Predictive factors for extubation success in very low and extremely low birth weight preterm infants.

Background: Although invasive mechanical ventilation (IMV) has contributed to the survival of preterm infants with extremely low birth weight (ELBW), it is also associated with unsatisfactory clinical outcomes when used for prolonged periods. This study aimed to identify factors that may be decisive for extubation success in very low birth weight (VLBW) and extremely low birth weight (ELBW) preterm infants. Methods: The cohort study included preterm infants with gestational age (GA) <36 weeks, birth weight (BW) <1500 grams who underwent IMV, born between 2015 and 2018. The infants were allocated into two groups: extubation success (SG) or failure (FG). A stepwise logistic regression model was created to determine variables associated with successful extubation. Results: Eighty-three preterm infants were included. GA and post-extubation arterial partial pressure of carbon dioxide (PaCO2) were predictive of extubation success. Infants from FG had lower GA and BW, while those from SG had higher weight at extubation and lower post-extubation PaCO2. Discussion: Although we found post-extubation PaCO2 as an extubation success predictor, which is a variable representative of the moment after the primary outcome, this does not diminish its clinical relevance since extubation does not implicate in ET removal only; it also involves all the aspects that take place within a specified period (72 hours) after the planned event. Conclusion: GA and post-extubation PaCO2 were predictors for extubation success in VLBW and ELBW preterm infants. Infants who experienced extubation failure had lower birth weight and higher FiO2 prior to extubation.

Risk factors associated with limited functional status among out-of-hospital patients 30 days and one year after a diagnosis of COVID-19: a cohort study.

Some people experience indefinitely persistent and disabling symptoms after acute COVID-19, even those who have not been hospitalized. The purpose of this study was to analyze the long-term health consequences at 30 days and one year among people who were not hospitalized after a diagnosis of COVID-19 and to analyze which variables predict limitations in functional status. This is a prospective cohort study with non-hospitalized adults infected with SARS-CoV-2 in the city of Londrina. After 30 days and one year of the acute symptoms of COVID-19, participants received the questionnaire through a social media that consisted of sociodemographic data and data on functionality through the Post-COVID Functional State Scale (PCFS)-the primary outcome of the study "presence of functional status limitation" was grouped into without functional status limitation (value: zero) and with functional limitation (value 1 to 4), fatigue through of the Fatigue Severity Scale (FSS) and dyspnea using the modified Borg scale. In the statistical analysis, multivariable analysis was performed. Statistical significance was set to 5%. Of 140 individuals analyzed, 103 (73.6%) were female with a median age of 35.5 (27-46) years. One year after the diagnosis of COVID-19, 44.3% had at least one self-reported symptom: memory loss (13.6%), gloominess (8.6%), anosmia (7.9%), body pain (7.1%), ageusia (7%), headache (6.4%), and cough (3.6%). According to the FSS and modified Borg scale 42.9% reported fatigue and 18.6% reported dyspnea, respectively. As for functionality, 40.7% reported some limitation, being 24.3% negligible functional limitation, 14.3% slight and 2.1% moderate according to the PCFS. There was a univariate association between the presence of limitation in the functional status with the female sex, diagnosis of anxiety and depression, presence of persistent symptoms after one year, fatigue and dyspnea. In the multivariable analysis, the predictor variables for functional status limitation were female sex, diagnosis of anxiety/depression, presence of at least one persistent symptom and fatigue one year after the diagnosis of COVID-19. One year after the disease, the patients presented functional limitation according to the PCFS, even without hospitalization. Risk factors associated with functional limitation include female sex, presence of fatigue, anxiety and depression, and at least one persistent symptom after one year of COVID-19 diagnosis.

Quantification of changes in functional capacity and muscle strength in patients: a burn intensive care unit cohort study.

