Respiratory muscular strength in children with mucopolysacaridosis: comparison with predictive equations.

BACKGROUND: Mucopolysaccharidoses (MPS) are rare metabolic diseases that impair respiratory function leading to respiratory failure. This study aimed to compare maximal inspiratory and expiratory pressures (MIP and MEP) obtained in children with MPS and compare with predicted values from previous studies involving healthy children. METHODS: This is a cross-sectional study, in which the chest deformity was evaluated; MIP, MEP through digital manometer, and lung function through spirometry. MIP and MEP were compared with five different predict equations and with a control group of healthy children. Agreement between respiratory muscle weakness regarding absolute values of MIP and MEP in relation to predictive values by the equations included in the study were assessed by Kappa coefficient. RESULTS: MPS group was composed of 22 subjects. 45.5% had pectus carinatum, 36.4% pectus excavatum, and presented lower MIP (37.14±36.23 cmH2O) and MEP (60.09±22.3 cmH2O) compared with control group (22 healthy subjects) (MIP: 91.45±35.60; MEP: 95.73±22.38). Only the MEP equations proposed by Tomalak et al. were close to those found in our MPS children (P=0.09). In the MPS group it was observed a weak agreement between inspiratory weakness through absolute and predicted values in only two equations: Tomalak et al. and Domenèch-Clar et al. (for both: k=0.35, P value =0.03); and for MEP a moderate agreement was found using all predictive equations. CONCLUSIONS: In MPS children MRP data should not be normalized using the reference equations for healthy ones, is more coherent to longitudinally follow absolute pressures and lung volumes in this group.

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.

Mapping peripheral and abdominal sarcopenia acquired in the acute phase of COVID-19 during 7 days of mechanical ventilation.

Our aim was to map acquired peripheral and abdominal sarcopenia in mechanically ventilated adults with COVID-19 through ultrasound measurements. On Days 1, 3, 5 and 7 after admission to critical care, the muscle thickness and cross-sectional area of the quadriceps, rectus femoris, vastus intermedius, tibialis anterior, medial and lateral gastrocnemius, deltoid, biceps brachii, rectus abdominis, internal and external oblique, and transversus abdominis were measured using bedside ultrasound. A total of 5460 ultrasound images were analyzed from 30 patients (age: 59.8 ± 15.6 years; 70% men). Muscle thickness loss was found in the bilateral anterior tibial and medial gastrocnemius muscles (range 11.5-14.6%) between Days 1 and 3; in the bilateral quadriceps, rectus femoris, lateral gastrocnemius, deltoid, and biceps brachii (range 16.3-39.1%) between Days 1 and 5; in the internal oblique abdominal (25.9%) between Days 1 and 5; and in the rectus and transversus abdominis (29%) between Days 1 and 7. The cross-sectional area was reduced in the bilateral tibialis anterior and left biceps brachii (range 24.6-25.6%) between Days 1 and 5 and in the bilateral rectus femoris and right biceps brachii (range 22.9-27.7%) between Days 1 and 7. These findings indicate that the peripheral and abdominal muscle loss is progressive during the first week of mechanical ventilation and is significantly higher in the lower limbs, left quadriceps and right rectus femoris muscles in critically ill patients with COVID-19.

Chest wall volumes, diaphragmatic mobility, and functional capacity in patients with mucopolysaccharidoses.

PURPOSE: We investigated respiratory muscle strength, diaphragm mobility, lung function, functional capacity, quality of life, body composition, breathing pattern, and chest wall (VT,CW) and compartmental volumes of Mucopolysaccharidosis (MPS) patients and compared these variables with matched healthy individuals. METHODS: A cross-sectional study with data analyzed separately according to age group. A total of 68 individuals (34 MPS and 34 matched-healthy subjects) were included. Six-minute walking test assessed functional capacity and ultrasound assessed diaphragm mobility during quiet spontaneous breathing (QB). Optoelectronic plethysmography assessed VT,CW and breathing pattern during QB in two different positions: seated and supine (45° trunk inclination). RESULTS: Body composition, lung function, respiratory muscle strength, and functional capacity were reduced in MPS (all p < 0.01). Diaphragm mobility was only reduced in adolescents (p = 0.01) and correlated with body composition and breathing pattern. Upper chest wall compartmental volumes were significantly lower in MPS, while abdominal volume only differed significantly in adolescents. Percentage contribution (%) of upper ribcage compartments to tidal volume was reduced in MPS children, whereas %AB was significantly increased compared with healthy subjects. CONCLUSION: Lung function, respiratory muscle strength, functional capacity, diaphragm mobility, and quality of life are reduced in MPS compared with matched healthy subjects. VT,CW was mainly reduced due to pulmonary and abdominal ribcage impairment. Implications for RehabilitationReduction in respiratory muscle strength, functional capacity, diaphragm excursion and low lung volumes were found in individuals with Mucopolysaccharidoses (MPS).Chest wall volumes and the upper chest wall compartmental volumes during quiet spontaneous breathing are reduced in MPS.Assessment and monitoring of the respiratory system for individuals with MPS should be performed periodically through standardized assessments to enable identification of changes and early intervention by rehabilitation protocols.This study may provide the necessary basis for carrying out respiratoty rehabilitation protocols that can improving chest wall mechanics with breathing exercise in this group.

