Impacto del entrenamiento de los músculos respiratorios sobre la mortalidad y estancia hospitalaria en la unidad de cuidados intensivos
Palabras clave:
Musculos respiratorios, ejercicios respiratorios, unidad de cuidados intensivos, complicaciones posoperatorias, mortalidad, tiempo de internación
Resumen
Introducción: los pacientes ingresados a la Unidad de Cuidados Intensivos (UCI) presentan desacondicionamiento que impacta en la musculatura respiratoria y por ende en la recuperación de estos.
Materiales y métodos: se llevó a cabo una revisión sistemática combinada con análisis descriptivo de cronología retrospectiva de ensayos clínicos entre 2010 a 2023 en bases de datos indexadas y basados en la Colaboración Cochrane se realizó la recopilación de datos y la selección de estudios de acuerdo con los criterios de la Declaración de PRISMA y PICO. Los críterios de inclusión y exclusión fueron enfocados en personas mayores de 18 años internadas en UCI, que realizaran entrenamiento muscular respiratorio (EMR) sin importar sus características sociodemográficas, enfermedad o su estadio. Se recopiló el tipo de población, grupos de intervención y control, duración y frecuencia de la intervención y resultados obtenidos.
Resultados: se identificaron 1.171.143 documentos en la primera búsqueda y luego de los respectivos filtros se incluyeron 14 ensayos clínicos, en donde se implementaron EMR con dispositivos de carga de umbral inspiratoria y que evaluaron los parámetros fisiológicos (ventilación minuto, volumen tidal), intercambio de gases (PaO2, PaCO2), aumento del flujo inspiratorio y espiratorio máximo y presión inspiratoria máxima.
Conclusiones: los pacientes en UCI que realizaron EMR obtuvieron una reducción en las complicaciones pulmonares, estancia y costos hospitalarios, como también en la mortalidad. Se resalta que los estudios existentes combinan el EMR con otras modalidades terapéuticas como movilizaciones, ejercicio cardiovascular y entrenamiento de fuerza.
Citas
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3. Brunker LB, Boncyk ChS, Rengel KF, Hughes ChG. Elderly patients and management in Intensive Care Units (ICU): Clinical challenges. Clin Interv Aging [Internet]. 2023 [cited 2023 Oct 10]; 18:93-112. Available from: https://pubmed.ncbi.nlm.nih.gov/36714685. doi: 10.2147/CIA.S365968
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5. García-Talavera I, Díaz Lobato S, Bolado PR, Villasante C. Músculos respiratorios. Arch Bronconeumol [Internet]. 1992 [citado 3 Nov 2023]; 28 (5): 239-46. Disponible en: https://www.elsevier.es/es-revista-imagen-diagnostica-308-pdf-S0300289615313351
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17. Valkenet K, Trappenburg JCA, Ruurda JP, Guinan EM, Reynolds JV, Nafteux P, et al. Multicentre randomized clinical trial of inspiratory muscle training versus usual care before surgery for oesophageal cancer. Br J Surg [Internet]. 2018 [cited 2023 Sept 9]; 105(5): 502-11. Available from: https://pubmed.ncbi.nlm.nih.gov/29603130. doi: 10.1002/bjs.10803
18. Laurent H, Aubreton S, Galvaing G, Pereira B, Merle P, Richard R, et al. Preoperative respiratory muscle endurance training improves ventilatory capacity and prevents pulmonary postoperative complications after lung surgery. Eur J Phys Rehabil Med [Internet]. 2020 [cited 2023 Sept 9]; 56(1): 73-81. Available from: https://pubmed.ncbi.nlm.nih.gov/31489810. doi: 10.23736/S1973-9087.19.05781-2