BACKGROUND: Regular functional status and muscle strength assessments should be performed with burn victims. OBJECTIVE: To evaluate the functionality and peripheral muscle strength of burn patients admitted to the hospital. METHODS: A longitudinal and prospective study was conducted from March to November 2019, including adult burn victims who were admitted to the ICU and discharged from the hospital. Patients were assessed on admission, every 10 days, at discharge from the ICU and from the hospital. Functionality was assessed using the Chelsea Critical Care Physical Assessment (CPAx) and the Functional Independence Measure (FIM). Muscle strength was assessed using the Medical Research Council (MRC) scale and handgrip dynamometry. RESULTS: 41 patients were included, 27 men and 14 women, with a median age of 41 (IQR [28-56]) years, mean TBSA of 19 (SD ± 12) percent, mean Abbreviated Burn Severity Index (ABSI) of 6 (SD ± 2) and the mean ICU time was 29 (SD ± 9) days. The CPAx, FIM and MRC evaluations improved (P < 0.0001) when compared to admission to the ICU and at hospital discharge, while the dynamometry showed no statistical difference. The ABSI only showed an association with the length of stay. CONCLUSION: The CPAX scale was sensitive to changes in functionality throughout the hospital stay in severely burned patients, in the present study. The assessment of global muscle strength was more sensitive than handgrip strength and the ABSI was associated with length of stay in this population.

Atuação fisioterapêutica e perfil epidemiológico de crianças queimadas admitidas em um centro de referência de queimaduras de um hospital universitário / Physiotherapeutic performance and epidemiological profile of burned children admitted in a burn reference center in a university hospital

OBJETIVO: Traçar o perfil epidemiológico de crianças queimadas atendidas pelo Centro de Tratamento de Queimados de um hospital universitário e analisar os tratamentos clínico, cirúrgico e a intervenção fisioterapêutica. MÉTODO: Estudo transversal, retrospectivo, por meio de prontuários de crianças queimadas (0 a 12 anos), de janeiro de 2020 a março de 2021. Foram coletadas informações pessoais, clínicas e referentes ao tratamento e atuação fisioterapêutica. A significância estatística adotada foi 5%. RESULTADOS: Amostra composta por 54 crianças, 66,7% masculinos, e 55,6% lactentes. Houve prevalência de queimaduras de segundo grau em membros superiores (59,3%) e tronco anterior (57,4%) por meio da escaldadura (64,8%), ocorrida em domicílio (92,6%). A maioria dos pacientes ficou na enfermaria/Centro de Tratamento de Queimados (77,8%) e recebeu alta (98,1%). Tiveram complicações 42,6% das crianças, a mais comum foi infecção. Procedimento cirúrgico mais realizado: desbridamento (57,4%) e todas as crianças fizeram troca de curativos. O número total de sessões de fisioterapia teve mediana 11 [7-21,3]. As condutas respiratórias foram feitas em 46,3% das crianças, destaque para técnicas reexpansivas e desobstrutivas. Já 98,1% realizaram condutas motoras: mobilização passiva e ativa, alongamentos, sedestação, ortostatismo e treino de marcha. Por fim, a fisioterapia promoveu orientações a 92,6% dos responsáveis. CONCLUSÕES: A população pediátrica mais atingida pelas queimaduras pertencia ao sexo masculino e era lactente. Houve prevalência de queimaduras de segundo grau em membros superiores e tronco anterior por escaldadura na residência. A maioria dos pacientes realizou desbridamento, troca de curativos e teve alta. A fisioterapia aplicou condutas motoras em quase todas as crianças, e respiratórias em metade.

OBJECTIVE: To trace the epidemiological profile of burned children treated by the Burn Treatment Center of a university hospital and to analyze the clinical, surgical and physical therapy interventions. METHODS: Cross-sectional, retrospective study, using medical records of burned children (0 to 12 years old), from January 2020 to March 2021. Personal, clinical, and treatment-related information and physiotherapeutic performance were collected. The adopted statistical significance was 5%. RESULTS: Sample composed of 54 children, 66.7% male, and 55.6% infants. There was a prevalence of second-degree burns on upper limbs (59.3%) and anterior trunk (57.4%) through scalding (64.8%), which occurred at home (92.6%). Most patients stayed in the ward/Burn Treatment Center (77.8%) and were discharged (98.1%). 42.6% of children had complications, the most common being infection. Most performed surgical procedure: debridement (57.4%) and all children changed dressings. The total number of physiotherapy sessions had a median of 11 [7-21.3]. Respiratory procedures were performed in 46.3% of the children, with emphasis on airway clearance and lung expansion techniques. 98.1% already performed motor conducts: passive and active mobilization, stretching, sedestation, orthostatism and gait training. Finally, physiotherapy provided guidance to 92.6% of those responsible. CONCLUSIONS: The pediatric population most affected by burns belonged to the male gender and were infants. There was a prevalence of second degree burns in upper limbs and anterior trunk through scalding at home. Most patients underwent debridement, changed dressings and were discharged. Physiotherapy applied motor conducts in almost all children, and respiratory in half.

