Decúbito prono en el tercer trimestre del embarazo durante la era COVID-19: un abordaje transdisciplinar / Prone position in the third trimester of pregnancy during the COVID-19 era: A transdisciplinary approach

Existe evidencia muy limitada respecto del uso de la ventilación en decúbito prono como parte del tratamiento de un síndrome de distrés respiratorio agudo severo para pacientes en periodo de gestación. Actualmente las recomendaciones para el manejo ventilatorio invasivo en esta población son muy escasas y se basan en la extrapolación de las conclusiones obtenidas en estudios de pacientes no gestantes. La literatura disponible asevera que la anatomía y la fisiología de la gestante experimentan complejos cambios adaptativos que deben ser considerados durante el soporte ventilatorio invasivo y el prono. Con la ventilación en decúbito prono, los beneficios obtenidos para el binomio superan ampliamente a los eventuales riesgos. La programación adecuada del ventilador mecánico se correlaciona con un concepto claro y simple: la individualización del soporte. De todas maneras, la decisión del momento oportuno para la interrupción del embarazo debe fundamentarse con un adecuado juicio clínico multidisciplinario y además debe ser respaldado con una estricta monitorización fetal.(AU)

There is very limited evidence regarding the use of prone position as part of the treatment of severe acute respiratory distress syndrome in pregnant patients. Currently, recommendations for invasive ventilatory management in this population are very scarce and are based on the extrapolation of conclusions obtained in studies of non-pregnant patients. The available literature asserts that the anatomy and physiology of the pregnant woman undergoes complex adaptive changes that must be considered during invasive ventilatory support and prone position. With prone ventilation, the benefits obtained for the couple far outweigh the eventual risks. Adequate programming of the mechanical ventilator correlates with a clear and simple concept: individualization of support. In any case, the decision on the timing of termination of pregnancy should be based on adequate multidisciplinary clinical judgment and should be supported by strict monitoring of the product.(AU)

Respiratory Center Function and Its Impact in Obesity Hypoventilation Syndrome Treatment

Introduction: Patients with obesity hypoventilation syndrome (OHS) need treatment with positive pressure either with continuous (CPAP) or double pressure (NIV). The apnea–hypopnea index (AHI) is considered a key data for making therapeutic decisions. We hypothesized that HR may be an useful tool to establish different phenotypes and individualize treatment in patients with OHS. Our objective was to analyze the role of the respiratory center response to hypercapnia (HR) in the adequacy of positive airway pressure therapy. Method: We included subjects with OHS treated with CPAP or NIV according to AHI and baseline pCO2. We analyzed therapeutic effectiveness and treatment changes prioritizing CPAP if AHI>30/h. Therapy was considered adequate if it was effective after two years. HR was measured with the p0.1/pEtCO2 ratio and its capability to select therapy was analyzed. The statistical study was performed by means comparison (Student's t) and multivariate analysis (logistic regression). Results: 67 subjects were included of 68(11) years old, 37 (55%) males, initially 45 (67%) treated with NIV and 22 (33%) with CPAP, one case was excluded and in 25 (38%) the treatment was changed. Finally, CPAP was adequate for 29 subjects (44%) and NIV for 37 (56%). The CPAP group showed AHI 57/h (24) and p0.1/pEtCO2 0.37cmH2O/mmHg (0.23), NIV group AHI 43/h (35) and p0.1/pEtCO2 0.24 (0.15) with p=0.049 and 0.006. In multivariate analysis, p0.1/pEtCO2 (p=0.033) and AHI>30 (p=0.001) were predictors of adequate therapy. Conclusion: Measuring the RH of the respiratory center helps to select the most appropriate treatment for patients with OHS. (AU)

Dr. Joseph Milic-Emili (1931-2022) / Dr. Joseph Milic-Emili (1931-2022)

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[Translated article] Dr. Joseph Milic-Emili (1931–2022) / Dr. Joseph Milic-Emili (1931–2022)

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El arte de respirar: inspirando juntos / The Art of Breathing: Getting Inspiration

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20 años en fisiología respiratoria / 20 years in respiratory physiology

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Valores de la movilidad torácica en niños colombianos sanos entre 8 y 11 años / Thoracic mobility values in healthy Colombian children between 8 and 11 years old

