• Manoel Luiz de Cerqueira Neto, Álvaro Vieira Moura, CerqueiraTelma Cristina FontesTC, Esperidião Elias Aquim, Álvaro Reá-Neto, Mirella Cristine Oliveira, Silva JúniorWalderi Monteiro daWM, Valter J Santana-Filho, and Rosana Herminia Scola.
• Department of Internal Medicine, Universidade Federal do Paraná, CuritibaPR, Brazil.
• Clinics (Sao Paulo). 2013 Sep 1; 68 (9): 121012141210-4.

ObjectiveTo evaluate the effects of physiotherapeutic respiratory maneuvers on cerebral and cardiovascular hemodynamics and blood gas variables.MethodA 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.ResultsThe 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.ConclusionRespiratory 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.

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