Effects of increasing tidal volume and end-expiratory lung volume on induced bronchoconstriction in healthy humans.

BACKGROUND: Increasing functional residual capacity (FRC) or tidal volume (VT) reduces airway resistance and attenuates the response to bronchoconstrictor stimuli in animals and humans. What is unknown is which one of the above mechanisms is more effective in modulating airway caliber and whether their combination yields additive or synergistic effects. To address this question, we investigated the effects of increased FRC and increased VT in attenuating the bronchoconstriction induced by inhaled methacholine (MCh) in healthy humans. METHODS: Nineteen healthy volunteers were challenged with a single-dose of MCh and forced oscillation was used to measure inspiratory resistance at 5 and 19 Hz (R5 and R19), their difference (R5-19), and reactance at 5 Hz (X5) during spontaneous breathing and during imposed breathing patterns with increased FRC, or VT, or both. Importantly, in our experimental design we held the product of VT and breathing frequency (BF), i.e, minute ventilation (VE) fixed so as to better isolate the effects of changes in VT alone. RESULTS: Tripling VT from baseline FRC significantly attenuated the effects of MCh on R5, R19, R5-19 and X5. Doubling VT while halving BF had insignificant effects. Increasing FRC by either one or two VT significantly attenuated the effects of MCh on R5, R19, R5-19 and X5. Increasing both VT and FRC had additive effects on R5, R19, R5-19 and X5, but the effect of increasing FRC was more consistent than increasing VT thus suggesting larger bronchodilation. When compared at iso-volume, there were no differences among breathing patterns with the exception of when VT was three times larger than during spontaneous breathing. CONCLUSIONS: These data show that increasing FRC and VT can attenuate induced bronchoconstriction in healthy humans by additive effects that are mainly related to an increase of mean operational lung volume. We suggest that static stretching as with increasing FRC is more effective than tidal stretching at constant VE, possibly through a combination of effects on airway geometry and airway smooth muscle dynamics.

Improvements of the shape and strength of the diaphragm after endoscopic lung volume reduction.

RATIONALE: Endoscopic lung volume reduction improves lung function, quality of life and exercise capacity in severe emphysema patients. However, its effect on the diaphragm function is not well understood. We hypothesised that endoscopic lung volume reduction increases its strength by modifying its shape. OBJECTIVES: To investigate changes in both diaphragm shape and strength induced by the insertion of endobronchial valves. METHODS: In 19 patients, both the diaphragm shape and strength were investigated respectively by 3D Slicer software applied on CT scans acquired at functional residual capacity and by transdiaphragmatic pressure measurements by bilateral magnetic stimulation of the phrenic nerves before and 3 months after unilateral valves insertion. MEASUREMENTS AND MAIN RESULTS: After lung volume reduction (median (IQR), 434 mL (-597 to -156], p<0.0001), diaphragm strength increased (transdiaphragmatic pressure: 3 cmH2O (2.3 to 4.2), p<0.0001). On the treated side, this increase was associated with an increase in the coronal (16 mm (13 to 24), p<0.0001) and sagittal (26 mm (21 to 30), p<0.0001) lengths as well as in the area of the zone of apposition (62 cm2 (3 to 100), p<0.0001) with a decrease in the coronal (8 mm (-12 to -4), p<0.0001) and sagittal (9 mm (-18 to -2), p=0.0029) radii of curvature. CONCLUSIONS: Endoscopic lung volume reduction modifies the diaphragm shape by increasing its length and its zone of apposition and by decreasing its radius of curvature on the treated side, resulting in an increase in its strength. TRIAL REGISTRATION NUMBER: NCT05799352.

Respiratory and chest wall mechanics in very preterm infants.

