Clinical and functional outcomes associated with pulmonary complications after coronary artery bypass grafting.

INTRODUCTION: Coronary artery bypass grafting(CABG) is a surgical treatment for coronary artery disease aiming at improving symptoms and life expectancy. Despite this, there are pulmonary and functional complications that may arise during the postoperative period due to invasive mechanical ventilation(IMV), cardiopulmonary bypass and immobility, leading to longer hospital stays. OBJECTIVE: To evaluate the clinical and functional outcomes related to pulmonary complications in the postoperative period of CABG. METHODS: Prospective cohort. During the ICU stay the patients were divided into: Non Complicated Group(NCG) who did not present complications and Complicated Group(CG) who presented complication. Functional variables were applied as the six-minute walk test(6MWT), gait speed, sit up and stand up test, Timed Up and Go, peripheral muscle strength, ventilatory, pulmonary function and Functional Independence Measure. These tests were applied preoperatively, at ICU discharge, hospital discharge and six months after surgery. RESULTS: The study evaluated 90 patients, 59 in the NCG and 31 CG. In the 6MWT there was a 2%(p = 0.43) decrease in the NCG, while the decrease was 13%(p < 0.01) in the CG. In the MRC the drop was 2%(p = < 0.01) in the CNG, while in the CG the drop was 14%(p = < 0.01). In MIP the NCG had a 6%(p = 0.67) decrease, while the CG had a 16%(p = < 0.01) decrease. CONCLUSION: Patients with postoperative complications of CABG may have reduced functional performance, muscle strength, and pulmonary function at hospital discharge and after six months.

Bronchodilator response assessment through impulse oscillometry system and spirometry in children and adolescents with cystic fibrosis / Avaliação da resposta broncodilatadora por meio do sistema de oscilometria de impulso e espirometria em crianças e adolescentes com fibrose cística

ABSTRACT Objective: To investigate the effect of bronchodilator on the respiratory mechanics and pulmonary function of children and adolescents with cystic fibrosis. Methods: Cross-sectional study on clinically stable children and adolescents with cystic fibrosis aged from six to 15 years. Participants underwent impulse oscillometry and spirometry evaluations before and 15 minutes after bronchodilator inhalation. The Kolmogorov-Smirnov test was applied to verify the sample distribution, and the Student's t-test and Wilcoxon test were used to compare the data before and after bronchodilator inhalation. Results: The study included 54 individuals with a mean age of 9.7±2.8 years. The analysis showed a statistically significant improvement in impulse oscillometry and spirometry parameters after bronchodilator inhalation. However, according to the American Thoracic Society (ATS) and European Respiratory Society (ERS) recommendations (2020 and 2021), this improvement was not sufficient to classify it as a bronchodilator response. Conclusions: The use of bronchodilator medication improved respiratory mechanics and pulmonary function parameters of children and adolescents with cystic fibrosis; however, most patients did not show bronchodilator response according to ATS/ERS recommendations.

RESUMO Objetivo: Investigar o efeito do broncodilatador na mecânica respiratória e função pulmonar de crianças e adolescentes com fibrose cística. Métodos: Estudo transversal em crianças e adolescentes com fibrose cística clinicamente estáveis, com idade entre seis e 15 anos. Os participantes realizaram avaliações por meio do sistema de oscilometria de impulso e espirometria antes e 15 minutos depois da inalação de broncodilatador. Foi aplicado o teste Kolmogorov-Smirnov para verificar a distribuição da amostra. Para comparar os dados antes e depois do broncodilatador foram utilizados os testes t de Student e Wilcoxon. Resultados: Participaram do estudo 54 indivíduos com média de idade de 9,7±2,8 anos. Houve melhora estatisticamente significativa nos parâmetros do oscilometria de impulso e espirometria após a inalação com broncodilatador. No entanto, de acordo com recomendações da American Thoracic Society (ATS) e European Respiratory Society (ERS) (2020 and 2021), essa melhora não foi suficiente para classificar como reposta broncodilatadora. Conclusões: O uso de medicamento broncodilatador melhorou a mecânica respiratória e função pulmonar de crianças e adolescentes com fibrose cística, no entanto a maioria da amostra não apresentou resposta ao broncodilatador de acordo com as recomendações da ATS/ERS.

