Immediate effects of Chandra Nadi Shuddhi Pranayama on blood pressure, heart rate and rate pressure product among normal individuals: an experimental study

Background: Chandra Nadi Shuddhi Pranayama is a type of alternate nostril breathing which is the control-positive inhalation and exhalation process. Alternate nostril breathing technique shows the best result in health improvement especially in controlling the blood pressure. It activates the parasympathetic nervous system which dilates blood vessels, decreases the heart rate which leads to reduce blood pressure. Many studies have been done to see effects of breathing exercises on cardiovascular system however, no such studies were done to see specific and immediate effect of Chandra Nadi Shuddhi on cardiovascular system. In this article, we will look how Chandra Nadi Shuddhi improves blood pressure, heart rate, and rate pressure product. Methods: Ethical clearance and participant consent was taken. Study design was experimental study. The 80 subjects were taken by convenient sampling. Participants were asked to perform 27 rounds of the Chandra Nadi Shuddhi Pranayama and outcome measures were assessed before and immediately after performing Chandra Nadi Shuddhi. The normality of the data was assessed using parametric paired t test. Results: Immediate effect of Chandra Nadi Shuddhi Pranayama showed that there was statistically significant decrease in blood pressure, heart rate and rate pressure product (p=0.0001, 0.0045, 0.0001 respectively) Conclusions: There is immediate effects of Chandra Nadi Shuddhi Pranayama on individuals with normal blood pressure.These results suggest a possible role for this technique in helping to control hypertension, lower anxiety and depression, improve breathing and immunity.

Presentation of the ATLETAS DA VOZ™ Conditioning Program

Objectives: To present a simple form of vocal and breathing conditioning for voice professionals based on concepts from vocal science. The vocal conditioning program called Voice Athletes Conditioning uses the principles of exercise physiology to gradually improve vocal and respiratory overload to achieve endurance, power, and flexibility. Methods: Due to our personal experience with high voice users, we synthesized a vocal conditioning program (AVCP) that combines voice science, exercise physiology, sports science and physical therapy principles. This is an 8-week program of daily vocal and breathing exercises with overload enhancement each week using different types of breathing devices and semi-occluded vocal tract exercises, designed and developed according to the specific requirements and performance of the voice professional. Reflections: Professional voice users often experience episodes of vocal fatigue that can directly affect their performance and vocal health. As with physical training for athletes, voice exercises can also contribute to improving vocal conditioning, preventing voice disorders, as well as helping to obtain better performance, greater tolerance to fatigue and shorter recovery time. Conclusions: AVCP is an approach that considers the principles of muscle training aimed objectively at the respiratory and vocal muscles, carried out with a variety of breathing devices and specific vocal exercises in search of greater performance time, less physiological stress, and shorter recovery time in the professional use of the voice.

Objetivos: Presentar una forma sencilla de acondicionamiento vocal y respiratorio para profesionales de la voz, basada en conceptos de la ciencia vocal. El programa de acondicionamiento vocal denominado Voice Athletes Conditioning utiliza los principios de la fisiología del ejercicio para mejorar gradualmente la sobrecarga vocal y respiratoria, con el fin de lograr resistencia, potencia y flexibilidad. Métodos: Debido a nuestra experiencia personal con usuarios de voz aguda, sintetizamos un programa de acondicionamiento vocal (AVCP) que combina principios de la ciencia de la voz, la fisiología del ejercicio, las ciencias del deporte y la fisioterapia. Se trata de un programa de 8 semanas de ejercicios vocales y respiratorios diarios con realce de sobrecarga cada semana utilizando diferentes tipos de dispositivos respiratorios y ejercicios semioclusivos del tracto vocal, diseñado y desarrollado de acuerdo con los requerimientos específicos y el rendimiento del profesional de la voz. Reflexiones: Los usuarios profesionales de la voz experimentan a menudo episodios de fatiga vocal que pueden afectar directamente su rendimiento y salud vocal. Al igual que ocurre con el entrenamiento físico de los deportistas, los ejercicios vocales también pueden contribuir a mejorar el acondicionamiento vocal, prevenir trastornos de la voz, además de ayudar a obtener un mejor rendimiento, una mayor tolerancia a la fatiga y un menor tiempo de recuperación. Conclusiones: El AVCP es un enfoque que considera los principios del entrenamiento muscular dirigido objetivamente a la musculatura respiratoria y vocal, realizado con diversos aparatos respiratorios y ejercicios vocales específicos en busca de un mayor tiempo de actuación, menor estrés fisiológico y menor tiempo de recuperación en el uso profesional de la voz.

Factors associated with decreased respiratory pressures in high-risk pregnant women / Fatores associados à diminuição das pressões respiratória em gestantes de alto risco

Introduction: The gestational period brings anatomical and physiological changes to women in several systems, especially the respiratory system. Objective: To determine whether there is an association between gestational age (GA), Diabetes, uterine fundal height (UFH), Body Mass Index (BMI), level of dyspnea, and physical activity with maximum respiratory and nasal pressures. Methods: Cross-sectional study that included 55 high-risk pregnant women in the 2nd and 3rd trimester of pregnancy at the Obstetrics Outpatient Clinic of the Hospital das Clínicas in Recife ­ PE, Brazil, personal, sociodemographic, anthropometric, clinical and Maximal Inspiratory Pressure (MIP) data were described and nasal inspiratory pressure (NIP), that, using regression and multivariate analysis, analyzed the influence of risk factors for high-risk pregnancy with NIP considering a p<0.005. Results: Among the pregnant women, according to the clinical variables, it was observed that 56.4% (n=31) had a gestational age above 28 weeks, 27.3% (n=15) diabetes, 25.5% (n=14) asthma, 43.6% (n=24) Gestational Hypertension, 56.4% (n=31) obesity, 85.5% (n=47) complaints of dyspnea 38.1% (n=21) mild to severe dyspnea and 65.5% (n=36) vigorous physical activity. Low MIP (76.76 cmH2O) and NIP (68.62 cmH2O) values were found for age. An association was observed between an increase in UFH and a decrease of 0.8 cmH2O in NIP, regardless of gestational age. Conclusion: High-risk pregnant women in the second and third trimester of pregnancy have decreased NIP and MIP with a negative association of UFH with NIP regardless of gestational age.

