Abstract Introduction Early mobilization is an alternative used in the Intensive Care Unit (ICU) to reduce the effects of immobility. The Intensive Care Unit Mobility Score (IMS) is applied to assess mobility status. Objective To determine the functional level of ICU patients submitted to cardiac surgery using the IMS scale. Methods This is an analytical observational study carried out with adult ICU patients submitted to cardiac surgery. Data on the use of vasoactive drugs, functional level through IMS, duration of mechanical ventilation and length of ICU stay were collected from the physiotherapy routine form and recorded on a specific instrument developed for the study. The data obtained from the IMS scale score on the postoperative days in the ICU were used to classify the patients' mobility during the hospitalization period. Descriptive statistics were used to present the data. Results A total of 69 patients were evaluated, 43% of whom were men, and all had an SMI of 0 on the first postoperative day. Classification on the scale increased over the course of hospitalization (IMS between 7 and 10), despite the use of vasoactive drugs in 54.6% of the individuals. Conclusion Patients submitted to cardiac surgery admitted to the ICU had moderate-to-high mobility levels throughout their stay and at discharge from the ICU. (ICU immobility status period 6 evaluated 43 men day 10, 10 , 10) 546 54 54.6 individuals moderatetohigh moderate high 4 1 5 54.

Resumo Introdução A mobilização precoce é uma alternativa utilizada em Unidades de Terapia Intensiva (UTIs) na tentativa de reduzir os efeitos decorrentes do imobilis-mo. A escala de mobilidade em UTIs ou Intensive Care Unit Mobility Score (IMS) é aplicada para avaliar o nível de mobilidade. Objetivo Verificar por meio da escala IMS o nível de funcionalidade de pacientes submetidos à cirurgia cardíaca internados em uma UTI. Métodos Trata-se de um estudo observacional analítico realizado em UTI com pacientes adultos submetidos à cirurgia car-díaca. Foram coletados da ficha de rotina da fisioterapia informações quanto ao uso de drogas vasoativas, nível funcional por meio da IMS, tempo de ventilação mecânica e de internação na UTI, e registrados em instrumento específico desenvolvido para o estudo. Os dados obtidos do escore da escala IMS nos dias de pós-operatório na UTI foram utilizados para classificar a mobilidade dos pacientes durante o período de internação. Utilizou-se estatística descritiva para a apresentação dos dados. Resultados Foram avaliados 69 pacientes, 43% eram do sexo masculino e todos apresentavam IMS 0 no primeiro dia de pós-operatório. A classificação na escala aumentou com o decorrer do período de internação (IMS entre 7 e 10), apesar do uso de drogas vasoativas em 54,6%. Conclusão Os pacientes submetidos à cirurgia cardíaca internados na UTI apresentaram níveis de mobilidade de moderado a alto ao longo da internação e na alta da UTI. (UTIs imobilismo. imobilismo imobilis mo. mo imobilis-mo Tratase Trata se cardíaca. car díaca. díaca car-díaca pósoperatório pós operatório Utilizouse Utilizou 6 43 pósoperatório. operatório. 10, 10 , 10) 546 54 54,6% 4 1 5 54,6 54,

ABSTRACT Introduction: Early mobilization of patients in the postoperative period of cardiac surgery who are hospitalized in the intensive care unit (ICU) is a practice that has a positive impact. Methods: This is a systematic review of studies published until September 2020 in the Medical Literature Analysis and Retrieval System Online (or MEDLINE®), Embase, Physiotherapy Evidence Database (or PEDro), Scientific Electronic Library Online (or SciELO), and Latin American and Caribbean Health Sciences Literature (or LILACS) databases. Randomized clinical trials describing mobilization protocols performed early in ICU patients after cardiac surgery were included. Results: According to the eligibility criteria, only 14 of the 1,128 articles found were included in the analysis. Early mobilization protocols were initiated in the immediate postoperative period or first postoperative day. The resources and technics used were progressive mobilization, cycle ergometer, early bed activities, walking protocols, resistance exercise, and virtual reality. Intensity of the mobilization activities was determined using the Borg scale and heart rate. Conclusion: Early mobilization protocols are generalist (not individual), and low-intensity exercises are used, through progressive mobilization, with two daily physical therapy sessions, during 10 to 30 minutes.