Data on static compliance of the chest wall (Ccw) in preterm infants are scarce. We characterized the static compliance of the lung (CL) and Ccw to determine their relative contribution to static compliance of the respiratory system (Crs) in very preterm infants at 36 wk postmenstrual age (PMA). We also aimed to investigate how these compliances were influenced by the presence of bronchopulmonary dysplasia (BPD) and impacted breathing variables. Airway opening pressure, esophageal pressure, and tidal volume (VT) were measured simultaneously during a short apnea evoked by the Hering-Breuer reflex. We computed tidal breathing variables, airway resistance (R), and dynamic lung compliance (CL,dyn), inspiratory capacity (IC), and Crs, CL, and Ccw. Functional residual capacity was assessed by the multiple breath washout technique (FRCmbw). Breathing variables, compliances, and lung volumes were adjusted for body weight. Twenty-three preterm infants born at 27.2 ± 2.0 wk gestational age (GA) were studied at 36.6 ± 0.6 wk PMA. Median and interquartile range (IQR) Crs/kg is 0.69 (0.6), CL/kg 0.95 (1.0), and Ccw/kg 3.0 (2.4). Infants with BPD (n = 11) had lower Crs/kg (P = 0.013), CL/kg (P = 0.019), and Ccw/kg (P = 0.027) compared with infants without BPD. Ccw/CL ratio was equal between groups. FRCmbw/kg (P = 0.044) and IC/kg (P = 0.005) were decreased in infants with BPD. Infants with BPD have reduced static compliance of the respiratory system, the lungs, and chest wall. Decreased Crs, CL, and Ccw in infants with BPD explain the lower FRC and IC seen in these infants.NEW & NOTEWORTHY Data on chest wall compliance in very preterm infants in the postsurfactant era are scarce. To our knowledge, we are the first group to report data on static respiratory system compliance (Crs), lung compliance (CL), and chest wall compliance (Ccw) in preterm infants with and without bronchopulmonary dysplasia (BPD) in the postsurfactant era.

The Impact of Positive Expiratory Pressure Therapy on Hyperinflation in Patients With COPD.

BACKGROUND: Lung hyperinflation is a typical clinical feature of patients with COPD. Given the association between breathing at elevated lung volumes and the manifestation of severe debilitating symptoms, therapeutic interventions such as positive expiratory pressure (PEP) therapy and its variations (temporary, oscillatory) have been devised to mitigate lung hyperinflation. However, the efficacy of these interventions remains to be conclusively demonstrated. METHODS: A systematic review with meta-analysis of randomized trials was conducted following the PRISMA guidelines. Seven databases were screened with no date or language restriction. Two authors independently applied eligibility criteria and assessed the risk of bias of included studies using the Cochrane risk-of-bias tool. Outcomes were lung hyperinflation measures detected through changes in inspiratory capacity (IC), functional residual capacity (FRC), total lung capacity (TLC), and residual volume (RV), as well as FEV1, FVC, dyspnea, and physical capacity. Pooled standardized mean differences (SMDs) or mean differences (MDs) and 95% CI were calculated using a random-effects model. RESULTS: Seven trials, all with a high risk of bias, were included. Compared to control group, RV significantly decreased (4 studies, n = 231; SMD -0.42 [95% CI -0.77 to -0.08], P = .02), dyspnea improved (n = 321, SMD -1.17 [95% CI -1.68 to -0.66], P < .001), and physical capacity increased (5 studies, n = 311; MD 30.1 [95% CI 19.2-41.0] m, P < .001) with PEP therapy. There was no significant difference between PEP therapy and the control group in TLC, FVC, or FEV1. Only one study reported changes in inspiratory capacity as well as FRC. CONCLUSIONS: In patients with COPD, the effect of PEP therapy on lung hyperinflation is unclear owing to the non-consistent change in lung hyperinflation outcomes, insufficient data, and lack of high-quality trials. Dyspnea and physical capacity might improve with PEP therapy.

Lung Ultrasound Assessment of Lung Hyperinflation in Patients with Stable COPD: An Effective Diagnostic Tool.