Quali-quantitative analysis of adherence and perceived satisfaction of individuals with COPD after high-intensity training on land and in water: additional analysis from a randomized clinical trial / Análise quali-quantitativa da aderência e percepção da satisfação de indivíduos com DPOC após treinamento físico de alta intensidade no solo e na água: análises adicionais de um ensaio clínico randomizado / Análisis cuali-cuantitativo de adherencia y percepción de la satisfacción de individuos con EPOC después de entrenamiento físico de alta intensidad en suelo y en agua: análisis adicionales de un ensayo clínico aleatorizado

ABSTRACT Although patients with chronic obstructive pulmonary disease (COPD) benefit in many ways after participating in pulmonary rehabilitation programs, high dropout rates are still observed among participants. This study aims to analyze the adherence rate and perceived satisfaction in individuals with chronic obstructive pulmonary disease who underwent high-intensity physical training on land (LG) and in water (WG). This study is an additional analysis from a randomized controlled trial. In total, 36 subjects (51%) completed the intervention. All participants underwent six months of high-intensity endurance and strength training. Adherence was assessed by the proportion of patients who completed the training program. Perceived satisfaction was evaluated using a questionnaire composed of structured and semi-structured questions. The interviews were recorded, transcribed, and analyzed according to the criteria of our thematic analysis. The Shapiro-Wilk test was used to assess data normality, and dropout rates were compared using the chi-square test. Statistical significance was set at 5%. Regarding adherence, 59% of WG participants and 44% of LG participants completed the program, with no difference between the groups (p>0.05). Individuals from both groups were equally satisfied after six months of physical training (<90%); the therapist-patient relationship and treatment effectiveness being important factors for this perception. Qualitative analysis also showed that WG participants reported a more prominent improvement in their respiratory symptoms, leisure, sensation of pain, and sleep. In conclusion, patients with COPD were satisfied after six months of high-intensity physical training in water and on land, noting that water exercising promoted additional benefits compared to land exercising. There seems to be no superiority to any of the regimens (water or land) regarding the adherence to the training programs.

RESUMO Embora os pacientes com doença pulmonar obstrutiva crônica (DPOC) se beneficiem de muitas maneiras de programas de reabilitação pulmonar, ainda são observadas altas taxas de desistência entre os participantes. O objetivo deste estudo foi analisar a taxa de adesão e a percepção de satisfação de indivíduos com DPOC que realizaram treinamento físico de alta intensidade em solo (GS) e água (GA). Foram realizadas análises adicionais de um ensaio clínico randomizado. 36 indivíduos (51%) completaram a intervenção. Todos os participantes foram submetidos a seis meses de treinamento de força e resistência de alta intensidade. A adesão foi avaliada pela proporção de pacientes que completaram o programa de treinamento e a satisfação foi avaliada por meio de um questionário composto por questões estruturadas e semiestruturadas. As entrevistas foram gravadas, transcritas e analisadas de acordo com o critério de análise de conteúdo. Foi utilizado o teste de Shapiro-Wilk para avaliar a normalidade dos dados e o teste qui-quadrado para a comparação da taxa de aderência. Foi adotado p<0,05 como significância estatística. Em relação à adesão, 59% dos participantes do GA e 44% do GS completaram o programa, sem diferença entre os grupos (p>0,05). Os indivíduos de ambos os grupos estavam igualmente satisfeitos após seis meses de treinamento físico (<90%), sendo a relação terapeuta-paciente e a eficácia no tratamento fatores importantes para essa percepção. A análise qualitativa também mostrou que os participantes do GA relataram benefícios mais proeminentes em relação aos sintomas respiratórios, ao lazer, a sensação de dor e ao sono. Portanto, os pacientes com DPOC se mostraram satisfeitos após seis meses de treinamento e perceberam que o exercício na água promoveu mais benefícios do que em solo. Em relação à adesão aos programas de treinamento não pareceu haver superioridade de nenhum dos regimes (água ou solo).