19. Teixeira Sobrinho M, Negretti Guirado G, de Moraes Silva MA. Preoperative therapy restores ventilatory parameters and reduces length of stay in patients undergoing myocardial revascularization. Rev Bras Cir Cardiovasc [Internet]. 2014 [cited 2023 Nov 3]; 29(2): 221-8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4389447. Doi: 10.5935/1678-9741.20140021
20. Huang J, Lai Y, Zhou X, Li S, Su J, Yang M, Che G. Short-term high-intensity rehabilitation in radically treated lung cancer: a three-armed randomized controlled trial. J Thorac Dis [Internet]. 2017 [cited 2023 Dec 4]; 9(7):1919-29. Available from: https://pubmed.ncbi.nlm.nih.gov/28839990. doi: 10.21037/jtd.2017.06.15
21. Chen X, Hou L, Zhang Y, Liu X, Shao B, Yuan B, et al. The effects of five days of intensive preoperative inspiratory muscle training on postoperative complications and outcome in patients having cardiac surgery: a randomized controlled trial. Clin Rehabil. 2019; 33(5):913-22. doi: 10.1177/0269215519828212
22. Pehlivan E, Turna A, Gurses A, Nilgun Gurses H. The effects of preoperative short-term intense physical therapy in lung cancer patients: a randomized controlled trial. Ann Thorac Cardiovasc Surg [Internet]. 2011 [cited 2023 Dec 4 3]; 17(5):461-8. Available from: https://pubmed.ncbi.nlm.nih.gov/21881371. doi: 10.5761/atcs.oa.11.01663
23. Lai Y, Huang J, Yang M, Su J, Liu J, Che G. Seven-day intensive preoperative rehabilitation for elderly patients with lung cancer: a randomized controlled trial. J Surg Res. 2017; 209: 30-36. doi: 10.1016/j.jss.2016.09.033
24. Bissett BM, Leditschke IA, Neeman T, Boots R, Paratz J. Inspiratory muscle training to enhance recovery from mechanical ventilation: a randomised trial. Thorax [Internet]. 2016 [cited 2023 Nov 3]; 71(9): 812-9. Available from: https://pubmed.ncbi.nlm.nih.gov/27257003. Doi: 10.1136/thoraxjnl-2016-208279
25. Kulkarni SR, Fletcher E, McConnell AK, Poskitt KR, Whyman MR. Pre-operative inspiratory muscle training preserves postoperative inspiratory muscle strength following major abdominal surgery – a randomised pilot. Ann R Coll Surg Engl [Internet]. 2010 [cited 2023 Sep 9]; 92(8): 700-7. Available from: https://pubmed.ncbi.nlm.nih.gov/20663275. doi: 10.1308/003588410X12771863936648
26. Benzo R, Wigle D, Novotny P, Wetzstein M, Nichols F, Shen RK, et al. Preoperative pulmonary rehabilitation before lung cancer resection: Results from two randomized studies. Lung Cancer [Internet]. 2011 [cited 2023 Ago 8];74(3):441-5. Available from: https://pubmed.ncbi.nlm.nih.gov/21663994. doi: 10.1016/j.lungcan.2011.05.011
27. Ferreira Barros G, da Silva Santos C, Boromello Granado F, Costa PT, Prado Límaco R, Gardenghi G. Respiratory muscle training in patients submitted to coronary arterial bypass graft. Rev Bras Cir Cardiovasc. 2010; 25(4): 483-90. doi: 10.1590/s0102-76382010000400011
28. Savci S, Degirmenci B, Saglam M, Arikan H, Inal-Ince D, Nur Tural H. Short-term effects of inspiratory muscle training in coronary artery bypass graft surgery: a randomized controlled trial. Scand Cardiovasc J [Internet]. 2011 [cited 2023 Nov 3]; 45(5):286-93. Available from: https://pubmed.ncbi.nlm.nih.gov/21793631. doi: 10.3109/14017431.2011.595820
29. Sprague SS, Hopkins PD. Use of inspiratory strength training to wean six patients who were ventilator-dependent. Phys Ther. 2003; 83(2):171-81.