Lung function is related to salivary cytokines and hormones in healthy children. An exploratory cross-sectional study.

Pulmonary mechanics has been traditionally viewed as determined by lung size and physical factors such as frictional forces and tissue viscoelastic properties, but few information exists regarding potential influences of cytokines and hormones on lung function. Concentrations of 28 cytokines and hormones were measured in saliva from clinically healthy scholar children, purposely selected to include a wide range of body mass index (BMI). Lung function was assessed by impulse oscillometry, spirometry, and diffusing capacity for carbon monoxide, and expressed as z-score or percent predicted. Ninety-six scholar children (55.2% female) were enrolled. Bivariate analysis showed that almost all lung function variables correlated with one or more cytokine or hormone, mainly in boys, but only some of them remained statistically significant in the multiple regression analyses. Thus, after adjusting by height, age, and BMI, salivary concentrations of granulocyte-macrophage colony-stimulating factor (GM-CSF) in boys were associated with zR5-R20 and reactance parameters (zX20, zFres, and zAX), while glucagon inversely correlated with resistances (zR5 and zR20). Thus, in physiological conditions, part of the mechanics of breathing might be influenced by some cytokines and hormones, including glucagon and GM-CSF. This endogenous influence is a novel concept that warrants in-depth characterization.

Reference value for the 6-min walking distance in women with systemic sclerosis considering the impact of muscle strength.

BACKGROUND: Early triage, the search for new therapies, and closer monitoring of patients with systemic sclerosis before their lung function irreversibly deteriorates are urgent concerns. Because it is an independent predictor of systemic sclerosis-related mortality, the 6-min walk test is a potentially useful tool to evaluate outcomes, along with pulmonary function and computed tomography. This study aimed to establish a reference value for the 6-min walking distance in women with diffuse cutaneous systemic sclerosis-associated interstitial lung disease that takes into account the effects of muscle and lung function. METHODS: This was a cross-sectional study in which 69 women with systemic sclerosis underwent the 6-min walk test, Health Assessment Questionnaire-Disability Index, pulmonary function, handgrip strength test, and quadriceps strength test. FINDINGS: The mean 6-min walking distance was 447 ± 78 m, and 43.5% of the participants did not reach 80% of their predicted value. 6-min walking distance correlated positively with quadriceps strength (r = 0.418, P = 0.0004), forced vital capacity (r = 0.306, P = 0.011), pulmonary diffusion (r = 0.360, P = 0.002), maximum inspiratory pressure (r = 0.268, P = 0.029), and maximum expiratory pressure (r = 0.288, P = 0.019) and negatively with age (r = -0.378, P = 0.001), body mass index (r = -0.248, P = 0.039), and Health Assessment Questionnaire-Disability Index (r = -0.438, P = 0.0001). In the multiple linear regression analysis, quadriceps strength, body mass index, pulmonary diffusion, age, and maximum expiratory pressure explained 72% of the 6-min walking distance variability. INTERPRETATION: Muscle function and, to a lesser extent, lung function are key contributors in determining the reference value for the 6-min walking distance in women with diffuse cutaneous systemic sclerosis-associated interstitial lung disease.

Inspiratory Muscle Training in Patients in the Postoperative Phase of Cardiac Surgery: A Systematic Review and Meta-Analysis.

To review the evidence about inspiratory muscle training (IMT) in patients in postoperative of cardiac surgery. We conducted this systematic review used the databases Ovid, LILACS, CINAHL, PubMed, PEDro, and CENTRAL. Randomized clinical trials that addressed IMT after cardiac surgery were selected. The outcomes assessed were maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), tidal volume (TV), peak expiratory flow (PEF), functional capacity (6-minute walk test) and length of hospital stay. The mean difference between groups and the respective 95% confidence interval (CI) were calculated and used to quantify the effect of continuous outcomes. Seven studies were selected. The IMT was superior to the control over MIP 15.77 cmH2O (95% CI, 5.95-25.49), MEP 15.87 cmH2O (95% CI, 1.16-30.58), PEF 40.98 L/min (95% CI, 4.64-77.32), TV 184.75 mL (95% CI, 19.72-349.77), hospital stay -1.25 days (95% CI, -1.77 to -0.72), but without impact on functional capacity 29.93 m (95% CI, -27.59 to 87.45). Based on the results presented, IMT was beneficial as a form of treatment for patients after cardiac surgery.