Purpose: To evaluate the degree of lung hyperinflation (LH) in patients with stable chronic obstructive pulmonary disease (COPD) by lung ultrasound score (LUS) and assess its value. Patients and Methods: We conducted a study of 149 patients with stable COPD and 100 healthy controls recruited by the Second Affiliated Hospital of Fujian Medical University. The pleural sliding displacement (PSD) was measured, the sliding of the pleura in different areas was observed, and LUS was calculated from both of them. The diaphragm excursion (DE), residual capacity (RV), total lung capacity (TLC), inspiratory capacity (IC) and functional residual capacity (FRC) were measured. We described the correlation between ultrasound indicators and pulmonary function indicators reflecting LH. Multiple linear regression analysis was used. The ROC curves of LUS and DE were drawn to evaluate their diagnostic efficacy, and De Long method was used for comparison. Results: (1) The LUS of patients with stable COPD were positively correlated with RV, TLC, RV/TLC and FRC and negatively correlated with IC and IC/TLC (r1=0.72, r2=0.41, r3=0.72, r4=0.70, r5=-0.56, r6=-0.65, P < 0.001). The correlation was stronger than that between DE at maximal deep inspiration and the corresponding pulmonary function indices (r1=-0.41, r2=-0.26, r3=-0.40, r4=-0.43, r5=0.30, r6=0.37, P < 0.001). (2) Multiple linear regression analysis showed that LUS were significantly correlated with IC/TLC and RV/TLC. (3) With IC/TLC<25% and RV/TLC>60% as the diagnostic criterion of severe LH, the areas under the ROC curves of LUS and DE at maximal deep inspiration for diagnosing severe LH were 0.914 and 0.385, 0.845 and 0.543, respectively (P < 0.001). Conclusion: The lung ultrasound score is an important parameter for evaluating LH. LUS is better than DE at maximal deep inspiration for diagnosing severe LH and is expected to become an effective auxiliary tool for evaluating LH.

A pessoa submetida a artroplastia total do joelho: intervenção do enfermeiro de reabilitação / The person undergoing total knee arthroplasty: the rehabilitation nurse's intervention

Introdução A patologia degenerativa do joelho é uma das causas mais frequentes de incapacidade nas populações ocidentais. As manifestações clínicas da doença têm repercussões evidentes na vida das pessoas sendo a Artroplastia Total do Joelho a opção de tratamento frequente nos casos de artrose avançada do joelho. Objetivo Avaliar a influência de um programa de Enfermagem de Reabilitação na capacidade funcional da Pessoa submetida a ATJ. Metodologia Estudo quasi-experimental e longitudinal, sustentado num paradigma quantitativo. A amostra, constituída por 40 participantes foi submetida a um programa de Enfermagem de Reabilitação. O período de intervenção e recolha de dados ocorreu entre dezembro de 2022 e fevereiro de 2023, no qual cada participante foi alvo da intervenção de cuidados de Enfermagem de Reabilitação. A colheita de dados foi realizada em três momentos distintos mediante preenchimento dos instrumentos selecionados. Resultados O estudo desenvolvido revela que a pessoa submetida a ATJ apresenta melhor capacidade funcional no andar, subir/descer escadas, grau de amplitude articular (flexão/extensão) no momento de admissão em relação ao momento da alta clínica. No entanto, existindo redução dessa capacidade, entre as 48 horas e a alta clínica verifica-se melhoria no andar, subir/descer escadas e grau de amplitude articular (flexão/extensão). Revela ainda que a pessoa submetida a ATJ apresenta maior nível de dor no momento de admissão em relação às 48 horas pós-operatório e momento da alta clínica. Conclusão Os resultados do estudo indicaram que existem diferenças estatisticamente significativas no andar, subir/descer escadas e amplitude articular do joelho (flexão/extensão) da pessoa submetida a ATJ indicando que o programa de Enfermagem de Reabilitação se traduz em ganhos em saúde. Relativamente à dor não foram encontrados resultados estatisticamente significativos, mas verificou-se uma diminuição desde a admissão até à alta clínica.

Degenerative knee pathology is one of the most frequent causes of disability in Western populations. The clinical manifestations of the disease have obvious repercussions on people's lives, and Total Knee Arthroplasty is the most common treatment option in cases of advanced knee arthrosis. Goal to evaluate the influence of a Rehabilitation Nursing programme on the functional capacity of people undergoing TKA. Methodology Quasi-experimental and longitudinal study, based on a quantitative paradigm. The sample, composed of 40 participants, underwent a Rehabilitation Nursing programme. The period of intervention and data collection occurred between December 2022 and February 2023, in which each participant was the target of the Rehabilitation Nursing care intervention. Data were collected in three different moments by completing the selected instruments. Results The study reveals that patients undergoing TKA have better functional capacity in walking, stair climbing/stairs and joint range of motion (flexion/extension) at admission than at clinical discharge. However, if there is a reduction in this capacity, between 48 hours and clinical discharge, there is an improvement in walking, stair climbing/climbing and joint range of motion (flexion/extension). It also reveals that the person submitted to TKA presents a higher level of pain at admission than at 48 hours postoperatively and at discharge. Conclusion The results of the study indicated that there are statistically significant differences in the walking, stair climbing/stairs and knee joint range of motion (flexion/extension) of the person undergoing TKA, indicating that the Nursing Rehabilitation programme translates into health gains. No statistically significant results were found regarding pain, but a decrease was observed from admission to clinical discharge.