Introdução: O período gestacional traz para a mulher alterações anatômicas e fisiológicas, em diversos sistemas, principalmente no sistema respiratório. Objetivo: Determinar se há associação da idade gestacional (IG), Diabetes, altura de fundo de útero (AFU), Índice de Massa Corpórea (IMC), nível de dispneia e atividade física com as pressões respiratória máxima e nasal. Método: Estudo transversal que incluiu 55 gestantes de alto risco no 2º e 3º trimestre de gestação do Ambulatório de Obstetrícia do Hospital das Clínicas de Recife ­ PE, foi descrito os dados pessoais, sociodemográficos, antropométricos, clínicos e das Pressão Inspiratória Máxima (PImáx) e pressão inspiratória nasal (PIN), que, por meio da regressão e da análise multivariada analisou a influência dos fatores de risco para gestação de alto risco com a PIN considerando um p<0,005. Resultados: Dentre as gestantes, segundo as variáveis clínicas, observou-se que 56,4% (n=31) apresentaram idade gestacional acima de 28 semanas, 27,3% (n=15) diabetes, 25,5% (n=14) asma, 43,6% (n=24) Hipertensão Arterial Sistêmica Gestacional (HASG), 56,4% (n=31) obesidade, 85,5% (n=47) queixas de dispneia 38,1% (n=21) dispneia de um pouco forte a forte e 65,5% (n=36) atividade física vigorosa. Foram encontrados valores baixos de PImáx (76,76 cmH2O) e PIN (68,62 cmH2O) para a idade. Foi observada uma associação do aumento da AFU com a diminuição de 0,8 cmH2O da PIN, independentemente da idade gestacional. Conclusão: As gestantes de alto risco no segundo e terceiro trimestre gestacional apresentam PIN e PImáx diminuídas com uma associação negativa da AFU com a PIN independentemente da idade gestacional.

Effect of Buteyko breathing technique on peak expiratory flow rate in patients undergone upper abdominal surgery

Upper abdominal surgery (UAS) alters postoperative pulmonary function, as observed by impairment of lung volumes such as total lung capacity, vital capacity. Impaired clearance of sputum results in a vicious cycle of colonization and infection of bronchi with pathogenic organisms, dilation of bronchi and further sputum production. Ten patients undergone UAS were assigned randomly in two groups equally; their ages ranged from 23 to 60 years. The group A received Buteyko breathing. The data were collected before and after the same treatment period for both groups. The evaluation procedure was carried out to measure peak expiratory flow meter. Post treatment evaluation showed a significant difference in peak expiratory flow meter in both groups but in the favor of group A. Post treatment result showed a significant difference within the group. The post treatment value of group A was 272 which was better than group B which was 172. Combination of Buteyko breathing with conventional physiotherapy were considered to be an effective exercise for postoperative pulmonary complications after upper abdominal surgeries.

Effectiveness of patterned breathing techniques on maternal and newborn outcome among intranatal primi women at Government Doon Medical College and Hospital Dehradun, Uttarakhand, India

Background: Aim and the objectives of the study were to assess the maternal and newborn outcome, effectiveness of patterned breathing technique on maternal and newborn outcome among intranatal primi women at Government Doon Medical College and Hospital Dehradun, Uttarakhand.Methods: This was a quasi-experimental research study conducted at the department of obstetrics and gynecology, Government Doon Medical College and Hospital Dehradun, Uttarakhand, India from June 1st to June 30th, 2023. The study comprised 60 samples selected through purposive sampling technique, adhering to specific inclusion and exclusion criteria. Microsoft office tools were employed for data processing and analysis. The analytical approach employed was descriptive and inferential in nature.Results: There was significant difference (p<0.001) between mean maternal and newborn outcome among experimental and control group after performing patterned breathing exercise.Conclusions: The patterned breathing technique is statistically significant. Thus, the investigator concluded that patterned breathing exercise helps in improving the maternal and newborn outcome among intranatal primi women.

Comparison of GRASP free-breathing dynamic contrast-enhanced MRI and traditional BH-VIBE sequences in the imaging quality of lung cancer / 实用放射学杂志

Objective To evaluate the clinical practical value of the golden angle radial sparse parallel(GRASP)technology in the MR imaging quality of lung cancer under free-breathing state.Methods The imaging data of 30 lung cancer patients diagnosed with CT screening were collected by using a large-aperture 3.0T MR scanner.All patients underwent routine Cartesian breath-hold volume interpolation(BH-VIBE)scanning,then free-breathing dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)scanning based on GRASP technology,and another repetitive BH-VIBE scanning.The MR imaging quality was independently evaluated by two experienced thoracic radiologists including overall image quality,lesion outline,artifact grade and diagnostic confidence,mean-while,the CT images of the patient at the same time were used as a reference.The sequence information on MR images was also pro-cessed blindly.Results The GRASP sequence could effectively eliminate the interference of motion artifacts such as respiration and cardiac large vessel beats,and the image quality,lesion outline,artifact grade,and diagnostic confidence of the GRASP sequence were significantly better than the BH-VIBE(P＜0.01).The image quality of the GRASP sequence was more satisfactory with clea-rer tumor boundary and more details.Conclusion Free-breathing high-temporal-spatial resolution GRASP technology has better image quality than traditional BH-VIBE scanning,and it is a reliable method for high-resolution imaging of lung cancer.

