Intramuscular Gluteoplasty: A Comparative Study between Different Incisional Access Routes.

BACKGROUND: Silicone implants have been used to improve volume and body contour in buttocks for almost 45 years. Although the intramuscular plane continues to be the standard, surgeons still diverge on the best incision technique: using a vertical incision, and thus without the preservation of the intergluteal groove, or preserving this area through a triangular dissection. The goal of this research study was to evaluate and compare these techniques of intramuscular augmentation gluteoplasty. METHODS: Two randomized groups were formed with 53 patients in each group. One of the groups underwent intramuscular gluteoplasty with a vertical incision in the intergluteal groove, and therefore without the preservation of said intergluteal groove (group A). In the other group, intramuscular gluteoplasty was performed using a triangular dissection, thus preserving the intergluteal groove (group B). The groups were compared in relation to the incidence of complications (ie, dehiscence, hematoma, seroma, and infection). RESULTS: A total of 7.5% of patients in group A presented dehiscence and 1.9% presented seroma. In group B, however, 28.3% of patients presented dehiscence and 7.5% presented seroma and dehiscence during the first 21 days after surgery. No patient had hematoma or infection in either group. CONCLUSION: In the comparison between the groups of patients, the technique with a vertical incision in the intergluteal groove showed a lower number of surgical wounds, dehiscences, and seromas when compared with the technique that preserves the intergluteal groove. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Corrigendum: The effects of COVID-19 on the placenta during pregnancy.

[This corrects the article DOI: 10.3389/fimmu.2021.743022.].

The Effects of COVID-19 on the Placenta During Pregnancy.

Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a global pandemic. The virus primarily affects the lungs where it induces respiratory distress syndrome ranging from mild to acute, however, there is a growing body of evidence supporting its negative effects on other system organs that also carry the ACE2 receptor, such as the placenta. The majority of newborns delivered from SARS-CoV-2 positive mothers test negative following delivery, suggesting that there are protective mechanisms within the placenta. There appears to be a higher incidence of pregnancy-related complications in SARS-CoV-2 positive mothers, such as miscarriage, restricted fetal growth, or still-birth. In this review, we discuss the pathobiology of COVID-19 maternal infection and the potential adverse effects associated with viral infection, and the possibility of transplacental transmission.

Long-term pulmonary rehabilitation progressively reduces hospitalizations and mortality in patients with severe COPD: a 5-year follow-up.

BACKGROUND: Pulmonary rehabilitation (PR) is recognized as a multidisciplinary intervention designed to reduce symptoms, improve functional status, and prevent acute exacerbations in patients with chronic obstructive pulmonary disease (COPD). AIM: This study was aimed at evaluating the effects of a long-term PR program on the hospitalization rate and mortality of patients with severe and very severe COPD. DESIGN: Longitudinal, prospective study. SETTING: Pulmonary rehabilitation program at our institution. POPULATION: A cohort of 195 patients undergoing a PR program was followed up for 5 years. They were divided into three groups: control (PR<3 months), partial adherence (PR>6 and ≤18 months) and adherence (PR=24 months). METHODS: This was a prospective study where All patients were evaluated every 6 months (D0, D6, D12, D18 and D24, and mapped annually concerning hospitalizations and mortality). Data were analyzed by medians and interquartile ranges, and Kruskal-Wallis non-parametric comparative tests were applied. Comparisons of time to first admission and time to death were made using the Kaplan-Meier estimators, and the factors associated with these outcomes were modeled using semi-parametric Cox models. RESULTS: The results demonstrated a significant reduction in the rate of hospitalization and mortality. The protective effect seems to be dependent on the lengths of stay of patients in the PR program. CONCLUSIONS: A multi-disciplinary, long-term PR program with individually tailored 96-week supervised interventions, reduces hospitalization rates and mortality in patients with severe and very severe COPD in a 5-year follow-up period. This protective effect on hospitalization and mortality is obtained from at least 18 months of intervention. Patients who stay longer in the PR program appear to experience a longer protective effect at the end of treatment. CLINICAL REHABILITATION IMPACT: This long-term PR program for patients with severe and very severe COPD produced progressively favorable clinical effects, thus reducing the frequency of hospitalizations and mortality in this population.

