CAROLINA FU

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Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina - Docente
LIM/54 - Laboratório de Bacteriologia, Hospital das Clínicas, Faculdade de Medicina

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  • article 49 Citação(ões) na Scopus
    Impact of a Progressive Mobility Program on the Functional Status, Respiratory, and Muscular Systems of ICU Patients: A Randomized and Controlled Trial*
    (2020) SCHUJMANN, Debora Stripari; GOMES, Tamires Teixeira; LUNARDI, Adriana Claudia; LAMANO, Murilo Zoccoler; FRAGOSO, Aretha; PIMENTEL, Mayara; PESO, Claudia Neri; ARAUJO, Priscila; FU, Carolina
    Objectives: The aim was to investigate whether patients who participated in a mobility program in the ICU performed better on functional status, muscle, mobility, and respiratory assessments upon discharge than patients who received conventional physiotherapy. Design: Randomized controlled trial. Setting: Blind evaluation. Patients: Adults with previous functional independence and without contraindications for mobilization were eligible. Interventions: The intervention group participated in an early and progressive mobility program with five levels of activity. The control group underwent the conventional treatment without a preestablished routine. We evaluated functional status, level of activity, respiratory status, muscle strength, and mobility at ICU discharge. Measurements and Main Results: We analyzed 49 patients in the control group and 50 patients in the intervention group. Our data showed patients with better functional status and more functionally independent patients in the intervention group compared with those in the control group (96% vs 44%; p < 0.001). The results of the sit-to-stand and 2-minute walk tests, as well as the results of the maximum voluntary ventilation tests, also varied between the groups. The intervention group had shorter ICU stays than the control group. Higher Barthel index scores were associated with the amount of activity and participation in the protocol. The benefits to functional status remained during follow-up. Conclusions: Patients who participated in an ICU mobility program had better functional status at discharge from the ICU. The other benefits of the program included better performance in the mobility tests and improved maximum voluntary ventilation performance.
  • article 5 Citação(ões) na Scopus
    Noninvasive positive-pressure ventilation in clinical practice at a large university-affiliated Brazilian hospital
    (2012) YAMAUCHI, Liria Yuri; TRAVAGLIA, Teresa Cristina Francischetto; BERNARDES, Sidnei Ricardo Nobre; FIGUEIROA, Maise C.; TANAKA, Clarice; FU, Carolina
    OBJECTIVES: To describe noninvasive positive-pressure ventilation use in intensive care unit clinical practice, factors associated with NPPV failure and the associated prognosis. METHODS: A prospective cohort study. RESULTS: Medical disorders (59%) and elective surgery (21%) were the main causes for admission to the intensive care unit. The main indications for the initiation of noninvasive positive-pressure ventilation were the following: post-extubation, acute respiratory failure and use as an adjunctive technique to chest physiotherapy. The noninvasive positive-pressure ventilation failure group was older and had a higher Simplified Acute Physiology Score II score. The noninvasive positive-pressure ventilation failure rate was 35%. The main reasons for intubation were acute respiratory failure (55%) and a decreased level of consciousness (20%). The noninvasive positive-pressure ventilation failure group presented a shorter period of noninvasive positive-pressure ventilation use than the successful group [three (2-5) versus four (3-7) days]; they had lower levels of pH, HCO3 and base excess, and the FiO(2) level was higher. These patients also presented lower PaO2:FiO2 ratios; on the last day of support, the inspiratory positive airway pressure and expiratory positive airway pressure were higher. The failure group also had a longer average duration of stay in the intensive care unit [17 (10-26) days vs. 8 (5-14) days], as well as a higher mortality rate (9 vs. 51%). There was an association between failure and mortality, which had an odds ratio (95% CI) of 10.6 (5.93 - 19.07). The multiple logistic regression analysis using noninvasive positive pressure ventilation failure as a dependent variable found that treatment tended to fail in patients with a Simplified Acute Physiology Score II >= 34, an inspiratory positive airway pressure level >= 15 cmH2O and pH<7.40. CONCLUSION: The indications for noninvasive positive-pressure ventilation were quite varied. The failure group had a longer intensive care unit stay and higher mortality. Simplified Acute Physiology Score II >= 34, pH<7.40 and higher inspiratory positive airway pressure levels were associated with failure.