Antecedentes y objetivo: La medición de la movilidad torácica tiene importancia en la valoración clínica de niños con afecciones del sistema respiratorio; sin embargo, se sabe que los valores pueden cambiar de acuerdo con las características de la población de cada país. El objetivo del estudio fue describir los valores de la movilidad torácica en niños colombianos. Materiales y métodos: Estudio descriptivo transversal realizado en 2 colegios de la ciudad de Cali (Colombia) mediante un muestreo aleatorizado simple con asignación proporcional por grupo etario. Se evaluó la movilidad torácica con cirtometría y se tomaron las medidas antropométricas peso, talla e IMC para la edad. Resultados: Se incluyó a 79 niños y 72 niñas que, en su mayoría, tuvieron un IMC normal para la edad (62,3%). Los promedios de cirtometría axilar y xifoidea fueron 4,3 ± 1,1 cm y 4,1 ± 1,1 cm respectivamente. Los niños de 11años tuvieron una cirtometría axilar mayor que las niñas de esa misma edad (4,3 ± 0,5 vs. 3,7 ± 0,9; p = 0,006). En las niñas, la cirtometría axilar desciende a medida que aumenta la edad (p = 0,040). Conclusiones: En las edades estudiadas la movilidad torácica difiere entre niños y niñas, probablemente porque el desarrollo de la composición corporal varía durante la pubertad y es diferencial por sexo

Background and objective: Although the measurement of thoracic mobility is important in the clinical assessment of children with respiratory system disorders, it is known that the values can change according to the characteristics of the population of each country. The aim of the study was to report the thoracic mobility values in healthy Colombian children between 8 and 11 years old. Materials and methods: Cross-sectional descriptive study carried out in 2schools in the city of Cali, Colombia, using simple random sampling with proportional allocation by age group. The thoracic mobility was measured with cirtometry (measurement of circumferences), and the anthropometric measurements recorded for weight, height, and BMI-for-age. Results: A total of 79 boys and 72 girls were included. Most of them had a normal BMI-for-age (62.3%), with mean axillary and xiphoid cirtometry being 4.3 ± 1.1 cm and 4.1 ± 1.1 cm, respectively. Eleven-year-old boys had a higher axillary cirtometry than girls of the same age (4.3 ± 0.5 vs. 3.7 ± 0.9, p = .006). In girls, axillary cirtometry decreased as age increased (p = .040). Conclusions: At the ages studied, thoracic mobility differs between boys and girls, probably because the development of body composition varies during puberty and is differentiated by gender

Aerobic fitness predicts the air consumption time in the self-contained breathing apparatus during physical task of firefighters / La capacidad aeróbica predice el tiempo de consumo de aire de un equipo de respiración autónoma durante tareas físicas de bomberos / Aptidão aeróbia prediz o tempo de consume de ar no equipamento autônomo de proteção respiratória durante tarefa física de bombeiros

Objective: The aerobic fitness on predicting firefighters' air consumption time from self-contained breathing apparatus (T_SCBA) during physical task was investigated. Methods: Twenty firefighters were divided in two groups: G1 (n=10; 28.0±3.1 years) for the generation of a predictive equation of T_SCBA and G2 (n=10; 25.4±2.3 years) for the validation of the predictive equation. The groups completed two performance tests in separate days: 1) maximal 1600m running in order to determine mean velocity (1600mV) and maximal heart rate; 2) submaximal running/walking at intensity between 88-92% of the maximal heart rate. In second test, the firefighters were equipped with protective clothing (boots, gloves, cape, helmet and balaclava) and the self-contained breathing apparatus. The T_SBCA (corresponding to 1020 liters of pressurized air), blood lactate, heart rate and rate of perceived exertion were measured. Results: The linear regression of G1 (T_SCBA vs. 1600mV) resulted in the following predictive equation: T_SCBA= 0.0442*1600mV (m.min-1) + 4.5029 (r= 0.85; SEE= 0.73; p<0.001). When analyzing in G2, the measured and predicted T_SCBA using the equation generated in G1, no significant differences were found (T_SCBA measured= 15.5±2.5 min vs. T_SCBA predicted= 14.7±0.4 min; p=0.21). High correlation (r=0.95; SEE= 0.79; p<0.001) and agreement of the difference of the means (0.9 min [-3.1/+4.8]) were also found. Conclusion: Aerobic fitness presented high correlation with T_SCBA. In addition, the proposed predictive equation was considered valid to estimate T_SCBA during physical task of firefighters, which can have practical application in the labor activity of this population

