dos Santos Rafael S, Donadio Márcio V F, da Silva Gabriela V, Blattner Clarissa N, Melo Denizar A S, Nunes Fernanda B, Dias Fernando S, Squizani Eamim D, Pedrazza Leonardo, Gadegast Isabella, de Oliveira Jarbas R
Faculdade de Fisioterapia Hospital São Lucas, Porto Alegre, Rio Grande do Sul, Brazil.
Faculdade de Enfermagem, Nutrição e Fisioterapia.
Respir Care. 2014 Sep;59(9):1398-403. doi: 10.4187/respcare.02859. Epub 2014 Jul 8.
Septic shock presents as a continuum of infectious events, generating tissue hypoxia and hypovolemia, and increased oxidative stress. Chest physiotherapy helps reduce secretion, improving dynamic and static compliance, as well as improving secretion clearance and preventing pulmonary complications. The purpose of this study was to evaluate the immediate effect of chest physiotherapy on hemodynamic, metabolic, inflammatory, and oxidative stress parameters in subjects in septic shock.
We conducted a quasi-experimental study in 30 subjects in septic shock, who underwent chest physiotherapy, without associated heart diseases and with vasopressors < 0.5 μg/kg/min. Venous and arterial blood gases, clinical and hemodynamic data, inflammatory data, lactate, and oxidative stress were evaluated before and 15 min after physiotherapy.
Thirty subjects with a mean age of 61.8 ± 15.9 y and Sequential Organ Failure Assessment of 8 (range 6-10) were included. Chest physiotherapy caused a normalization of pH (P = .046) and P(aCO2) (P = .008); reduction of lactate (P = .001); and an increase in P(aO2) (P = .03), arterial oxygen saturation (P = .02), and P(aO2)/F(IO2) (P = .034), 15 min after it was applied.
The results indicate that chest physiotherapy has immediate effects, improving oxygenation and reducing lactate and oxidative damage in subjects in septic shock. However, it does not cause alterations in the inflammatory and hemodynamic parameters.
感染性休克表现为一系列感染事件，可导致组织缺氧、血容量不足以及氧化应激增加。胸部物理治疗有助于减少分泌物，改善动态和静态顺应性，以及促进分泌物清除并预防肺部并发症。本研究的目的是评估胸部物理治疗对感染性休克患者血流动力学、代谢、炎症和氧化应激参数的即时影响。
我们对30例感染性休克患者进行了一项准实验研究，这些患者接受了胸部物理治疗，无相关心脏病且血管升压药用量<0.5μg/kg/min。在物理治疗前和治疗后15分钟评估静脉和动脉血气、临床和血流动力学数据、炎症数据、乳酸和氧化应激情况。
纳入了30例平均年龄为61.8±15.9岁且序贯器官衰竭评估得分为8分（范围6 - 10分）的患者。胸部物理治疗在治疗后15分钟使pH值（P = 0.046）和动脉血二氧化碳分压（P = 0.008）恢复正常；降低了乳酸水平（P = 0.001）；并使动脉血氧分压（P = 0.03）、动脉血氧饱和度（P = 0.02）和动脉血氧分压/吸入氧分数（P = 0.034）升高。
结果表明，胸部物理治疗具有即时效果，可改善感染性休克患者的氧合情况，降低乳酸水平和氧化损伤。然而，它不会引起炎症和血流动力学参数的改变。