Airway Clearance Techniques for Mechanically Ventilated Patients: Insights for Optimization.

Secretion management in mechanically ventilated patients is a paramount task for clinicians. A better understanding of the mechanisms of flow bias and airway dynamic compression during airway clearance therapy may enable a more effective approach for this population. Ventilator hyperinflation, expiratory rib cage compression, a PEEP-ZEEP maneuver, and mechanical insufflation-exsufflation are examples of techniques that can be optimized according to such mechanisms. In addition, novel technologies, such as electric impedance tomography, may help improve airway clearance therapy by monitoring the consequences of regional secretion displacement on lung aeration and regional lung mechanics.

Predictive models for the six-minute walk test considering the walking course and physical activity level.

BACKGROUND: In recent decades, space limitations in the clinical environment have forced health professionals to administer the six-minute walk test (6MWT) using a 20-m or even a 10-m course. However, course length and physical activity level (PAL) affect the test outcomes. AIM: To develop a reference equation for the 6MWT that takes into account the effects of course length and PAL on the walking distance. DESIGN: Cross-sectional study. SETTING: Federal University of the State of Rio de Janeiro. POPULATION: Two hundred fifteen healthy adults. METHODS: All subjects performed the 6MWT on 10-, 20- and 30-m courses. Eight regression models were constructed considering the association between the six-minute walking distance (6MWD) and heart rate, perceived effort (scores from the Borg's Perceived Exertion Scale-BPES), PAL (classification according to the International Physical Activity Questionnaire, IPAQ), as well as anthropometric and demographic variables. The models were analyzed for the coefficients of determination (R2) and statistical significance at P<0.05. RESULTS: A nonlinear increase in the means of the 6MWDs obtained using the three course lengths was observed (591±70, 652±79 and 678±85 m for course lengths of 10, 20 and 30 m, respectively, with P<0.001). The 6MWD correlated positively with the following variables: sex (r=0.20), body height (r=0.30), IPAQ classification (r=0.14), ΔBPES rating (r=0.25) and Δheart rate (HR, r=0.23), with P<0.001 for all. In contrast, the 6MWD correlated negatively with age (r=-0.23) and Body Mass Index (BMI, r=-0.18), with P<0.001 for both. The regression model with the highest coefficient of determination (adjusted R2=0.36) included the following variables: sex, age, BMI, course length (CL), BPES, HR, and IPAQ. CONCLUSIONS: The length of the course strongly impacts individual performance on the 6MWT in a predominantly young adult population. Furthermore, IPAQ-assessed PAL is an important independent predictor of 6MWD. CLINICAL REHABILITATION IMPACT: The incorporation of course length in the prediction of 6MWD allows the use of a prediction equation that includes the effects of different course sizes. PAL should be used in the prediction of 6MWD.

Chilean version of the Functional Status Score for the Intensive Care Unit: a translation and cross-cultural adaptation. / Versión chilena de la Functional Status Score for the Intensive Care Unit: traducción y adaptación transcultural.

BACKGROUND: The Functional Status Score for the Intensive Care Unit (FSS-ICU) is a valid and reliable instrument to measure physical functioning in the intensive care unit setting. Translation and cross-cultural adaptation in Chile has not been published for the FSS-ICU. AIM: To translate and cross-culturally adapt all associated documents of the original FSS-ICU for Chile. METHOD: The Spanish version of FSS-ICU, available at www.ImproveLTO.com, was used as the starting point. This version was previously translated, with the original FSS-ICU developers, following established guidelines for this process. The Chilean pocket card version was newly developed based on the English version at www.ImproveLTO.com. Cognitive interviews were conducted for the adaptation of the FSS-ICU and pocket card version to assess understanding of relevant stakeholders (i.e., Chilean intensive care unit physiotherapists). Adaptations to the translation were made when agreement among the physiotherapists was less than 80%. RESULTS: Cognitive interviews of the Chilean FSS-ICU (85 items) and pocket card version (18 items) were performed with 30 Chilean physiotherapists from 18 hospitals (14 public and 4 private). During the interviews, modest adaptations mainly made in the general guidelines and specific instructions for three items of the FSS-ICU and two items of the pocket card. Finally, the frequently asked questions, pocket card and full version of the FSS-ICU were developed. The original developers accepted all adaptations. CONCLUSIONS: The Chilean version of the FSS-ICU was easy to understand by the physiotherapists. The FSS-ICU is freely available for non-commercial clinical and research use by Chilean Spanish-speakers.

