title: Acute effects of physiotherapeutic respiratory maneuvers in critically ill patients with craniocerebral trauma.
abstract: OBJECTIVE
  To evaluate the effects of physiotherapeutic respiratory maneuvers on cerebral and cardiovascular hemodynamics and blood gas variables.
  
  
  METHODS
  A descriptive, longitudinal, prospective, nonrandomized clinical trial that included 20 critical patients with severe craniocerebral trauma who were receiving mechanical ventilation and who were admitted to the intensive care unit. Each patient was subjected to the physiotherapeutic maneuvers of vibrocompression and increased manual expiratory flow (5 minutes on each hemithorax), along with subsequent airway suctioning with prior instillation of saline solution, hyperinflation and hyperoxygenation. Variables related to cardiovascular and cerebral hemodynamics and blood gas variables were recorded after each vibrocompression, increased manual expiratory flow and airway suctioning maneuver and 10 minutes after the end of airway suctioning.
  
  
  RESULTS
  The hemodynamic and blood gas variables were maintained during vibrocompression and increased manual expiratory flow maneuvers; however, there were increases in mean arterial pressure, intracranial pressure, heart rate, pulmonary arterial pressure and pulmonary capillary pressure during airway suctioning. All of the values returned to baseline 10 minutes after the end of airway suctioning.
  
  
  CONCLUSIONS
  Respiratory physiotherapy can be safely performed on patients with severe craniocerebral trauma. Additional caution must be taken when performing airway suctioning because this technique alters cerebral and cardiovascular hemodynamics, even in sedated and paralyzed patients.
authors.affiliation: Department of Internal Medicine, Universidade Federal do Paraná, CuritibaPR, Brazil.
authors.forename: Manoel Luiz de
authors.initials: ML
authors.lastname: Cerqueira Neto
authors.forename: Álvaro Vieira
authors.initials: ÁV
authors.lastname: Moura
authors.forename: Telma Cristina Fontes
authors.initials: TC
authors.lastname: Cerqueira
authors.forename: Esperidião Elias
authors.initials: EE
authors.lastname: Aquim
authors.forename: Álvaro
authors.initials: Á
authors.lastname: Reá-Neto
authors.forename: Mirella Cristine
authors.initials: MC
authors.lastname: Oliveira
authors.forename: Walderi Monteiro da
authors.initials: WM
authors.lastname: Silva Júnior
authors.forename: Valter J
authors.initials: VJ
authors.lastname: Santana-Filho
authors.forename: Rosana Herminia
authors.initials: RH
authors.lastname: Scola
mesh_terms: D000328:Adult; D062186:Arterial Pressure / Q000502:physiology; D001784:Blood Gas Analysis; D006259:Craniocerebral Trauma / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D003422:Critical Care; D016638:Critical Illness; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012123:Pulmonary Ventilation; D012016:Reference Values; D012138:Respiratory Therapy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult