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336 Cordeiro et al.ǀ Journal of Clinical and Translational Research 2024; 10(6): 334-342
the procedure. Sealed, opaque, and sequentially numbered The FIM aims to assess what a person can actually achieve,
envelopes were used to conceal the allocation sequence until regardless of diagnosis, generating a valid score for functional
interventions were assigned. Researchers responsible for limitations. This scale evaluates the patient’s ability to perform
evaluations were blinded to the intervention and control groups. self-care, maintain sphincter control, transfer, and ambulate, as
Patients were divided into two groups: The immediate NIV well as cognitive functions such as communication and memory.
group (NIVI) and the conventional NIV group (NIVC). The Scores range from 1 to 7, with the lowest score indicating total
NIVI group received NIV immediately following orotracheal dependence and the highest score reflecting complete independence
extubation, while the NIVC group received NIV on the first from a functional perspective. The maximum possible score is 126
post-operative day, approximately 24 h after extubation. points when all variables are combined [14].
NIV was administered using the Servo-S ventilator (Dräger The MRC scale evaluates peripheral muscle strength by
Medical, Germany) in pressure support ventilation mode, assessing the ability to overcome resistance in six muscle
with pressure sufficient to maintain tidal volume between 6 groups: shoulder abductors, elbow flexors, wrist extensors, hip
to 8 mL/kg, PEEP starting at 5 cm H O and increasing to 12 cm flexors, knee extensors, and ankle dorsiflexors. Each group is
2
H O, and an inspired oxygen fraction (F O ) of 30%. A face scored bilaterally from 0 to 5, where 0 indicates the absence of
2
2
I
mask was utilized, and PEEP adjustments were protocol-driven contraction and five represents the patient overcoming maximum
for all patients. This therapy was maintained for 40 min in resistance imposed by the examiner. The minimum score for this
both groups and was performed only once. Arterial blood gas test is 0 (indicative of quadriplegia), while the maximum score
analysis was conducted before and after NIV for evaluation is 60 (indicating preserved muscle strength). A score below 48
of gas exchange, with a follow-up analysis performed one day may suggest the presence of polyneuromyopathy [15].
later for assessment of oxygenation.
On the day of discharge from the ICU, patients were reassessed 2.6. Measurement of pulmonary function
using FIM and the MRC scale, and they were also evaluated for To assess vital capacity (VC), the Ferraris Mark 8 Wright
pulmonary complications, mortality, and length of stay in the Respirometer (Wright, USA) was used. The respirometer was
ICU. These assessments were repeated on the day of hospital unlocked and cleared; a facial mask was then placed on the
discharge, along with a repetition of the 6MWT. All patients individual’s face. The patient was instructed to take a deep
received standard physiotherapy assistance, which included breath until reaching total lung capacity, followed by a slow
kinesiotherapy, cycle ergometry, and walking exercises.
Outcomes related to post-operative complications were and gradual expiration until reaching residual volume. After
assessed by a blinded radiologist. Gasometric and functional this, the respirometer was locked, and the result was recorded.
evaluations were conducted by a blinded physician and The test was repeated three times, with the highest value being
physiotherapist, respectively. Due to the nature of the considered. ®
intervention, blinding of patients and unit staff was not feasible. Peak expiratory flow was measured using the Mini Wright
peak flow meter (Wright, USA). During the evaluation, the
2.5. Measurements patient was seated with the head in a neutral position and a
nasal clip to prevent air escape through the nostrils. The patient
The 6MWT was conducted following the recommendations
of the American Thoracic Society (ATS) in a flat, obstacle- took a deep breath to total lung capacity, followed by a forced
free corridor measuring 30 m [13]. Before the test, patients expiration into the device. After three measurements, the highest
were given a rest period of at least 10 min. During this value was selected, ensuring that no individual measurement
time, contraindications were assessed, and vital signs were differed by more than 40 L from the others.
recorded, including blood pressure (using a Premium Aneroid 2.7. Calculation of statistical power
Sphygmomanometer [Welch Allyn, United States of America
[USA] and Littmann 3M stethoscope [USA]), pulse oximetry In our study, 79 patients were evaluated, revealing a standard
®
(pulse oximeter from Rossmax [USA]), dyspnea level (assessed deviation in average oxygenation of 191 mmHg in the control
®
using the Borg scale), heart rate (measured by palpating the group and 266 mmHg in the training group, resulting in a
radial artery for 1 min), and respiratory rate (evaluated by difference of 75 mmHg between the two groups.
observing respiratory movements over 1 min). The convenience sample provided a statistical power of 30%
Patients were instructed to walk as quickly as possible – (alpha = 5%). A convenience sample is a non-random sampling
without running – around the corridor for 6 min. Encouragement method where participants are selected based on their easy
was provided at intervals throughout the test. At the end of the availability or proximity to the researcher, rather than through
6 min, the examiner recorded the total distance covered. a random or systematic process. This sample type is often
Throughout the entire protocol, patients were monitored used in exploratory research, where time, cost, or access to a
closely. The test would be interrupted if there was an increase specific population is limited. However, as it is not random, a
in systolic or diastolic blood pressure greater than 30% from convenience sample may not be representative of the broader
baseline, a heart rate drop of more than 20% from baseline, population, potentially introducing bias into the results.
peripheral oxygen saturation below 90%, or a respiratory rate In addition, the standard deviation in average distance walked
exceeding 30 breaths/min. was 322 m in the control group and 378 m in the training group,

DOI: http://doi.org/10.36922/jctr.24.00011