RESUMEN Aunque los programas de rehabilitación pulmonar ayudan a los pacientes con enfermedad pulmonar obstructiva crónica (EPOC), todavía se observan altas tasas de abandono de los participantes en estos programas. El objetivo de este estudio fue evaluar la tasa de adherencia y la percepción de satisfacción de las personas con EPOC que realizaron entrenamiento físico de alta intensidad en suelo (GS) y en agua (GA). Se realizaron análisis adicionales de un ensayo clínico aleatorizado. 36 participantes (51%) completaron la intervención. Todos se sometieron a seis meses de entrenamiento de fuerza y resistencia de alta intensidad. La adherencia se evaluó por la proporción de pacientes que completaron el programa de entrenamiento, y la satisfacción se evaluó mediante un cuestionario con preguntas estructuradas y semiestructuradas. Las entrevistas fueron grabadas, después transcritas y analizadas según el criterio de análisis de contenido. Para evaluar la normalidad de los datos, se utilizó el test de Shapiro-Wilk, y para comparar la tasa de adherencia se aplicó la prueba de chi-cuadrado. El nivel de significación estadística fue de p<0,05. En cuanto a la adherencia, el 59% de los participantes del GA y el 44% del GS completaron el programa, sin diferencia entre grupos (p>0,05). Ambos grupos estaban igualmente satisfechos después de seis meses de entrenamiento físico (<90%), por lo que la relación terapeuta-paciente y la eficacia del tratamiento fueron los factores importantes de esta percepción. El análisis cualitativo también apuntó que los participantes de GA informaron más beneficios con respecto a los síntomas respiratorios, el ocio, la sensación de dolor y el sueño. Por lo tanto, los pacientes con EPOC estaban satisfechos después de seis meses de entrenamiento y se dieron cuenta de que el ejercicio en el agua les brindaba más beneficios que el ejercicio en el suelo. En cuanto a la adherencia al carácter de los programas de entrenamiento (si agua o suelo), no pareció haber superioridad en ninguno de ellos.

Which is the best protocol and cut-off point in the 4-metre gait speed test to discriminate exercise capacity in COPD? / Qual o melhor protocolo e ponto de corte no teste 4-metre gait speed para discriminar capacidade de exercício na Doença Pulmonar Obstrutiva Crônica?

Objective To determine the discriminative capacity and cut-off point of different 4-metre gait speed test (4MGS) protocols in identifying preserved or reduced exercise capacity using the six-minute walk test (6MWT) in patients with Chronic Obstructive Pulmonary Disease (COPD); also, to compare 4MGS protocols and characteristics of individuals according to the best cut-off point. Methods We evaluated fifty-six patients with COPD, all of which were submitted to the assessment of anthropometric characteristics, pulmonary function (spirometry) and functional exercise capacity (6MWT and four protocols of the 4MGS). In the 4MGS test, patients were instructed to walk at normal pace and at maximum speed in a 4 meters course (4MGS 4m - usual pace and at maximum) and 8 meters course (4MGS 8m - usual pace and at maximum). Results Only the 4MGS 4m-maximum protocol was able to identify preserved exercise capacity in the 6MWT (AUC=0.70) with moderate correlation between them (r=0.52; P=0<0.0001). The cut-off point found in the 4MGS 4m-maximum was 1.27 m/s. Patients with preserved exercise capacity (4MGS 4m-maximum ≥1.27m/s) walker greater distances on the 6MWT in %pred (91±2 vs 76±3; P<0.0001). In the other comparisons involving gender, BMI, FEV1% pred and GOLD index there were no significant differences between the groups. In addition, the agreement of individuals classified as preserved and reduced exercise capacity in the 6MWT and 4MGS 4m-maximum was significant (P = 0.008). Conclusion The 4MGS 4m-maximum test can be used to discriminate preserved exercise capacity in patients with COPD and correlates with the 6MWT.

Are the Effects of High-Intensity Exercise Training Different in Patients with COPD Versus COPD+Asthma Overlap?