Pulmonary Evaluation of Post-COVID-19 Patients: An Ecuadorian Experience.

Background: Despite the growing concerns related to the potential of long-term pulmonary sequelae due to COVID-19, data about intermediate and long-term changes in the respiratory function of patients who recover is relatively sparse, particularly in developing countries. Objectives: To assess the characteristics and pulmonary function at follow-up in a sample of Ecuadorian patients that recovered from the virus. Methods: We conducted a cross-sectional study that included 43 patients after symptomatic COVID infection, who were evaluated by spirometry, single breath DLCO, and 6MWT. For statistical analysis we performed point biserial correlations, and chi squared tests. Results: Overall, 30.3% of patients (n = 13) reported persistent symptoms, with fatigue being the most common (23.3%, n = 10). Around 34.9% (n = 15) of the sample had a restrictive spirometry pattern, 18.6% (n = 8) had an abnormally decreased adjusted DLCO. A restrictive spirometry pattern was associated with an abnormally low adjusted DLCO (χ2(2) = 11,979, p = 0.001). Conclusion: We found that a considerable proportion of patients presented with persistent symptoms and alterations in pulmonary function following COVID-19, mainly a restrictive respiratory pattern and abnormally low DLCO. Further studies are needed to determine which patients may benefit from the follow-up with specific pulmonary function tests.

Gas Exchange Impairment During COVID-19 Recovery.

BACKGROUND: Persistent impairment of pulmonary function and exercise capacity has been known to last for months or even years in the survivors who recovered from other coronavirus pneumonia. Some reports showed that subjects with coronavirus disease 2019 pneumonia after being discharged could have several sequelae, but there are few studies on gas exchange and exercise capacity complications in these subjects. AIMS: To describe residual gas exchange abnormalities during recovery from coronavirus disease 2019 pneumonia. METHODS: In an observational study, ∼90 d after onset of disease, we scheduled almost 200 subjects for an out-patient visit with pulmonary function testing and computed tomography of the lungs. Lung mechanics by using body plethysmography, gas exchange with diffusing lung capacity for carbon monoxide determined by the single-breath technique (DLCOsb) and diffusing lung capacity for nitric oxide determined by the single-breath technique (DLNOsb), and exercise ability by using the 6-min walk test (6MWT) were measured in the subjects. The results were compared between those who required invasive mechanical ventilation and those who did not. RESULTS: A total of 171 subjects were included, the majority (96%) had signs of residual pneumonia (such as an excess of high attenuation areas) on computed tomography of the lungs. The DLCOSB results were below the lower limit of the normal range in 29.2% of the subjects; during the 6MWT, 67% experienced oxygen desaturation ([Formula: see text]) > 4%; and, in 81 (47%), the dropped below 88%. Subjects who required invasive mechanical ventilation (49.7%) were more likely to have lower lung volumes, more gas exchange abnormality, less exercise capacity and more radiologic abnormality. CONCLUSIONS: Subjects who recovered from severe COVID-19 pneumonia continued to have abnormal lung function and abnormal radiologic findings.

Recommendations for pulmonary function laboratories in the COVID-19 era / Recomendaciones para el laboratorio de función pulmonar en la era COVID-19

Abstract The airborne spread is the main route of human-to-human transmission of coronavirus, including he SARS CoV-2 virus causing the disease known as COVID-19. The implicit risk of aerosolization of SARS CoV-2 infective microdroplets while carrying out respiratory function tests has caused a significant limitation of activity in most Pulmonary Function Laboratories since the beginning of the pandemic. This document aims to update the recommendations for the management of Pulmonary Function Laboratories in the context of the COVID-19 outbreak in Argentina. New recommendations include ways to carry out pulmonary function testing during the context of a high and low community viral spread phase, the evaluation of post-COVID-19 patients, as well as several aspects of biosafety for patients and operators. Measures consist of promoting air circulation in the environment, the use of antimicrobial filters, the protection of airways and mucous membranes, and hand washing.