Effect of Early Active Cycle of Breathing Technique Training on Aspiration in Patients with Dysphagia after Partial Laryngectomy / 听力学及言语疾病杂志

Objective To investigate the effect of early active cycle breathing technique(ACBT)on aspiration in patients with dysphagia after partial laryngectomy.Methods A total of 40 patients with laryngeal cancer with dysphagia who were hospitalized in the Department of Otorhinolaryngology of the Third Xiangya Hospital of Central South University in January 2019～January 2022 were selected,and the patients were randomly divided into 20 cases in the observation group and the control group by random number method,the control group was given routine swallowing function training,and the observation group was combined with active cycle of breathing technique(ACBT)on the basis of the control group.The two groups were treated 5 days a week,twice a day,45 minutes each for 2 weeks.The M.D.Anderson Dysphagia Inventory(MDADI),maximum phonation time(MPT),and Standardized Swallowing Assessment(SSA),flexible endoscopic examination of swallowing(FEES)combined with modified invasion and aspiration score(MPAS score)and overall clinical efficacy before and after treatment were compoued between the two groups.Results After 2 weeks of treatment,the swallowing function of both groups improved,but the MDADI scores in the observation group were better than those of in the control group in all cate-gories(P＜0.001),MPT(7.19±1.31)was better than that of the control group(4.29±0.88)(=9.436,P＜0.001),SSA(19.25±1.12)was better than that of the control group(21.20±2.55)(=-2.894,P＜0.05),and FEES combined with MPAS score(1.75±0.85)was better than the control group(2.70±1.34)(=-2.674,P＜0.001),and the overall clinical efficacy(18,90.00％)was better than the control group(12,60.00％)(Z=-3.894,P＜0.001).Conclusion Early application of active breathing and circulation technique combined with swallowing training can improve the swallowing function of patients to a greater extent and reduce the incidence of aspiration compared with swallowing function training alone.

The mechanism and application of heart rate variability biofeedback regulation of the autonomic nervous system / 中国组织工程研究

BACKGROUND:Heart rate variability biofeedback is a respiratory training method that uses slow and deep breathing at the resonant frequency to induce rhythmic,high-amplitude oscillations in the cardiovascular system,thereby stimulating and exercising the autonomic and baroreflex.However,current studies have not systematically reviewed how heart rate variability biofeedback modulates the autonomic function and produces effects.There is a lack of public understanding of the mechanism of heart rate variability biofeedback,and its application progress and scheme are not fully understood. OBJECTIVE:To review the existing experimental studies on the effects of heart rate variability biofeedback on symptoms in different populations at home and abroad and to introduce the mechanisms and advances in the application of heart rate variability biofeedback to modulate the autonomic nervous system. METHODS:"Heart rate variability biofeedback,resonance breathing,heart rate variability,autonomic nerve,breathing training,chronic diseases,mental illness,biofeedback"were used as Chinese or English keywords to search in CNKI,WanFang Database,PubMed,and Web of Science.A total of 72 core related papers were included according to the inclusion and exclusion criteria. RESULTS AND CONCLUSION:The body's oscillation system and resonance system are essential for the effectiveness of heart rate variability biofeedback.Oscillations reflect the response to external stimuli and self-regulating reflex systems,while resonances involve synchronous oscillations that result in higher amplitude operations.The balance between sympathetic and parasympathetic nerves is crucial for maintaining a stable internal environment.Autonomic nervous system disorders are associated with reduced heart rate variability and are closely linked to the progression of related diseases.Heart rate variability biofeedback utilizes the resonance characteristics of the cardiovascular system,inducing rhythmic high-amplitude oscillations by employing deep slow breathing at the resonance frequency.This method improves the regulatory function of the sympathetic and parasympathetic system reflexes and enhances the balance regulation between the two systems.Two major mechanisms of cardiovascular system resonance are the baroreflex closed-loop pathway and respiratory sinus arrhythmia.These mechanisms,along with the unique delay of baroreflex,result in a 0° phase angle oscillation between heart rate and respiration and a 180° phase angle oscillation between blood pressure and respiration during breathing at the resonant frequency rhythm.Periodically stimulating the human cardiovascular oscillation system through this method is an easy-to-operate and effective training approach.Currently,heart rate variability biofeedback is mainly applied in the fields of mental illness,chronic disease,and sports.However,the intervention mechanism and efficacy are unclear,the intervention content,frequency and duration are varied,and there are limited review studies on the intervention methods tailored to different types of individuals.As a non-drug and non-invasive intervention,heart rate variability biofeedback can significantly increase heart rate variability,regulate the balance between sympathetic and parasympathetic nerves,and improve the stability and adaptability of the autonomic nervous system.In the future,it is suggested to investigate the mechanisms and potential applications of the pathways of the heart rate variability biofeedback that induce cardiovascular resonance.It is also recommended to incorporate long-term follow-ups to assess the sustained value of heart rate variability biofeedback in various fields.This would provide new directions and strategies for the comprehensive treatment of complex diseases.

Study on the clinical application of pre-breathing mode in double-low imaging of 320-slices CT for pulmonary artery / 中国医学装备

Objective:To explore the clinical application value of pre-breathing mode in double-low imaging of 320-slices computed tomography(CT)for pulmonary artery.Methods:A total of 100 patients who underwent CT pulmonary angiography(CTPA)for suspected pulmonary embolism(PE)in Liuzhou People's Hospital from July 2021 to September 2022 were prospectively selected as the research subjects and they were randomly divided into observation group and control group,with 50 cases in each group.The patients of the control group adopted conventional breathing mode(the breathing password was activated after reaching the threshold,and the scan was triggered after 6 s),while the patients of the observation group adopted the pre-breathing mode(the breathing password was activated after 1 or 2 seconds,and the scan was triggered after reaching the threshold).Both two groups adopted double low-technique scan of 320 slices CT.The differences in delay time,radiation dose,the points of subjective and objective image quality,and other indicators were compared between the two groups.Results:The volume CT dose index(CTDIvol),dose length product(DLP),effective dose(ED)and delay time of the observation group were significantly lower than those of the control group(t=76.230,30.225,12.282,7.088,P<0.05),respectively.The comparison of the subjective points of image qualities between the two groups indicated that there were 25 cases with 5 points,23 cases with 4 points and 2 cases with 3 points in the observation group,and there were 21 cases with 5 points,26 cases with 4 points and 3 cases with 3 points in the control group.There was no significant difference in the averagely subjective points of image qualities between two groups(P>0.05).The signal-to-noise ratio(SNR)and signal to noise ratio(CNR)of the observation group were significantly lower than those of the control group,and the noise level(SD)of the observation group was significantly higher than that of the control group(t=25.441,23.886、11.426,P<0.05),respectively.The CT values of the artery trunk of right pulmonary,artery branch of right pulmonary,artery trunk of left pulmonary and artery branch of left pulmonary in the observation group were significantly higher than those in the control group(t=2.256,2.225,2.042,2.277,P<0.05),respectively.Conclusion:The pre-breathing mode can effectively improve CTPA image quality,and reduce radiation dose and the dosage of contrast agent,which clinical application effect is significant.It is worth learning.