PURPOSE: This study aimed to investigate whether patients with chronic obstructive pulmonary disease (COPD) presenting asthma overlap (ACO) benefit similarly in comparison to patients with only COPD after a 12-week high-intensity exercise training (ET) program. METHODS: Subjects with a diagnosis of COPD alone or ACO were evaluated and compared before and after a high-intensity ET program composed of walking and cycling plus strengthening exercises of the upper and lower limbs (3 days/week, 3 months, 36 sessions). Assessments included spirometry, bioelectrical impedance, 6-min walk test (6MWT), London Chest Activity of Daily Living Scale (LCADL), Hospital anxiety and depression Scale, modified Medical Research Council Scale (mMRC), Saint George Respiratory Questionnaire (SGRQ), and respiratory and peripheral muscle strength [manovacuometry and 1-repetition maximum test (quadriceps femoris, biceps and triceps brachialis), respectively]. ACO was defined according to Sin et al. (Eur Respir J 48(3):664-673, 2016). RESULTS: The sample was composed of 74 subjects (57% male, age 67 ± 8 years, BMI 26 (21-32) kg/m2, FEV1 47 ± 17%predicted), and 12 (16%) of them were classified as presenting ACO. Both groups improved pulmonary function, 6MWT, peripheral and inspiratory muscle strength, LCADL, and SGRQ after ET (p < 0.005 for all). There were no significant interactions between ACO and COPD on ET effects (p > 0.05 for all). Likewise, there was no difference in the proportion of patients achieving the minimum clinical important difference for 6MWT and mMRC. CONCLUSION: High-intensity exercise training generates similar benefits in patients with COPD regardless of whether presenting asthma overlap or not.

Can the six-minute walk distance predict the occurrence of acute exacerbations of COPD in patients in Brazil? / A distância percorrida no teste de caminhada de seis minutos pode predizer a ocorrência de exacerbações agudas da DPOC em pacientes brasileiros?

ABSTRACT Objective: To evaluate whether a six-minute walk distance (6MWD) of < 80% of the predicted value can predict the occurrence of acute exacerbations of COPD in patients in Brazil over a 2-year period. Methods: This was a retrospective cross-sectional study involving 50 COPD patients in Brazil. At enrollment, anthropometric data were collected and patients were assessed for pulmonary function (by spirometry) and functional exercise capacity (by the 6MWD). The patients were subsequently divided into two groups: 6MWD ≤ 80% of predicted and 6MWD > 80% of predicted. The occurrence of acute exacerbations of COPD over 2 years was identified by analyzing medical records and contacting patients by telephone. Results: In the sample as a whole, there was moderate-to-severe airflow obstruction (mean FEV1 = 41 ± 12% of predicted) and the mean 6MWD was 469 ± 60 m (86 ± 10% of predicted). Over the 2-year follow-up period, 25 patients (50%) experienced acute exacerbations of COPD. The Kaplan-Meier method showed that the patients in whom the 6MWD was ≤ 80% of predicted were more likely to have exacerbations than were those in whom the 6MWD was > 80% of predicted (p = 0.01), whereas the Cox regression model showed that the former were 2.6 times as likely to have an exacerbation over a 2-year period as were the latter (p = 0.02). Conclusions: In Brazil, the 6MWD can predict acute exacerbations of COPD over a 2-year period. The risk of experiencing an acute exacerbation of COPD within 2 years is more than twice as high in patients in whom the 6MWD is ≤ 80% of predicted.

RESUMO Objetivo: Avaliar se a distância percorrida no teste de caminhada de seis minutos (DTC6) < 80% do valor previsto pode predizer a ocorrência de exacerbações agudas da DPOC ao longo de 2 anos em pacientes brasileiros. Métodos: Estudo transversal, retrospectivo, com 50 pacientes brasileiros com diagnóstico de DPOC. Após a admissão, os pacientes foram submetidos à coleta de dados antropométricos, avaliação da função pulmonar (resultados espirométricos) e da capacidade funcional de exercício (DTC6), sendo posteriormente divididos em dois grupos: DTC6 ≤ 80% do predito e DTC6 > 80% do predito. A ocorrência de exacerbações agudas da DPOC ao longo de 2 anos foi identificada por meio de registros de prontuários e contato telefônico. Resultados: A amostra geral apresentou obstrução moderada/grave ao fluxo aéreo (média de VEF1 = 41 ± 12% do predito) e média de DTC6 de 469 ± 60 m (86 ± 10% do predito). Nos 2 anos de seguimento após a realização do teste, 25 pacientes (50%) apresentaram exacerbação aguda da DPOC. O método de Kaplan-Meier mostrou que os pacientes com DTC6 ≤ 80% do predito apresentaram exacerbação mais frequentemente que pacientes com desempenho > 80% do predito (p = 0,01), enquanto o modelo de regressão de Cox mostrou que os pacientes no primeiro grupo apresentavam 2,6 mais chances de apresentar exacerbação em 2 anos em comparação ao segundo grupo (p = 0,02). Conclusões: A DTC6 é capaz de predizer exacerbações agudas da DPOC em pacientes brasileiros ao longo de 2 anos. Pacientes com DTC6 ≤ 80% do valor predito têm mais que o dobro de chances de apresentar exacerbação em 2 anos.