INTRODUCCIÓN: La Functional Status Score for the Intensive Care Unit (FSS-ICU) es un instrumento válido y confiable para medir funcionamiento físico en unidades de cuidados intensivos. Sin embargo, la traducción y adaptación trans-cultural de la FSS-ICU en Chile no ha sido publicada. OBJETIVO: Traducir y adaptar transculturalmente todos los documentos asociados de la FSS-ICU original para Chile. MÉTODO: Se utilizó como punto de partida la versión en español de la FSS-ICU, disponible en www.ImproveLTO.com. Esta versión se tradujo previamente junto a los desarrolladores originales de la FSS-ICU, siguiendo las recomendaciones establecidas para este proceso. La versión de bolsillo chilena se desarrolló recientemente en base a la versión original en inglés. Se realizaron entrevistas cognitivas a kinesiólogos de la unidad de cuidados intensivos para evaluar la comprensión de la FSS-ICU y versión de bolsillo. Las adaptaciones se realizaron cuando el acuerdo entre los kinesiólogos fue inferior al 80%. RESULTADOS: Se realizaron las entrevistas cognitivas de la FSS-ICU en español (85 ítems) y versión de bolsillo (18 ítems) en 30 kinesiólogos chilenos provenientes de 18 diferentes hospitales (14 públicos y 4 privados). Durante las entrevistas se realizaron adaptaciones principalmente en las guías generales e instrucciones específicas para tres ítems de la FSS-ICU y dos ítems de la versión de bolsillo. Finalmente, se desarrollaron las preguntas frecuentes, la versión de bolsillo y la versión completa de la FSS-ICU. Todas las adaptaciones fueron aceptadas por los desarrolladores originales. CONCLUSIONES: La versión chilena de la FSS-ICU fue fácil de entender por los kinesiólogos. La FSS-ICU está disponible gratis para uso clínico e investigación no comercial en Chile.

Selecting the best ventilator hyperinflation technique based on physiologic markers: A randomized controlled crossover study.

BACKGROUND: Ventilator hyperinflation (VHI) is effective in improving respiratory mechanics, secretion removal, and gas exchange in mechanically ventilated subjects; however, there are no recommendations for the best ventilator settings to perform the technique. OBJECTIVE: To compare six modes of VHI, concerning physiological markers of efficacy and safety criteria to support the selection of optimal settings. METHODS: Thirty mechanically ventilated patients underwent six modes of VHI in a randomized order. The delivered volume, expiratory flow bias criteria, overdistension, patient-ventilator asynchronies and hemodynamic variables were assessed during the interventions. RESULTS: Volume-controlled ventilation with inspiratory flow of 20 lpm (VC-CMV20) and pressure support ventilation (PSV) achieved the best effectiveness scores (P < 0.05). The target peak pressure of 40 cmH2O was associated with a high incidence of overdistension. PSV showed a lower incidence of patient-ventilator asynchronies. CONCLUSIONS: The modes VC-CMV20 and PSV are the most effective for VHI. Alveolar overdistension and patient-ventilator asynchronies must be considered when applying VHI.

Heart rate response and recovery in wheelchair tetraplegic rugby athletes: a pilot study.