Objetivo: Investigar la capacidad aeróbica como factor de predicción del tiempo de consumo de aire de un equipo de respiración autónoma (T_ERA) durante la realización de tareas físicas de bomberos. Método: Veinte bomberos se dividieron en dos grupos: G1 (n=10; 28.0±3.1 años) para la generación de la ecuación predictiva de T_ERA y G2 (n=10; 25.4±2.3 años) para la validación de la ecuación predictiva. Los grupos completaron dos test en días separados: 1) 1600m de carrera máxima para determinar la velocidad media (1600mV) y la frecuencia cardiaca máxima; 2) carrera submáxima/caminata a una intensidad entre el 88-92% de la frecuencia cardiaca máxima. En el segundo test, los bomberos usaron su ropa de protección (botas, guantes, capa, casco y pasamontañas) y el equipo de respiración autónomo. Se midió: el T_ERA (correspondiente a 1020 litros de aire presurizado), el lactato en sangre, la frecuencia cardiaca y el índice de esfuerzo percibido. Resultados: La regresión lineal del G1 (T_ERA vs. 1600mV) resultó en la siguiente ecuación predictiva: T_ERA= 0.0442*1600mV (m.min-1) + 4.5029 (r= 0.85; EEE= 0.73; p<0.001). Cuando se analizó el G2, no se encontraron diferencias significativas entre el valor de T_ERA medido y el calculado usando la ecuación generada con el G1 (T_ERA medido= 15.5±2.5 min vs. T_ERA calculado= 14.7±0.4 min; p=0.21). Se encontró una alta correlación (r=0.95; EEE= 0.79; p<0.001) y concordancia con la diferencia de las medias (0.9 min [-3.1/+4.8]). Conclusión: La capacidad aeróbica presentó una alta correlación con el T_ERA. Además, la ecuación de predicción propuesta se consideró válida para estimar el T_ERA durante tareas físicas de bomberos, lo que tiene grandes aplicaciones prácticas en la labor de esta población

Objetivo: Investigar a aptidão aeróbia na predição do tempo de consumo de ar durante tarefa física de bombeiros a partir do equipamento de proteção respiratória (T_EPR). Método: Vinte bombeiros foram divididos em dois grupos: G1 (n=10; 28.0±3.1 anos) para geração da equação preditiva do T_EPR e G2 (n=10; 25.4±2.3 anos) para validação da equação preditiva. Os grupos realizaram dois testes de desempenho em dias distintos: 1) 1600m de corrida em máxima intensidade para determinar a velocidade média (Vm1600) e a frequência cardíaca máxima; 2) corrida/caminhada em intensidade submáxima entre 88-92% da frequência cardíaca máxima. No segundo teste, os bombeiros estavam equipados com roupa de proteção (botas, luvas, capa, capacete e balaclava) e equipamento de proteção respiratória. O T_EPR (correspondente a 1020 litros de ar pressurizado), lactate sanguíneo, frequência cardíaca e percepção subjetiva de esforço foram mensurados. Resultados: A regressão linear do G1 (T_EPR vs. Vm1600) resultou na seguinte equação de predição: T_EPR= 0.0442*Vm1600 (m.min-1) + 4.5029 (r= 0.85; EPM= 0.73; p<0.001). Quando analizado em G2, o T_EPR medido e predito a partir da equação gerada em G1, não foi encontrada diferença significante (T_EPR medido= 15.5±2.5 min vs. T_EPR predito= 14.7±0,4 min; p=0.21). Alta correlação (r=0.95; EPM= 0.79; p<0.001) e concordância na média das diferenças (0.9 min [-3.1/+4.8]) também foi encontrada. Conclusão: A aptidão aeróbia apresentou alta correlação com o T_EPR. Em adicional, a equação preditiva proposta foi considerada valida em estimar o T_EPR durante tarefa física de bombeiros, o que pode ter aplicação prática na atividade laboral dessa população

Air pollution and its relationship to lung function among adolescents from Taubate, São Paulo, Brazil