Can the six-minute walk distance predict the occurrence of acute exacerbations of COPD in patients in Brazil?

OBJECTIVE: To evaluate whether a six-minute walk distance (6MWD) of < 80% of the predicted value can predict the occurrence of acute exacerbations of COPD in patients in Brazil over a 2-year period. METHODS: This was a retrospective cross-sectional study involving 50 COPD patients in Brazil. At enrollment, anthropometric data were collected and patients were assessed for pulmonary function (by spirometry) and functional exercise capacity (by the 6MWD). The patients were subsequently divided into two groups: 6MWD ≤ 80% of predicted and 6MWD > 80% of predicted. The occurrence of acute exacerbations of COPD over 2 years was identified by analyzing medical records and contacting patients by telephone. RESULTS: In the sample as a whole, there was moderate-to-severe airflow obstruction (mean FEV1 = 41 ± 12% of predicted) and the mean 6MWD was 469 ± 60 m (86 ± 10% of predicted). Over the 2-year follow-up period, 25 patients (50%) experienced acute exacerbations of COPD. The Kaplan-Meier method showed that the patients in whom the 6MWD was ≤ 80% of predicted were more likely to have exacerbations than were those in whom the 6MWD was > 80% of predicted (p = 0.01), whereas the Cox regression model showed that the former were 2.6 times as likely to have an exacerbation over a 2-year period as were the latter (p = 0.02). CONCLUSIONS: In Brazil, the 6MWD can predict acute exacerbations of COPD over a 2-year period. The risk of experiencing an acute exacerbation of COPD within 2 years is more than twice as high in patients in whom the 6MWD is ≤ 80% of predicted.

Avaliação da capacidade funcional de exercício no ambiente aquático / Evaluación de la capacidad funcional del ejercicio hecho en ambiente acuático / Functional exercise capacity evaluation in an aquatic environment

RESUMO Os objetivos deste estudo foram verificar a correlação da distância percorrida e comparar a velocidade média durante a caminhada por meio do teste de caminhada de seis minutos (TC6min) realizado em solo com o teste de caminhada de três minutos aquático (TC3minA) em jovens saudáveis, bem como contrastar variáveis fisiológicas (frequência cardíaca, saturação periférica de oxigênio e pressão arterial) e sintomatológicas entre os testes. Estudo transversal com amostragem de vinte indivíduos jovens saudáveis. Todos foram submetidos à espirometria, responderam a um questionário sobre saúde e atividade física, além de realizarem o TC6min e o TC3minA. Na análise estatística foi utilizado teste de Shapiro-Wilk para avaliar normalidade dos dados, o teste t de Student pareado e Wilcoxon nas comparações entre as variáveis e o coeficiente de correlação de Pearson para verificar associações. A significância estatística de p<0,05 foi adotada. A média de idade foi de 22 (±2) anos, IMC de 23 (±3) Kg/m2 e todos os indivíduos apresentaram valores normais de função pulmonar. A distância média percorrida no TC6min foi de 657 (±43) e no TC3minA 135 (±13) metros. Foi encontrada fraca correlação entre o TC3minA e TC6min (r=0,35). A velocidade durante os testes apresentou diferença estatisticamente significante (TC3minA 0,75±0,07 versus TC6min 1,85±9,1, p<0,0001). Não houve diferença nas variáveis fisiológicas iniciais e finais entre o TC3minA e o TC6min. Aquele embora possa ser uma boa ferramenta a ser utilizada para avaliação e prescrição de exercício no ambiente aquático mostrou uma fraca correlação com o TC6min e semelhante esforço fisiológico, porém novos estudos são sugeridos para comprovar esse achado.

