Fernando Silva Guimarães

Non-invasive ventilation (NIV) is a cornerstone of acute and perioperative respiratory support, but its effectiveness is constrained by patient selection, interface leaks, patient-ventilator asynchrony, excessive inspiratory effort, and delayed recognition of treatment failure. Closed-loop and adaptive approaches may address some of these limitations by allowing ventilators or decision-support systems to adjust support according to physiological feedback. This mini review synthesizes current evidence on closed-loop concepts relevant to NIV in critical care, including leak-compensation algorithms, automated triggering and cycling, waveform-guided synchronization, proportional and neurally adjusted ventilatory assistance, volume-assured pressure support, monitoring of respiratory drive and effort, and emerging artificial intelligence approaches. The available literature suggests that most clinically available NIV technologies should be regarded as partial closed-loop systems rather than fully autonomous physiological controllers. Evidence is strongest for improved patient-ventilator interaction through leak-adapted algorithms, dedicated NIV ventilators, NAVA, and automated waveform-guided cycling, whereas direct evidence that closed-loop NIV improves patient-centred outcomes in critically ill adults remains limited. Physiological monitoring, particularly early assessment of inspiratory effort, may provide key input signals for future closed-loop NIV strategies designed to personalize support and avoid delayed intubation. Artificial intelligence, ontologies, digital twins, and reinforcement learning may accelerate development, but their current role is mainly preclinical or conceptual. Future trials should test clinically supervised, safety-constrained systems that integrate ventilator waveforms, gas exchange, leaks, comfort, drive, and failure prediction.

Bronchiectasis is a chronic and heterogeneous respiratory disease characterized by irreversible airway dilation, recurrent infection, persistent inflammation, and progressive functional impairment. Pulmonary rehabilitation is consistently recommended in international guidelines as a core non-pharmacological intervention; however, its implementation in clinical practice remains inconsistent and access to comprehensive rehabilitation programmes remains limited despite strong guideline endorsement. Recent advances in disease conceptualization, particularly the treatable traits framework, together with growing evidence supporting exercise training, physical activity promotion, and digitally enabled care models, have expanded the scope and relevance of rehabilitation in bronchiectasis. This Mini Review synthesizes contemporary evidence on rehabilitation interventions, integrating established practices with emerging strategies, and critically discusses current controversies, research gaps, and future directions. While airway clearance and exercise training remain foundational, current European Respiratory Society guidance supports their use based on defined patient profiles and evidence strength, and increasing evidence supports individualized, multimodal rehabilitation approaches that incorporate physical activity promotion, adjunct interventions, home-based and tele-rehabilitation models, and patient-managed strategies. Persistent uncertainties regarding optimal prescription, implementation, and long-term outcomes underscore the need for patient-centered, phenotype-informed rehabilitation strategies. Broadening rehabilitation beyond traditional paradigms may enhance clinical relevance, improve functional outcomes, and better align care with the complex and evolving nature of bronchiectasis.