BACKGROUND: Subjects with spinal cord injuries (SCI) have impaired autonomic cardiac regulation and increased risk of cardiovascular disease. In face of the insufficient research data on the autonomic control of physically active subjects with SCI, this study aimed at describing the chronotropic response, as well as the heart rate recovery behavior of a cohort of elite wheelchair rugby athletes. METHODS: This is a cross-sectional study including a convenience sample of 17 elite wheelchair rugby athletes with tetraplegia. The subjects underwent a maximal arm ergometry exercise test. Heart rate (HR) was computed at five time points: at rest (before the test), peak exercise, and 1, 2, and 3 minutes after exercise. Data distribution was assessed by using the Shapiro-Wilk Test and correlations were measured by Pearson's correlation coefficient. The level of statistical significance was set at P<0.05. RESULTS: The subjects presented with HR at rest=69.53±8.3 bpm; HR reserve=66.9±8.3%; Chronotropic Index=47.9±11.8%; HRR at 1'=15.2±7.5 bpm; HRR at 2'=25.2±7.4 bpm; HRR at 3'=37±8.4 bpm. 82.3% of the athletes had HRR at 1'>12 bpm, and 64.7% had HRR at 2"> 22 bpm. There were associations between duration of injury and HRR at 1' (r=-0.5; P=0.0398), peak HR (HRpeak) and total weekly training time (r=-0.591; P=0.0125) and HRpeak and weekly physical training time (r=-0.519; P=0.032). CONCLUSIONS: Tetraplegic elite athletes present with reduced chronotropic response. Most of them exhibit an HRR within the values considered normal for the general population.

Determination of functional prognosis in hospitalized patients following an intensive care admission.

AIM: To investigate the factors associated with the functional progress of hospitalized patients following an intensive care admission. METHODS: Retrospective study including data from a cohort of 198 hospitalized patients following an intensive care admission and not requiring mechanical ventilation in a single tertiary referral hospital. A generalized linear model was used to identify the main effects of clinical and demographic variables on the outcomes of functionality (KATZ Index of Independence in Activities of Daily Living) and muscle strength (MRC Scale). The covariates identified as independent predictors were analysed using the receiver operating characteristic curves. The analysis differentiated the periods in the intensive care unit (ICU), in the Ward (WARD) and the total time of hospital stay (TOT). RESULTS: Considering the functional outcome (ΔKATZ), the variables that significantly contributed to the model (P < 0.05) were the KATZ and MRC on admission, age, sepsis (no), and total length of stay (TLS). Regarding the muscle strength outcome model (ΔMRC), the predictors were MRC on admission, Simplified Acute Physiology Score III, previous stroke, TLS, and sex (female). The variable age (AUC = 0.664) discriminated the ΔKATZICU. The variables age (AUC = 0.712), KATZ in ICU (AUC = 0.590) and on ward admission (AUC = 0.746), and MRC on ward admission (AUC = 0.721) were discriminative for ΔKATZWARD. For ΔKATZTOT the variables KATZ on ICU admission (AUC = 0.621) and TLS (AUC = 0.617) were discriminative. For ΔMRCICU the variables SAPSIII (AUC = 0.661) and MRC on ICU admission (AUC = 0.653) were discriminative. MRC on ICU (AUC = 0.681) and ward admission (AUC = 0.553) were discriminative for ΔMRCWARD. TLS (AUC = 0.649) and MRC on ward admission (AUC = 0.696) discriminative for the ΔMRCTOT. CONCLUSION: Specific functional, clinical and demographical variables at ICU admission are associated with the functional prognosis during the hospitalization period.

Currents issues in cardiorespiratory care of patients with post-polio syndrome.

METHOD: A search for papers was made in the databases Bireme, Scielo and Pubmed with the following keywords: post polio syndrome, cardiorespiratory and rehabilitation in English, French and Spanish languages. Although we targeted only seek current studies on the topic in question, only the relevant (double-blind, randomized-controlled and consensus articles) were considered. RESULTS AND DISCUSSION: Certain features of PPS such as generalized fatigue, generalized and specific muscle weakness, joint and/or muscle pain may result in physical inactivity deconditioning obesity and dyslipidemia. Respiratory difficulties are common and may result in hypoxemia. CONCLUSION: Only when evaluated and treated promptly, somE patients can obtain the full benefits of the use of respiratory muscles aids as far as quality of life is concerned.