Background: This paper sought to evaluate individual exposure to air pollution by quantifying the carbon in alveolar macrophages (AMs) and its relationship to lung function. We also examined the proximity of participants' residences to the Presidente Dutra highway (PDH) in adolescents with asthma from Taubaté, São Paulo, Brazil. Methods: This descriptive study examined fifty 13- to 14-year-old adolescents with asthma identified by the International Study of Asthma and Allergies in Childhood (ISAAC) in Taubaté. These adolescents underwent spirometry and sputum induction via the inhalation of 3% hypertonic saline (HSS). Sputum was collected after each nebulisation, and forced expiratory flow in one second (FEV1) was measured. The collected sputum was stored and transported to the laboratory; it was then processed and analysed for ultrafine particles (≤100 nm). This analysis was correlated with the residence location and FEV1 of each adolescent. Results: A total of 39 adolescents completed the study. The comparison of the carbon fraction within macrophages (CA/MA) showed no differences according to residence in relation to the PDH (p=0.758). After adjustment, a mixed linear model with FEV1 as the dependent variable and CA/MA, location, and evaluation condition as the predictors found that the interactions among the variables were not significant. Conclusions:T he amount of carbon present within the AMs of adolescents with asthma was not correlated with either lung function or residence location. Evaluations of the topograghy and local climatic conditions in Taubaté should be considered in future studies (AU)

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Asthma predictive index in relation to respiratory mechanics by impulse oscillometry in recurrent wheezers

Background: The identification of children who will have persistent asthma has become a focus of recent research. The aim of this study was to assess whether impulse oscillometry (IOS) has a diagnostic value to predict modified API (asthma predictive index) in pre-schoolers with recurrent wheezing. Methods: Pre-school children aged 3-6 years with recurrent wheezing were enrolled. The study population was divided into two groups based on mAPI criteria. Lung function was assessed by IOS. Results: 115 children were assessed; 75 (65.2%) of them were male. The median age was 39 months (min: 36, max: 68 months). 64 (55.6%) of the children were mAPI positive. The R5-R20% levels of children with positive mAPI were significantly higher compared to negative mAPI. Also, R5-R20% levels of children with parental asthma and R20% pred and resonant frequency (Fres) levels of children with inhalant sensitization were higher than those without. No significant differences were found in IOS indices between groups based on the presence of atopic dermatitis, food sensitization, eosinophilia, inhaled corticosteroid usage or wheezing without colds. R5-R20% and total IgE values were found to be significantly related to positive mAPI (aOR: 1.40, p = 0.022 and aOR: 1.02, p = 0.001, respectively). In the ROC analysis, R5-R20% levels >14.4 had a sensitivity of 75% and specificity of 53% for predicting a positive mAPI (p = 0.003). Conclusion: IOS may help clinicians to identify the pre-school wheezers with a high risk of asthma (AU)

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Respirar en altitudes extremas - Proyectos científicos "EVEREST" (Segunda parte) / Breathing at extreme altitudes - Scientific projects "EVEREST" (Second part)

Escalar el punto más alto de la Tierra, el Mt. Everest (8.848 m), sin equipos de oxígeno conlleva una demanda fisiológica que está próxima a la máxima capacidad de tolerancia humana. Exponerse a altitudes extremas condiciona drásticamente la función pulmonar, el nivel de oxígeno y el rendimiento físico. Esta revisión reúne interesantes aspectos respiratorios, de gases sanguíneos y ejercicio aeróbico aportados por aquellos proyectos científicos que han llevado a cabo mediciones fisiológicas entre 8.000 m y 8.848 m, en altitud real o simulada, como las Operaciones "Everest I" (1946), "Everest II" (1985) y "Everest III-COMEX" (1997), y las Expediciones "AMREE" (1981), "British 40th Anniversary Everest" (1993) y "Caudwell Xtrem Everest" (2007). Estos fascinantes eventos de investigación, junto a otros destacados proyectos biomédicos realizados a más de 5.500 m, muy especialmente las Expediciones "Silver Hut" (1960-61), "Italiana all’Everest" (1973) y "British Everest Medical" (1994), incluyendo aquellas pioneras observaciones científicas llevadas a cabo en el s.XIX hasta los más recientes proyectos de investigación realizados, han sentado las bases del conocimiento sobre la tolerancia humana ante niveles de hipoxia hipobárica extrema, donde el pulmón y la cadena respiratoria adquieren un trascendente protagonismo requiriéndose de finos ajustes fisiológicos que garanticen la oxigenación celular. Asimismo, se exponen ciertos aspectos geofísicos, factores climáticos y otros condicionantes ambientales que limitan la viabilidad biológica y pueden afectar la salud respiratoria de los alpinistas situados en las cotas superiores de la troposfera a la latitud subtropical donde se encuentra ubicada dicha montaña. Actualmente cientos de alpinistas intentan alcanzar la cumbre del Mt. Everest todos los años, pero solo algunos consiguen su objetivo sin inhalar oxígeno suplementario, entre ellos algunos excepcionalmente dotados nativos Sherpa, protagonistas de insospechadas hazañas en la montaña más elevada de la superficie terrestre, cuya cima roza el límite fisiológico de supervivencia para el ser humano