The effectiveness of different training modes of six-character qigong in improving respiratory muscle functioning after a stroke / 中华物理医学与康复杂志

Objective:To explore the impact of different six-character qigong training modes on respiratory muscle function early after a stroke.Methods:Sixty-six stroke survivors in the early stage of recovery were randomly divided into a control group, a modified training group, and an ancient training group, each of 22. In addition to routine rehabilitation training, the control group received conventional respiratory training. The modified training and ancient training groups were trained in modified six-character qigong or ancient six-character qigong, respectively, for two weeks. Before the treatment, after the two weeks and one month later, maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP), forced expiratory volume in one second, forced vital capacity, peak expiratory flow, maximum mid-expiratory flow, and peak inspiratory flow were measured. Diaphragm mobility during quiet inspiration and maximum inspiration were also quantified.Results:After 2 weeks of treatment and at 1 and 3 months after the end of the treatment, all three groups showed significant improvement in MIP, MEP and the pulmonary ventilation indicators, but the average improvement in the modified training group was significantly greater than in the other two groups. Their average diaphragm mobility was also significantly greater.Conclusion:Modified six-character qigong respiratory training is more effective than its ancient counterpart in improving respiratory muscle function, pulmonary ventilation, and diaphragm mobility early after a stroke, with effects which persist for at least one month.

Correlation between diaphragmatic-rapid shallow breathing index and lung ultrasound score in elderly patients with mechanical ventilation and its predictive value for weaning results / 中华危重病急救医学

Objective:To investigate the correlation between diaphragmatic-rapid shallow breathing index (D-RSBI) and lung ultrasound score (LUS) in elderly patients with mechanical ventilation and its predictive value for weaning results.Methods:A retrospective study was conducted. The clinical data of elderly patients (age > 60 years old) with invasive positive pressure ventilation (IPPV) admitted to the department of intensive care unit (ICU) of the First Affiliated Hospital of Jinzhou Medical University from January 2021 to June 2022 were enrolled. According to the outcome of withdrawal, the patients were divided into successful and failed groups. The differences in gender, age, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ), D-RSBI and LUS before weaning and extubation were compared between the two groups. Pearson correlation was used to analyze the correlation between D-RSBI and LUS. The predictive value of D-RSBI and LUS on weaning results of elderly patients with IPPV was analyzed by receiver operator characteristic curve (ROC curve).Results:A total of 398 elderly patients with IPPV were enrolled, including 300 successful weaning patients and 98 failed weaning patients. There were no significant differences in gender and age between the failed group and successful group [male: 55.1% (54/98) vs. 59.0% (177/300), age (years old): 67.02±5.03 vs. 66.96±4.99, both P > 0.05]. APACHEⅡ score in the failed group was significantly higher than that in the successful group (17.09±3.30 vs. 16.06±3.81, P < 0.05), and the D-RSBI and LUS score before extubation were significantly higher than those in the successful group [D-RSBI (time·min -1·mm -1): 2.19±0.33 vs. 1.60±0.22, LUS: 17.30±3.04 vs. 11.97±3.20, both P < 0.01]. All patients showed a significant positive correlation between D-RSBI and LUS score ( r = 0.406, P = 0.000). ROC curve analysis showed that the area under the curve (AUC) of D-RSBI for predicting weaning outcomes in elderly IPPV patients was 0.920, with a 95% confidence interval (95% CI) of 0.881-0.958 and P = 0.000. When the cut-off value was 1.85 times·min -1·mm -1, the sensitivity was 88.7% and the specificity was 86.7%. The AUC of LUS score for predicting weaning outcome in elderly IPPV patients was 0.875, with a 95% CI of 0.839-0.912 and P = 0.000. When the cut-off value was 14.50, the sensitivity was 75.7% and the specificity was 84.7%. Conclusion:There is a significant correlation between D-RSBI and LUS score in elderly mechanically ventilated patients, both of them can predict weaning outcome in elderly patients with mechanical ventilation.

Contamination of equipment and surfaces in the operating room anesthesia workspace: a cross-sectional study

ABSTRACT BACKGROUND: Contamination of the breathing circuit and medication preparation surface of an anesthesia machine can increase the risk of cross-infection. OBJECTIVE: To evaluate the contamination of the anesthetic medication preparation surface, respiratory circuits, and devices used in general anesthesia with assisted mechanical ventilation. DESIGN AND SETTING: Cross-sectional, quantitative study conducted at the surgical center of a philanthropic hospital, of medium complexity located in the municipality of Três Lagoas, in the eastern region of the State of Mato Grosso do Sul. METHODS: Eighty-two microbiological samples were collected from the breathing circuits. After repeating the samples in different culture media, 328 analyses were performed. RESULTS: A higher occurrence of E. coli, Enterobacter spp., Pseudomonas spp., Staphylococcus aureus, and Streptococcus pneumoniae (P < 0.001) were observed. Variations were observed depending on the culture medium and sample collection site. CONCLUSION: The study findings underscore the inadequate disinfection of the inspiratory and expiratory branches, highlighting the importance of stringent cleaning and disinfection of high-touch surfaces.