Resumen La diseminación aerógena del virus SARS CoV-2 es la principal forma de transmisión interhumana de este coronavirus causante de la enfermedad conocida como COVID-19. El riesgo implícito de la aerosolización de microgotas infectantes del SARS CoV-2 durante la ejecución de las pruebas funcionales respiratorias ha provocado una importante limitación de la actividad en la mayoría de los laboratorios de función pul monar desde el inicio de la pandemia. Este documento tiene por objetivo actualizar las recomendaciones para el manejo del laboratorio de función pulmonar en el contexto de la epidemia COVID-19 en Argentina. Se incorporan nuevas recomendaciones para realizar pruebas funcionales respiratorias en el contexto de una fase alta y baja de circulación viral comunitaria, para pacientes post COVID-19, así como para la bio seguridad de pacientes y operadores. Las medidas incluyen la ventilación del ambiente, el uso de filtros antimicrobianos, la protección de vía área y mucosas y el lavado de manos.

Recommendations for pulmonary function laboratories in the COVID-19 era.

The airborne spread is the main route of human-to-human transmission of coronavirus, including e SARS CoV-2 virus causing the disease known as COVID-19. The implicit risk of aerosolization of SARS CoV-2 infective microdroplets while carrying out respiratory function tests has caused a significant limitation of activity in most Pulmonary Function Laboratories since the beginning of the pandemic. This document aims to update the recommendations for the management of Pulmonary Function Laboratories in the context of the COVID-19 outbreak in Argentina. New recommendations include ways to carry out pulmonary function testing during the context of a high and low community viral spread phase, the evaluation of post-COVID-19 patients, as well as several aspects of biosafety for patients and operators. Measures consist of promoting air circulation in the environment, the use of antimicrobial filters, the protection of airways and mucous membranes, and hand washing.

La diseminación aerógena del virus SARS CoV-2 es la principal forma de transmisión interhumana de este coronavirus causante de la enfermedad conocida como COVID-19. El riesgo implícito de la aerosolización de microgotas infectantes del SARS CoV-2 durante la ejecución de las pruebas funcionales respiratorias ha provocado una importante limitación de la actividad en la mayoría de los laboratorios de función pulmonar desde el inicio de la pandemia. Este documento tiene por objetivo actualizar las recomendaciones para el manejo del laboratorio de función pulmonar en el contexto de la epidemia COVID-19 en Argentina. Se incorporan nuevas recomendaciones para realizar pruebas funcionales respiratorias en el contexto de una fase alta y baja de circulación viral comunitaria, para pacientes post COVID-19, así como para la bioseguridad de pacientes y operadores. Las medidas incluyen la ventilación del ambiente, el uso de filtros antimicrobianos, la protección de vía área y mucosas y el lavado de manos.

High-resolution CT pulmonary findings in children with severe asthma

Abstract Objective: To compare quantitative CT parameters between children with severe asthma and healthy subjects, correlating to their clinical features. Methods: We retrospectively analyzed CT data from 19 school-aged children (5-17 years) with severe asthma and 19 control school-aged children with pectus excavatum. The following CT parameters were evaluated: total lung volume (TLV), mean lung density (MLD), CT air trapping index (AT%) (attenuation ≤856 HU), airway wall thickness (AWT), and percentage of airway wall thickness (AWT%). Multi-detector computed tomography (MDCT) data were correlated to the following clinical parameters: forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), forced expiratory flow at 25-75% (FEF 25-75%), FEV1/FVC ratio, sputum and bronchoalveolar lavage analysis, serum IgE levels, and previous hospitalizations due to asthma. Results: Asthma patients presented higher mean values of AT% (23.8 ± 6.7% vs. controls, 9.7 ± 3.2%), AWT (1.46 ± 0.22 mm vs. controls, 0.47 ± −735 ± 28 HU vs. controls, −666 ± 19 HU). Mean AT% was 29.0 ± 4.7% in subjects with previous hospitalization against 19.2 ± 5.0% in those with no prior hospitalization (p < 0.001). AT% presented very strong negative correlations with FVC (r = −0.933, p < 0.001) and FEV1 (r = −0.841, p < 0.001) and a moderate correlation with FEF 25-75% (r = −0.608, p = 0.007). AT% correlation with FEV1/FVC ratio and serum IgE was weak (r = −0.184, p = 0.452, and r = −0.363, p = 0.202) Conclusion: Children with severe asthma present differences in quantitative chest CT scans compared to healthy controls with strong correlations with pulmonary function tests and previous hospitalizations due to asthma.