Currents issues in cardiorespiratory care of patients with post-polio syndrome / Tópicos atuais no tratamento cardiorrespiratório de pacientes com síndrome pós-poliomielite

ABSTRACT Post-polio syndrome (PPS) is a condition that affects polio survivors years after recovery from an initial acute attack of the poliomyelitis virus. Most often, polio survivors experience a gradual new weakening in muscles that were previously affected by the polio infection. The actual incidence of cardiovascular diseases (CVDs) in individuals suffering from PPS is not known. However, there is a reason to suspect that individuals with PPS might be at increased risk. Method A search for papers was made in the databases Bireme, Scielo and Pubmed with the following keywords: post polio syndrome, cardiorespiratory and rehabilitation in English, French and Spanish languages. Although we targeted only seek current studies on the topic in question, only the relevant (double-blind, randomized-controlled and consensus articles) were considered. Results and Discussion Certain features of PPS such as generalized fatigue, generalized and specific muscle weakness, joint and/or muscle pain may result in physical inactivity deconditioning obesity and dyslipidemia. Respiratory difficulties are common and may result in hypoxemia. Conclusion Only when evaluated and treated promptly, somE patients can obtain the full benefits of the use of respiratory muscles aids as far as quality of life is concerned.

RESUMO Síndrome pós-polio (SPP) é uma condição que afeta sobreviventes da poliomielite aguda (PAA), anos após a recuperação de um ataque agudo inicial do vírus. Na maioria das vezes, os sobreviventes da polio começam a apresentar nova paresia gradual nos músculos que foram previamente afetados pela infecção. A incidência real de doenças cardiovasculares (DCV) em indivíduos que sofrem de SPP não é conhecida. Entretanto, há indícios para suspeitar de que sujeitos com SPP podem estar em maior risco. Método Realizou-se uma busca de artigos nas bases de dados: Bireme, Scielo e Pubmed, utilizando as seguintes palavras-chave: síndrome pós-poliomielite, função cardiorrespiratória e reabilitação, nos idiomas Inglês, Francês e Espanhol. Embora tenhamos selecionado um número expressivo de artigos, somente foram considerados os duplo-cegos, randomizados-controlados, além de consensos. Resultados e Discussão Certas características da SPP, tais como fadiga muscular, paresia, dor muscular e/ou articulares podem resultar em descondicionamento por inatividade física, além de obesidade e dislipidemia. Dificuldades respiratórias são comuns e podem resultar em hipoxemia. Conclusão Somente quando avaliados e tratados em tempo hábil, alguns pacientes são capazes de obter os benefícios do uso dos músculos respiratórios auxiliares em termos de qualidade de vida.

Lower limb muscle strength is associated with functional performance and quality of life in patients with systemic sclerosis

Background: Complaints of peripheral muscle weakness are quite common in patients with systemic sclerosis (SSc). It is likely that the muscle impairments may reduce the patients' exercise performance, which in turn may decrease their functional capacity and exert a direct impact on their quality of life. Objectives: To assess the peripheral and respiratory muscle strength in individuals with SSc and to investigate their correlation with the 6-min walk distance (6MWD) and quality of life measurements. Moreover, we aimed to characterize their nutritional status, pulmonary function, functional capacity, and quality of life compared to the controls. Method: The present cross-sectional study included 20 patients with SSc and 20 control subjects. All of the participants were subjected to isometric dynamometry, surface electromyography, bioelectrical impedance analysis, pulmonary function testing, and the 6-min walk test. Patients with SSc also responded to the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and the Health Assessment Questionnaire Disability Index (HAQ-DI). Results: The individuals with SSc exhibited a reduction in quadriceps strength (p=0.0001), increased quadriceps fatigability (p=0.034), impaired pulmonary function, and a reduced 6MWD (p=0.0001) compared to the controls. Quadriceps strength was significantly correlated with the 6MWD (Rho=0.719; p=0.0004) and the HAQ-DI (Rho=-0.622; p=0.003). We also found significant correlations between quadriceps fatigability and maximal inspiratory (Rho=0.684; p=0.0009) and maximal expiratory (Rho=0.472; p=0.035) pressure. Conclusions: Patients with SSc exhibited reduced respiratory muscle and quadriceps strength and an increase in its fatigability. In these individuals, there was a relationship between quadriceps strength, functional capacity, and quality of life. .