Impacto del entrenamiento de los músculos respiratorios sobre la mortalidad y estancia hospitalaria en la unidad de cuidados intensivos

Introducción: los pacientes ingresados a la Unidad de Cuidados Intensivos (UCI) presentan desacondicionamiento que impacta en la musculatura respiratoria y por ende en la recuperación de estos. Materiales y métodos: se llevó a cabo una revisión sistemática combinada con análisis descriptivo de cronología retrospectiva de ensayos clínicos entre 2010 a 2023 en bases de datos indexadas y basados en la Colaboración Cochrane se realizó la recopilación de datos y la selección de estudios de acuerdo con los criterios de la Declaración de PRISMA y PICO. Los críterios de inclusión y exclusión fueron enfocados en personas mayores de 18 años internadas en UCI, que realizaran entrenamiento muscular respiratorio (EMR) sin importar sus características sociodemográficas, enfermedad o su estadio. Se recopiló el tipo de población, grupos de intervención y control, duración y frecuencia de la intervención y resultados obtenidos. Resultados: se identificaron 1.171.143 documentos en la primera búsqueda y luego de los respectivos filtros se incluyeron 14 ensayos clínicos, en donde se implementaron EMR con dispositivos de carga de umbral inspiratoria y que evaluaron los parámetros fisiológicos (ventilación minuto, volumen tidal), intercambio de gases (PaO2, PaCO2), aumento del flujo inspiratorio y espiratorio máximo y presión inspiratoria máxima. Conclusiones: los pacientes en UCI que realizaron EMR obtuvieron una reducción en las complicaciones pulmonares, estancia y costos hospitalarios, como también en la mortalidad. Se resalta que los estudios existentes combinan el EMR con otras modalidades terapéuticas como movilizaciones, ejercicio cardiovascular y entrenamiento de fuerza.

Introduction: Patients admitted to the Intensive Care Unit (ICU) present deconditioning that impacts their respiratory muscles and recovery. Materials and methods: A systematic review combined with descriptive analysis of retrospective chronology of clinical trials between 2010 and 2023 was carried out in indexed databases. Based on the Cochrane Collaboration, data collection, and study selection were carried out according to the criteria of the PRISMA and PICO Declaration. The inclusion and exclusion criteria were focused on people over 18 years of age admitted to the ICU, who performed respiratory muscle training (RMT) regardless of their sociodemographic characteristics, disease, or stage. The type of population, intervention and control groups, duration and frequency of the intervention, and results obtained were collected. Results: In the first search, 1,171,143 documents were identified and after the respective filters, 14 clinical trials were included, in which RMT was implemented with inspiratory threshold loading devices, and that evaluated the physiological parameters (minute ventilation, tidal volume), gas exchange (PaO2, PaCO2), increase in maximum inspiratory and expiratory flow and maximum inspiratory pressure. Conclusions: ICU patients who performed RMT obtained a reduction in pulmonary complications, hospital stay, and costs, as well as mortality. It is highlighted that existing studies combine RMT with other therapeutic modalities such as mobilizations, cardiovascular exercise, and strength training.

Parámetros ventilatorios asociados a mortalidad en pacientes con neumonía adquirida en la comunidad grave

Introducción: La predicción del desenlace de los pacientes tratados con ventilación invasiva por insuficiencia respiratoria aguda es todo un reto. Objetivo: Analizar los parámetros de monitorización ventilatoria asociados a la mortalidad en pacientes con neumonía adquirida en la comunidad grave. Métodos: Se realizó un estudio de casos y controles en pacientes con neumonía adquirida en la comunidad grave, tratados con ventilación invasiva. Los casos fueron los pacientes fallecidos. Las variables cuantitativas se resumieron con la mediana y el rango intercuartil en la comparación entre casos y controles, se empleó la prueba de U de Mann - Whitney. Se computó la presencia de riesgo de mortalidad y su significación estadística mediante el análisis de los odds ratio (OR), sus intervalos de confianza y la prueba ji al cuadrado de Mantel y Haenszel con nivel de significación ɑ = 0,05. Resultados: Los pacientes con las siguientes variables: presión pico ≥ 32 cmH2O (OR = 9,27), presión meseta ≥ 24 cmH2O (OR = 24,10), presión media ≥ 19 cmH2O (OR = 10,21), presión de conducción ≥ 19 cmH2O (OR = 10,98), compliance estática < 20 ml/cmH2O (OR = 5,90) y compliance dinámica < 15 ml/cmH2O (OR = 14,20), tuvieron más probabilidad de fallecer. Conclusiones: Los parámetros de la presión pico, la presión meseta, la presión media, la presión de conducción, la compliance estática y la compliance dinámica están asociados a la mortalidad en pacientes con neumonía adquirida en la comunidad grave.

Introduction: Predicting the outcome in patients treated with invasive ventilation for acute respiratory failure is fully challenging. Objective: To analyze ventilatory monitoring parameters associated with mortality in patients with severe community-acquired pneumonia. Methods: A case-control study was carried out in severely-ill patients with community-acquired pneumonia and treated with invasive ventilation. The cases were the deceased patients. The quantitative variables were summarized using the median and the interquartile range, while the Mann-Whitney U test was used in the comparison between cases and controls. The presence of mortality risk and its statistical significance were computed by odds ratio (OR) analysis, their confidence intervals, as well as the Mantel and Haenszel chi-squared test, with significance level ɑ = 0.05. Results: The patients more likely to die were those with peak pressure ≥ 32 cmH2O (OR = 9.27), plateau pressure ≥ 24 cmH2O (OR = 24.10), mean pressure ≥ 19 cmH2O (OR = 10.21), driving pressure ≥ 19 cmH2O (OR = 10.98), static compliance < 20 ml/cmH2O (OR = 5.90) and dynamic compliance < 15 ml/cmH2O (OR = 14.20). Conclusions: The variables peak pressure, plateau pressure, mean pressure, driving pressure, static compliance and dynamic compliance were concluded to be associated with mortality in patients with severe community-acquired pneumonia.

Efeitos imediatos do inspirômetro de incentivo em mulheres vocalmente saudáveis / Immediate effects of the incentive spirometer in women with healthy voice

RESUMO Objetivo Avaliar o efeito imediato do inspirômetro de incentivo nas medidas acústicas, medidas aerodinâmicas e na avaliação perceptivo-auditiva da qualidade vocal de mulheres com vozes saudáveis. Método Trata-se de um estudo experimental de comparação intrassujeito que contou com a participação de 22 mulheres sem queixas vocais. Foram obtidas as medidas acústicas, medidas aerodinâmicas e a avaliação perceptivo-auditiva da qualidade vocal antes e imediatamente após o uso do inspirômetro de incentivo pelas participantes. O dispositivo foi utilizado na posição ortostática, e as participantes realizaram três séries de dez repetições com intervalo de um minuto entre as séries. Resultados Após uso do inspirômetro de incentivo, observou-se redução significativa nas medidas de jitter, shimmer e PPQ (period perturbation quociente) e aumento do volume expiratório máximo. As demais medidas acústicas e aerodinâmicas não foram impactadas significativamente. Além disso, houve melhora na avaliação perceptivo-auditiva da qualidade vocal em oito (36,4%) participantes, e 11 (50,0%) não apresentaram mudanças após uso do inspirômetro de incentivo. Conclusão O uso do inspirômetro de incentivo é seguro e, em seu efeito imediato, promove redução nas medidas acústicas de aperiodicidade a curto prazo, tanto relacionadas à frequência quanto à intensidade, e aumenta o volume expiratório máximo em mulheres com vozes saudáveis.