Rotating nasal masks with nasal prongs reduces the incidence of moderate to severe nasal injury in preterm infants supported by noninvasive ventilation. / Alternância de máscara nasal com pronga nasal reduz a incidência de lesão nasal moderada a grave em prematuros em uso de ventilação não invasiva.

OBJECTIVE: To investigate the association between noninvasive ventilation delivery devices and the incidence of nasal septum injury in preterm infants. METHODS: This retrospective singlecenter cohort study included preterm infants supported by noninvasive ventilation. The incidence of nasal injury was compared among three groups according to the noninvasive ventilation delivery device (G1 - nasal mask; G2 - binasal prongs; and G3, rotation of nasal mask with prongs). Nasal injury was classified according to the National Pressure Ulcer Advisory Panel as stages 1 - 4. Multivariate regression analyses were performed to estimate relative risks to identify possible predictors associated with medical device-related injuries. RESULTS: Among the 300 infants included in the study, the incidence of medical device-related injuries in the rotating group was significantly lower than that in the continuous mask or prong groups (n = 68; 40.48%; p value < 0.01).The basal prong group presented more stage 2 injuries (n = 15; 55.56%; p < 0.01). Staying ≥ 7 days in noninvasive ventilation was associated with a higher frequency of medical device-related injuries, regardless of device (63.81%; p < 0.01). Daily increments in noninvasive ventilation increased the risk for nasal injury by 4% (95%CI 1.02 - 1.06; p < 0.01). Higher birth weight indicated protection against medical device-related injuries. Each gained gram represented a decrease of 1% in the risk of developing nasal septum injury (RR: 0.99; 95%CI 0.99 - 0.99; p < 0.04). CONCLUSION: Rotating nasal masks with nasal prongs reduces the incidence of moderate to severe nasal injury in comparison with single devices. The addition of days using noninvasive ventilation seems to contribute to medical device-related injuries, and higher birth weight is a protective factor.

OBJETIVO: Investigar a relação entre dispositivos de ventilação não invasiva e incidência de lesão do septo nasal em recém-nascidos pré-termo. MÉTODOS: Este estudo de coorte retrospectivo e unicêntrico incluiu prematuros em uso de ventilação não invasiva. A incidência de lesão nasal foi comparada entre três grupos, de acordo com o dispositivo de ventilação não invasiva (G1 para máscara nasal; G2 para prongas binasais e G3 para alternância entre máscaras e prongas nasais). As lesões nasais foram classificadas de acordo com o National Pressure Ulcer Advisory Panel como estágios 1 - 4. Foram realizadas análises de regressão multivariada para estimar os riscos relativos, a fim de identificar possíveis preditores associados a lesões relacionadas a dispositivos médicos. RESULTADOS: Entre os 300 lactentes incluídos no estudo, a incidência de lesões relacionadas a dispositivos médicos no grupo em uso alternado foi significativamente menor do que a nos grupos de máscara ou prongas de uso contínuo (n = 68; 40,48%; valor de p < 0,01).O grupo de prongas nasais apresentou mais lesões de estágio 2 (n = 15; 55,56%; p < 0,01). A permanência ≥ 7 dias em ventilação não invasiva foi associada a maior incidência de lesões relacionadas a dispositivos médicos, independentemente do dispositivo (63,81%; p < 0,01). Os incrementos diários na ventilação não invasiva aumentaram o risco de lesões nasais em 4% (IC95% 1,02 - 1,06; p < 0,01). Um maior peso ao nascer indicou proteção contra lesões relacionadas a dispositivos médicos. Cada grama extra representou diminuição de 1% no risco de desenvolver lesão do septo nasal (RR: 0,99; IC95% 0,99 - 0,99; p < 0,04). CONCLUSÃO: A alternância entre máscaras e prongas nasais reduz a incidência de lesão nasal moderada a grave em comparação com dispositivos únicos. O incremento de dias em uso de ventilação não invasiva parece contribuir para lesões relacionadas a dispositivos médicos, e um maior peso ao nascer é um fator de proteção.