High-resolution CT pulmonary findings in children with severe asthma.

OBJECTIVE: To compare quantitative CT parameters between children with severe asthma and healthy subjects, correlating to their clinical features. METHODS: We retrospectively analyzed CT data from 19 school-aged children (5-17 years) with severe asthma and 19 control school-aged children with pectus excavatum. The following CT parameters were evaluated: total lung volume (TLV), mean lung density (MLD), CT air trapping index (AT%) (attenuation ≤856 HU), airway wall thickness (AWT), and percentage of airway wall thickness (AWT%). Multi-detector computed tomography (MDCT) data were correlated to the following clinical parameters: forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), forced expiratory flow at 25-75% (FEF 25-75%), FEV1/FVC ratio, sputum and bronchoalveolar lavage analysis, serum IgE levels, and previous hospitalizations due to asthma. RESULTS: Asthma patients presented higher mean values of AT% (23.8 ±â€¯6.7% vs. controls, 9.7 ±â€¯3.2%), AWT (1.46 ±â€¯0.22 mm vs. controls, 0.47 ±â€¯-735 ±â€¯28 HU vs. controls, -666 ±â€¯19 HU). Mean AT% was 29.0 ±â€¯4.7% in subjects with previous hospitalization against 19.2 ±â€¯5.0% in those with no prior hospitalization (p < 0.001). AT% presented very strong negative correlations with FVC (r = -0.933, p < 0.001) and FEV1 (r = -0.841, p < 0.001) and a moderate correlation with FEF 25-75% (r = -0.608, p = 0.007). AT% correlation with FEV1/FVC ratio and serum IgE was weak (r = -0.184, p = 0.452, and r = -0.363, p = 0.202) CONCLUSION: Children with severe asthma present differences in quantitative chest CT scans compared to healthy controls with strong correlations with pulmonary function tests and previous hospitalizations due to asthma.

Maximum Voluntary Ventilation and Its Relationship With Clinical Outcomes in Subjects With COPD.

BACKGROUND: Previous studies have reported that maximum voluntary ventilation (MVV) may be better associated with commonly used outcomes in COPD than FEV1 and may provide information on respiratory mechanics. In this study, we aimed to investigate the relationship between MVV and clinical outcomes in COPD and to verify whether MVV predicts these outcomes better than FEV1. METHODS: We conducted a cross-sectional study involving individuals with COPD. Lung function was assessed with spirometry; maximum inspiratory and expiratory pressures (PImax and PEmax, respectively) were assessed with manuvacuometry; and functional exercise capacity was assessed with the 6-min-walk test (6MWT). Dyspnea was assessed with the modified Medical Research Council (mMRC) scale; functional status was assessed with the modified Pulmonary Functional Status and Dyspnea Questionnaire (PFSDQ-m); and health status was assessed with the COPD Assessment Test (CAT). Correlations were verified with the Spearman coefficient, and stepwise multiple linear regression models investigated the predictors of clinical outcomes. RESULTS: Our study included 157 subjects: 82 males; median (interquartile range) age 66 (61-73) y; FEV1 46 (33-57) % predicted; 6MWT 86 (76-96) % predicted; PFSDQ-m total score 34 (14-57); and CAT total score 13 (7-19). Moderate correlations were found between MVV and PImax (r = 0.40), 6MWT (r = 0.50), mMRC (r = -0.56), and total scores on the PFSDQ-m (r = -0.40) and the CAT (r = -0.54). In the regression models, MVV was a predictor of almost all clinical outcomes, unlike FEV1. CONCLUSIONS: MVV correlates moderately with clinical outcomes commonly used in the evaluation of individuals with COPD, and MVV is a better predictor of respiratory muscle strength, functional exercise capacity, and patient-reported outcomes than FEV1.