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    Association Between Days of Start Rehabilitation and Development of ICU-Acquired Weakness in Critical Ill Patients with COVID-19
    (2022) FRANCELIN, H.; SANTOS, D. P.; LUNARDI, A. C.; PESO, C. N.; SCHUJMANN, D. S.; FU, C.
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  • article 4 Citação(ões) na Scopus
    Characteristics of physiotherapy staffing levels and caseload: a cross-sectional survey of Chilean adult Intensive Care Units
    (2019) ARANIS, Nadine; MOLINA, Jorge; LEPPE, Jaime; CASTRO-AVILA, Ana Cristina; FU, Carolina; MERINO-OSORIO, Catalina
    Introduction The European Society of Intensive Care Medicine recommends the presence of a specialist physiotherapist, available every five beds, seven days a week in the high complexity Intensive Care Unit. However, in Chile the adherence of adult Intensive Care Units to this recommendation is unknown. Objective To describe the organizational characteristics and the physiotherapist availability in adult Intensive Care Units in Chile, and according to the adherence to international recommendations, inform health decision-makers. Methods Observational study based on a telephone survey. All adult Intensive Care Units institutions of high complexity, private hospitals and teaching health centers in Chile were eligible (n = 74). The primary outcome measures were the proportion of institutions with physiotherapist availability 24 hours a day and seven days a week (24/7 physiotherapist), a maximum caseload per physiotherapist of five patients and the presence of a specialist physiotherapist. Results Response rate was 86.5%, with 59% of responding units being public and 83% offering level Hi care. 70% of the adult intensive Care Units in Chile have 24/7 physiotherapist (87% of the public and 46% of the private sector). 41% of the centers had a maximum caseload per physiotherapist of five patients during the day on weekdays. This number decreased on weekends and during night shifts. 23% of the intensive Care Units had a specialist physiotherapist, being more common in the private sector (31%). Conclusions In Chilean adult ICU, 24/7 physiotherapist availability is high, the prevalence of physiotherapists with specialist raining is low. Future efforts should focus on promoting the uptake of specialist training.
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    Occurrence Of Systemic And Pulmonary Complications In Patients Undergoingtracheostomy
    (2013) RAMOS, M. C. S.; SILVA, J. M.; MAFRA, M.; SILVEIRA, L.; CARRASCOSA, T.; TANAKA, C.; FU, C.
  • article 16 Citação(ões) na Scopus
    Progressive mobility program and technology to increase the level of physical activity and its benefits in respiratory, muscular system, and functionality of ICU patients: study protocol for a randomized controlled trial
    (2018) SCHUJMANN, Debora Stripari; LUNARDI, Adriana Claudia; FU, Carolina
    Background: Enhanced mobility in the Intensive Care Unit (ICU) could minimize the negative effects of critical illness, such as declines in cognitive, muscular, respiratory, and functional capacity. We aim to compare the functional status at ICU discharge of patients who underwent a progressive mobilization protocol versus patients who received conventional physiotherapy. We also examine the level of physical activity in the ICU, the degree of pulmonary and muscle function, and the length of stay to analyze correlations between these variables. Methods: This is a protocol for a randomized controlled trial with blind evaluation. Ninety-six ICU patients will be recruited from a single center and randomly assigned to a control group or an intervention group. To determine the level of protocol activity the patient will receive, the patients' ability to participate actively and their muscle strength will be considered. The protocol consists of five phases, ranging from passive therapies to walking and climbing stairs. The primary outcome will be the functional status at ICU discharge, measured with the Barthel Index and the ICU Mobility Scale (IMS). Measured secondary outcomes will include the level of physical activity, maximal inspiratory and expiratory pressures, forced expiratory volume in 1 second, maximum voluntary ventilation, handgrip strength, surface electromyography of the lower limb muscles, and results of the Timed Up and Go and 2-Minute Walk tests. Evaluations will be made within 2 days of ICU discharge except for the level of activity, which will be evaluated daily. Physiological variables and activity level will be analyzed by chi-square and t tests, according to the intention-to-treat paradigm. Discussion: Mobility and exercise in the ICU should be undertaken with intensity, quantity, duration, and frequency adjusted according to the patients' status. The results of this study may contribute to new knowledge of early mobility in the ICU, activity level, and varying benefits in critical patients, directing new approaches to physiotherapeutic interventions in these patients.
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