30. Belman MJ. Respiratory failure treated by ventilatory muscle training (VMT), a report of 2 two cases. Eur J Respir Dis. 1981; 62(6): 391-5
31. Martin AD, Davenport PD, Franceschi AC, Harman E. Use of inspiratory muscle strength training to facilitate ventilator weaning: a series of 10 consecutive patients. Chest. 2002;122(1):192-6. doi: 10.1378/chest.122.1.192
32. Caruso P, Friedrich C, Denari SD, Ruiz SA, Deheinzelin D. The unidirectional valve is the best method to determine maximal inspiratory pressure during weaning. Chest. 1999; 115(4):1096-101. DOI: 10.1378/chest.115.4.1096
33. Cargnin C, Vieira da Costa Guaragna JC, Dal Lago P. Inspiratory muscle training after heart valve replacement surgery improves inspiratory muscle strength, lung function, and functional capacity: A randomized controlled trial. J Cardiopulm Rehabil Prev. 2019; 39(5):E1-E7. doi: 10.1097/HCR.0000000000000409
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2. Zaragoza R, Vidal-Cortés P, Aguilar G, Borges M, Diaz E, Ferrer R, et al. Update of the treatment of nosocomial pneumonia in the ICU. Crit Care [Internet]. 2020 [cited 2023 Oct 10]; 24 :383. Available from: https://ccforum.biomedcentral.com/articles/10.1186/s13054-020-03091-2. doi: https://doi.org/10.1186/s13054-020-03091-2
3. Brunker LB, Boncyk ChS, Rengel KF, Hughes ChG. Elderly patients and management in Intensive Care Units (ICU): Clinical challenges. Clin Interv Aging [Internet]. 2023 [cited 2023 Oct 10]; 18:93-112. Available from: https://pubmed.ncbi.nlm.nih.gov/36714685. doi: 10.2147/CIA.S365968
4. Mañanas Villanueva MA. Capítulo 1. Introducción [Internet]. In: Análisis de la actividad muscular respiratoria mediante técnicas temporales, frecuenciales y estadísticas. [Tesis] Catalunya: Universitat Politécnica de Catalunya; 1999. p. 1-32. [citado 10 Oct 2023]. Disponible en: https://upcommons.upc.edu/bitstream/handle/2117/93513/02_mananaVillanueva_capitol_1.pdf?sequence=2&isAllowed=y
5. García-Talavera I, Díaz Lobato S, Bolado PR, Villasante C. Músculos respiratorios. Arch Bronconeumol [Internet]. 1992 [citado 3 Nov 2023]; 28 (5): 239-46. Disponible en: https://www.elsevier.es/es-revista-imagen-diagnostica-308-pdf-S0300289615313351
6. Diaz Ballve LP, Dargains N, García Urrutia Inchaustegu J, Bratos A, Percaz MM, Bueno Ardariz C, et al. Debilidad adquirida en la unidad de cuidados intensivos. Incidencia, factores de riesgo y su asociación con la debilidad inspiratoria. Estudio de cohorte observacional. Rev Bras Ter Intensiva [Internet]. 2017 [citado 3 Nov 2023]; 29(4): 466-75. Disponible en: https://www.scielo.br/j/rbti/a/48Jbmf4fHt7Rd9VZPYHXwmC/?format=pdf&lang=es. doi: https://doi.org/10.5935/0103-507X.20170063
7. Carámbula A, Visca A, D’Amico S, Angulo M. Evaluación muscular respiratoria y periférica en la Unidad de Cuidados Intensivos. Arch Bronconeumol [Internet]. 2019 [citado 3 Nov 2023]; 55(5): 258-65. Disponible en: https://www.archbronconeumol.org/es-pdf-S0300289618303351. doi: https://doi.org/10.1016/j.arbres.2018.09.002
8. Díaz MC, Ospina Tascón GA, Salazar C BC. Disfunción muscular respiratoria: una entidad multicausal en el paciente críticamente enfermo sometido a ventilación mecánica. Arch Bronconeumol [Internet]. 2014 [citado 3 Nov 2023]; 50(2): 73-7. Disponible en: https://www.archbronconeumol.org/en-disfuncion-muscular-respiratoria-una-entidad-articulo-S0300289613000938. doi: 10.1016/j.arbres.2013.03.005
9. Bissett B, Leditschke IA, Green M, Marzano V, Collins S, Van Haren F. Inspiratory muscle training for intensive care patients: A multidisciplinary practical guide for clinicians. Aust Crit Care [Internet]. 2019 [cited 2023 Nov 3];32(3):249-55. Available from: https://pubmed.ncbi.nlm.nih.gov/30007823. doi: 10.1016/j.aucc.2018.06.001