RESUMEN En este estudio se verificó la correlación de la distancia recorrida en jóvenes saludables y se comparó la velocidad media durante la caminata mediante el test de caminata de seis minutos (TC6min) realizado en suelo y del test de caminata de tres minutos acuático (TC3minA), así como se contrastó las variables fisiológicas (frecuencia cardiaca, saturación periférica de oxígeno y presión arterial) y de síntomas entre los test. Es un estudio transversal con muestra de veinte sujetos jóvenes saludables. Se les sometieron a la espirometría y se les aplicaron un cuestionario sobre salud y actividad física, además de que realizaron el TC6min y el TC3minA. En el análisis estadístico se utilizó la prueba Shapiro-Wilk para evaluar la normalidad de los datos, la prueba t Student emparejada y Wilcoxon para las comparaciones entre las variables y el coeficiente de correlación de Pearson para verificar las asociaciones. Se utilizó la significancia estadística de p<0,05. El promedio de edad fue el de 22 (±2) años, el IMC de 23 (±3) Kg/m2 y todos los participantes presentaron valores normales para la función pulmonar. El promedio de distancia recorrida en el TC6min fue de 657 (±43) y en el TC3minA de 135 (±13) metros. Se encontró una débil correlación entre el TC3minA y el TC6min (r=0,35). La velocidad durante los test presentó diferencias estadísticamente significativas (TC3minA 0,75±0,07 versus TC6min 1,85±9,1, p<0,0001). No hubo diferencias en las variables fisiológicas iniciales y finales entre el TC3minA y el TC6min. Aunque el TC3minA pueda ser una buena herramienta a utilizarse para la evaluación y la prescripción del ejercicio en el ambiente acuático se mostró una débil correlación con el TC6min y semejante esfuerzo fisiológico, sin embargo se recomiendan nuevos estudios para comprobarlo.

ABSTRACT The aim of this study was to investigate the correlation between distance achieved and compare the average speed while walking in the six-minute walk test (6MWT) performed on solid ground and in the three-minute walk test in water (3MWT-W) with healthy young individuals, as well as compare physiological (heart rate, oxygen saturation and blood pressure) and symptomatic variables between tests. It is a cross-sectional study, with a sample of 20 healthy young subjects. All patients underwent spirometry, answered a questionnaire on health and physical activity, in addition to performing the 6MWT and 3MWT-W. Statistical analysis used the Shapiro-Wilk test to evaluate normality of the data, the paired Student's t-test and Wilcoxon in the comparisons between the variables and the Pearson correlation coefficient to verify associations. Statistical significance of p < 0.05 was adopted. The mean age was 22 (±2) years, the mean BMI was 23 (±3) kg/m2 and all subjects had normal pulmonary function. The average distance achieved in the 6MWT was of 657 (±43) meters and in the 3MWT-W of 135 (±13) meters. A weak correlation between the 3MWT-W and 6MWT (r=0.35) was found. The speed during the tests showed a statistically significant difference (3MWT-W 0.75±0.07 versus 6MWT 1.85±9.1, p<0.0001). There was no difference in the initial and the final physiological variables between 3MWT-W and 6MWT. The 3MWT-W may be a good tool for evaluation and exercise prescription in the aquatic environment, but showed a weak correlation with the 6MWT and similar physiological strain, though further studies are suggested to confirm this finding.

Trinta minutos de repouso entre dois testes de caminhada de 6 minutos são suficientes para recuperação cardiovascular e sintomatológica em pacientes com doença pulmonar obstrutiva crônica? / ¿Son suficientes treinta minutos de descanso entre dos test de caminata de 6 minutos para recuperación cardiovascular y de síntomas en pacientes con enfermedad pulmonar obstructiva crónica? / Are thirty minutes of rest between two 6-Minute Walk Tests enough for cardiovascular and symptomatic recovery for patients with chronic obstructive pulmonary disease?

RESUMO Dois testes da caminhada de 6 minutos (TC6min) são necessários para avaliação da capacidade funcional de exercício em pacientes com doença pulmonar obstrutiva crônica (DPOC). Apesar de a American Thoracic Society (ATS) preconizar um intervalo de 1 hora entre dois testes, não se sabe se um período menor poderia ser utilizado para normalização das variáveis fisiológicas. O objetivo foi verificar se o intervalo de 30 minutos de repouso entre dois TC6min seria suficiente para que as variáveis cardiovasculares e sintomatológicas retornassem aos valores basais. Duzentos e quinze pacientes com DPOC (121H, 66±8 anos; VEF1: 44[32-57]% previsto) realizaram dois TC6min com intervalo de 30 minutos entre eles. Foram mensuradas antes e após os testes, pressão arterial (PA), frequência cardíaca (FC), saturação periférica de oxigênio (SpO2) e grau de dispneia e fadiga. Os pacientes caminharam maior distância no segundo teste (TC6min1: 450 [390-500]m vs TC6min2: 470 [403-515]m; p<0,0001). A FC inicial foi maior no segundo TC6min (FC inicial TC6min1: 83 [73-91]bpm vs TC6min2: 83 [75-93]bpm; p=0,001). Dispneia e fadiga foram menores antes do segundo teste (Borg dispneia inicial TC6min1: 0,5 [0-2] vs TC6min2: 0 [0-2]; p=0,0006 e Borg fadiga inicial TC6min1: 0 [0-2] vs TC6min2: 0 [0-2]; p=0,007). Não houve diferenças quanto à PA e SpO2 (p>0,05 para todos). Embora haja diferença estatisticamente significante na FC inicial entre o primeiro e segundo teste, tal achado não parece ser clinicamente relevante. Portanto, trinta minutos de repouso entre dois TC6min são suficientes para recuperação sintomatológica e cardiovascular em pacientes com DPOC.