ABSTRACT Purpose To evaluate the immediate effect of the incentive spirometer on acoustic measures, aerodynamic measures and on the auditory-perceptual assessment of vocal quality in vocally healthy women. Methods This is an experimental intra-subject comparison study with the participation of 22 women without vocal complaints. Acoustic measures, aerodynamic measures and auditory-perceptual assessment of vocal quality were obtained before and immediately after using the incentive spirometer by the participants. The device was used in the orthostatic position and the participants performed three sets of ten repetitions with a one-minute interval between sets. Results After using the incentive spirometer, there was a significant reduction in jitter, shimmer and PPQ (period perturbation quotient) measurements and an increase in maximum expiratory volume, while the other acoustic and aerodynamic measurements were not significantly impacted. In addition, there was improvement in vocal quality in eight (36.4%) participants and 11 (50.0%) participants showed no changes in the auditory perceptual assessment of voice quality after using the incentive spirometer. Conclusion The use of the incentive spirometer is safe and, in its immediate effect, positively impacts the acoustic measures of short-term aperiodicity of frequency and intensity and increases the maximum expiratory volume in women with healthy voices.

Avaliação do modo respiratório por meio da termografia: um estudo piloto / Breathing mode assessment with thermography: a pilot study

RESUMO Objetivo Apresentar um método de análise do modo respiratório por meio da termografia infravermelha. Método Estudo transversal exploratório de 38 imagens térmicas que representavam o momento da inspiração e da expiração durante a respiração nasal e durante a simulação da respiração oral de quatro voluntárias respiradoras nasais sem queixas respiratórias. Para a extração da temperatura das regiões de interesse (nariz e boca) foram utilizadas três formas de seleção distintas de dados (linha, retângulo e elipse) e três medidas de temperatura (mínima, média e máxima) por meio do software FLIR Tools®. Resultados Dentre as três formas de seleção houve maior variabilidade nas medidas obtidas pela linha, revelando limitações nessa medida. Não houve diferenças entre as medidas do retângulo e elipse, mostrando que ambas as formas de seleção apresentam resultados semelhantes para a extração das temperaturas. Na comparação entre as temperaturas do nariz e da boca na inspiração e expiração, os resultados indicaram que houve diferença com relevância estatística em todas as medidas realizadas, exceto para as medidas de temperatura média da inspiração, usando o retângulo e a elipse. Percebe-se diferenciação do modo respiratório tanto na inspiração quanto na expiração quando utilizada a temperatura média da boca com o retângulo e a elipse. Conclusão Sugere-se para avaliação do modo respiratório a avaliação da boca, por meio da elipse, com análise da temperatura média durante a inspiração.

ABSTRACT Purpose To present a method for analyzing breathing modes with infrared thermography. Methods This exploratory cross-sectional study used 38 thermal images of inspiration and expiration with nasal breathing and simulated mouth breathing in four nasal breathers without respiratory complaints. Three different data selection forms (line, rectangle, and ellipse) were used to extract the minimum, mean, and maximum temperatures of the regions of interest (nose and mouth) using the FLIR Tools® software. Results Among the three selection forms, there was greater temperature variability obtained with the line, revealing limitations in this measurement. There were no differences between the rectangle and ellipse values, showing that both selection forms present similar temperature extraction results. The comparison results between nose and mouth temperatures during inspiration and expiration indicated a statistically significant difference between all measurements, except for mean inspiration temperatures with the rectangle and ellipse. The breathing mode can be distinguished in both inspiration and expiration when using mean mouth temperatures with the rectangle and ellipse. Conclusion Breathing modes should be assessed based on mean mouth temperatures during inspiration, using the ellipse.

Towards a better diagnosis of mouth breathing: validity and reliability of a protocol for assessing the awake breathing pattern in preschool children

Abstract Purpose The Awake Breathing Pattern Assessment (ABPA) is a prototypical clinical grid recently designed through an international consensus of Speech and Language Pathologists (SLPs) to categorize the awake and habitual breathing pattern during the orofacial myofunctional assessment. This cross-sectional study aims to explore the psychometric properties of the ABPA in a preschool population. Methods 133 children from 2;11 to 6 years old were assessed with the ABPA. The percentage of time spent breathing through the mouth was objectively measured by a CO2 sensor and used as a baseline measurement. We first performed a multivariate Latent Profile Analysis based on the CO2 measurement and a parental questionnaire to define the number of categories that best characterize the breathing pattern. Subsequently, we assessed the intra- and inter-rater reliability, internal consistency criterion validity, construct validity and sensitivity and specificity. Results The awake breathing pattern can best be described by two groups: nasal and mouth breathing. The ABPA, initially designed in three groups, was adjusted accordingly. This final version showed excellent intra-rater and inter-rater reliability. There was a significant correlation between the ABPA and the CO2 measurement. The ABPA showed a fair sensitivity and a good specificity. Conclusion The reference tool based on CO2 data was used in children for the first time and was found to be reliable. The ABPA is a suitable tool for SLPs to confirm the diagnosis of mouth breathing in preschool children if more sensitive screening tools, like parental questionnaires, are used beforehand.

