-care-associated pneumonia, 2003: recommendations of CDC and the healthcare infection control practices advisory committee. MMWR Recomm Rep. 2004; 53(RR-3): 1-36.
Kollef MH. The prevention of ventilator-associated pneumonia. N Engl J Med. 1999; 340(8):627-34.
Vollman KM. The right position at the right time: mobility makes a difference. Intensive Crit Care Nurs. 2004; 20(4):179-82.
Raoof S, Chowdhrey N, Raoof S, Feuerman M, King A, Sriraman R, et al. Effect of combined kinetic therapy and percussion therapy on the resolution of atelectasis in critically ill patients. Chest. 1999; 115(6): 1658-66.
Fink MP, Helsmoortel CM, Stein KL, Lee PC, Cohn SM. The efficacy of an oscillating bed in the prevencion of lower respiratory tract infection in pritically ill victims of blunt trauma. Chest. 1990; 97(1):132-7.
Summer WR, Curry P, Haponik EF, Nelson S, Elston R. Continuous mechanical turning of intensive care unit patients shortens length of stay in some diagnosticrelated groups. J Crit Care. 1989; 4(1):45-53.
Gentilello L, Thompson DA, Tonnesen AS, Hernandez D, Kapadia AS, Allen SJ, et al. Effect of rotating bed on the incidence of pulmonary complications in critically ill patients. Crit Care Med. 1988; 16(8): 783-6.
Clemmer TP, Green S, Ziegler B, Wallece CJ, Menlove R, Orme JF Jr, et al. Effectiveness of the kinetic treatment table for preventing and treating pulmonary complications in severely head-injured patients. Crit Care Med. 1990; 18(6):614-7.
Takiguchi SA, Myers SA, Yu M, Levy MM, McNamara JJ. Clinical and financial outcomes of lateral rotation low air-loss therapy in patients in the intensive care unit. Heart Lung. 1995; 24(4):315-20.
Ahrens T, Kollef M, Stewart J, Shannon W. Effect of kinetic therapy on pulmonary complications. Am J Crit Care. 2004; 13(5):376-83.
Zack MB, Pontoppidan H, Kazemi H. The effect of lateral positions on gas exchange in pulmonary disease: a prospective evaluation. Am Rev Respir Dis. 1974; 110(1):49-55.
Rance M. Kinetic therapy positively influences oxygenation in patients with ALI/ARDS. Nurs Crit Care. 2005; 10(1):35-41.
Powers J, Daniels D. Turning points: implementing kinetic therapy in the ICU. Nurs Manage. 2004; 35(Supl. 5):1-7.
Gonzalez-Arias SM, Goldberg ML, Baumgartner R, Hoopes D, Ruben B. Analysis of the effect of kinetic therapy on intracranial pressure in comatose neurosurgical patients. Neurosurgery. 1983; 13(6): 654-6.
Reines HD, Harris RC. Pulmonary complications of acute spinal cord injuries. Neurosurgery. 1987; 21(2):193-6.
Green BA, Green KL, Klose KJ. Kinetic therapy for spinal cord injury. Spine. 1983; 8(7):722-8.
Whiteman K, Nachtmann L, Kramer D, Sereika S, Bierman M. Effects of continuous lateral rotation therapy on pulmonary complications in liver transplant patients. Am J Crit Care. 1995; 4(2):133-9.
Kelley RE, Bell LK, Mason RL. Cost analysis of kinetic therapy in the prevention of complications of stroke. South Med J. 1990; 83(4):433-4.
Kelley RE, Vibulsresth S, Bell L, Duncan RC. Evaluation of kinetic therapy in the prevention of complications of prolonged bed rest secondary to stroke. Stroke. 1987; 18(3):638-42.
Wang JY, Chuang PY, Lin CJ, Yu CJ, Yang PC. Continuous lateral rotational therapy in the medical intensive care unit. J Formos Med Assoc. 2003; 102(11):788-92.