Alternância de máscara nasal com pronga nasal reduz a incidência de lesão nasal moderada a grave em prematuros em uso de ventilação não invasiva / Rotating nasal masks with nasal prongs reduces the incidence of moderate to severe nasal injury in preterm infants supported by noninvasive ventilation

RESUMO Objetivo: Investigar a relação entre dispositivos de ventilação não invasiva e incidência de lesão do septo nasal em recém-nascidos pré-termo. Métodos: Este estudo de coorte retrospectivo e unicêntrico incluiu prematuros em uso de ventilação não invasiva. A incidência de lesão nasal foi comparada entre três grupos, de acordo com o dispositivo de ventilação não invasiva (G1 para máscara nasal; G2 para prongas binasais e G3 para alternância entre máscaras e prongas nasais). As lesões nasais foram classificadas de acordo com o National Pressure Ulcer Advisory Panel como estágios 1 - 4. Foram realizadas análises de regressão multivariada para estimar os riscos relativos, a fim de identificar possíveis preditores associados a lesões relacionadas a dispositivos médicos. Resultados: Entre os 300 lactentes incluídos no estudo, a incidência de lesões relacionadas a dispositivos médicos no grupo em uso alternado foi significativamente menor do que a nos grupos de máscara ou prongas de uso contínuo (n = 68; 40,48%; valor de p < 0,01). O grupo de prongas nasais apresentou mais lesões de estágio 2 (n = 15; 55,56%; p < 0,01). A permanência ≥ 7 dias em ventilação não invasiva foi associada a maior incidência de lesões relacionadas a dispositivos médicos, independentemente do dispositivo (63,81%; p < 0,01). Os incrementos diários na ventilação não invasiva aumentaram o risco de lesões nasais em 4% (IC95% 1,02 - 1,06; p < 0,01). Um maior peso ao nascer indicou proteção contra lesões relacionadas a dispositivos médicos. Cada grama extra representou diminuição de 1% no risco de desenvolver lesão do septo nasal (RR: 0,99; IC95% 0,99 - 0,99; p < 0,04). Conclusão: A alternância entre máscaras e prongas nasais reduz a incidência de lesão nasal moderada a grave em comparação com dispositivos únicos. O incremento de dias em uso de ventilação não invasiva parece contribuir para lesões relacionadas a dispositivos médicos, e um maior peso ao nascer é um fator de proteção.

ABSTRACT Objective: To investigate the association between noninvasive ventilation delivery devices and the incidence of nasal septum injury in preterm infants. Methods: This retrospective singlecenter cohort study included preterm infants supported by noninvasive ventilation. The incidence of nasal injury was compared among three groups according to the noninvasive ventilation delivery device (G1 - nasal mask; G2 - binasal prongs; and G3, rotation of nasal mask with prongs). Nasal injury was classified according to the National Pressure Ulcer Advisory Panel as stages 1 - 4. Multivariate regression analyses were performed to estimate relative risks to identify possible predictors associated with medical device-related injuries. Results: Among the 300 infants included in the study, the incidence of medical device-related injuries in the rotating group was significantly lower than that in the continuous mask or prong groups (n = 68; 40.48%; p value < 0.01). The basal prong group presented more stage 2 injuries (n = 15; 55.56%; p < 0.01). Staying ≥ 7 days in noninvasive ventilation was associated with a higher frequency of medical device-related injuries, regardless of device (63.81%; p < 0.01). Daily increments in noninvasive ventilation increased the risk for nasal injury by 4% (95%CI 1.02 - 1.06; p < 0.01). Higher birth weight indicated protection against medical device-related injuries. Each gained gram represented a decrease of 1% in the risk of developing nasal septum injury (RR: 0.99; 95%CI 0.99 - 0.99; p < 0.04). Conclusion: Rotating nasal masks with nasal prongs reduces the incidence of moderate to severe nasal injury in comparison with single devices. The addition of days using noninvasive ventilation seems to contribute to medical device-related injuries, and higher birth weight is a protective factor.

Functioning profiles of individuals with Mucopolysaccharidosis according to the International Classification of Functioning.