Maximal respiratory pressures: Measurements at functional residual capacity in individuals with different health conditions using a digital manometer.

BACKGROUND: Measuring maximal respiratory pressure is a widely used method of investigating the strength of inspiratory and expiratory muscles. OBJECTIVES: To compare inspiratory pressures obtained at functional residual capacity (FRC) with measures at residual volume (RV), and expiratory pressures obtained at FRC with measures at total lung capacity (TLC) in individuals with different health conditions: post-COVID-19, COPD, idiopathic pulmonary fibrosis (IPF), heart failure (CHF), and stroke; and to compare the mean differences between measurements at FRC and RV/TLC among the groups. METHODS: Inspiratory and expiratory pressures were obtained randomly at different lung volumes. Mixed factorial analysis of covariance with repeated measures was used to compare measurements at different lung volumes within and among groups. RESULTS: Seventy-five individuals were included in the final analyses (15 individuals with each health condition). Maximal inspiratory pressures at FRC were lower than RV [mean difference (95% CI): 11.3 (5.8, 16.8); 8.4 (2.3, 14.5); 11.1 (5.5, 16.7); 12.8 (7.1, 18.4); 8.0 (2.6, 13.4) for COVID-19, COPD, IPF, CHF, and stroke, respectively] and maximal expiratory pressures at FRC were lower than TLC [mean difference (95% CI): 51.9 (37.4, 55.5); 60.9 (44.2, 77.7); 62.9 (48.1, 77.8); 58.0 (43.9, 73.8); 57.2 (42.9, 71.6) for COVID-19, COPD, IPF, CHF, and stroke, respectively]. All mean differences were similar among groups. CONCLUSION: Although inspiratory and expiratory pressures at FRC were lower than measures obtained at RV/TLC for the five groups of health conditions, the mean differences between measurements at different lung volumes were similar among groups, which raises the discussion about the influence of the viscoelastic properties of the lungs on maximal respiratory pressure.

Role of lung lobar sliding on parenchymal distortion during breathing.

Sliding between lung lobes along lobar fissures is a poorly understood aspect of lung mechanics. The objective of this study was to test the hypothesis that lobar sliding helps reduce distortion in the lung parenchyma during breathing. Finite element models of left lungs with geometries and boundary conditions derived from medical images of human subjects were developed. Effect of lobar sliding was studied by comparing nonlinear finite elastic contact mechanics simulations that allowed and disallowed lobar sliding. Lung parenchymal distortion during simulated breath-holds and tidal breathing was quantified with the model's spatial mean anisotropic deformation index (ADI), a measure of directional preference in volume change that varies spatially in the lung. Models that allowed lobar sliding had significantly lower mean ADI (i.e., lesser parenchymal distortion) than models that disallowed lobar sliding under simulations of both tidal breathing (5.3% median difference, P = 0.008, n = 8) and lung deformation between breath-holds at total lung capacity and functional residual capacity (3.2% median difference, P = 0.03, n = 6). This effect was most pronounced in the lower lobe where lobar sliding reduced parenchymal distortion with statistical significance, but not in the upper lobe. In addition, more lobar sliding was correlated with greater reduction in distortion between sliding and nonsliding models in our study cohorts (Pearson's correlation coefficient of 0.95 for tidal breathing, 0.87 for breath-holds, and 0.91 for the combined dataset). These findings are consistent with the hypothesis that lung lobar sliding reduces parenchymal distortion during breathing.NEW & NOTEWORTHY The role of lobar sliding in lung mechanics is poorly understood. Delineating this role could help explain how breathing is affected by anatomical differences between subjects such as incomplete and missing lobar fissures. We used computational contact mechanics models of lungs from human subjects to delineate the effect of lobar sliding by comparing simulations that allowed and disallowed sliding. We found evidence consistent with the hypothesis that lung lobar sliding reduces parenchymal distortion during breathing.

Assessing the calculation of conductive and acinar ventilatory heterogeneity indices Scond and Sacin from multiple-breath washout data.