Abstract Background Cardiac surgery causes pathophysiological changes that favor the occurrence of pulmonary and functional complications. Objective To investigate the effects of inspiratory muscle training (IMT) with an electronic device on patients undergoing cardiac surgery. Methods A randomized controlled trial was conducted with 30 adult patients undergoing elective cardiac surgery. A control group (CG) received conventional physical therapy care, and an intervention group (IG) received IMT using the POWERbreathe K5® electronic device. Two daily sessions of physical therapy were performed at the intensive care unit and one daily session at the ward until the sixth postoperative day. The following variables were measured preoperatively and on the sixth postoperative day, in both groups: inspiratory muscle strength, dynamic inspiratory muscle strength, and peak inspiratory flow. Data distribution was evaluated by the Shapiro-Wilk test. Analysis of variance was used, and the results were considered statistically significant when p < 0.05. Results Maximal inspiratory pressure (71.7 ± 17.1 cmH2O vs 63.3 ± 21.3 cmH2O; p = 0.11], S-index (52.61 ± 18.61 vs 51.08 ± 20.71), and peak inspiratory flow [(2.94 ± 1.09 vs 2.79 ± 1.26)] were maintained in the IG but had a significant reduction in the CG. Conclusion IMT performed with an electronic device was effective at maintaining inspiratory muscle strength, dynamic inspiratory muscle strength, and peak inspiratory flow when compared to conventional physical therapy. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0

Abstract Objective: To apply the InsCor in patients undergoing cardiac surgery in a university hospital in Brazil's northeast. Methods: It is a retrospective, quantitative and analytical study, carried out at the University Hospital of the Federal University of Maranhão. InsCor is a remodeling of two risk score models. It evaluates the prediction of mortality through variables such as gender, age, type of surgery or reoperation, exams, and preoperative events. Data from January to December 2015 were collected, using a Physical Therapy Evaluation Form and medical records. Quantitative variables were expressed as mean and standard deviation and qualitative variables as absolute and relative frequencies. Fisher's exact and Kruskal-Wallis tests were applied, considering significant differences when P value was < 0.05. Calibration was performed by Hosmer-Lemeshow test. Results: One hundred and forty-eight patients were included. Thirty-six percent were female, with mean age of 54.7±15.8 years and mean body mass index (BMI) equal to 25.6 kg/m2. The most frequent surgery was coronary artery bypass grafting (51.3%). According to InsCor, 73.6% of the patients had low risk, 20.3% medium risk, and only 6.1% high risk. In this sample, 11 (7.4%) patients died. The percentage of death in patients classified as low, medium and high risk was 6.3, 7.1% and 11.1%, respectively. Conclusion: InsCor presented easy applicability due to the reduced number of variables analyzed and it showed satisfactory prediction of mortality in this sample of cardiac surgery patients.

ABSTRACT OBJECTIVE: To evaluate the effects of resistance exercise applied early after coronary artery bypass grafting. METHODS: It is a randomized controlled trial with 34 patients undergoing coronary artery bypass grafting between August 2013 and May 2014. Patients were randomized into two groups by simple draw: a control group (n=17), who received conventional physical therapy and an intervention group (n=17), who received, additionally, resistance exercise. Pulmonary function and functional capacity were evaluated in preoperative period and hospital discharge by spirometry and the six-minute walk test. For statistical analysis, we used the following tests: Shapiro-Wilk, Mann-Whitney, Student'st and Fisher's exact. Variables withP<0.05 were considered significant. RESULTS: Groups were homogeneous in terms of demographic, clinical and surgical variables. Resistance exercise exerted no effect on pulmonary function of intervention group compared to control group. However, intervention group maintained functional capacity at hospital discharge measured by percentage of predict distance in 6MWT (54.122.7% vs. 52.515.5%,P=0.42), while control group had a significant decrease (59.211.1% vs. 50.69.9%, P<0.016). CONCLUSION: Our results indicate that resistance exercise, applied early, may promote maintenance of functional capacity on coronary artery bypass grafting patients, having no impact on pulmonary function when compared to conventional physical therapy.

ABSTRACT OBJECTIVE: To test several weaning predictors as determinants of successful extubation after elective cardiac surgery. METHODS: The study was conducted at a tertiary hospital with 100 adult patients undergoing elective cardiac surgery from September to December 2014. We recorded demographic, clinical and surgical data, plus the following predictive indexes: static compliance (Cstat), tidal volume (Vt), respiratory rate (f), f/ Vt ratio, arterial partial oxygen pressure to fraction of inspired oxygen ratio (PaO2/FiO2), and the integrative weaning index (IWI). Extubation was considered successful when there was no need for reintubation within 48 hours. Sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR-) were used to evaluate each index. RESULTS: The majority of the patients were male (60%), with mean age of 55.4±14.9 years and low risk of death (62%), according to InsCor. All of the patients were successfully extubated. Tobin Index presented the highest SE (0.99) and LR+ (0.99), followed by IWI (SE=0.98; LR+ =0.98). Other scores, such as SP, NPV and LR-were nullified due to lack of extubation failure. CONCLUSION: All of the weaning predictors tested in this sample of patients submitted to elective cardiac surgery showed high sensitivity, highlighting f/Vt and IWI.

Resumo Introdução: Após a remoção do tubo endotraqueal e ventilação artificial, o suporte ventilatório deve ser continuado, oferecendo suprimento de oxigênio para garantir uma saturação arterial de oxigênio próxima da fisiológica. Objetivo: O objetivo deste estudo foi investigar os efeitos da pressão expiratória positiva final antes de extubação nos índices de oxigenação de pacientes submetidos à cirurgia de revascularização miocárdica. Métodos: Ensaio clínico randomizado com 78 pacientes submetidos à cirurgia de revascularização do miocárdio, divididos em três grupos e ventilados com diferentes níveis de pressão expiratória positiva final antes da extubação: Grupo A, 5 cmH2O (n=32); Grupo B, 8 cm H2O (n=26); e grupo C, 10 cmH2O (n=20). Dados do índice de oxigenação foram obtidos a partir de amostras de gases sanguíneos arteriais coletados em 1, 3 e 6 h após a extubação. Pacientes com doença pulmonar crônica e aqueles que foram submetidos à cirurgia sem circulação extracorpórea, de emergência ou combinadas foram excluídos. Para a análise estatística, foram utilizados Shapiro-Wilk, G, Kruskal-Wallis, e análise dos testes de variância e definição do nível de significância em P<0,05. Resultados: Os grupos foram homogêneos em relação às variáveis demográficas, clínicas e cirúrgicas. Não houve diferenças estatisticamente significativas entre os grupos nas primeiras 6 h após extubação no que diz respeito aos índices de oxigenação e a utilização de oxigenoterapia. Conclusão: Nesta amostra de pacientes submetidos à revascularização do miocárdio, o uso de diferentes níveis de pressão expiratória positiva final antes da extubação não afetou as trocas gasosas ou utilização de oxigenoterapia nas primeiras 6h após a remoção do tubo endotraqueal.

Abstract Introduction After removal of endotracheal tube and artificial ventilation, ventilatory support should be continued, offering oxygen supply to ensure an arterial oxygen saturation close to physiological. Objective: The aim of this study was to investigate the effects of positive-end expiratory pressure before extubation on the oxygenation indices of patients undergoing coronary artery bypass grafting. Methods: A randomized clinical trial with seventy-eight patients undergoing coronary artery bypass grafting divided into three groups and ventilated with different positive-end expiratory pressure levels prior to extubation: Group A, 5 cmH2O (n=32); Group B, 8 cmH2O (n=26); and Group C, 10 cmH2O (n=20). Oxygenation index data were obtained from arterial blood gas samples collected at 1, 3, and 6 h after extubation. Patients with chronic pulmonary disease and those who underwent off-pump, emergency, or combined surgeries were excluded. For statistical analysis, we used Shapiro-Wilk, G, Kruskal-Wallis, and analysis of variance tests and set the level of significance at P<0.05. Results Groups were homogenous with regard to demographic, clinical, and surgical variables. There were no statistically significant differences between groups in the first 6 h after extubation with regard to oxygenation indices and oxygen therapy utilization. Conclusion: In this sample of patients undergoing coronary artery bypass grafting, the use of different positive-end expiratory pressure levels before extubation did not affect gas exchange or oxygen therapy utilization in the first 6 h after endotracheal tube removal.