Davis K, Johannigmam JA, Campbell RS, Marraccini A, Luchette FA, Frame SB, et al. The acute effects of body position strategies and respiratory therapy in paralyzed patients with acute lung injury. Crit Care. 2001; 5(2):81-7.
Kirschenbaum L, Azzi E, Sfeir T, Tietjen P, Astiz M. Effect of continuous lateral rotational therapy on the prevalence of ventilator-associated pneumonia in patients requiring long-term ventilatory care. Crit Care
Med. 2002; 30(9):1983-6.
Staudinger T, Kofler J, Müllner M, Locker GJ, Laczika K, Knapp S, et al. Comparison of prone positioning
and continuous rotation of patients with adult respiratory distress syndrome: results of a pilot study. Crit Care Med. 2001; 29(1):51-6.
Bein T, Reber A, Ploner F, Taeger K, Jauch KW. Continuous axial rotation and pulmonary fluid balance in acute lung injury. Clin Intensive Care. 2000; 11(6):307-10.
Swadener-Culpepper L, Skaggs RL, Vangilder CA. The impact of continuous lateral rotation therapy in overall clinical and financial outcomes of critically ill patients. Crit Care Nurs Q. 2008; 31(3):270-9.
Krishnagopalan S, Johnson EW, Low LL, Kaufman LJ. Body positioning of intensive care patients: clinical practice versus standards. Crit Care Med. 2002; 30(11):2588-92.
Keane FX. The minimum physiological mobility requirement for man supported on a soft surface. Paraplegia. 1979; 16(4):383-9.
Schallom L, Metheny NA, Stewart J, Schnelker R, Ludwig J, Sherman G, et al. Effect of frequency of manual turning on pneumonia. Am J Crit Care. 2005; 14(6):476-8.
Torres A, Serra-Batlles J, Ros E, Piera C, Puig da la Bellacasa J, Cobos A, et al. Pulmonary aspiration of gastric contents in patients receiving mechanical ventilation: the effect of body position. Ann Intern Med. 1992; 116(7):540-3.
Drakulovic MB, Torres A, Bauer TT, Nicolas JM, Nogué S, Ferrer M. Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet.1999; 354(9193): 1851-8.
Marik PE, Fink MP. One good turn deserves another! Crit Care Med. 2002; 30(9):2146-8.
Bryan-Brown CW, Dracup K. The patient is turned every 2 hours. Am J Crit Care. 1998; 7(3):165-7.
Doering LV. The effect of positioning on hemodynamics and gas exchange in the critically ill: a review. Am J Crit Care. 1993; 2(3):208-16.
Marklew A. Body positioning and its effect on oxynation: a literature review. Nurs Crit Care. 2006; 11(1):16-22.
Goldhill DR, Badacsonyi A, Goldhill AA, Waldmann C. A prospective observational study of ICU patient position and frequency of turning. Anaesthesia. 2008; 63(5):509-15.
Hess DR. Patient positioning and ventilator-associated pneumonia. Respir Care. 2005; 50(7):892-8; discussion 898-9.
Sahn SA. Continuous lateral rotational therapy and nosocomial pneumonia. Chest. 1991; 99(5):1263-7.
Brackett TO, Condon N. Comparison of the wedge turning frame and kinetic treatment table in the acute care of spinal cord injury patients. Surg Neurol. 1984; 22(1):53-6.
Kelley RE, Vibulsresth S, Bell L, Duncan RC. Evaluation of kinetic therapy in the prevention of complications of prolonged bed rest secondary to stroke. Stroke. 1987; 18(3):638-42.
Choi SC, Nelson LD. Kinetic therapy in critically Ill patients: combined results based on meta-analysis. J Crit Care. 1992; 7(1):57-62.
MacIntyre NR, Helms M, Wunderink R, Schmidt G, Sahn SA. Automated rotational therapy for the prevention of respiratory complications during mechanical ventilation. Respir Care. 1999; 44(12): 1447-51.
Kollef MH, Witte MC. Pacing wire-induced recurrent ventricular tachycardia secondary to kinetic therapy bed motion. Crit Care Med. 1988; 16(6):651-2.
