Complications from immobility in intensive care unit patients contribute to functional decline, increased healthcare costs, reduced quality of life and higher post-discharge mortality. Physical therapy focuses on promoting recovery and preserving function, and it may minimize the impact of these complications. A group of Brazilian Association of Intensive Care Medicine physical therapy experts developed this document that contains minimal physical therapy recommendations appropriate to the Brazilian real-world clinical situation. Prevention and treatment of atelectasis, procedures related to the removal of secretions and treatment of conditions related to physical deconditioning and functional decline are discussed. Equally important is the consideration that prescribing and executing activities, mobilizations and exercises are roles of the physical therapist, whose diagnosis should precede any intervention.

Influence of early mobilization on respiratory and peripheral muscle strength in critically ill patients Influência da mobilização precoce na força muscular periférica e respiratória em pacientes críticos ORIGINAL ARTICLE INTRODUCTION Advances in intensive care and mechanical ventilation (MV) in the past two decades have increased critically ill patient survival. However, some patients require prolonged MV (PMV) and are deconditioned due to respiratory insufficiency caused by underlying disease, adverse effects of medications, and prolonged immobilization. (1-3) Patients in the intensive care unit (ICU) are often confined to their beds, which results in inactivity, immobility, and severe osteomyoarticular system dysfunction. (4,5) These changes are predisposing factors for polyneuropathy and/or myopathy in critically ill patients and lead to a 2-to 5-fold increase in MV duration and time for ventilatory weaning. (6) Immobility disproportionately affects respiratory muscles because the mechanical ventilator performs a large amount of the respiratory effort, decreasing the spontaneous ventilation effort. This results in the partial or complete absence of neural activation and muscle

During nebulization with noninvasive ventilation in healthy volunteers, there was an increase in V(t) associated to a higher inspiratory flow rate, without resulting in a significant increase in pulmonary radioaerosol deposition.

EMS used at low current intensity and for a short duration failed to prevent muscle atrophy in critically ill patients. However, we did find a significant improvement in active dorsiflexion of the ankle joint suggesting that it could help to prevent against stance plantar flexion in these patients.

Roux-en-Y gastric bypass (RYGB) is an effective treatment for morbid obesity. However, it may lead to diseases of the bilio-pancreatic tract. We evaluated transgastric endoscopic retrograde cholangiopancreatography (ERCP) for managing common biliary tract diseases in patients that underwent RYGB treatment for obesity. This prospective study was conducted between 2003 and 2010 at three medical institutions. We included 23 patients with a mean body mass index of 28.2 kg/m(2) after RYGB treatment. ERCP was performed in all patients to manage biliary tract diseases within 9 to 27 months (mean 16.3 months) of RYGB surgery. The gastrotomy was conducted through the anterior wall of the greater curve of the excluded stomach. A duodenoscope was introduced in the direction of the ostomy to perform the ERCP with sphincterotomy. All patients underwent an ERCP and papillotomy without incident. Ten patients underwent simultaneous cholecystectomy. A total of 17 gallstones were removed. The average gastrotomy duration was 92.69 min; the average hospital stay was 2 days. One patient had mild acute pancreatitis that resolved clinically. There was no mortality. Laparoscopy-assisted transgastric ERCP was feasible and safe for patients after RYGB. The necessary equipment is available in most bariatric surgery centers.

Objective: the objective was to assess the level of physical activity (LPA) and the quality of life QL of the professionals who work in ICU. Method: this was a cross-sectional study carried out in Adult ICUs. LPA was assessed by the International Questionnarie of Physical Activity -short form (IQPA-SF) and the QL by the Medical Outcomes Study 36 (SF-36) questionnaire. Results: it was classifi ed active 50.89% out of a total of 59 professionals. Nursing technicians were considered the most active with 60.6%. The QL of the professionals who were considered active were better when compared to inactives, with statistical differences to the category of physical aspects limitation, social aspects and mental health. The working hours were higher than recommend, the physicians were higher than the physical therapist, nurses and technicians nurses (p=0.046). Conclusion: physically active professionals who work in ICU had higher quality of life probably why have lower hours of work and consequently more free time to engage in physical activity.

Smoking is a risk factor for progression of CKD.

OBJECTIVE:The passive cycle ergometer aims to prevent hypotrophy and improve muscle strength, with a consequent reduction in hospitalization time in the intensive care unit and functional improvement. However, its effects on oxidative stress and immune system parameters remain unknown. The aim of this study is to analyze the effects of a passive cycle ergometer on the immune system and oxidative stress in critical patients.METHODS:This paper describes a randomized controlled trial in a sample of 19 patients of both genders who were on mechanical ventilation and hospitalized in the intensive care unit of the Hospital Agamenom Magalhães. The patients were divided into two groups: one group underwent cycle ergometer passive exercise for 30 cycles/min on the lower limbs for 20 minutes; the other group did not undergo any therapeutic intervention during the study and served as the control group. A total of 20 ml of blood was analysed, in which nitric oxide levels and some specific inflammatory cytokines (tumour necrosis factor alpha (TNF-α), interferon gamma (IFN-γ) and interleukins 6 (IL-6) and 10 (IL-10)) were evaluated before and after the study protocol.RESULTS:Regarding the demographic and clinical variables, the groups were homogeneous in the early phases of the study. The nitric oxide analysis revealed a reduction in nitric oxide variation in stimulated cells (p=0.0021) and those stimulated (p=0.0076) after passive cycle ergometer use compared to the control group. No differences in the evaluated inflammatory cytokines were observed between the two groups.CONCLUSION:We can conclude that the passive cycle ergometer promoted reduced levels of nitric oxide, showing beneficial effects on oxidative stress reduction. As assessed by inflammatory cytokines, the treatment was not associated with changes in the immune system. However, further research in a larger population is necessary for more conclusive results.