BACKGROUND: The classification of health problems of persons with Mucopolysaccharidosis (MPS) based on the International Classification of Functioning, Disability and Health (ICF) may contribute to better understanding the disease impacts. The ICF is a useful tool to describe disabilities and functioning, especially in diseases with multisystemic involvement. AIM: To identify and classify the health needs of persons with non-neuronopathic MPS according to the ICF. DESIGN: A cross-sectional study. SETTING: Department of Physical Therapy (Federal University, Brazil). POPULATION: Persons with non-neuronopathic MPS. METHODS: Semi-structured interviews covering all components of the ICF were conducted to know the patients' perspectives of their health problems (patient-reported outcomes). The speeches were transcribed verbatim and analyzed by researchers to identifying meaningful concepts. Then, the concept units were linked to ICF components and the magnitude of the problem to ICF qualifiers. Data are shown by descriptive statistics and separated into two groups: children and adolescents, and adults. RESULTS: A total of 60 different ICF categories were used to classify participants' functioning. A total of 28 and 51 categories was necessary to classify the health problems of children and adults, respectively. Additionally, 16 categories related to contextual factors were used, of which eight and 12 were identified as facilitators by children, adolescents, and adults, respectively. The main problems were related to supportive functioning of arms or legs (b7603), pain in the body part (b2801), respiratory functions (b440), and voice functions (b310). Limitations in the activity and participation component were related to walking (d450), fine hand use (d440), washing oneself (d510), and dressing (d540). Recreation and leisure (d920) was restricted to approximately half of the studied population. CONCLUSIONS: People with MPS face impairments of body structures and functions, activity limitations and restrictions to participation. Environmental factors may be act as facilitators of these problems. CLINICAL REHABILITATION IMPACT: The ICF is a useful tool to classify the health problems of people with non-neuropathic MPS. The planning of rehabilitation programs needs to covers all components of functioning to provide a biopsychosocial model of care. The ICF categories may direct health professionals to more effective targets.

Impact of moderate-severe persistent allergic rhinitis on thoraco-abdominal kinematics and respiratory muscle function.

Objective: To assess thoraco-abdominal kinematics, respiratory muscle strength and electromyographic activity of the diaphragm (EAdi) in moderate-severe allergic rhinitis (AR) patients. Methods: A cross-sectional study involving 40 individuals (20 in the AR group) and 20 in the control group [CG]) was conducted. Ventilatory pattern and chest wall volume distribution (optoelectronic plethysmography), respiratory muscle strength (manovacuometry and sniff nasal inspiratory pressure [SNIP]), and EAdi were assessed in both groups. Results: The AR patients had impaired thoraco-abdominal kinematics (reduced total chest wall volume) (p = 0.004), lower values of total respiratory cycle time (p = 0.014) and expiratory time (p = 0.006). They also presented an increase of percentage contribution of the abdominal rib cage (p = 0.475) and respiratory rate (p = 0.019). A positive correlation among pulmonary rib cage tidal volume and MIP (r = 0.544; p < 0.001), SNIP (r = 0.615; p < 0.001), and MEP (r = 0.604; p < 0.001) was observed. After adjusting for age, BMI and gender through multivariate analysis, the individuals with AR presented lower values ​​of MIP (ß = -24.341; p < 0.001), MEP (ß = -0.277; p < 0.001), SNIP (ß = -34.687; p < 0.001) and RMS (ß = -0.041; p = 0.017). Conclusions: The individuals with moderate-severe persistent AR had worse respiratory muscle strength, diaphragm activation and chest wall volume distribution with a higher abdominal contribution to tidal volume than the control group. These findings reinforce the notion that the upper and lower airways work in an integrated and synergistic manner.

Is transcutaneous electrical muscle stimulation an alternative for preventing acquired muscle weakness in the pediatric intensive care unit? A scoping review.

BACKGROUND: Transcutaneous electrical muscle stimulation (TEMS) has been progressively used as add-on therapy to reduce muscle atrophy in adults unable to carry out active mobilization in the intensive care unit (ICU). There are no studies addressing TEMS in the pediatric ICU. Therefore, we decided to develop a scoping review, a type of knowledge synthesis, which unlike systematic review, identify gaps in the literature to aid the planning and commissioning of future research. OBJECTIVE: To provide current perspectives on the application of TEMS for combating pediatric intensive care unit acquired weakness (PICUAW). METHODS: Online databases were used to identify papers published 2006-2016, from which we selected those used musculoskeletal and cardiorespiratory performance as a primary or secondary outcome variable in participants under 18 years. RESULTS: The publications reported six clinical trials from 218 outpatients with 9.5 ± 8 years old. There were differences in current modulation and duration of TEMS sessions, with a predominance of high intensity and short duration in which a muscle contraction is triggered. The main use of TEMS was in pediatric neurological disorders. TEMS was more effective when compared with SHAM on spasticity, bone mineral density, disability, and gait. One study regarding spine injury showed improvement in VO2 (P = 0.035) when combined cycling with TEMS. CONCLUSION: TEMS was an effective and safe treatment for musculoskeletal impairments and cardiorespiratory performance in children with neurological disorders. Although the physiopathology is different in outpatients, an individualized protocol with TEMS might be promising for preventing PICUAW. Its effectiveness, however, deserves further investigation.