Sensor errors resulting in elevated values of N2 concentration [N2] in commercial multiple-breath washout (MBW) devices have been shown to prolong the washout and result in erroneously high functional residual capacity (FRC) and lung clearance index (LCI) values. The errors also affect the indices of conductive and acinar ventilatory heterogeneity (Scond and Sacin) although the mechanism by which this change in values occurs remains unclear. Exploring these effects also provides a timely opportunity to examine the appropriateness of the algorithm used to calculate these indices. Using a two-compartment model with differing specific ventilation (SV) such that the lower SV unit empties late, noise-free MBW were simulated both corrected and uncorrected for the recent sensor error. Scond was calculated using regression of normalized phase III slope (SnIII) against lung turnover (TO) from a TO range starting at 1.5 and ending at an upper turnover (TOupper) between 4 and 8 (default 6) over a range of simulated values. The principal effect of the sensor error was that as the MBW proceeded the phase III slope of successive breaths was normalized by an increasingly overestimated [N2], resulting in SnIII values that fell precipitously at high TO, greatly reducing Scond. Reanalysis of previously published data and of simulated data showed a large proportional bias in Scond, whereas Sacin was only minimally affected. In adult subject data, reducing TOupper below 5.5 was associated with a large drop of up to ∼60% in Scond calculated from data corrected for sensor error. Raising the upper TO limit elevated Scond by ∼20% but with a large concomitant increase in variability. In contrast to Scond, Sacin was relatively unaffected by changes in TOupper with changes of <3%. This work serves to emphasize that the upper limit of TO of 6 represents an appropriate upper limit for the calculation of Scond.NEW & NOTEWORTHY Sensor errors that elevated values of N2 concentration in commercial multiple-breath washout (MBW) devices resulted in errors in calculated parameters including Scond and Sacin. We examined the mechanism of the change in values produced by these errors and explored the appropriateness of the calculation of Scond and Sacin. This work serves to emphasize that the current algorithm in use is appropriate for the calculation of Scond and Sacin.

Optimization of sniff nasal inspiratory pressure (SNIP) measurement methodology in healthy subjects.

BACKGROUND: Maximal inspiratory pressure (MIP) is currently the most commonly used measure for respiratory muscle strength (RMS) estimation, however, requires significant effort. Falsely low values are therefore common, especially in fatigue-prone subjects, such as neuromuscular disorder patients. In contrast, sniff nasal inspiratory pressure (SNIP) requires a short, sharp sniff; this is a natural manoeuvre, decreasing required effort. Consequently, it has been suggested that use of SNIP could confirm the accuracy of MIP measurements. However, no recent guidelines regarding the optimal method of SNIP measurement exist, and varied approaches have been described. OBJECTIVES: We compared SNIP values from three conditions, namely with 30, 60 or 90 s time intervals between repeats, the right (SNIPR) and left (SNIPL) nostril, and the contralateral nostril occluded (SNIPO) or non-occluded (SNIPNO). Additionally, we determined the optimal number of repeats for accurate SNIP measurement. METHOD: 52 healthy subjects (23 males) were recruited for this study, of which a subset of 10 subjects (5 males) completed tests comparing the time interval between repeats. SNIP was measured from functional residual capacity via a probe in one nostril, while MIP was measured from residual volume. RESULTS: There was no significant difference in SNIP depending on the interval between repeats (P = 0.98); subjects preferred the 30 s. SNIPO was significantly higher than SNIPNO (P < 0.00001) but SNIPL and SNIPR did not significantly differ (P = 0.60). There was an initial learning effect for the first SNIP test; SNIP did not decline during 80 repeats (P = 0.64). CONCLUSIONS: We conclude that SNIPO is a more reliable RMS indicator than SNIPNO, as there is reduced risk of RMS underestimation. Allowing subjects to choose which nostril to use is appropriate, as this did not significantly affect SNIP, but may increase ease of performance. We suggest that twenty repeats is sufficient to overcome any learning effect and that fatigue is unlikely after this number of repeats. We believe these results are important in aiding the accurate collection of SNIP reference value data in the healthy population.

Perioperative Improvement in Pulmonary Function in Infants with Congenital Diaphragmatic Hernia.

