Conocimiento y manejo de cuidados respiratorios especializados en pacientes con enfermedades neuromusculares en unidades de cuidado intensivo: aproximación por encuesta a profesionales de la salud
Keywords:
Neuromuscular Diseases, Air Stacking; Non Invasive Ventilatory Support, Mechanical Cough Support, Intensive Care Units, Health Care ProfessionalsAbstract
Introduction:
In neuromuscular diseases, the decrease in vital capacity relates to decreased coughing and then ventilatory capacity, the combination of both generating serious complications due to ventilatory failure. In intubated patients, the extubation process is difficult unless specialized respiratory care is provided. The knowledge and treatment application of the professionals who care for these patients in intensive care is of outmost importance.
Objectives:
Report the knowledge and specialized application of respiratory care in neuromuscular diseases in Intensive Care Units.
Materials and methods:
Qualitative, descriptive, cross-sectional, non-probabilistic study, at criteria. The accessible population were Health professionals from the Intensive Care Units, and the analysis of the responses of a structured survey, sent to different professionals worldwide.
Results:
The questionnaires of 41 professionals were included, 34% of the professionals reported the regular use of the Mechanical Cough Assistant; 22% reported the regular use of air stacking; 31% reported the regular use of Non-Invasive Ventilatory Assistance. 56.1% of the professionals stated that they knew the difference between Non-Invasive Ventilation and Non-Invasive Ventilatory Support, 34% of the professionals reported having specialized training in the area.
Conclusion:
Despite the existence of a high proportion of professionals with specialized knowledge, an important group does not routinely apply them. The justification is mainly due to the difficulty of acquiring and financing the necessary equipment.
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Giménez G, Prado F, Herrero M, Bach J. Treatment alternatives in patients with neuromuscular pathologies and respiratory diseases. An la Fac Ciencias Médicas. 2017 Aug 30;50(2):79-88.
Voulgaris A, Antoniadou M, Agrafiotis M, Steiropoulos P. Respiratory Involvement in Patients with Neuromuscular Diseases: A Narrative Review. PubMed. 2019.
Bach J, Bravo Quiroga L. Soporte respiratorio muscular para evitar el fallo respiratorio y la traqueotomía: ventilación no invasiva y técnicas de tos asistida TT - Respiratory muscle aids to prevent respiratory failure and tracheotomy: Noninvasive mechanical ventilation and mech. Rev am med respir. 2013;13(2):71-83. Available from: http://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S1852-236X2013000200005
Bach JR. Noninvasive respiratory management of patients with neuromuscular disease. Annals of Rehabilitation Medicine. Korean Academy of Rehabilitation Medicine; 2017. Vol. 41 p. 519-38.
Salinas P, Prado F, Pinchak C, Herrero MV, Concepción Giménez G, García C, et al. CUIDADOS RESPIRATORIOS PARA PACIENTES CON ENFERMEDADES NEUROMUSCULARES. Neumología Pediátrica, 12(3), 103-113. 2017 https://doi.org/10.51451/np.v12i3.261
Czaplinski A, Yen AA. Forced vital capacity (FVC) as an indicator of survival and disease progression in an ALS clinic population. J Neurol Neurosurg Psychiatry. 2006;77:390-2. Available from: www.jnnp.com
Gonçalves MR, Bach JR, Ishikawa Y, Saporito L, Winck JC. Continuous noninvasive ventilatory support outcomes for patients with neuromuscular disease: a multicenter data collaboration. Pulmonology. 2021 Nov 1;27(6):509-17.
Chatwin M, Toussaint M, Gonçalves MR, Sheers N, Mellies U, Gonzales-Bermejo J, et al. Airway clearance techniques in neuromuscular disorders: A state of the art review. Respir Med. 2018 Mar 1;136:98-110.
Bach JR, Sinquee DM, Saporito RRT LR, Botticello AL. Efficacy of Mechanical Insufflation-Exsufflation in Extubating Unweanable Subjects With Restrictive Pulmonary Disorders. Respir Care. 2015;60(4):477-83.
Sarmento A, de Andrade AFD, Lima ÍNDF, Aliverti A, de Freitas Fregonezi GA, Resqueti VR. Air stacking: A detailed look into physiological acute effects on cough peak flow and chest wall volumes of healthy subjects. Respir Care . 2017 Apr 4;62(4):432-43.
Chawla R, Dixit SB, Zirpe KG, Chaudhry D, Khilnani GC, Mehta Y, et al. ISCCM guidelines for the use of non-invasive ventilation in acute respiratory failure in adult ICUS. Indian J Crit Care Med. 2020;24:61-81. Available from: https://creativecommons.
Bach JR, Kazi AW, Pinto T, Gonçalves MR. Noninvasive ventilatory support in morbid obesity. Pulmonology . 2021 Sep 1;27(5):386-93.
Shah NM, Murphy PB, Kaltsakas G. The adult multidisciplinary respiratory neuromuscular clinic. Breathe. 2020 Sep 1;16(3):1-13. Available from: /pmc/articles/PMC7792801/
Stehling F, Bouikidis A, Schara U, Mellies U. Mechanical insufflation/exsufflation improves vital capacity in neuromuscular disorders. Chron Respir Dis. 2015 Feb;12(1):31-5
Giménez GC, Prado F, Bersano C, Kakisu H, Herrero MV, Manresa AL, Pronello D, Salinas P, Morales JC, Gutiérrez M, Guillén S, Aravena S, Morales P, Bach J. 2021. Recomendaciones para el manejo respiratorio de los pacientes con atrofia muscular espinal. Arch Pediatr Urug; 92(1): e401.
Kaminska M, Browman F, Trojan DA, Genge A, Benedetti A, Petrof BJ. Feasibility of Lung Volume Recruitment in Early Neuromuscular Weakness: A Comparison Between Amyotrophic Lateral Sclerosis, Myotonic Dystrophy, and Postpolio Syndrome. PM&R. 2015 Jul 1;7(7):677-84.
Pinchak C, Salinas P, Prado F, Herrero M, Giménez G, García C, Bach J. Actualización en el manejo respiratorio de pacientes con enfermedades neuromusculares. Archivos de Pediatría del Uruguay.2018. 89(1), 40-51.
Prado J, Müller-Thies M. Evaluación de la función respiratoria en pacientes con patologías neuromusculares. An. Fac. Cienc. Méd. (Asunción). 2021 Apr; 54( 1 ): 67-76.
Huerta A, Valdebenito C, Madrid C, Concepción G, Herrero MV, Prado F. ABORDAJE RESPIRATORIO DEL PACIENTE CON ENFERMEDAD NEUROMUSCULAR EN LA UNIDAD DE CUIDADO INTENSIVO PEDIÁTRICA. 2022. Neumología Pediátrica , 17(4), 139-144.
Morel Y, Giménez G. Funcionalidad de la tos en pacientes con Enfermedad Neuromuscular atendidos en el Hospital de Clínicas-San Lorenzo. 2019. Medicina Clínica y Social, 3(1), 14-18.