Impacto da mobilização passiva precoce com cicloergômetro na interação paciente-ventilador

Abstract

BACKGROUND: Early exercise has been recommended in critically ill subjects, but its impact on patient-ventilator interaction is still unclear. So, the aim of this study was to evaluate the occurrence of patient-ventilator asynchrony during passive exercise in subjects mechanically ventilated. METHODS: This study included 21 patients (56.8 ± 16.1 years, 71.4% male) who were under mechanical ventilation for less than 72 hours, and deeply sedated (RASS -5 [-2]). Patients were submitted to one session of passive exercise with a cycle ergometer for 20 minutes. The occurrence of asynchrony was monitored by the analysis of flow and airway pressure curves, registered during five-minute periods: baseline (before exercise), exercise (during the last 5 minutes of exercise), and recovery (10 minutes after exercise). Hemodynamic and respiratory parameters were registered in these periods as well, and arterial blood gas analysis was performed at baseline and recovery periods. RESULTS: The asynchrony index increased during exercise (32.1 [29.0]%) compared to baseline (6.6 [6.5]%), returning to the initial levels during the recovery period (2.7 [12.2]%). The most frequent types of asynchrony were ineffective triggering and insufficient flow. It was also observed an increase in the respiratory rate during exercise compared to baseline and recovery (20.0 [6.5] vs. 18.0 [4.5] and 18.0 [5.0] min, respectively), resulting in a mild hypocapnia (36.4 ± 7.5 vs. 33.5 ± 6.9 mmHg), and a slight increase in the pH (7.36 ± 0.06 vs. 7.41 ± 0.07). There were no significant changes in the hemodynamic variables. CONCLUSION: Early passive exercise with cycle ergometer exercise in sedated patients can worse patient-ventilator asynchrony, increasing the occurrence of asynchrony. Adjustments in the ventilator parameters may be necessary in patients during exercise.