10. Pagea MJ, McKenziea JE, Bossuyt PM, Boutron I, Hoffmann TC, Cynthia D. Mulrow CD, et al. Declaración PRISMA 2020: Una guía actualizada para la publicación de revisiones sistemáticas. Rev Esp Cardiol [Internet]. 2021 [citado 3 Nov 2023]; 74 (9): 790–9. Disponible en: https://www.sciencedirect.com/science/article/pii/S0300893221002748. doi: https://doi.org/10.1016/j.recesp.2021.06.016
11. da Costa Santos CM, Andrucioli de Mattos Pímenta C, Cuce Nobre MR. The PICO strategy for the research question construction and evidence search. Rev Lat Am Enfermagem [Internet]. 2007 [cited 2023 Ago 15];15(3):508-11. Available from: https://pubmed.ncbi.nlm.nih.gov/17653438. doi: 10.1590/s0104-11692007000300023
12. Maher ChG, Sherrington C, Herbert RD, Moseley AM, Elkins M, et al. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther [Internet]. 2003 [cited 2023 Nov 3]; 83 (8): 713-21. Available from: https://academic.oup.com/ptj/article/83/8/713/2805287. doi: https://doi.org/10.1093/ptj/83.8.713
13. Verhagen AP, De Vet HCW, De Bie RA, Kessels AGH, Boers M, Bouter LM, Knipschild PG. The delphi list: A criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. J Clin Epidemiol [Internet]. 1998 [cited 2023 Ago 15] ;51(12):1235-41. Available from: https://research.vu.nl/files/2896948/263658.pdf
14. Moseley AM, Herbert RD, Sherrington C, Maher ChG. Evidence for physiotherapy practice: a survey of the Physiotherapy Evidence Database (PEDro). Aust J Physiother [Internet]. 2002 [cited 2023 Sep 9]; 48(1):43-9. Available from: https://pubmed.ncbi.nlm.nih.gov/11869164. doi: 10.1016/s0004-9514(14)60281-6
15. Van Adrichem EJ, Meulenbroek RL, Plukker JTM, Groen H, van Weert E. Comparison of two preoperative inspiratory muscle training programs to prevent pulmonary complications in patients undergoing esophagectomy: a randomized controlled pilot study. Ann Surg Oncol [Internet]. 2014 [cited 2023 Nov 3]; 21(7):2353-60. Available from: https://pubmed.ncbi.nlm.nih.gov/24604584. doi: 10.1245/s10434-014-3612-y
16. Zanini M, Nery RM, Beust de Lima J, Petry Buhler R, Donelli da Silveira A, Stein R. Effects of different rehabilitation protocols in inpatient cardiac rehabilitation after coronary artery bypass graft surgery: A randomized clinical trial. J Cardiopulm Rehabil Prev. 2019;39(6):E19-E25. DOI: 10.1097/HCR.0000000000000431
17. Valkenet K, Trappenburg JCA, Ruurda JP, Guinan EM, Reynolds JV, Nafteux P, et al. Multicentre randomized clinical trial of inspiratory muscle training versus usual care before surgery for oesophageal cancer. Br J Surg [Internet]. 2018 [cited 2023 Sept 9]; 105(5): 502-11. Available from: https://pubmed.ncbi.nlm.nih.gov/29603130. doi: 10.1002/bjs.10803
18. Laurent H, Aubreton S, Galvaing G, Pereira B, Merle P, Richard R, et al. Preoperative respiratory muscle endurance training improves ventilatory capacity and prevents pulmonary postoperative complications after lung surgery. Eur J Phys Rehabil Med [Internet]. 2020 [cited 2023 Sept 9]; 56(1): 73-81. Available from: https://pubmed.ncbi.nlm.nih.gov/31489810. doi: 10.23736/S1973-9087.19.05781-2
19. Teixeira Sobrinho M, Negretti Guirado G, de Moraes Silva MA. Preoperative therapy restores ventilatory parameters and reduces length of stay in patients undergoing myocardial revascularization. Rev Bras Cir Cardiovasc [Internet]. 2014 [cited 2023 Nov 3]; 29(2): 221-8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4389447. Doi: 10.5935/1678-9741.20140021
20. Huang J, Lai Y, Zhou X, Li S, Su J, Yang M, Che G. Short-term high-intensity rehabilitation in radically treated lung cancer: a three-armed randomized controlled trial. J Thorac Dis [Internet]. 2017 [cited 2023 Dec 4]; 9(7):1919-29. Available from: https://pubmed.ncbi.nlm.nih.gov/28839990. doi: 10.21037/jtd.2017.06.15
21. Chen X, Hou L, Zhang Y, Liu X, Shao B, Yuan B, et al. The effects of five days of intensive preoperative inspiratory muscle training on postoperative complications and outcome in patients having cardiac surgery: a randomized controlled trial. Clin Rehabil. 2019; 33(5):913-22. doi: 10.1177/0269215519828212
22. Pehlivan E, Turna A, Gurses A, Nilgun Gurses H. The effects of preoperative short-term intense physical therapy in lung cancer patients: a randomized controlled trial. Ann Thorac Cardiovasc Surg [Internet]. 2011 [cited 2023 Dec 4 3]; 17(5):461-8. Available from: https://pubmed.ncbi.nlm.nih.gov/21881371. doi: 10.5761/atcs.oa.11.01663
23. Lai Y, Huang J, Yang M, Su J, Liu J, Che G. Seven-day intensive preoperative rehabilitation for elderly patients with lung cancer: a randomized controlled trial. J Surg Res. 2017; 209: 30-36. doi: 10.1016/j.jss.2016.09.033
24. Bissett BM, Leditschke IA, Neeman T, Boots R, Paratz J. Inspiratory muscle training to enhance recovery from mechanical ventilation: a randomised trial. Thorax [Internet]. 2016 [cited 2023 Nov 3]; 71(9): 812-9. Available from: https://pubmed.ncbi.nlm.nih.gov/27257003. Doi: 10.1136/thoraxjnl-2016-208279
25. Kulkarni SR, Fletcher E, McConnell AK, Poskitt KR, Whyman MR. Pre-operative inspiratory muscle training preserves postoperative inspiratory muscle strength following major abdominal surgery – a randomised pilot. Ann R Coll Surg Engl [Internet]. 2010 [cited 2023 Sep 9]; 92(8): 700-7. Available from: https://pubmed.ncbi.nlm.nih.gov/20663275. doi: 10.1308/003588410X12771863936648
26. Benzo R, Wigle D, Novotny P, Wetzstein M, Nichols F, Shen RK, et al. Preoperative pulmonary rehabilitation before lung cancer resection: Results from two randomized studies. Lung Cancer [Internet]. 2011 [cited 2023 Ago 8];74(3):441-5. Available from: https://pubmed.ncbi.nlm.nih.gov/21663994. doi: 10.1016/j.lungcan.2011.05.011
27. Ferreira Barros G, da Silva Santos C, Boromello Granado F, Costa PT, Prado Límaco R, Gardenghi G. Respiratory muscle training in patients submitted to coronary arterial bypass graft. Rev Bras Cir Cardiovasc. 2010; 25(4): 483-90. doi: 10.1590/s0102-76382010000400011
28. Savci S, Degirmenci B, Saglam M, Arikan H, Inal-Ince D, Nur Tural H. Short-term effects of inspiratory muscle training in coronary artery bypass graft surgery: a randomized controlled trial. Scand Cardiovasc J [Internet]. 2011 [cited 2023 Nov 3]; 45(5):286-93. Available from: https://pubmed.ncbi.nlm.nih.gov/21793631. doi: 10.3109/14017431.2011.595820
29. Sprague SS, Hopkins PD. Use of inspiratory strength training to wean six patients who were ventilator-dependent. Phys Ther. 2003; 83(2):171-81.
30. Belman MJ. Respiratory failure treated by ventilatory muscle training (VMT), a report of 2 two cases. Eur J Respir Dis. 1981; 62(6): 391-5
31. Martin AD, Davenport PD, Franceschi AC, Harman E. Use of inspiratory muscle strength training to facilitate ventilator weaning: a series of 10 consecutive patients. Chest. 2002;122(1):192-6. doi: 10.1378/chest.122.1.192
32. Caruso P, Friedrich C, Denari SD, Ruiz SA, Deheinzelin D. The unidirectional valve is the best method to determine maximal inspiratory pressure during weaning. Chest. 1999; 115(4):1096-101. DOI: 10.1378/chest.115.4.1096
33. Cargnin C, Vieira da Costa Guaragna JC, Dal Lago P. Inspiratory muscle training after heart valve replacement surgery improves inspiratory muscle strength, lung function, and functional capacity: A randomized controlled trial. J Cardiopulm Rehabil Prev. 2019; 39(5):E1-E7. doi: 10.1097/HCR.0000000000000409
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