Exhaled nitric oxide as a diagnostic tool for wheezing in preschool children: A diagnostic accuracy study.

BACKGROUND: Airways inflammation may precede pulmonary dysfunction in wheezing individuals. The fraction of exhaled nitric oxide (FENO) has been described as a useful method for wheezing diagnosis in children, however, its application requires evidence. This study aimed to determine the accuracy of FENO in identifying wheezing in preschoolers. METHODS: A cross-sectional study was carried out with children from 3 to 5 years old, from Brazilian day care centers and public schools. They were evaluated by FENO measurement through the single breath method, and by ATS-DLD-78-C questionnaire that is used as a gold standard to phenotype wheezing patterns. RESULTS: The sample consisted of 243 non-wheezing children, 118 non-recurrent wheezing and 62 recurrent wheezing. The means of FENO and confidence intervals of 95%, were 5.4 (CI 95%, 5.2-5.6); 7.5 (CI 95%, 6.9-8.2) and 11.2 (CI 95%, 9.6-12.7), respectively. The sensitivity, specificity, positive and negative predictive FENO values in the 6 parts per billion (ppb) cut-off point that best diagnosed wheezing of non-wheezing children, were: 65.5%, 84.3%, 75.6% and 76.7%, respectively, with an area under the curve (AUC) = 0.77. At 10 ppb, the best cut-off points for differentiating recurrent wheezing of non-recurrent wheezing were: 56.4%, 81.3%, 61.4%, 78.0%, respectively, with an AUC = 0.69. The post-test probability for each FENO cut-off points was increased by 33% for wheezing and 20% for recurrent wheezing diagnosis when associated with clinical examination. CONCLUSION: FENO can provide a reliable and accurate method to discriminate the presence and type of wheezing in preschoolers with 92% of acceptable in this study population.

Tidal volume measurements in infants: Opto-electronic plethysmography versus pneumotachograph.

Tidal breathing measurements by Opto-Electronic Plethysmography (OEP) has been reported for infants limited to protocols with two chest wall compartments. Standard protocol for the analysis of adults, with three compartments of chest wall, has been unavailable for analysis of infants. We aimed to study the agreement of simultaneous measurements of tidal volume by OEP (VT,OEP ) and a heated pneumotachograph (PNT) (VT,PNT ) performed during sleeping in 20 infants (gestational age 35.1 ± 4.6 weeks) at 3-4 months postconceptual age with a three compartment protocol. From PNT and OEP measurements, tidal volume corrected (VT,PNT ) for ambient conditions were calculated with a total number of 200 breaths. The two methods were in good agreement with tidal volume mean difference of 0.02 ml and limit of agreement -4.11 to 4.08 ml (95%CI), no relationship was found between differences and means of OEP and PNT measurements. Pulmonary rib cage, abdominal rib cage and abdomen contributed by 12.4 ± 9.7%, 5.2 ± 5.1%, and 82.4 ± 11.4% to VT,OEP , respectively. The OEP experimental protocol based on 52 markers and a three-compartment model of the chest wall could be used in spontaneously sleeping infants. Pediatr Pulmonol. 2016;51:850-857. © 2016 Wiley Periodicals, Inc.

The influence of supine posture on chest wall volume changes is higher in obese than in normal weight children.

The objective of this study was to analyze thoraco-abdominal kinematics in obese children in seated and supine positions during spontaneous quiet breathing. An observational study of pulmonary function and chest wall volume assessed by optoelectronic plethysmography was conducted on 35 children aged 8-12 years that were divided into 2 groups according to weight/height ratio percentiles: there were 18 obese children with percentiles greater than 95 and 17 normal weight children with percentiles of 5-85. Pulmonary function (forced expiratory volume in 1 s (FEV1); forced vital capacity (FVC); and FEV1/FVC ratio), ventilatory pattern, total and compartment chest wall volume variations, and thoraco-abdominal asynchronies were evaluated. Tidal volume was greater in seated position. Pulmonary and abdominal rib cage tidal volume and their percentage contribution to tidal volume were smaller in supine position in both obese and control children, while abdominal tidal volume and its percentage contribution was greater in the supine position only in obese children and not in controls. No statistically significant differences were found between obese and control children and between supine and seated positions regarding thoraco-abdominal asynchronies. We conclude that in obese children thoraco-abdominal kinematics is influenced by supine posture, with an increase of the abdominal and a decreased rib cage contribution to ventilation, suggesting that in this posture areas of hypoventilation can occur in the lung.

