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      Acute effect of passive cycle-ergometry and functional electrical stimulation on nitrosative stress and inflammatory cytokines in mechanically ventilated critically ill patients: a randomized controlled trial

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          Abstract

          Early mobilization is beneficial for critically ill patients because it reduces muscle weakness acquired in intensive care units. The objective of this study was to assess the effect of functional electrical stimulation (FES) and passive cycle ergometry (PCE) on the nitrous stress and inflammatory cytometry in critically ill patients. This was a controlled, randomized, open clinical trial carried out in a 16-bed intensive care unit. The patients were randomized into four groups: Control group (n=10), did not undergo any therapeutic intervention during the study; PCE group (n=9), lower-limb PCE for 30 cycles/min for 20 min; FES group (n=9), electrical stimulation of quadriceps muscle for 20 min; and FES with PCE group (n=7), patients underwent PCE and FES, with their order determined randomly. The serum levels of nitric oxide, tumor necrosis factor alpha, interferon gamma, and interleukins 6 and 10 were analyzed before and after the intervention. There were no differences in clinical or demographic characteristics between the groups. The results revealed reduced nitric oxide concentrations one hour after using PCE (P<0.001) and FES (P<0.05), thereby indicating that these therapies may reduce cellular nitrosative stress when applied separately. Tumor necrosis factor alpha levels were reduced after the PCE intervention (P=0.049). PCE and FES reduced nitric oxide levels, demonstrating beneficial effects on the reduction of nitrosative stress. PCE was the only treatment that reduced the tumor necrosis factor alpha concentration.

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          Early intensive care unit mobility therapy in the treatment of acute respiratory failure.

          Immobilization and subsequent weakness are consequences of critical illness. Despite the theoretical advantages of physical therapy to address this problem, it has not been shown that physical therapy initiated in the intensive care unit offers benefit. Prospective cohort study in a university medical intensive care unit that assessed whether a mobility protocol increased the proportion of intensive care unit patients receiving physical therapy vs. usual care. Medical intensive care unit patients with acute respiratory failure requiring mechanical ventilation on admission: Protocol, n = 165; Usual Care, n = 165. An intensive care unit Mobility Team (critical care nurse, nursing assistant, physical therapist) initiated the protocol within 48 hrs of mechanical ventilation. The primary outcome was the proportion of patients receiving physical therapy in patients surviving to hospital discharge. Baseline characteristics were similar between groups. Outcome data are reflective of survivors. More Protocol patients received at least one physical therapy session than did Usual Care (80% vs. 47%, p < or = .001). Protocol patients were out of bed earlier (5 vs. 11 days, p < or = .001), had therapy initiated more frequently in the intensive care unit (91% vs. 13%, p < or = .001), and had similar low complication rates compared with Usual Care. For Protocol patients, intensive care unit length of stay was 5.5 vs. 6.9 days for Usual Care (p = .025); hospital length of stay for Protocol patients was 11.2 vs. 14.5 days for Usual Care (p = .006) (intensive care unit/hospital length of stay adjusted for body mass index, Acute Physiology and Chronic Health Evaluation II, vasopressor). There were no untoward events during an intensive care unit Mobility session and no cost difference (survivors + nonsurvivors) between the two arms, including Mobility Team costs. A Mobility Team using a mobility protocol initiated earlier physical therapy that was feasible, safe, did not increase costs, and was associated with decreased intensive care unit and hospital length of stay in survivors who received physical therapy during intensive care unit treatment compared with patients who received usual care.
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            Physical complications in acute lung injury survivors: a two-year longitudinal prospective study.

            Survivors of severe critical illness frequently develop substantial and persistent physical complications, including muscle weakness, impaired physical function, and decreased health-related quality of life. Our objective was to determine the longitudinal epidemiology of muscle weakness, physical function, and health-related quality of life and their associations with critical illness and ICU exposures.
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              WINPEPI updated: computer programs for epidemiologists, and their teaching potential

              Background The WINPEPI computer programs for epidemiologists are designed for use in practice and research in the health field and as learning or teaching aids. The programs are free, and can be downloaded from the Internet. Numerous additions have been made in recent years. Implementation There are now seven WINPEPI programs: DESCRIBE, for use in descriptive epidemiology; COMPARE2, for use in comparisons of two independent groups or samples; PAIRSetc, for use in comparisons of paired and other matched observations; LOGISTIC, for logistic regression analysis; POISSON, for Poisson regression analysis; WHATIS, a "ready reckoner" utility program; and ETCETERA, for miscellaneous other procedures. The programs now contain 122 modules, each of which provides a number, sometimes a large number, of statistical procedures. The programs are accompanied by a Finder that indicates which modules are appropriate for different purposes. The manuals explain the uses, limitations and applicability of the procedures, and furnish formulae and references. Conclusions WINPEPI is a handy resource for a wide variety of statistical routines used by epidemiologists. Because of its ready availability, portability, ease of use, and versatility, WINPEPI has a considerable potential as a learning and teaching aid, both with respect to practical procedures in the planning and analysis of epidemiological studies, and with respect to important epidemiological concepts. It can also be used as an aid in the teaching of general basic statistics.
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                Author and article information

                Journal
                Braz J Med Biol Res
                Braz. J. Med. Biol. Res
                bjmbr
                Brazilian Journal of Medical and Biological Research
                Associação Brasileira de Divulgação Científica
                0100-879X
                1414-431X
                09 April 2020
                2020
                : 53
                : 4
                : e8770
                Affiliations
                [1 ]Departamento de Fisioterapia e Programa de Pós-graduação em Fisioterapia, Universidade Federal da Paraíba, João Pessoa, PB, Brasil
                [2 ]Unidade de Terapia Intensiva, Hospital Agamenon Magalhães, Recife, PE, Brasil
                [3 ]Programa de Residência de Clínica Médica, Hospital Otávio de Freitas, Recife, PE, Brasil
                [4 ]Programa de Pós-graduação em Educação Física e Hebiatria, Universidade de Pernambuco, Recife, PE, Brasil
                [5 ]Departamento de Fisioterapia e Programa de Pós-graduação em Saúde e Desenvolvimento Humano, Universidade La Salle, Canoas, RS, Brasil
                [6 ]Departamento de Fisioterapia, Universidade Federal de Pernambuco, Recife, PE, Brasil
                [7 ]Departamento de Fisioterapia e Medicina Tropical, Universidade Federal de Pernambuco, Recife, PE, Brasil
                Author notes
                Correspondence: E.E.T. França: < edueriko@ 123456hotmail.com >
                Author information
                http://orcid.org/0000-0001-9207-2180
                http://orcid.org/0000-0003-1546-8856
                http://orcid.org/0000-0001-9277-1694
                http://orcid.org/0000-0001-6109-2728
                http://orcid.org/0000-0002-4056-958X
                http://orcid.org/0000-0002-5137-6951
                http://orcid.org/0000-0001-5426-4253
                http://orcid.org/0000-0003-0386-5256
                http://orcid.org/0000-0002-6706-2703
                http://orcid.org/0000-0002-2489-127X
                http://orcid.org/0000-0002-2026-7891
                http://orcid.org/0000-0003-2549-998X
                http://orcid.org/0000-0003-4910-3476
                Article
                00605
                10.1590/1414-431X20208770
                7162584
                32294698
                019289ba-6684-47b7-9aa6-d2c743abfa4d

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 5 May 2019
                : 6 January 2020
                Page count
                Figures: 3, Tables: 1, Equations: 0, References: 28
                Categories
                Research Article

                cytokines,nitrosative stress,intensive care unit,physiotherapy

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