Efeito imediato de exercício inspiratório com exercitador e incentivador respiratório em mulheres sem queixas vocais / Immediate effect of inspiratory exercise with exerciser and respiratory encourager in women without vocal complaints

RESUMO Objetivo Avaliar o efeito imediato do exercício inspiratório com incentivador e exercitador respiratório na voz de mulheres sem queixas vocais. Método Participaram 25 mulheres sem queixas vocais, entre 18 e 34 anos, com pontuação 1 no Índice de Triagem para Distúrbio Vocal (ITDV). A coleta de dados foi realizada nos momentos antes e após realização de exercício inspiratório e consistiu na gravação de vogal sustentada /a/, fala encadeada e tempos máximos fonatórios (TMF) de vogais, fonemas fricativos e contagem de números. No julgamento perceptivo-auditivo foi utilizada a Escala de Desvio Vocal (EDV) para verificar o grau geral do desvio vocal. Avaliação acústica foi feita no software PRAAT e foram extraídos os parâmetros frequência fundamental (f0), jitter, shimmer, proporção harmônico -ruído (HNR), Cepstral Peak Prominence Smoothed (CPPS), Acoustic Voice Quality Index (AVQI) e Acoustic Breathiness Index (ABI). Para mensuração das medidas aerodinâmicas, o tempo de emissão foi extraído no programa Audacity. Para comparar os resultados utilizou-se o teste paramétrico t de Student para amostras dependentes na análise das variáveis com distribuição normal e o teste de Wilcoxon para variáveis com distribuição não normal. Resultados Não houve diferenças entre os resultados do JPA e das medidas acústicas, nos momentos pré e pós exercício inspiratório. Quanto às medidas aerodinâmicas foi possível observar aumento significativo no valor do TMF /s/ (p=0,008). Conclusão Não houve modificação na qualidade vocal após o exercício inspiratório com incentivador e exercitador respiratório, porém foi observado aumento do TMF do fonema /s/ após a realização do exercício.

ABSTRACT Purpose To evaluate the immediate effect of the inspiratory exercise with a booster and a respiratory exerciser on the voice of women without vocal complaints. Methods 25 women with no vocal complaints, between 18 and 34 years old, with a score of 1 on the Vocal Disorder Screening Index (ITDV) participated. Data collection was performed before and after performing the inspiratory exercise and consisted of recording the sustained vowel /a/, connected speech and maximum phonatory times (MPT) of vowels, fricative phonemes and counting numbers. In the auditory-perceptual judgment, the Vocal Deviation Scale (VSD) was used to verify the general degree of vocal deviation. Acoustic evaluation was performed using the PRAAT software and the parameters fundamental frequency (f0), jitter, shimmer, harmonium-to-noise ratio (HNR), Cepstral Peak Prominence Smoothed (CPPS), Acoustic Voice Quality Index (AVQI) and Acoustic Breathiness Index (ABI). To measure the aerodynamic measurements, the time of each emission was extracted in the Audacity program. Data were statistically analyzed using the Statistica for Windows software and normality was tested using the Shapiro-Wilk test. To compare the results, Student's and Wilcoxon's t tests were applied, adopting a significance level of 5%. Results There were no significant differences between the results of the JPA and the acoustic measures, in the pre and post inspiratory exercise moments. As for the aerodynamic measures, it was possible to observe a significant increase in the value of the TMF /s/ (p=0.008). Conclusion There was no change in vocal quality after the inspiratory exercise with stimulator and respiratory exerciser, but an increase in the MPT of the phoneme /s/ was observed after the exercise.

Rehabilitación pulmonar en adultos mayores con enfermedad pulmonar obstructiva crónica / Pulmonary rehabilitation in older adults with chronic obstructive pulmonary disease

RESUMEN Objetivo: Determinar la eficacia de una intervención en rehabilitación pulmonar en adultos mayores. Materiales y métodos: Estudio experimental clínico aleatorizado, contó con una participación de treinta y dos pacientes, distribuidos en un grupo intervención y control; se incluyeron pacientes con diagnóstico de EPOC confirmado a través de la prueba de espirometría forzada y se administró el cuestionario de aptitud para la actividad física (PAR-Q) siguiendo las recomendaciones internacionales. Resultados: El grupo intervención y control contó cada uno con la participación de 11 mujeres y 5 hombres, esto corresponde al 68 % [IC95% 51 -84] y el 32 % [IC95 % 15 -48], respectivamente, en su totalidad con una edad mínima de 60 años y máxima de 84 años; en los dos grupos intervenidos se emplearon pruebas de evaluación inicial; en la postintervención se evidencia cambios significativos en variables como la fuerza muscular respiratoria, metros recorridos y consumo de oxígeno indirecto, que muestra un valor de la P <0,05 estadísticamente significativa en cada uno de los grupos; sin embargo, la comparación entre grupos no muestra diferencias significativas. Lo anterior sugiere que cualquier intervención puede tener efectos similares en este tipo de pacientes. Conclusión: La rehabilitación pulmonar sigue generando efectos positivos, sin embargo, el estudio nos permitió identificar que la frecuencia con la que se realiza la intervención es fundamental en el tratamiento y su elección debe adaptarse de acuerdo a los objetivos que se desean alcanzar con el paciente.

ABSTRACT Objective: To determine the efficacy of a pulmonary rehabilitation intervention in older adults. Materials and methods: Randomized clinical experimental study with a participation of thirty-two patients distributed in an intervention and control group, including patients with a diagnosis of COPD confirmed through the forced spirometry test and administered the physical activity fitness questionnaire (PAR-OÍ) following international recommendations. Results: The intervention and control group each had the participation of 11 women and 5 men, this corresponds to 68% [IC9 5% 51 -84] and 32 % [IC95 % 15 -48], respectively, in their totality with a minimum age of 60 years and maximum age of 84 years; In the two intervened groups, initial evaluation tests were used; in the post-intervention, significant changes are evidenced in variables such as respiratory muscle strength, meters covered and indirect oxygen consumption, which shows a statistically significant P value <0.05 in each of the groups; however, the comparison between groups does not show significant differences, which suggests that any intervention can have similar effects in this type of patients. Conclusions: Pulmonary rehabilitation continues to generate positive effects, however, the study allowed us to identify that the frequency with which the intervention is performed is fundamental in the treatment and its choice must be adapted according to the objectives that are desired to be achieved with the patient.