Influence of posture on the ventilatory pattern and the thoraco-abdominal kinematics of patients with chronic obstructive pulmonary disease (COPD).

OBJECTIVE: Evaluate the influence of posture on ventilatory pattern, compartmental distribution of volume of chest wall and thoraco-abdominal kinematics of patients with severe chronic obstructive pulmonary disease (COPD). DESIGN: Cross-sectional study. METHODS: Twelve, male patients with severe COPD (Forced Expiratory Volume in the first second (FEV1) = 24.35 ± 4.52%, Forced Vital Capacity% (FVC%) = 60 ± 13.39% and relationship FEV1/FVC = 53.42 ± 14.47). The distribution of the volume of the ribcage [pulmonary rib cage (Rcp), abdominal ribcage (Rca) and abdomen (Ab)] during quiet breathing in a sitting position without back support (SWB), sitting with backrest (SB) and supine position (SUP) was determined using an opto-electronic plethysmograph. RESULTS: The following differences were observed: a greater tidal volume in the SWB position when compared to the SB position (p = 0.01); greater expiratory time in the SUP position in relation to the SWB (p = 0.03) and SB (p = 0.01); and increased abdominal contribution to the tidal volume in the SUP position in relation to the SWB (p < 0.01) and SB (p < 0.001). No difference was found in the thoraco-abdominal synchrony among the positions. CONCLUSION: Sitting position without back support enhances the activation of respiratory muscles by increasing the tidal volume and supine position seems to favor lung deflation by increasing the expiratory time. It seems appropriate to adopt these positions to optimize the ventilation/perfusion relationship and physiotherapeutic intervention in different clinical conditions.

Influence of change in lateral decubitus on pulmonary aerosol deposition.

BACKGROUND: The lateral decubitus position leads to the greatest changes in regional pulmonary ventilation and is used in respiratory physical therapy routines. OBJECTIVES: To evaluate the influence of the lateral decubitus position on the pulmonary deposition of inhaled radioaerosol particles in young people and report the effects of the decubitus position on routine therapy. METHODS: Eight healthy male volunteers, mean age 23.6±2.5 years, were included in a randomized study in two phases. In the first phase, aerosol was inhaled for nine minutes in a randomly-selected lateral decubitus position and after an interval of 5 to 7 days, the second phase was conducted. Pulmonary scintigraphy was carried out by inhalation of 25 mCi of 99mTc-DTPA. Following inhalation, images were acquired with scintillation cameras and regions of interest (ROI) were investigated in the longitudinal and cross-sectional divisions of the lungs. Statistical analysis included a paired Student's t-test with a significance level of p≤0.05. RESULTS: Inhalation in the right lateral decubitus position presented higher counts (p≤0.04) in posterior ROI of the right lung than in the posterior ROI of the left lung. In the left lateral decubitus position, the count was higher in the left lung (p≤0.02) than in the posterior ROI of the right lung. CONCLUSIONS: The deposition of aerosol particles during inhalation was position-dependent in the two phases of the study, which confirms the validity of technical and therapeutic resources based on the physiology of position-dependent ventilation and suggests that body positioning can be used to advantage in routine therapy.

Motor development evaluated by Test of Infant Motor Performance: comparison between preterm and full-term infants.

OBJECTIVES: To compare the motor development of preterm infants whose gestational age had been corrected to 38-40 weeks with full term newborns using the Test of Infant Motor Performance (TIMP). METHODS: The cross-sectional study compared preterm infants (PT group), with a gestational age at birth of 28-33 weeks, at an equivalent age to full term newborns (FT group), who were assessed up to 48 hours after birth. The assessments were performed between December 2008 and April 2009 in a hospital nationally recognized for premature infant care in the city of Recife, PE, Brazil. The sample consisted of 92 infants, 46 in each group. The test was administered at age 38-40 weeks (or equivalent age in the PT group). RESULTS: In the 46 preterm infants studied, 26.1% were classified as atypical, while in the FT group 100% were classified as typical (p<0.001). Moreover, there was a significant difference in average raw TIMP score between the two groups, with the PT group being lower (p<0.001). CONCLUSION: According to TIMP performance, prematurity seems to be associated with impaired motor development.