Lower limb muscle strength is associated with functional performance and quality of life in patients with systemic sclerosis.

BACKGROUND: Complaints of peripheral muscle weakness are quite common in patients with systemic sclerosis (SSc). It is likely that the muscle impairments may reduce the patients' exercise performance, which in turn may decrease their functional capacity and exert a direct impact on their quality of life. OBJECTIVES: To assess the peripheral and respiratory muscle strength in individuals with SSc and to investigate their correlation with the 6-min walk distance (6 MWD) and quality of life measurements. Moreover, we aimed to characterize their nutritional status, pulmonary function, functional capacity, and quality of life compared to the controls. METHOD: The present cross-sectional study included 20 patients with SSc and 20 control subjects. All of the participants were subjected to isometric dynamometry, surface electromyography, bioelectrical impedance analysis, pulmonary function testing, and the 6-min walk test. Patients with SSc also responded to the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and the Health Assessment Questionnaire Disability Index (HAQ-DI). RESULTS: The individuals with SSc exhibited a reduction in quadriceps strength (p=0.0001), increased quadriceps fatigability (p=0.034), impaired pulmonary function, and a reduced 6 MWD (p=0.0001) compared to the controls. Quadriceps strength was significantly correlated with the 6 MWD (Rho=0.719; p=0.0004) and the HAQ-DI (Rho=-0.622; p=0.003). We also found significant correlations between quadriceps fatigability and maximal inspiratory (Rho=0.684; p=0.0009) and maximal expiratory (Rho=0.472; p=0.035) pressure. CONCLUSIONS: Patients with SSc exhibited reduced respiratory muscle and quadriceps strength and an increase in its fatigability. In these individuals, there was a relationship between quadriceps strength, functional capacity, and quality of life.

The six-minute walk distance is a marker of hemodynamic-related functional capacity in hypertension: a case-control study.

This study investigated the association between hemodynamic variables and the 6-minute walk distance (6MWD) in adults with and without hypertension and explored the role of hemodynamic variables as predictors of 6MWD. Patients undergoing antihypertensive medication therapy (n=41) and sex-matched healthy subjects (n=41) were evaluated for their clinical status and cardiovascular risk factors. Two 6-minute walk tests were performed along an 18-m corridor with a 30-minute rest interval. The intraclass correlation (ICC) was high among patients (ICC=0.984 (0.965; 0.992), P<0.001) and controls (ICC=0.987 (0.832; 0.996), P<0.001). The patients presented 6MWD values that were significantly lower than those of healthy controls (338.8±112.8 vs. 388.0±66.7 m, P=0.010). In patients, the 6MWD was significantly and positively correlated with sex (0.737; P<0.001), height (0.502; P<0.001) and weight (0.303; P=0.027). In addition, negative and significant correlations were observed between 6MWD and the mean (-0.577; P<0.001), systolic (-0.521; P<0.001), diastolic (-0.505; P=0.001) and pulse (-0.353; P=0.015) pressures after simultaneous adjustment for age, body height and weight. The same behavior was observed in healthy controls (except for pulse pressure), albeit with lower correlation values. A regression model with sex, age, height and weight explained 52.2% (P<0.001) of the variance. The highest explained variance in patients (64.8%; P<0.001) and controls (56.5%; P<0.001) was observed after replacing the body weight with mean pressure in the model. The 6MWD is inversely associated with hemodynamic variables in both groups and is lower in patients with hypertension compared with healthy controls. Hemodynamic variables, particularly the mean pressure, should be included in prediction equations for 6MWD.