Climbing to the highest height on Earth, the Mt. Everest (8.848 m), without supplementary oxygen equipment involves a physiological demand that is close to the maximum human tolerance. Exposures at extreme altitudes drastically conditions lung function, stores of oxygen and physical performance. This review brings interesting aspects about respiration, blood gases and aerobic exercise reported by those scientific projects that have carried out physiological measurements between 8,000 m and 8,848 m above sea level, under real or simulated altitude: the Operations "Everest I" (1946), "Everest II" (1985), "Everest III-COMEX" (1997), and the Expeditions "AMREE" (1981), "British 40th Anniversary Everest" (1993), and "Caudwell Xtrem Everest" (2007). These fascinating scientific research events, along with other outstanding biomedical expeditions performed above 5,500 m, like especially the "Silver Hut" (1960-61), "Italiana all’Everest" (1973), and "British Everest Medical" (1994), including those pioneer scientific reports made on the XIX century until the most recent research projects performed, have laid the foundations and knowledge on the human tolerance to such extreme levels of hypobaric hypoxia, where the lung, breathing and respiratory chain takes on a major role requiring fine physiological adjustments to ensure cellular oxygenation. Geophysical aspects, climatic factors and other environmental conditions that limit the biological viability and can affect the respiratory health of climbers on the upper troposphere zone at the subtropical latitude where that mountain is located are likewise reviewed and analyzed. Every year, hundreds of climbers try to reach the top of Mt. Everest, but only a few of them achieved their goal without inhaling supplemental oxygen, including some exceptionally gifted Sherpa natives, protagonist on unsuspected exploits in the highest mountain on terrestrial surface, whose summit touch the physiological limit of survival for the human being

Pilates en pacientes con espondilitis anquilosante: repercusión en la función pulmonar / Pilates physiotherapy for ankylosing spondylitis patients: Impact on lung function

Objetivo: Evaluar el impacto de la fisioterapia basada en el método de Pilates en la función pulmonar de pacientes con espondilitis anquilosante (EA). Material y método: Se realiza un ensayo clínico aleatorizado (ECA) con 49 pacientes diagnosticados de EA según los criterios de Nueva York modificados. Se establecen al azar 2 grupos de trabajo. Se aplicó ejercicio terapéutico en 26 pacientes, 17 semanas, días alternos y 1h de duración, supervisado por un fisioterapeuta. El grupo control (23 pacientes) realizó un programa de ejercicios convencionales en el domicilio. Terminan el estudio 45 de los 49 pacientes que iniciaron el ECA. Las variables analizadas son: expansión costal, capacidad vital forzada (CVF), volumen espirado forzado (FEV1) y el cociente FEV1/CVF. Resultados: No hay diferencias significativas en los valores de expansión costal entre ambos grupos (p valor=0,686) ni diferencias en el grupo experimental antes y después de la intervención (p valor=0,780). Los valores de la espirometría se comportan de forma similar. La CVF aumenta de forma discreta en el grupo experimental no de forma significativa (p valor = 0,122). Conclusiones: El impacto de los ejercicios basados en pilates sobre los valores espirométricos y la expansión costal es escaso, a pesar de la tendencia del grupo experimental a mejorar su CVF después de la intervención. Se debe considerar, para su aplicación clínica, implementar este tipo de protocolos con fisioterapia respiratoria específica