Motor development evaluated by Test of Infant Motor Performance: comparison between preterm and full-term infants / Desenvolvimento motor avaliado pelo Test of Infant Motor Performance: comparação entre lactentes pré-termo e a termo

OBJECTIVES: To compare the motor development of preterm infants whose gestational age had been corrected to 38-40 weeks with full term newborns using the Test of Infant Motor Performance (TIMP). METHODS: The cross-sectional study compared preterm infants (PT group), with a gestational age at birth of 28-33 weeks, at an equivalent age to full term newborns (FT group), who were assessed up to 48 hours after birth. The assessments were performed between December 2008 and April 2009 in a hospital nationally recognized for premature infant care in the city of Recife, PE, Brazil. The sample consisted of 92 infants, 46 in each group. The test was administered at age 38-40 weeks (or equivalent age in the PT group). RESULTS: In the 46 preterm infants studied, 26.1 percent were classified as atypical, while in the FT group 100 percent were classified as typical (p<0.001). Moreover, there was a significant difference in average raw TIMP score between the two groups, with the PT group being lower (p<0.001). CONCLUSION: According to TIMP performance, prematurity seems to be associated with impaired motor development.

OBJETIVOS: Comparar, por meio do Test of Infant Motor Performance (TIMP), o desenvolvimento motor de lactentes nascidos pré-termo que estavam com idade gestacional corrigida de 38 a 40 semanas com o de recém-nascidos a termo. MÉTODOS: Estudo de desenho transversal em que se comparou o desempenho motor de lactentes pré-termo (grupo RNPT), com idade gestacional no parto de 28 a 33 semanas, avaliados na idade equivalente ao termo, com o de recém-nascidos a termo (grupo RNT), avaliados em até 48 horas de vida, por meio do TIMP. A coleta dos dados foi realizada no período de dezembro de 2008 a abril de 2009, num hospital de referência para assistência a prematuros na cidade de Recife, PE, Brasil. A amostra foi constituída de 92 lactentes, 46 para cada grupo. O teste foi aplicado na idade de 38 a 40 semanas de idade gestacional (corrigida, no caso dos lactentes nascidos pré-termo). RESULTADOS:Dos 46 lactentes pré-termo avaliados, 26,1 por cento foram classificados como atípicos, enquanto 100 por cento dos recém-nascidos a termo foram classificados como típicos (p<0,001). Além disso, houve diferença significativa na média do escore bruto do teste nos dois grupos, sendo a média do grupo RNPT menor (p<0,001). CONCLUSÕES: A prematuridade parece estar associada a prejuízo no desenvolvimento motor, avaliado pelo TIMP.

Influência da variação dos decúbitos laterais na deposição pulmonar de aerossol / Influence of change in lateral decubitus on pulmonary aerosol deposition

CONTEXTUALIZAÇÃO: O decúbito lateral apresenta as maiores mudanças em relação à ventilação pulmonar regional e é utilizado na rotina da fisioterapia respiratória. OBJETIVOS: Avaliar a influência do decúbito lateral na deposição pulmonar de radioaerossol durante a inalação em indivíduos jovens e relacionar os efeitos desse decúbito na rotina terapêutica. MÉTODOS: Em estudo randomizado em duas fases, foram incluídos oito homens voluntários saudáveis, com média de idade de 23,6±2,5 anos. Na primeira fase, inalou-se aerossol durante nove minutos no decúbito lateral sorteado e, após intervalo de cinco a sete dias, realizou-se a segunda fase. Para a cintilografia, inalou-se uma dose média de ácido dietilnotriaminopentacético marcado com tecnécio (DTPA - TC99m), com uma atividade radioativa em média de 25 milicuries (mCi). Ao final da inalação, as imagens foram adquiridas em câmaras de cintilação e analisadas por meio da divisão longitudinal e transversal dos pulmões em regiões de interesse (ROI). Para análise estatística, utilizou-se o teste t de Student pareado, considerando significativo p<0,05. RESULTADOS: A inalação em decúbito lateral direito apresentou, na ROI posterior do pulmão direito, um maior número de contagem (p<0,04) quando comparada à ROI posterior do pulmão esquerdo. No decúbito lateral esquerdo, observou-se um maior número de contagem no pulmão esquerdo (p<0,02) do que na ROI posterior do pulmão direito. CONCLUSÕES: A deposição das partículas de aerossol durante inalação apresentou um comportamento decúbito dependente nas duas fases do estudo, ratificando técnicas e recursos terapêuticos baseados na fisiologia da ventilação decúbito dependente e sugere a utilização do posicionamento corporal na rotina terapêutica.