Expiratory rib cage Compression in mechanically ventilated subjects: a randomized crossover trial [corrected].

BACKGROUND: Expiratory rib cage compression (ERCC) has been empirically used by physiotherapists with the rationale of improving expiratory flows and therefore the airway clearance in mechanically ventilated patients. This study evaluates the acute mechanical effects and sputum clearance of an ERCC protocol in ventilated patients with pulmonary infection. METHODS: In a randomized crossover study, sputum production and respiratory mechanics were evaluated in 20 mechanically ventilated subjects submitted to 2 interventions. ERCC intervention consisted of a series of manual bilateral ERCCs, followed by a hyperinflation maneuver. Control intervention (CTRL) followed the same sequence, but instead of the compressive maneuver, the subjects were kept on normal ventilation. Static (Cst) and effective (C(eff)) compliance and total (R(tot)) and initial (R(init)) resistance of the respiratory system were measured pre-ERCC (baseline), post-ERCC or CTRL (POST1), and post-hyperinflation (POST2). Peak expiratory flow (PEF) and the flow at 30% of the expiratory tidal volume (flow 30% VT) were measured during the maneuver. RESULTS: ERCC cleared 34.4% more secretions than CTRL (1 [0.5-1.95] vs 2 [1-3.25], P < .01). Respiratory mechanics showed no differences between control and experimental intervention in POST1 for Cst, Ceff, R(tot), and R(init). In POST2, ERCC promoted an increase in Cst (38.7 ± 10.3 vs 42.2 ± 12 mL/cm H2O, P = .03) and in C(eff) (32.6 ± 9.1 vs 34.8 ± 9.4 mL/cm H2O, P = .04). During ERCC, PEF increased by 16.2 L/min (P < .001), and flow 30% VT increased by 25.3 L/min (P < .001) compared with CTRL. Six subjects (30%) presented expiratory flow limitation (EFL) during ERCC. The effect size was small for secretion volume (0.2), Cst (0.15), and C(eff) (0.12) and negligible for R(tot) (0.04) and R(init) (0.04). CONCLUSIONS: Although ERCC increases expiratory flow, it has no clinically relevant effects from improving the sputum production and respiratory mechanics in hypersecretive mechanically ventilated patients. The maneuver can cause EFL in some patients. (ClinicalTrials.gov registration NCT01525121).

Relationship between body balance, lung function, nutritional status and functional capacity in adults with cystic fibrosis

BACKGROUND: Cystic fibrosis (CF) is a hereditary condition in which lung disease affects all patients. In addition to pulmonary involvement, the multisystemic components of CF cause significant physical limitations. However, the impact of lung function on balance control in CF has not been studied. OBJECTIVE: To assess body balance in adults with CF and to test its possible associations with lung function, nutritional status, and functional capacity. METHOD: This was a cross-sectional study in which 14 adults with CF underwent pulmonary function testing (spirometry, body plethysmography, and carbon monoxide diffusing capacity (DLco), respiratory muscle strength, 6-min walking distance (6MWD), Berg balance scale (BBS), nutritional analysis (body mass index and bioelectrical impedance), and stabilometry. Body balance was quantified using stabilometry; all participants performed the following two trials: opened base, eyes open (OBEO); closed base, eyes closed (CBEC). RESULTS: In stabilometry, the median for the lateral range and anterior-posterior range in the CBEC trial was 0.10 (0.08-0.11) and 0.13 (0.11-0.22), respectively (p<0.05). The maximal inspiratory pressure (MIP) correlated inversely with the lateral standard deviation (ρ=–0.61; p<0.05) as the DLco correlated positively with the anterior-posterior range (ρ=0.54; p<0.05). There were significant relationships between body composition indexes and almost all stabilometric variables measured. There were no relationships of the BBS and 6MWD with the stabilometric variables. CONCLUSIONS: In adults with CF, imbalance occurs mainly in the anterior-posterior direction and is especially associated with body composition. .