Evidências na assistência respiratória em pacientes com distrofia muscular de Duchenne

Japão - o autor faz uma revisão das manobras ventilatórias realizadas em pacientes com distrofia muscular de Duchenne, destacando aquelas que a literatura médica considera como válidas. Dentre as principais manobras destacam-se: a máquina da tosse, ventilação percussiva intrapulmonar, ventilação não-invasiva noturna, assistência manual da tosse, empilhamento de ar, respiração glossofaríngea e insuflação mecânica.

O resumo em inglês pode ser lido abaixo:

(Developmental Medicine & Child Neurology, Volume 50, Issue s113, 49-59, 2008) PEDIATRIC PATIENTS WITH DUCHENNE MUSCULAR DYSTROPHY

Fiona Adams, Susan Bostock, Angela Potter - Australia

Objective: This review aims to give recommendations for best respiratory management (and associated costs) for pediatric patients with Duchenne Muscular Dystrophy, in accordance with evidence in the literature and usual practice in Australia and overseas.

Design: Narrative review of the literature, and a survey of usual practice.

Method: Database search using Medline, CINAHL, PubMed, Cochrane and PEDro from 2003–2007. A survey was conducted amongst paediatric physiotherapists (and 2 physiotherapists working with adults), seeking information (including protocols) on usual management. Liaison with professionals regarding cost and training for recommended interventions also took place.

Results: The interventions supported by the strongest current evidence include mechanical in-exsufflation (MI-E), intrapulmonary percussive ventilation (IPV), nocturnal noninvasive ventilation (NIV), manually assisted cough (MAC), breath- stacking, glossopharyngeal breathing (GPB) and mechanical insufflation. The use of PEP treatment, chest physiotherapy, autogenic drainage and IPPB are supported by low-level evidence, while suction has little and conflicting evidence. Survey findings and protocols indicate majority of practitioners use postural drainage, percussion, MAC, manual insufflation, MI-E, suction and NIV, yet very few include IPV in management of clients with DMD. Technique application is variable depending on patient and physiotherapist. Implementation of MI-E is costly but time efficient. Conclusion: There remains a lack of strong evidence for certain techniques commonly used for children with DMD, such as postural drainage, percussion and suction. Due to strong evidence showing benefit, MI-E , MAC and nocturnal NIV should be continued in practice, while IPV, breath stacking, GPB and mechanical insufflation should be re-considered for implementation (if not already used).

Fonte: http://distrofiamuscular.net/noticias.htm