Utilização da técnica de recrutamento volumétrico pulmonar em pacientes com doença respiratória crônica por profissionais de saúde brasileiros

Abstract

Introduction: The Lung Volume Recruitment technique (LVR) is an insufflation technique assisted by air stacking in which consecutive compressions or insufflations are performed without expiration until the maximum tolerable insufflation capacity is reached. How professionals prescribe and assess LVR remains a challenge. This Master's Thesis aimed to describe the healthcare professionals who prescribe LVR, its indications, frequency, application method, and assessment of LVR in practice throughout Brazil. Methods: This Master's Thesis included a summary with partial results published at the XXI Simpósio Internacional de Fisioterapia Respiratória, Cardiovascular e em Terapia Intensiva and an article published in Pulmonary Medicine. This cross-sectional electronic survey (September-November 2023) was conducted with participants invited through networks of the Brazilian Association of Cardiorespiratory Physiotherapy and Intensive Care Physiotherapy, the Respiratory Leaders Physiotherapy Groups, Speech Therapy, and social media platforms (Facebook, Instagram) to answer a questionnaire about region of residence, profession, and experience indication and prescription of LVR: population, prerequisites, performer, frequency, dosage, interfaces, devices, guidance on side effects, assessment of respiratory strength, and combined therapies. Inclusion criteria: healthcare professionals qualified for clinical/home care; exclusion criteria: caregivers/family members practicing LVR. The results were presented descriptively. Results: A total of 104 responses were collected, with 74 physiotherapists and 28 speech therapists. One nurse and one doctor were excluded from the analysis. Forty-five professionals (57%) reported attending to the adult population, and 87 responses (84%) indicated Amyotrophic Lateral Sclerosis as the most common diagnosis. Commonly used measures for prescription included cough peak flow and vital capacity. The most common side effects were pain and discomfort in the chest wall, and many respondents did not provide warnings about potential side effects to patients. Regarding the measurement of Lung Insufflation Capacity (LIC) and Maximal Insufflation Capacity (MIC), 43 physiotherapists (58%) emphasized the measurement, while 22 speech therapists (78%) did not measure it. The study highlighted the common use of respiratory therapy devices alongside LVR, particularly insufflation-exsufflation devices and inspiratory muscle training devices. Conclusion: LVR is available in routine clinical and home care settings in Brazil. There is a lack of standardization regarding measurements, indications, and dosages. Clear recommendations and guidelines for indications, prescription forms, and patient follow-up are needed to allow for more objective data and facilitate comparisons between centers. These findings contributed to the development of new research designs in the field of Respiratory Therapy in Chronic Respiratory Disease, which are already underway, namely: qualitative analysis to identify barriers and facilitators with patients and families for the execution of the technique.