Τόμος 31 (2013) – Τεύχος 3 – Άρθρο 7 – Επιθεώρηση Κλινικής Φαρμακολογίας και Φαρμακοκινητικής-Ελληνική Έκδοση – Volume 31 (2013) – Issue 3 – Article 7 – Epitheorese Klinikes Farmakologias και Farmakokinetikes-Greek Edition

 

Τίτλος – Title

O Ρόλος του Φυσιοθεραπευτή στη ∆ιαδικασία Αποδέσµευσης (Weaning) Ασθενών από το Μηχανικό Αερισµό

The Role of Physiotherapist in Weaning from Mechanical Ventilation

Συγγραφέας – Author

Πασχαλίνα Μπεµπελέτση

Φυσικοθεραπεύτρια, Μονάδα Εντατικής Θεραπείας, Περιφερειακό Γενικό Νοσοκοµείο Αλεξανδρούπολης, Αλεξανδρούπολη, Ελλάς

Paschalina Bebeletsi

ICU Physiotherapist, University General Hospital of Evros, Alexandroupolis, Hellas

Παραπομπή – Citation

Μπεµπελέτση,Μ. : O Ρόλος του Φυσιοθεραπευτή στη ∆ιαδικασία Αποδέσµευσης (Weaning) Ασθενών από το Μηχανικό Αερισµό, Επιθεώρηση Κλιν. Φαρμακολ. Φαρμακοκινητ. 31: 202-209 (2013)

Bebeletsi,P. : The Role of Physiotherapist in Weaning from Mechanical Ventilation, Epitheorese Klin. Farmakol. Farmakokinet. 31: 202-209 (2013)

Ημερομηνία Δημοσιευσης – Publication Date
– – –
Γλώσσα Πλήρους Κειμένου –
Full Text Language

Ελληνικά – Greek

Παραγγελία – Αγορά –
Order – Buy
Ηλεκτρονική Μορφή: pdf (15 €)
Digital Type: pdf (15 )
pharmakonpress[at]pharmakonpress[.]gr
Λέξεις κλειδιά – Keywords

Φυσιοθεραπεία, ΜΕΘ, µηχανικός αερισµός, αποδέσµευση από το µηχανικό αερισµό, ενδυνάµωση αναπνευστικών µυών

 Physiotherapy, ICU, mechanical ventilation, weaning from mechanical ventilation, respiratory muscle training
Λοιποί Όροι – Other Terms

Άρθρο

Article

Περίληψη – Summary

Οι φυσικοθεραπευτές καλούνται στην κλινική πράξη να συµµετέχουν στο χειρισµό βαρέως πασχόντων  ασθενών   στις   Μονάδες   Εντατικής   Θεραπείας. Η φυσικοθεραπευτική αξιολόγηση επικεντρώνεται στη φυσική αποδυνάµωση και  στην  αναπνευστική  λειτουργία του ασθενούς, ώστε να καθοριστούν οι στόχοι του φυσικοθεραπευτικού προγράµµατος. Ο βασικός στόχος ενός φυσικοθεραπευτικού  προγράµµατος  στη  ΜΕΘ  είναι η βελτίωση της αναπνευστικής λειτουργίας και  η  ενίσχυση της συνολικής λειτουργικής ικανότητας  του ασθενούς, µειώνοντας ταυτόχρονα τους κινδύνους της κατάκλισης ή αντιµετωπίζοντας τις επιπλοκές  αυτής. Σκοπός αυτής της εργασίας είναι  η  περιγραφή  του  ρόλου τoυ φυσικοθεραπευτή στην αποδέσµευση  των  ασθενών της  ΜΕΘ  από  το  µηχανικό  αερισµό.  Τα  στοιχεία για την εφαρµογή της διαδικασίας του απογαλακτισµού και την αποτελεσµατικότητα των φυσικοθεραπευτικών τεχνικών απορρέουν από την παρατήρηση  και  την  τεκµηριωµένη  επιστηµονική  απόδειξη.

Physiotherapists are involved in the management of patients with critical illness. Physiotherapy assessment is focused on physical deconditioning and respiratory conditions to identify targets for physiotherapy. The most important aim in this area is to enhance the overall patient’s functional capacity and to restore his/her respiratory and physical independence, thus decreasing the risks of bed rest associated complications. The purpose of this review is to present the current evidence for the role of physiotherapist in weaning from mechanical ventilation. The efficacy of chest physiotherapy on promoting the weaning process has been studied extensively and there is moderate-to- strong evidence in support of its role.

Αναφορές – References
1. Stiller K.: Physiotherapy in Intensive Care. Towards an evidence-based practice. Chest 718: 1801-1813 (2000)

2. Boles J.-M., Blon J., Connors A., Herridge M., Marsh B., et al.: Weaning from mechanical ventilation, Respir. J. 29: 1033-1056 (2007)

3. ACCP, AARC, ACCCM Task Force.: Evidence based guidelines for weaning and discontinuing ventilator support. Chest 120: 375S-395S (2001)

4. Combes A., Costa M.A., Trouillet J.L., Baudot , Mokhtari M., Gibert C., Chastre J.: Morbitidy, mortality and quality of life outcomes of patients requiring > or = 14 days of mechanical ventilation. Crit. Care Med. 31: 1373-1381 (2003)

5. Esteban A., Alia I., Tobin M.J., et al.: Characteristics and outcomes in adult patients receiving mechanical ventilation, a 28-days international study. Am. Med. Assoc. 287: 345-355 (2002)

6. Epstein S., et al.: Complications in ventilator supported. Pp. 877-902, McGraw Hill New York, 2006

7. Ali N.A., O’Brien J.M., Hoffman S.P., Phillips , Garland A., Finley J.C., et al.: Acquired weakness, handgrip strength and mortality in critically ill patients. Am. J. Resp. Crit. Care Med. 178: 261-268 (2008)

8. Epstein S.K.: Weaning parameters. Care Clin. N. Am. 6: 253-301 (2000)

9. Meade M., et al.: Predicting success in weaning from mechanical ventilation. Chest 120: 400-424 (2001)

10. Ezingeard E., et al.: Weaning from mechanical ventilation with pressure support in patients failing a T-tube trial of spontaneous breathing. Intensive Care Med. 32: 165-169 (2006)

11. Cohen J.D. et al.: Extubation outcome following a SBT with ATC versus PS. Care Med. 34: 6682-6686 (2006)

12. Vitacca M., et al.: Comparison of two methods for weaning patients with COPD requiring mechanical ventilation for more than 15 days. J. Respir. Crit. Care Med. 164: 225-230 (2001)

13. Matic I., Majeric-Kogler V.: Comparison of Pressure Support and T-tube weaning from mechanical ventilation, randomized prospective study. Med. J. 45: 162-166 (2004)

14. Saura P., Blanch L., Mestre L., et al.: Clinical consequences of the implementation of a weaning protocol. Intensive Care Med. 22: 1502-1506 (1996)

15. Ely E., O’Meade M., Haponik E., Kollef M., Cook D., Guyatt M., Stoller J.: Mechanical ventilator weaning protocols driven by non-physician health-care professionals. Chest 120: 454-462 (2001)

16. Krishnan J.A., Moore D., Robeson C., Rand C.S., Fessler  H.E.:  A  prospective controlled  trial  of  a protocol-based strategy to discontinue mechanical ventilation.    Am. Respir. Crit. Care Med. 169: 673-78 (2004)

17. Kollef M.H., Shapiro S.D., Silver P., St John R.E., Printice D., Sauer S., Ahrens T.S., Shannon W., Baker- Clinkscale D.: A randomized controlled trial of protocol- directed versus physician directed weaning from mechanical ventilation. Care Med. 22: 1052-1056 (1996)

18. Tanios M.A., et al.: A randomized controlled trial of the role of weaning predictors in clinical decision making. Care Med. 34: 2530-2535 (2006)

19. Teixeira C., et al.: Serial measurements of f/Vt can predict extubation failure in patients with f/Vt≤105? Crit. Care 23: 572-576 (2008)

20. Vassilakopoulos T., Zakynthinos S., Roussos Ch: Respiratory muscles and weaning failure. Respir. J. 9: 2383-2400 (1996)

21. Gosselink R., Bott J., Johnson M., Dean E., Nava S., Norrenberg M., Stiller K., Schonhofer B., Vincent J.L.: Physiotherapy for adult patients with criticall illness: Re- comentations of the Eur. Respir. Society and Eur. Society of Intensive Care Med. Task Force on physiotherapy for critically ill patients. Intensive Care Med J. 34: 1188-1199 (2008)

22. Clini E., Ambrosino N.: Early physiotherapy in the RICU. Med. 99: 1096-1104 (2005)

23. Denehy L., Berney S.: Physiotherapy in the Intensive Care Unit. Ther. Rev. 11: 49-56 (2006)

24. Dean E.: Oxygen transport: a physiologically-based conceptual framework for the practice of cardiopulmonary physiotherapy. Physiotherapy 80: 347-355 (1994)

25. Thomas P.J., Stanton W.R., et al.: Positioning practices for ventilated intensive care patients: current practice, indications and contraindications. Crit. Care 19: 122-126 (2006)

26. Mure M., Martling C.R., Lindahl S.G.E.: Dramatic effect on oxygenation I patients with ARDS treated in the prone position. Care Med. 26: 1977-1985 (1998)

27. Ibanez I., Raurich J.M., Abizanda R., et al.: The effect of lateral positions on gas exchange in patients with unilateral lung disease during mechanical ventilation. Intensive Care Med. 7: 231-234 (1981)

28. Raoof S., Chowdhrey N., et al.: Effect of combined kinetic therapy and percussion therapy on the resolution of atelectasis in critically ill patients. Chest 115: 1658-1666 (1999)

29. Morris P.E., Goad A., Tompson C., Taylor K., Harry B., Passmore L. et al.: Early ICU mobility therapy in treatment of acute respiratory failure. Care Med. 36: 2238-2243 (2008)