BACKGROUND: The lateral decubitus position leads to the greatest changes in regional pulmonary ventilation and is used in respiratory physical therapy routines. OBJECTIVES: To evaluate the influence of the lateral decubitus position on the pulmonary deposition of inhaled radioaerosol particles in young people and report the effects of the decubitus position on routine therapy. METHODS: Eight healthy male volunteers, mean age 23.6±2.5 years, were included in a randomized study in two phases. In the first phase, aerosol was inhaled for nine minutes in a randomly-selected lateral decubitus position and after an interval of 5 to 7 days, the second phase was conducted. Pulmonary scintigraphy was carried out by inhalation of 25 mCi of 99mTc-DTPA. Following inhalation, images were acquired with scintillation cameras and regions of interest (ROI) were investigated in the longitudinal and cross-sectional divisions of the lungs. Statistical analysis included a paired Student's t-test with a significance level of p<0.05. RESULTS: Inhalation in the right lateral decubitus position presented higher counts (p<0.04) in posterior ROI of the right lung than in the posterior ROI of the left lung. In the left lateral decubitus position, the count was higher in the left lung (p<0.02) than in the posterior ROI of the right lung. CONCLUSIONS: The deposition of aerosol particles during inhalation was position-dependent in the two phases of the study, which confirms the validity of technical and therapeutic resources based on the physiology of position-dependent ventilation and suggests that body positioning can be used to advantage in routine therapy.

Repercussões da cardiomegalia na função pulmonar de indivíduos adultos com insuficiência cardíaca crônica: uma revisão sistemática / Repercussions of the cardiomegaly on the pulmonary function of adult individuals with chronic heart failure: a systematic review

Para analisar as repercussões da cardiomegalia sobre a função pulmonar em indivíduos adultos com insuficiência cardíaca (IC) crônica, foram revisados artigos nas bases PUBMED, BIREME, ISI Web of Knowledge e COCHRANE, publicados na última década, estudos observacionais e sem restrição de idioma. Utilizados os descritores “cardiomegaly” e “Respiratory Function Tests”, e negada a palavra “exercise”. Foram incluídos artigos com IC crônica, de ambos os sexos, entre 19 e 64 anos, incluindo IC congestiva e cardiomiopatia dilatada e excluídos com IC aguda, com avaliações pós-intervenção clínica ou por exercício. Para avaliar a qualidade dos artigos foi utilizada a escala da Agency for Healthcare Research and Quality (AHRQ) e aceitos aqueles com escore>50 pontos (0-100). Foram selecionados cinco artigos do total de 1093 e agrupados por parâmetros relacionados aos fluxos e volumes pulmonares, padrão ventilatório e desempenho muscular. Na AHRQ, dois estudos ficaram na faixa de 50-75% e os demais >75%. Eles apontam para redução da capacidade vital inspiratória (CVI), volume expiratório forçado no 1o segundo (VEF1) e pressão inspiratória máxima (PImáx) em função da cardiomegalia, com discreta redução na relação VEF1/CVI e na capacidade de difusão para monóxido de carbono (DLCO). Portanto, segundo os estudos, a cardiomegalia leva a um padrão respiratório restritivo, com redução do volume alveolar que interfere na DLCO. As correlações mais fortes envolvem a redução da PImáx, CVI e VEF1.

To analyze the repercussions of the cardiomegaly on lung function in adults with chronic heart failure (CHF), the databases PUBMED, BIREME, ISI Web of Knowledge and COCHRANE were considered to review observational studies published in the last decade without language restriction. It was used the descriptors "cardiomegaly" and "respiratory function tests", and denied "exercise". It was included papers with CHF, of both sexes between 19 and 64 years accepting samples with congestive HF and dilated cardiomyopathy and excluding with acute heart failure, post-intervention assessment clinic or by exercise. The quality of papers was evaluated by using the scale of Agency for Healthcare Research and Quality (AHRQ) and accepted papers with score >50 points (0-100). We selected 5 studies from total of 1093 and grouped by parameters related to flows and lung volumes, respiratory pattern and muscle performance. At AHRQ, two studies were in the range of 50-75% and the others >75%. These studies showed lower inspiratory vital capacity (IVC), forced expiratory volume in 1st second (FEV1) and maximal inspiratory pressure (PImáx) as a function of cardiomegaly, with a slight reduction in the ratio VEF1/IVC and diffusion capacity for carbon monoxide (DLCO). Therefore, the studies suggest that the cardiomegaly leads to a restrictive lung pattern, with reduction in alveolar volume that interferes with DLCO. The strongest correlations involve the reduction of PImáx, IVC and FEV1 in this population.