Predictors of functional capacity as measured by the Glittre activities of daily living test in women with rheumatoid arthritis

Although pulmonary involvement is the most common extra-articular manifestation of rheumatoid arthritis (RA), traditional pulmonary function tests (PFTs) do not show a good correlation with the field tests usually performed in these patients. In recent decades, measurement of ventilation distribution heterogeneity through the nitrogen single-breath washout (N2SBW) test and evaluation of functional capacity during exercise using the Glittre activities of daily living test (GA-T) have been increasingly used. Therefore, the objective of this study was to evaluate predictors of GA-T outcomes in women with RA considering demographic, anthropometric, clinical, functional variables, and chest computed tomography (CT) findings. Forty-three women with RA underwent the GA-T, the N2SBW test, spirometry, measurement of the diffusing capacity for carbon monoxide (DLco), measurement of respiratory muscle strength, and evaluation of physical function of the lower and upper limbs through the Health Assessment Questionnaire Disability Index (HAQ-DI). Chest CT scans were analyzed retrospectively. The GA-T time showed significant correlations with the DLco (rs=-0.397, P=0.008), forced vital capacity/DLco (rs=0.307, P=0.044), phase III slope of the N2SBW test (SIIIN2, rs=0.644, P<0.0001), and the HAQ-DI (rs=0.482, P=0.001). Disease extent as assessed by chest CT was associated with the GA-T time. On multiple regression analysis, the SIIIN2 and HAQ-DI were the only predictors of the GA-T time, explaining 40% of its variability. Thus, ventilation distribution heterogeneity and worse physical function substantially explain the variability in GA-T time in women with RA and varying extents of disease on chest CT.

Diaphragm ultrasonography in adults with sickle cell anemia: evaluation of morphological and functional aspects.

OBJECTIVES: To assess morphological and functional aspects of the diaphragm by ultrasonography (US) in adults with sickle cell anemia (SCA) and evaluate if the diaphragmatic musculature can play a role in changes found in pulmonary function tests (PFTs) of these patients. METHODS: This is a cross-sectional observational and single-center study involving 40 adults with SCA who underwent diaphragm US and PFTs with a maximum of 1 month between the two tests. Diaphragm US was performed in B and M modes, and echogenicity, thickness and movement of the muscle was assessed in different respiratory maneuvers. RESULTS: Diaphragms had preserved echogenicity and the thickness was not significantly different between the groups. The SCA group exhibited significantly higher movement of the right hemidiaphragm during deep breathing (p = 0.004) and the sniff test (p = 0.0008) and lower movement of the left hemidiaphragm during quiet breathing (p = 0.009). There was a predominance of restrictive pattern (65%) and a global reduction in respiratory muscle strength (RMS) (70%). CONCLUSIONS: This study shows that adults with SCA had normal morphostructural aspects and absence of diaphragm dysfunction. Otherwise, they presented greater movement of the right hemidiaphragm during deep breathing and sniff test maneuvers. Despite the restrictive pattern and the reduction in RMS found in PFTs, the diaphragm of young adults with SCA did not have weakness or paralysis.

Sarcoidosis: Analysis of 24 cases

Sarcoidosis is a systemic granulomatous inflammatory disease of unknown etiology and variable incidence. For the purpose of de­scribing the clinical presentation of a group of patients diagnosed with sarcoidosis in a community hospital, we reviewed the medical records of patients whose diagnosis was consistent with sarcoidosis between 2007 and 2017. In this period, 24 patients were included and staged at presentation according to radiological data, showing that 75% were Stage I, 5% stage II, 10% stage III, and 10% stage IV. 60% of patients were treated. This study describes the patients' characteristics with the aim of helping to identify this entity and optimize early diagnosis and treatment.

Cross-Sectional Study on the Association between Pulmonary Function and Sarcopenia in Brazilian Community-Dwelling Elderly from the Amazon Region.