OBJECTIVE: The objective of this study was to compare serial changes in pulmonary function in contemporary infants with congenital diaphragmatic hernia managed with a gentle ventilation approach. STUDY DESIGN: Observational cohort, single-center study of infants ≥350/7 weeks gestation at delivery with congenital diaphragmatic hernia. Functional residual capacity (FRC), passive respiratory compliance, and passive respiratory resistance were measured presurgical and postsurgical repair and within 2 weeks of discharge. A 1-way analysis of variance for repeated measures was used to evaluate the change in FRC, passive respiratory compliance, and passive respiratory resistance over these repeated measures. RESULTS: Twenty-eight infants were included in the analysis with a mean gestational age of 38.3 weeks and birth weight of 3139 g. We found a significant increase in FRC across the 3 time points (mean in mL/kg [SD]: 10.9 [3.6] to 18.5 [5.2] to 24.2 [4.4]; P < .0001). There was also a significant increase in passive respiratory compliance and decrease in passive respiratory resistance. In contrast to a previous report, there were survivors in the current cohort with a preoperative FRC of <9 mL/kg. The mean FRC measured at discharge was in the range considered within normal limits. Sixteen infants had prenatal measurements of the lung-to-head ratio, but there was no relationship between the lung-to-head ratio and preoperative or postoperative FRC measurements. CONCLUSIONS: Infants with congenital diaphragmatic hernia demonstrate significant increases in FRC and improvements in respiratory mechanics measured preoperatively and postoperatively and at discharge. We speculate these improvements are due to the surgical resolution of the mechanical obstruction to lung recruitment and that after achieving preoperative stability, repair should not be delayed given these demonstrable postoperative improvements.

Correlação entre Capacidade Funcional e Qualidade de Vida em Pacientes Oncológicos em Cuidados Paliativos / Correlation between Functional Capacity and Quality-of-life in Cancer Patients in Palliative Care / Correlación entre Capacidad Funcional y Calidad de Vida en Pacientes Oncológicos en Cuidados Paliativos

Introdução: Cuidados paliativos são descritos como um conjunto de terapêuticas que visam minimizar as implicações negativas das doenças graves que ameaçam a vida e o bem-estar do indivíduo acometido. A progressão da doença e a sintomatologia provocam uma deterioração gradual e generalizada do estado do doente, e os sintomas físicos ocasionam a perda progressiva da capacidade funcional que, associados às manifestações emocionais pelo momento em que o paciente se encontra, impactam a sua qualidade de vida. Objetivo: Correlacionar a capacidade funcional com a qualidade de vida de pacientes oncológicos em cuidados paliativos. Método: Estudo transversal de abordagem quantitativa com 225 indivíduos. Os dados foram coletados por meio de questionário sociodemográfico, do índice de Barthel e do European Organization for Research in the Treatment of Cancer Questionnaire Palliative (EORTC QLQ-C15-PAL). Resultados: Dos 225 indivíduos elegíveis, observou-se homogeneidade entre a porcentagem de homens e mulheres, com média de 55,73±15,14 anos de idade. A análise estatística demonstrou associação positiva entre o escore do índice de Barthel e o escore de qualidade de vida do EORTC QLQ-C15-PAL com coeficiente de 0,74 e nível significância de p<0,05, bem como correlação negativa para as subescalas funcional e de sintomas com coeficiente de -0,702 e -0,544, respectivamente. Conclusão: Há uma correlação significativa entre a capacidade funcional e a qualidade de vida em pacientes oncológicos em cuidados paliativos.

Introduction: Palliative care is described as a set of therapies that aim to minimize the negative implications of severe life-threatening illnesses on the well-being of the individual affected. The progression of the disease and the symptomatology cause a gradual and generalized deterioration of the patient's condition and the physical symptoms cause the progressive loss of the functional capacity which, associated with emotional manifestations due to the moment the patient is living through, impact its quality-of-life. Objective: To correlate the functional capacity with the quality-of-life of cancer patients in palliative care. Method: Quantitative investigation with 225 individuals whose data were collected through sociodemographic questionnaire, Barthel Index and the European Organization for Research in the Treatment of Cancer Questionnaire Palliative (EORTC QLQ-C15- PAL) Results: The sample of 225 eligible individuals consisted in men and women evenly distributed with mean age of 55.73±15.14 years. Statistical analysis showed a positive association of 0.74 between the Barthel Index and the EORTC QLQ-C15-PAL quality-of-life with level of significance of p<0.05, as well as a negative correlation of -0.702 and -0.544 for the subscales functional and symptoms, respectively. Conclusion: There is a significant correlation between functional capacity and quality of life in cancer patients undergoing palliative care