Este livro se destina a estudantes de graduação e pós-graduação, bem como para profissionais da área da saúde, incluindo fisioterapeutas, educadores físicos, médicos, enfermeiros e demais profissionais que atuam com pessoas idosas. A expressão "funcionalidade" é amplamente reconhecida e utilizada para descrever a capacidade de um indivíduo de realizar atividades diárias e as tarefas necessárias para sua vida cotidiana. Para avaliar a funcionalidade de um indivíduo são utilizados testes funcionais que podem necessitar de amplos laboratórios para sua execução ou de equipamentos sofisticados. Porém, esta não é a realidade dos profissionais da área da saúde que convivem diariamente com pessoas idosas no consultório, na residência, em academias ou em programas públicos de saúde. Por este motivo faz-se necessário a divulgação de teste funcionais de baixo custo-efetividade para melhor rastreio e tratamento dessa condição, que possam ser aplicados em diversos ambientes e com baixo custo. Os testes descritos irão permitir uma avaliação precisa da capacidade funcional e de equilíbrio, planejamento de intervenções adequadas e monitoramento ao longo do tempo. Isso contribui significativamente para a promoção da saúde, bem-estar e qualidade de vida dos idosos, além de prevenir complicações, quedas e dependência nas atividades da vida diária, sendo que os testes são frequentemente utilizados em avaliações clínicas e em pesquisas sobre envelhecimento. O objetivo deste livro é abordar em um único livro os principais testes que avaliam a funcionalidade e equilíbrio de pessoas idosas pois geralmente estes testes estão fragmentados em capítulos de livros de neurologia, fisioterapia, educação física, geriatria e atenção primária. A formatação do livro com indicadores de textos específicos e importantes (que geralmente fazem parte de provas em concursos públicos), de indicação direta da referência responsável pela tradução para a língua brasileira (indispensável para alunos de pós graduação no momento da escrita do seu TCC, dissertação ou tese), individualização das fases (facilitando o uso dos profissionais) e os valores esperados para a população idosa (facilitando a realização da análise estatística) são fatores que diferenciam esta obra. Os testes abordados no livro são apresentados na seguinte sequênc ia 1) conceituação; 2) evidência científica e validação no Brasil; 3) descrição dos equipamentos necessários para o testes com especificações e forma de utilização; 4) descrição das etapas do testes por meio de figuras; 5) análise do teste e resultados esperados para a população idosa saudável.

INTRODUCTION: Hospitalization often causes mobility difficulties and hinders daily activities. Progressive mobilization of patients in intensive care units (ICUs) is safe and linked to better clinical and functional outcomes. OBJECTIVE: To assess the perception of a multidisciplinary team in the ICUs of a university hospital regarding early mobilization (EM). METHODS: A prospective observational study was conducted using data collected from professionals and students in the ICU of Clementino Fraga Filho University Hospital at the Federal University of Rio de Janeiro between June and December 2019. Data on EM perception were collected using a questionnaire. Descriptive statistics and Fisher's exact tests were used to analyze the differences between the professional categories. RESULTS: In comparison to physiotherapists (88%), a smaller percentage of physicians (37.5%) and nurses (50%) reported that patients on mechanical ventilation (MV) are mobilized within 48 hours (P<0.05). Additionally, a smaller percentage of physicians and nurses reported that their workload was sufficient to mobilize patients at least once a day (62.5% vs. 62.5% vs. 96%; P<0.05). Physiotherapists reported more frequently than physicians that “patients undergoing procedures” were a barrier (57.7% vs. 18.7%; P<0.05). Conversely, regarding mechanical ventilation (MV), physicians identified this barrier more frequently (43.7% vs. 7.7%; P80%), with the main perceived barriers being the availability of professionals (58%), the clinical condition of patients (55%) and patients undergoing procedures (45%). CONCLUSION: In a university hospital without an established EM protocol, the multidisciplinary team showed satisfactory knowledge and perceptions of EM. However, creating institutional protocols and guidelines is essential to engage multidisciplinary teams in implementing EM and overcoming barriers.

The objective of this work was to develop a prototype application to help decision making, at the bedside, regarding the use of non-invasive mechanical ventilation in patients with worsening respiratory failure. elaboration and validation of instruments and methods. This study was carried out in two stages: development of the application prototype and evaluation of the content by specialists. The verification of the level of agreement between the experts was based on the Content Validity Index. As a result, the NIV app software was created as a decision-making instrument for health professionals regarding the use of non-invasive ventilation in patients with respiratory failure. The tool presented proved to be useful in the scenario for which it was designed, due to its practicality, ease of user interaction, and the guidance of results to indicate or not non-invasive ventilation.

Objective: To identify the indications for physiotherapy and to evaluate physiotherapy practices in patients with COVID-19 admitted to the ICU (on mechanical ventilation) or to the ward (spontaneously breathing). Methods: An online, 50-item survey was completed by physiotherapists who had been treating hospitalized patients with COVID-19 in Brazil. Results: Of the 644 physiotherapists who initiated the survey, 488 (76%) completed it. The main reasons for indications for physiotherapy in both settings reported as