Aim: To evaluate the impact of physiotherapy, based on the Pilates Method, on the lung function of patients with Ankylosing Spondylitis (AS). Material and methods: A randomised clinical trial (RCT) was performed with 49 patients diagnosed with AS according to the modified New York criteria. Two groups were randomly established. Therapeutic Pilates-based exercise was performed by 26 patients for 17 weeks, in 90minute sessions on alternative days, supervised by a physiotherapist. The control group (23 patients) used a conventional exercise program at home. The variables analysed were: rib cage expansion, forced vital capacity (FVC), forced expiratory volume (FEV1), and the FEV1/FVC ratio. Results: No significant differences were found in the values of rib cage expansion between control and experimental groups (P=.686), while there were differences before and after intervention in the experimental group (P=.780). The values of spirometry were similar in both control and experimental groups. No-significant increase in FVC was observed in the experimental group (P=.122). Conclusions: The impact of Pilates-based exercises on spirometry values and rib cage expansion is limited, although there was a tendency to improve FVC after Pilates exercises. These types of exercise protocols should be considered, for their clinical application, in specific respiratory physiotherapy

How can video-based sessions improve e-learning of respiratory physiology? / ¿Cómo pueden mejorar las sesiones en vídeo la educación a distancia sobre la fisiología respiratoria?

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Cambios en la respuesta ventilatoria al esfuerzo en deportistas entrenados: efectos beneficiosos sobre la fisiología respiratoria más allá del rendimiento cardiovascular / Changes in Ventilatory Response to Exercise in Trained Athletes: Respiratory Physiological Benefits Beyond Cardiovascular Performance

Introducción: El efecto beneficioso de una temporada de competición de 8meses sobre el perfil ventilatorio en respuesta al esfuerzo no se ha evaluado en jugadores de fútbol. Material y métodos: Se evaluó el perfil ventilatorio (analizando los puntos de inflexión específicos del cociente entre el volumen corriente [VT] y la ventilación [VE] durante el esfuerzo) y la respuesta metabólica al esfuerzo gradual en 2 equipos de fútbol profesional, antes y después de una temporada de competición de 8 meses. Resultados: No se observaron diferencias entre equipos en las características antropométricas ni en las variables cardiopulmonares en reposo, incluidos el consumo de oxígeno (VO2) y la frecuencia cardíaca (FC). Durante la temporada de competición, a velocidad fija, se observaron mejorías globales en la producción de dióxido de carbono (VCO2), los cocientes VE/VO2 y VE/VCO2, la VE y la frecuencia respiratoria (FR). Los puntos de inflexión 1 y 2 del cociente VT/VE se observaron tras un mayor tiempo de ejercicio y mayores FC, VO2, VCO2, VE y VT durante la temporada de competición. Conclusiones: A pesar del elevado rendimiento inicial y de la escasa mejoría del VO2, la temporada de competición de 8 meses mejoró el perfil ventilatorio en respuesta al esfuerzo de estos deportistas de élite

Introduction: The beneficial impact of an 8-month competitive season on the ventilatory profile response to exercise in soccer players has never been evaluated. Material and methods: Ventilatory profile (evaluated by determining individual tidal volume [VT] relative to minute ventilation [VE] inflection points during exercise) and metabolic responses to incremental exercise were evaluated in 2 professional soccer teams before and after an 8-month competitive season. Results: No differences between teams in anthropometric characteristics or in resting cardiopulmonary variables, included oxygen uptake (VO2) and heart rate (HR), before and during the competitive season were found. At iso-speed, there were overall improvements in carbon dioxide output (VCO2), VE/VO2, VE/VCO2, VE and respiratory frequency (fR) during the season. The VT/VE inflection points 1 and 2 occurred with greater exercise time, HR, VO2, VCO2, VE and VT during the competitive season. Conclusions: Despite very high baseline performance and a negligible improvement in VO2, an 8-month competitive season improved ventilatory profile response to exercise in elite athletes

Evolución de la saturación regional cerebral de oxígeno en el perioperatorio de cirugía torácica y su relación con la saturación venosa central / Evolution of regional oxygen saturation in the peri-operative of thoracic surgery and its relationship with central venous saturation