OBJECTIVES: To compare the obtained and expected values of pulmonary function variables between sarcopenic and non-sarcopenic elderly; verify the association between the pulmonary function and the indicators and diagnosis of sarcopenia; and establish cut-off points for pulmonary function variables to predict sarcopenia. DESIGN: Cross-sectional study. LOCATION: Macapá, Brazil. PARTICIPANTS: community-dwelling elderly ≥ 60 years old (n=383), both sexes. MEASURES: Were evaluated according to variables of pulmonary function (spirometry) and sarcopenia, according to the EWGSOP consensus. The association between pulmonary function and sarcopenia was performed using logistic regression and cut-off points established from the ROC Curve. RESULTS: The prevalence of sarcopenia was 12.53% (n = 48). Sarcopenic individuals had significantly lower mean values for FVC, FEV1, FEF25-75% and PEF than non-sarcopenic. After adjustment, spirometric variables were inversely associated with sarcopenia (the increase by one unit of liter in FVC, FEV1 and FEF25-75% decreased the probability of sarcopenia by 59%, 67% and 39%, respectively), and the majority of these variables with the muscular strength indicator. Cut-off points, for elderly men and women, were discriminant criteria for the presence of sarcopenia: FVC (≤2.52 L and ≤1.82 L), FEV1 (≤2.1 L and ≤1.39 L), PEF (≤3.45 L/s and ≤2.93 L/s) and FEF5-75% (≤1.97 L/s and ≤1.74 L/s). CONCLUSIONS: There was loss of pulmonary function in sarcopenic elderly patients and an inverse association with the diagnosis of sarcopenia and its indicators. Cut-off points of pulmonary function variables can be used as a useful tool to discriminate sarcopenia.

[Follow-up of patients after COVID-19 pneumonia. Pulmonary sequelae]. / Seguimiento de los pacientes después de neumonía por COVID-19. Secuelas pulmonares.

Coronavirus disease 2019 (COVID-19) is an infection caused by SARS-CoV-2 that has caused an unprecedented pandemic with a high rate of morbidity and mortality worldwide. Although most cases are mild, there are a considerable number of patients who develop pneumonia or even acute respiratory distress syndrome (ARDS). After having recovered from the initial disease, many patients continue with various symptoms (fatigue, dry cough, fever, dyspnea, anosmia, and chest pain, among others.), which has led to consider the possible existence of "post-COVID-19 syndrome". Although the definition and validity of this syndrome are not clear yet, several studies report that individuals who have recovered from COVID-19 may have persistent symptoms, radiological abnormalities, and compromised respiratory function. Current evidence suggests that there is a large number of pulmonary sequelae after COVID-19 pneumonia (interstitial thickening, ground glass opacities, crazy paving pattern, and bronchiectasis, among others.). Likewise, it seems that pulmonary function tests (spirometry, DLCO, 6MWT, and measurement of maximum respiratory pressures), in addition to high-resolution computed axial tomographies (CAT scan), are useful for the assessment of these post-COVID-19 pulmonary sequelae. This review aims to describe the possible pulmonary sequelae after COVID-19 pneumonia, as well as to suggest diagnostic procedures for their correct assessment and follow-up; thus, allowing proper management by a multidisciplinary medical team.

COVID-19 es la enfermedad causada por el virus SARS-CoV-2, la cual ha ocasionado una pandemia sin precedentes, con gran cantidad de infectados y muertos en el mundo. Aunque la mayoría de los casos son leves, existe una cantidad considerable de pacientes que desarrollan neumonía o, incluso, síndrome de distrés respiratorio agudo (SDRA). Luego de recuperarse del cuadro inicial, muchos pacientes continúan con diversos síntomas (fatiga, tos seca, fiebre, disnea, anosmia, dolor torácico, entre otras), lo que ha llevado a considerar la posible existencia del "síndrome pos-COVID-19". Aunque la definición y validez de este síndrome aún no son claras, varios estudios reportan que los individuos recuperados de la COVID-19 pueden tener persistencia de síntomas, anormalidades radiológicas y compromiso en la función respiratoria. La evidencia actual sugiere que existe gran cantidad de secuelas pulmonares despues de una neumonía por COVID-19 (engrosamiento intersticial, infiltrado en vidrio esmerilado, patrón en empedrado, bronquiectasias, entre otras.). De igual forma, parece ser que las pruebas de función pulmonar (espirometría, prueba de difusión pulmonar de monóxido de carbono, prueba de caminata de seis minutos y la medición de las presiones respiratorias máximas), además de la tomografía axial computarizada de alta resolución, son útiles para evaluar las secuelas pulmonares pos-COVID-19. En esta revisión se pretende describir las posibles secuelas a nivel pulmonar posteriores a neumonía por COVID-19, así como sugerir procedimientos diagnósticos para su correcta evaluación y seguimiento, que permitan el manejo adecuado por parte de un equipo médico multidisciplinario.