Trastornos respiratorios del sueño en Insuficiencia Cardíaca con fracción de eyección reducida

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Introduction: Sleep-disordered breathing (SDB) are highly prevalent in patients with heart failure (HF). The presence of obstructive sleep apnea syndrome (OSA) determines a worse prognosis in these patients. There are questionnaires aimed at evaluating the probability of OSA, although none have been validated in patients with HF. The primary objective of this study was to establish the prevalence of SDB in a cohort of patients with HF and reduced ejection fraction (HFrEF) from the Multidisciplinary HF Unit (UMIC). As a secondary objective, to evaluate the usefulness of the Stop-Bang, Berlin, and 2ABN3M questionnaires for TRS screening in these patients. Methodology: Cross-sectional, observational study, including the active cohort of the UMIC, over 18 years with HFrEF, clinically stable and informed consent. Patients with cognitive, neurological or hearing impairment with limitations when conducting the interview were excluded. Patients with other limiting or uncontrolled sleep disorders, continuous home oxygen therapy requirements, did not enter the study. Berlin, Stop-Bang, and 2ABN3M questionnaires were administered, classifying the population into high-risk, intermediate-risk, and low-risk groups of presenting SDB. All patients underwent outpatient respiratory polygraphy (RP). Descriptive statistics were used to characterize demographic variables, measures of central tendency and dispersion. SPSS statistical software was used. Results: 387 patients were included, 248 men (64.1%), mean age was 63.5 ± 0.6 years. The etiology of HF was ischemic in 41.6% of patients. The body mass index was 29.3 ± 0.3 kg/m2. LVEF was 34.2 ± 0.5, pro-BNP 1233.8 ± 137.6 pg/ml. The results of the questionnaires showed that 52.1% (198) presented a high risk of SDB according to the Berlin questionnaire. With Stop-Bang, 35.9% (139) were high risk, 42.1% (163) intermediate risk, and the remaining 22% (85) low risk. With the 2ABN3M score, 62% (240) were high risk. A total of 156 respiratory polygraphs (40.3% of the population) were performed. The cut-off point to define the presence of sleep apnea was considered to be an AHI >15. 58.3% (91) of the patients presented TRS. Of these, 95% presented obstructive apnea and 5% central apnea with periodic Cheyne-Stokes breathing. A high percentage (26%) presented AHI greater than 30. The sensitivity of the Berlin and Stop-Bang questionnaires was 75.8% and 91.2%, respectively, with a specificity of 53.8% and 24.6%. Regarding the 2ABN3M score, a sensitivity of 71.4% and a specificity of 44.6% were observed. Conclusions: The prevalence of sleep-disordered breathing in patients with HFrEF was high in our cohort and obstructive apnea predominated. Given the high sensitivity (91.2%) of the Stop-Bang questionnaire found in our study, it could be useful as a screening tool for TRS in this type of patient. The importance of investigating this pathology whose clinical presentation can be non-specific and remain underdiagnosed is highlighted.

Introdução: Os distúrbios respiratórios do sono (DRS) são altamente prevalentes em pacientes com insuficiência cardíaca (IC). A presença da síndrome da apneia obstrutiva do sono (SAOS) determina pior prognóstico nesses pacientes. Existem questionários destinados a avaliar a probabilidade de AOS, porém nenhum foi validado em pacientes com IC. O objetivo primário deste estudo foi estabelecer a prevalência de DRS em uma coorte de pacientes com IC e fração de ejeção reduzida (ICFEr) da Unidade Multidisciplinar de IC (UMIC). Como objetivo secundário, avaliar a utilidade dos questionários Stop-Bang, Berlin e 2ABN3M para triagem de SRT nesses pacientes. Metodologia: Estudo transversal, observacional, inclui a coorte ativa da UMIC, maiores de 18 anos com ICFEr, clinicamente estável e consentimento informado. Foram excluídos pacientes com deficiência cognitiva, neurológica ou auditiva com limitações na realização da entrevista. Pacientes com outros distúrbios do sono limitantes ou descontrolados, requisitos de oxigenoterapia domiciliar contínua, não entraram no estudo. Os questionários Berlin, Stop-Bang e 2ABN3M foram aplicados, classificando a população em grupos de alto risco, risco intermediário e baixo risco de apresentar DRS. Todos os pacientes foram submetidos à poligrafia respiratória (PR) ambulatorial. A estatística descritiva foi utilizada para caracterizar as variáveis ​​demográficas, medidas de tendência central e dispersão. Foi utilizado o software estatístico SPSS. Resultados: foram incluídos 387 pacientes, 248 homens (64,1%), com idade média de 63,5 ± 0,6 anos. A etiologia da IC foi isquêmica em 41,6% dos pacientes. O índice de massa corporal foi de 29,3 ± 0,3 kg/m2. FEVE foi de 34,2 ± 0,5, pro-BNP 1233,8 ± 137,6 pg/ml. Os resultados dos questionários mostraram que 52,1% (198) apresentaram alto risco de DRS de acordo com o questionário de Berlim. Com Stop-Bang, 35,9% (139) eram de alto risco, 42,1% (163) de risco intermediário e os restantes 22% (85) de baixo risco. Com a pontuação 2ABN3M, 62% (240) eram de alto risco. Foram realizados 156 polígrafos respiratórios (40,3% da população). O ponto de corte para definir a presença de apneia do sono foi considerado um IAH >15. 58,3% (91) dos pacientes apresentaram SRT. Destes, 95% apresentavam apnéia obstrutiva e 5% apnéia central com respiração Cheyne-Stokes periódica. Uma alta porcentagem (26%) apresentou IAH maior que 30. A sensibilidade dos questionários Berlin e Stop-Bang foi de 75,8% e 91,2%, respectivamente, com especificidade de 53,8% e 24,6%. Em relação ao escore 2ABN3M, observou-se sensibilidade de 71,4% e especificidade de 44,6%. Conclusões: A prevalência de distúrbios respiratórios do sono em pacientes com ICFEr foi alta em nossa coorte, com predominância de apneias obstrutivas. Dada a alta sensibilidade (91,2%) do questionário Stop-Bang encontrado em nosso estudo, ele pode ser útil como uma ferramenta de triagem para ERT nesse tipo de paciente. Ressalta-se a importância da investigação dessa patologia cuja apresentação clínica pode ser inespecífica e permanecer subdiagnosticada.