Objetivo. Estudiar la relación existente entre los valores de SvcO2 y de SrcO2 en la resección pulmonar con ventilación unipulmonar (VUP) y los cambios de dichas variables y de la presión arterial media (PAM) y la saturación arterial de oxígeno (SpO2) durante el periodo perioperatorio. Material y métodos. Estudio prospectivo observacional en 25 pacientes en quienes se realizó una resección pulmonar con VUP. Los valores de PAM, SpO2, SvcO2 y SrcO2 se registraron en 6 momentos diferentes: 1)basal; 2)en ventilación bipulmonar antes de la VUP (VBP1); 3)durante la VUP; 4)en ventilación bipulmonar después de la VUP (VBP2); 5)en los primeros 30min del postoperatorio, y 6)a las 6h de postoperatorio. Resultados. La SrcO2 mostró un aumento significativo desde su valor basal al iniciar la ventilación (65,72±9,05% vs 70,44±7,24%; p<0,01). No hubo cambios significativos en sus valores en los diferentes momentos intraoperatorios. En el postoperatorio, al igual que en el caso de la SvcO2, se observó una disminución significativa (p<0,001) de su valor en comparación con el valor previo. Conclusiones. La SrcO2 experimenta un aumento significativo tras la inducción de la anestesia e inicio de la ventilación mecánica respecto al valor basal y un descenso significativo al final de la cirugía, tras la extubación en el postoperatorio inmediato. Al tratarse de una monitorización tisular, no invasiva y continua, advierte al clínico de cambios en la relación DO2/VO2 en momentos de mayor riesgo como la VUP, la extubación y el periodo postoperatorio inmediato (AU)

Objective. To study the relationship between the values of SvcO2 and SrcO2 in lung resection with one lung ventilation (OLV) and changes in these variables and mean arterial pressure (MAP) and arterial oxygen saturation (SpO2) during the perioperative period. Material and methods. Prospective, observational study of 25 patients in whom pulmonary resection was performed with OLV. The values of MAP, SpO2, SvO2, and SrcO2 were recorded at 6 different times: 1)baseline; 2)double-lung ventilation before the OLV (VBP1); 3)during OLV; 4)after double-lung ventilation (VBP2); 5)30minutes after surgery, and 6)6hours after surgery. Results. The SrcO2 showed a significant increase from baseline to starting ventilation (65.72±9.05% vs 70.44±7.24%; P<.01). There were no significant changes in their values at the different intraoperative times. Post-operatively, as in the case of the SvcO2, a significant decrease (P<.001) of its value compared with the previous value was observed. Conclusions. SrcO2 showed a significant increase after induction of anaesthesia and initiation of mechanical ventilation compared to baseline, and a significant decrease at the end of surgery after extubation in the immediate postoperative period. Being a tissue monitoring, non-invasive technique and with continuous values it can alert the clinician of changes in the ratio of oxygen consumption (VO2) to oxygen delivery (DO2) at times of greatest risk, such as OLV, extubation, and the early postoperative period (AU)

Función pulmonar en adultos jóvenes con síndrome de Down: estudio transversal / Pulmonary function in young adults with Down syndrome: a cross-sectional study

OBJETIVO: Comparar la función pulmonar entre adultos con síndrome de Down (SD) y adultos sanos. MÉTODO: Participan en el estudio 34 adultos jóvenes (17 con SD y 17 controles sanos) con edades comprendidas entre los 20 y 40 años. Se registran en ambos grupos variables antropométricas y de función pulmonar: volumen espiratorio forzado en un segundo (FEV1), capacidad vital forzada (FVC), flujo espiratorio máximo (PEF) y la relación FEV1/FVC. RESULTADOS: El grupo con SD presentó un mayor peso e índice de masa corporal (IMC) que el grupo control (31,4 ± 4,6 vs.23,4 ± 1,3 kg/m2, p < 0,001). Se registraron valores significativamente menores en la función pulmonar de los sujetos con SD que en la del grupo control: PEF (238,4 ± 89,4 vs.387,4 ± 52,9 l/min, p ≤ 0,001), FVC (2,2 ± 0,7 vs.3,1 ± 0,4 l, p ≤ 0,001) y FEV1 (1,9 ± 0,6 vs.3,1 ± 0,5 l, p ≤ 0,001). No se observaron diferencias entre grupos en el FEV1/FVC. Se observó una correlación inversa entre el IMC y el PEF (r = -0,691, p < 0,001), la FVC (r = -0,555, p = 0,001) y la FEV1 (r = -0,617, p < 0,001). CONCLUSIÓN: Los adultos con SD muestran una reducción de la función pulmonar cuando se les compara con controles de su misma edad. La función pulmonar correlaciona inversamente con el IMC

