Banca de DEFESA: CLÊNIA OLIVEIRA ARAÚJO

Uma banca de DEFESA de DOUTORADO foi cadastrada pelo programa.
STUDENT : CLÊNIA OLIVEIRA ARAÚJO
DATE: 16/12/2019
TIME: 14:00
LOCAL: Auditório do departamento de fisioterapia
TITLE:

EFFECTS OF NON-INVASIVE VENTILATION VERSUS RESPIRATORY MUSCULAR TRAINING ASSOCIATED WITH CARDIOVASCULAR REHABILITATION IN CHRONIC HEART FAILURE

KEY WORDS:

Heart failure; Cardiovascular rehabilitation; Expiratory muscle training; Inspiratory muscle training; Non-invasive ventilation.

PAGES: 173
BIG AREA: Ciências da Saúde
AREA: Fisioterapia e Terapia Ocupacional
SUMMARY:

Abstract

Introduction: Dyspnea is one of the most common symptoms of exertion in chronic heart failure with reduced left ventricular ejection fraction (rEFI) and relentlessly progresses with disease progression, leading to reduced functional capacity. Therefore, investigations into the use of noninvasive ventilation (NIV) or respiratory muscle training (RMT) may optimize exercise tolerance during Cardiovascular. NIV use has shown encouraging results in reducing cardiorespiratory work, while new protocols involving the combination of inspiratory muscle training (IMT) and expiratory muscle training (EMT) may be innovative and have an additive effect, further improving performance outcomes exercise after TMR, but evidence of the effectiveness of such an approach is not well established at this time. Although ventilatory inefficiency in HF may be aggravated as a result of expiratory muscle weakness, EMT is unclear in the literature, there are only a number of case reports showing improvement in ventilatory parameters and these beneficial effects have not yet been confirmed by randomized studies. We hypothesized that the modality combining EMT plus IMT plus CR may have superior or similar effects to the use of NIV plus CR. Objectives: The first study aimed to analyze the effects of EMT plus IMT plus CR versus CR plus NIV on exercise tolerance, respiratory muscle performance and quality of life in the HFrEF. The 2nd study; The objective was to evaluate the additional benefit of EMT plus IMT associated with aerobic exercise (AE) when compared to IMT plus AE alone in HFrEF. The third study was a systematic review that aimed to evaluate the effects of IMT on oxygen uptake (VO₂) kinetics in individuals with HF compared to healthy individuals. Methods: The research was divided into three stages. Initially, a randomized clinical trial was conducted involving 17 patients with CHF who were allocated to Group 1 RC-control (n = 6), Group 2 - RC + NIV (n = 5), Group 3 - TME + IMR plus CR (n = 6). = 6). All patients were evaluated before and after 12 weeks of the structured supervised CR program three times a week. Group 1- RC supervised. Group 2 - RC + NIV with Continuous Positive Airway Pressure (CPAP) mode using the VPAP TM Auto 25 ResMed System (ResMed® USA). The CPAP was gradually adjusted to 8 cmH2O for 20 minutes. CR plus RMT, for 30 minutes, being 15 minutes with inspiratory load up to 40% of maximal inspiratory pressure (MIP) and 15 minutes with expiratory load between 5 and 15% of MEP. according to the protocol performed in the study by Cahalin et al. The second study: was a randomized controlled trial; Fourteen patients with rFRIF and respiratory muscle weakness were randomized into three groups: Group 1: Aerobic exercise (AS; control); Group 2: AE plus IMT (40% MIP load), Group 3; EA + IMT plus EMT (5-15% MEP load), and received exercise program for 12 weeks. And the third study; the systematic review; The search included the MEDLINE, PEDRo, Embase, Cinahl and Cochrane Central bases to evaluate the effects of IMT on VO₂ kinetics. Results: Therefore, in the first study: when compared to NIV versus EMT + IMT, these complementary therapies associated with CR were similar for six-minute walk distance (6MWD) and VO₂peak, but there was a significant difference in the Minnesota Living with Heart Failure Questionnaire. (MLHFQ) compared to control (24.6 vs. 19.2 in CR plus NIV, P = 0.0001; and 26.6 vs. 19.2 in CR + EMT plus IMT, P <0.0001). CR plus NIV led to further increase in forced vital capacity (FVC). CR plus TME + IMR showed additional benefit in maximal inspiratory and expiratory pressures (p <0.0001) when compared to both NIV plus CR and control group. Both CR plus NIV or CR associated with EMT plus IMT can provide additional quality of life benefits. However, the combination of EMT plus IMT and CR has been shown to be better in improving ventilatory muscle performance in CHF patients. In the second stage; Training combining IMT plus EMT demonstrated further improvement  in DC6M, (339 ± 39 vs. 434 ± 31; P = 0.037); maximal voluntary ventilation (MVV; 69.6 ± 2.7 vs.77.4 ± 4.0; P = 0.021), compared to AE alone. And in PEmax; (75 ± 13 vs. 115 ± 16; p = 0.002); when compared to either IMT plus EA or isolated EA. The study suggests that AE plus IMT + MST may contribute to additional MEP gain; compared to IMT + AE and to optimize exercise tolerance in patients with HFrEF compared to isolated AE. And in the third stage the systematic review that included three randomized trials evaluating the effects of IMT on VO₂ kinetics; demonstrated that IMT in HF can significantly improve VO₂ recovery kinetics, meaning differences in VO₂ kinetics of -0.66mL / kg / mi (95% CI, -0.84 to -0.47; n = 56). However, there is no significant difference in VO₂ peak for participants in the IMT group compared to the control group. Bailey et al .; They also did not observe significant changes in VO₂max in healthy subjects during the incremental test after the IMT or Sham intervention, but the amplitude of the slow oxygen uptake kinetics was 

reduced and the initial maximal inspiratory pressure increased significantly. However, in the analysis of VO₂ kinetics there were a small number of participants and, according to the GRADE approach, the quality of evidence presented by this result was low due to limitations in methodology, inaccuracy and inconsistency of results.

BANKING MEMBERS:
Externa ao Programa - 2646588 - JOCELINE CASSIA FEREZINI DE SA
Externa à Instituição - NICOLE SOARES OLIVER CRUZ
Externa à Instituição - RENATA CARLOS FELIPE NOGUEIRA
Presidente - 1149619 - SELMA SOUSA BRUNO
Externo à Instituição - SHIRLEY LIMA CAMPOS - UFPE