A influência da cinesioterapia no sistema autonômico, marcadores inflamatórios, hemodinâmicos e ventilatórios em crianças com sepse em uma unidade de terapia intensiva pediátrica

Abstract

Objective: To observe the influence of kinesiotherapy on hemodynamic, autonomic, ventilatory parameters, and inflammatory markers in children with sepsis in a Pediatric Intensive Care Unit (PICU). Materials and methods: Individuals aged 1 to 6 years old of both genders, admitted to the PICU of Dr. Juvêncio Mattos Children's Hospital, and diagnosed with sepsis were selected. Blood samples were collected (C-reactive protein (CRP), lactate, procalcitonin, platelets, and arterial blood gas analysis), heart rate variability (HRV), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), respiratory rate (RR), heart rate (HR), and peripheral oxygen saturation (SpO2), being divided into two groups: control group (CG) and intervention group (IG). The motor kinesiotherapy was performed with a duration of 15 minutes for both groups, but in GI the therapy was performed in the morning, afternoon, and evening shifts, and in CG, in only one shift. Results: We observed a decrease in length of stay when comparing the CG vs. GI groups (p=0.0174) and a lower number of deaths in GI (n=2) vs. CG (n=5). We found no significant difference for the hemodynamic variables (HR, SBP, DBP and MAP), however, there was a large effect for the variables SBP and MAP, as well as a medium effect for the HR variable, when comparing CG vs. GI the post-intervention moments and a larger comparison delta in GI. In the ventilatory parameters, the RR variable showed a significant difference in its indexes in GI (p=0.0262), in addition to an effect size considered medium. The gasometric parameters (PH, PaCO2, PaO2, HCO3) were statistically significant in both groups evaluated, for almost all variables, with the exception of the PCO2 variable in the CG (p=0.6530). The comparison delta, in the pre- and post-intervention moments, showed a significant reduction in its indices for almost all variables in the IG, with the exception of PO2 and HCO3. In addition to a large effect for the PCO2 and PO2 variables and a medium effect for the RF, PH, and HCO3 variables, when comparing CG with GI the post-intervention moments. The inflammatory markers (CRP, lactate, procalcitonin, and platelets) significantly decreased their indexes at the end of the protocol. There was a medium effect for the variables lactate, procalcitonin, and platelets. The comparison delta showed that in GI there was a greater reduction in their indices. In the HRV variables there was a significant increase for almost all variables in the frequency domain, except for RMSSD (p=0.0522), in the IG when comparing the pre- and post-intervention moments. The delta of comparison showed its high indexes, there was a large effect for the variable RMSSD, a medium effect for the variables SDNN and PNN50. Conclusion: Kinesiotherapy promoted autonomic, hemodynamic, ventilatory and inflammatory profile benefits in children with sepsis. In addition, it reduced the length of ICU stay and cases of death in the population studied.