30. Norrenberg M., De Backer D., Moraine J.J.: Oxygen consumption can increase during passive leg mobilization. Intensive Care Med. 21: S177 (1995)

31. Burtin C., Clerckx B., Robbeets C., Ferdinande P., Langer D., Troosters T., Hermans G., et al.: Early exercise in critically ill patients enhances short term functional recovery. Care Med. 37: 2499-2505 (2009)

32. Kirschnbaum L., Azzi E., Sfeir T., Tietlen P., Astiz M.: Effect of continuous rotational therapy on the prevalence of ventilator-associated pneumonia in patients requiring long-term ventilator care. Care Med. 30: 1983-1986 (2002)

33. Maa S.H., Hung T.J., Hsu K.H., Hsieh Y.I., Wang K.Y., Wang C.H., et al.: Manual hyperinflation improves alveolar recruitment in difficult to wean patients. Chest 128: 2714- 2721 (2005)

34. Maxwell L., Ellis E.: The effect of circuit type, volume delivered and rapid release on flow rates dyring manual hyperinflation. Aust. J. Physiother. 49; 31-38 (2003)

35. Berney S., Denehy L.: A comparison of the effects of manual and ventilator hyperinflation on static lung compliance and sputum production in intubated and ventilated intensive care patients. Respir. Int. 7: 100-108 (2002)

36. Winck J.C., Goncalves M.R., Lourenco C., Viana P., Almeida J., Bach J.R.: Effects of mechanical insufflation- exsufflation on respiratory parameters for patients with chronic airway secretion encumbrance. Chest 126: 774-780 (2004)

37. Homnick M.N.: Mechanical Insufflation-Exsufflation for airway mucus clearance. Care 52: 1296-1305 (2007) Erratum in: Respir Care. 56: 888 (2911)

38. Chatwin M.: How to use a mechanical insufflator- exsufflator cough assist machine. Breathe 4: 321-329 (2008)

39. Choi J., Tasota F.J., Hoffman L.A.: Mobility interventions to improve outcomes in patients undergoing prolonged mechanical ventilation. Res. Nurs. 10: 21-33 (2008)

40. Petrof B.J., Jaber S., Matecki S.: Ventilator induced diaphragmatic dysfunction. Curr. Opin. Crit. Care 16: 19-25 (2010)

41. Chang A.T., Boots R.J., Brown M.G., Paratz J., Hodges P.W.: Reduced inspiratory muscle endurance following successful weaning from prolonged mechanical ventilation. Chest 128: 553-59 (2005)

42. Moodie L., Reeve J., Elkins M.: Inspiratory muscle training increases inspiratory muscle strength in patients weaning from mechanical ventilation: a systematic review. Physiother. 57: 213-221 (2011)

43. Zannoti E., Felicetti G., Maini M., Fracchia : Peripheral muscle strength training in bed-bound patients with COPD receiving mechanical ventilation. Effect of electrical stimulation. Chest 124: 2292-3296 (2003)

44. Gerovasili V., Stefanidis K., Vitzilaios K., Karatzanos E., Politis P., Koroneos A. et al.: Electrical muscle stimulation preserves the muscle mass of critically ill patients, a randomized study. Care 13: 161 (2009)

45. Meesen R.L., Dendale P., Cuypers K.: Neuromascular Electrical Stimulation as a possible means to prevent muscle tissue wasting in artificially ventilated and sedated patients in ICU: a pilot study. Neuromodulation 13: 315-321 (2010)

Online ISSN 1011-6575

Άρθρα Δημοσιευμένα σε αυτό το Περιοδικό Καταχωρούνται στα:
Chemical Abstracts

Elsevier’s Bibliographic Databases: Scopus, EMBASE, EMBiology, Elsevier BIOBASE
SCImago Journal and Country Rank Factor

Articles published in this Journal are Indexed or Abstracted in:
• Chemical Abstracts
• Elsevier’s Bibliographic Databases: Scopus, EMBASE, EMBiology, Elsevier BIOBASE
SCImago Journal and Country Rank Factor

Άρθρα Δημοσιευμένα στην Επιθεώρηση Κλινικής Φαρμακολογίας και Φαρμακοκινητικής-Ελληνική Έκδοση
Articles Published in Epitheorese Klinikes Farmakologias και Farmakokinetikes-Greek Edition

Συντακτικη Επιτροπή-Editorial Board

ΕΤΗΣΙΑ ΣΥΝΔΡΟΜΗ – ANNUAL SUBSCRIPTION
Γλώσσα Πλήρους Κειμένου –
Full Text Language
Ελληνικά – Greek
Παραγγελία – Αγορά –
Order – Buy
Ηλεκτρονική Μορφή: pdf (70 €) –
Digital Type: pdf (70 €)
pharmakonpress[at]pharmakonpress[.]gr
Έντυπη Μορφή (70 € + έξοδα αποστολής)
Printed Type (70 € + shipping)
pharmakonpress[at]pharmakonpress[.]gr
Προσθέστε στους σελιδοδείκτες το μόνιμο σύνδεσμο.

Τα σχόλια είναι απενεργοποιημένα.