Introducción: Cuidados paliativos se describen como un conjunto de terapias que tienen como objetivo minimizar las implicaciones negativas de enfermedades graves que amenazan la vida y el bienestar del individuo afectado. La progresión de la enfermedad y la sintomatología provocan un deterioro paulatino y generalizado del estado del paciente, los síntomas físicos provocan la pérdida progresiva de la capacidad funcional, asociados a manifestaciones emocionales debido al momento en el que se encuentra el paciente, impactando en la calidad de vida del paciente. Objetivo: Correlacionar la capacidad funcional con la calidad de vida de pacientes oncológicos en cuidados paliativos. Método: Estudio transversal con un enfoque cuantitativo en el que participaron 225 individuos. Los datos se recogieron mediante un cuestionario sociodemográfico, el índice de Barthel y el European Organisation for Research in the Treatment of Cancer Questionnaire Palliative (EORTC QLQ-C15-PAL). Resultados: De los 225 individuos elegibles, se observó homogeneidad de género, con una edad promedio de 55,73±15,14 años. El análisis estadístico mostró una asociación positiva entre la puntuación del índice de Barthel y la puntuación de calidad de vida de la EORTC QLQ-C15-PAL con un coeficiente de 0,74, adoptando una significancia de p<0,05, así como una correlación negativa para las subescalas funcional y de síntomas con un coeficiente de -0,702 y -0,544, respectivamente. Conclusión: Existe una correlación significativa entre la capacidad funcional y la calidad de vida en pacientes oncológicos en cuidados paliativos.

Infant pulmonary function tests in individuals with Down syndrome.

BACKGROUND AND OBJECTIVE: Down syndrome is associated with significant respiratory morbidity. The available pulmonary function testing data in school aged children and adults with Down show evidence of restrictive lung disease. We aimed to evaluated infant pulmonary function tests (iPFTs) in individuals with Down. METHODS: An observational case-control study evaluating iPFTs results from a registry of patients assessed at the Hadassah Hebrew University Medical Center between 2008 and 2018. iPFTs results in Infants with Down were compared to a spirometry control group of infants with normal expiratory airflows, using the Mann-Whitney U and Fisher's exact tests. RESULTS: iPFT data from 66 infants (20 Down and 46 control) were evaluated in the study. Most infants with Down showed abnormalities of an obstructive lung disease with mildly increased lung volumes and significantly decreased expiratory flows, mostly unresponsive to bronchodilators. Airflow limitations were most prominent at low lung volumes (median (IQR); maximal expiratory flow at functional residual capacity, V˙max FRC = 48 (26-78) %predicted in Down Vs. V˙max FRC = 100 (93-114) %predicted in controls, p < 0.001). We further observed an alteration in breathing mechanics with significantly decreased respiratory system compliance and increased airway resistance associated with decreased tidal volumes but similar minute ventilation. CONCLUSION: Our study shows that infants with have a fixed airflow obstruction phenotype. These results add comprehensive data to allow better understanding of the lung disease present early in life of infants with Down syndrome. Further studies are required to improve management of respiratory disease in individuals with Down.

Differences in the Measurement of Functional Residual Capacity Between Body Plethysmographs of Two Manufacturers.

Body plethysmography is a fundamental method for the assessment of static lung volumes. Although equipment is provided by several manufacturers, there are no established cross-vendor tools for quality control. In the process of quality control and analysis of data on hyperinflation from the large COPD cohort COSYCONET, hints appeared that plethysmographs of different vendors might yield different values for static lung volumes. Functional residual capacity (FRC) differed about 0.67 litres between plethysmographs of the manufacturer Vyaire and Ganshorn. Absolute differences of residual lung volume (RV) and total lung capacity (TLC) were similar. It appears undeniable that differences of this magnitude have an impact on clinical interpretation. Thus, device harmonization seems to be required.