AIM: To compare the pulmonary function of young adults with Down syndrome (DS) with healthy subjects. METHODS: Thirty-four young adults (17 with DS and 17 apparently healthy controls), aged 20-40, participated in this study. Anthropometric variables and lung function, namely forced expiratory volume in one second (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF), and the fraction of FVC expired in one second (FEV1/FVC%), were assessed in both groups. RESULTS: The group of young adults with DS had a lower height and higher body mass index (31.4 ± 4.6 vs.23.4 ± 1.3 kg/m2, p < 0.001). As regards pulmonary function, the group of participants with DS showed significantly lower values for PEF (238.4 ± 89.4 vs.387.4 ± 52.9 L/min, p ≤ 0.001), FVC (2.2 ± 0.7 vs.3.1 ± 0.4 L, p ≤ 0.001) and FEV1 (1.9 ± 0.6 vs.3.1 ± 0.5 L, p ≤ 0.001), when compared to subjects of the CONTROL GROUP: No changes were observed in FEV1/FVC%. An inverse correlation was observed between the body mass index and the PEF (r = −0.691, p < 0.001), the FVC (r = −0.555, p = 0.001), and the FEV1 (r = −0.617, p < 0.001). CONCLUSIONS: Young adults with DS showed reduced pulmonary function in comparison to age-matched controls. Additionally, the pulmonary function was inversely correlated with body mass index

Efectos de la Nintendo Wii sobre el estado cardiorrespiratorio de adultos mayores: ensayo clínico aleatorizado. Estudio piloto / Nintendo Wii effects on cardiorespiratory fitness in older adults: A randomized clinical trial. A pilot trial

Objetivo: Comparar los resultados de un programa de ejercicios realizados en la videoconsola Nintendo Wii con el entrenamiento aeróbico estándar de oro en bicicleta estática, sobre el estado cardiorrespiratorio de adultos mayores sedentarios. Material y métodos: Ensayo clínico aleatorizado. Participaron 16 sujetos adultos mayores, divididos en 2 grupos (n = 8 intervención 1 y n = 8 intervención 2). El grupo intervención 1 realizó 30 min de entrenamiento en bicicleta estática. El grupo intervención 2 realizó 30 min de ejercicios aeróbicos en la Nintendo Wii. Ambos entrenamientos fueron realizados 3 veces por semana en un período de 8 semanas. Los efectos agudos de esta intervención se determinaron mediante la medición de la frecuencia cardíaca y de la presión arterial antes, durante y después de ambos entrenamientos. Se utilizó el Test de la Marcha de 6 Minutos para determinar los efectos cardiorrespiratorios crónicos. Resultados: Se observó un aumento de la frecuencia cardíaca y de la presión arterial durante la realización de ambos programas de ejercicios. Hubo una diferencia significativa en la distancia recorrida en el Test de la Marcha de 6 Minutos en los 2 grupos. Conclusión: Los efectos cardiorrespiratorios agudos y crónicos de los ejercicios en la Nintendo Wii y del entrenamiento en bicicleta estática en adultos mayores son similares. Estos ejercicios pueden ser una modalidad alternativa a los entrenamientos tradicionales de intensidad moderada recomendados por el Colegio Americano de Medicina del Deporte

Objective: To compare the results of a physical exercise program performed in the video game Nintendo Wii with gold standard aerobic training on exercise bike, on the cardiorespiratory status of sedentary older adults. Material and methods: A randomized clinical trial was performed with the participation of 16 older adult subjects divided into 2 groups (n = 8 intervention 1 and n = 8 intervention 2). Intervention group 1 performed 30 min of training on exercise bike. Intervention group 2 performed 30 min of aerobic exercises in NW. Both trainings were performed 3 times a week over a period of 8 weeks. The acute effects of this intervention were determined by measuring heart rate and blood pressure before, during and after both workouts. The Six-Minute Walk Test was used to determine the chronic cardiorespiratory effects. Results: An increase in heart rate and blood pressure during the performance of both exercise programs was observed. There was a significant difference in the distance traveled in the Six-Minute Walk Test in the 2 groups. Conclusion: Acute and chronic cardiorespiratory effects of exercise with the Nintendo Wii and training on exercise bike are similar in older adults. These exercises can be an alternative to traditional training of moderate intensity recommended by the American College of Sports Medicine mode

Tabaco mentolado y EPOC / Mentholated tobacco and COPD

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