Existe influência da qualidade de vida na capacidade funcional em pacientes com insuficiência cardíaca / There is an influence of quality of life on functional capacity in patients with heart failure

FUNDAMENTO: A Insuficiência Cardíaca (IC) é uma síndrome que afeta a atuação do coração como bomba, ou seja, afeta a sístole e/ou a diástole, o que leva ao comprometimento do funcionamento do corpo. Diante disso, algumas consequências podem se manifestar, como a intolerância ao exercício e diminuição da capacidade funcional, afetando assim a qualidade de vida do indivíduo e suas participações na sociedade. OBJETIVO: Verificar se existe influência da qualidade de vida na capacidade funcional em pacientes com insuficiência cardíaca. Delineamento, MATERIAIS E MÉTODOS: Estudo transversal, descritivo e analítico, com abordagem quantitativa com pacientes portadores de IC atendidos pela Liga de Fisioterapia Cardiovascular num Hospital Universitário no período de maio de 2021 a fevereiro de 2022. Foi aplicado inicialmente um questionário com dados sociodemográficos e dados referentes à condição de saúde. A qualidade de vida (QV) foi avaliada utilizando o questionário de Minnesota e a capacidade funcional foi verificada pela aplicação do questionário de Duke Activity Status Index (DASI) e pelo teste da caminhada dos 6 minutos (TC6). O nível de significância adotado foi de 5% (p < 0,05). RESULTADOS: Foram avaliados 57 indivíduos, com média de idade de 60±15 anos, com média de fração de ejeção do ventrículo esquerdo (FEVE) de 43,18±13,07, com média de massa corpórea de 26,08±6,6 kg/m2 , sendo a maioria do sexo feminino (56,14% n=32). A maioria dos pacientes eram classe funcional 1 ou 2 do New York Heart Association (NYHA). A média da pontuação no Minnesota foi de 38,41±26,8. No DASI a média verificada foi de 28,73±15,07 MET e no TC6 os pacientes caminharam em média 334,68±106,24 metros. Quando realizado as correlações foi verificado a existência de uma correlação fraca e inversamente proporcional entre a QV e o DASI (r= -,313, p=0,049). Não foi verificado correlação entre a QV e o TC6 (r= -0,0529, p=0,7302). CONCLUSÃO: Foi observado que quanto pior a qualidade de vida maior é a dificuldade referida de atividade física no questionário DASI, entretanto, o mesmo não foi observado quando o paciente é submetido realmente ao teste funcional. Palavras-chave: insuficiência cardíaca, qualidade de vida, avaliação funcional, teste da caminhada.

Prolonged heart rate recovery time after 6-minute walk test is an independent risk factor for cardiac events in heart failure: a prospective cohort study

OBJECTIVES: To determine whether the time for peak exercise heart rate to return to resting heart rate after the 6-minute walk test (6MWT) can predict cardiac events in patients with heart failure (HF) within 2 years. DESIGN: Prospective cohort study. SETTING: HF outpatient facility at a tertiary teaching hospital. PARTICIPANTS: Seventy-six patients with HF, New York Heart Association functional classification II and III, and left ventricular ejection fraction <50% MAIN OUTCOME MEASURES: Patients used a heart rate monitor to measure the time for peak exercise heart rate to return to resting heart rate after the 6MWT. Data were analysed using Polar Pro-Trainer 5 software (Kempele, Finland). Patients were followed for >2 years for cardiac events (hospitalisations and death). RESULTS: Thirty-four patients had cardiac events during the 2-year follow-up period. There was a significant difference in time to return to resting heart rate between the groups with and without cardiac events {with 3.6 [standard deviation (SD) A] vs without 2.8 (SD B) minutes; mean difference C; 95% confidence interval (CI) of the difference D to E; P=0.003}. No significant differences between patients with and without cardiac events were found for mean walking distance, mean heart rate recovery at 1 minute and mean heart rate recovery at 2 minutes. The receiver operating curve discriminated between patients with and without cardiac events (área under the curve 0.71, 95% CI 0.61 to 0.81; P< 0.001). Using logistic regression analysis, prolonged time to return to resting heart rate (≥3 minutes) independently increased the risk for cardiac events 6.9-fold (95% CI 2.34 to 20.12; P< 0.001). The Kaplan­Meier curve showed more cardiac events in patients with prolonged time to return to resting heart rate (P=0.028). CONCLUSIONS: Prolonged time to return to resting heart rate (≥3 minutes) after the 6MWT was an independent predictor of cardiac events in patients with HF.