RESUMEN Dos test de caminata de 6 minutos (TC6min) son necesarios para que se evalúe la capacidad funcional de ejercicio en pacientes con enfermedad pulmonar obstructiva crónica (EPOC). Aunque la American Thoracic Society (ATS) sugiere 1 hora de intervalo entre dos test, todavía se desconoce si puede utilizarse un periodo menor para normalización de las variables fisiológicas. En este estudio se comprobó que es suficiente el intervalo de 30 minutos de descanso entre dos TC6min para que las variables cardiovasculares y de síntomas vuelvan a sus valores de referencia. El estudio se llevó a cabo con 215 pacientes con EPOC (121H, 66±8 años; VEF1: 44[32-57]% previsto), que hicieron dos TC6min con intervalos de 30 minutos. Antes y después de los test se midieron la presión arterial (PA), la frecuencia cardíaca (FC), la saturación de oxígeno (SpO2) y el grado de disnea y de cansancio. Los pacientes caminaron una distancia más grande en el segundo test (TC6min1: 450 [390-500]m vs TC6min2: 470 [403-515]m; p<0,0001). La FC fue mayor en el segundo TC6min (FC inicial TC6min1: 83 [73-91]lpm vs TC6min2: 83 [75-93]lpm; p=0,001). La disnea y el cansancio fueron menores antes del segundo test (Borg disnea inicial TC6min1: 0,5 [0-2] vs TC6min2: 0 [0-2]; p=0,0006 y Borg cansancio inicial TC6min1: 0 [0-2] vs TC6min2: 0 [0-2]; p=0,007). En cuanto a la PA y la SpO 2 no hubo diferencias significativas con p>0,05 para todos. Aunque tenga diferencia estadística significante en la FC inicial entre el primer y el segundo test, el resultado no es clínicamente relevante, por lo tanto, los 30 minutos de descanso entre dos TC6min son suficientes para la recuperación cardiovascular y de síntomas en pacientes con EPOC.

ABSTRACT Two 6-Minute Walk Tests (6MWT) are required to evaluate functional capacity of exercise in patients with Chronic Obstructive Pulmonary Disease (COPD). Despite the fact that the American Thoracic Society (ATS) has proposed a one-hour interval between two tests, it is unknown whether a shorter period could be used for the normalization of physiological variables. We aimed to verify that an interval of 30 minutes of rest between two 6MWT is sufficient for cardiovascular and symptomatic variables to return to their basal levels. Two hundred and fifteen patients with COPD (121H, 66±8 years; FEV1: 44 [32-57]% predicted) performed two 6MWT with a thirty-minute interval between them. Before and after the tests, we measured Blood Pressure (BP), Heart Rate (HR), peripheral oxygen saturation (SpO2), degree of dyspnea, and fatigue. Patients walked the longest distance in the second test (6MWT1: 450 [390-500]m vs 6MWT2: 470 [403-515]m; p<0.0001). The initial HR was greater in the second 6MWT (initial HR 6MWT1: 83 [73-91]bpm vs 6MWT2: 83 [75-93]bpm; p=0.001). Dyspnea and fatigue were lower before the second test (initial Borg dyspnea 6MWT1: 0.5 [0-2]m vs 6MWT2: 0 [0-2]; p = 0.0006 and initial Borg fatigue 6MWT1: 0 [0-2]m vs 6MWT2: 0 [0-2]; p = 0.007). There were no differences regarding the BP and the SpO2(p>0.05 for all). Although there are statistically significant differences in initial HR between the first and second test, this finding does not seem to be clinically relevant. Therefore, thirty minutes of rest between two 6MWT are sufficient for cardiovascular and symptomatic recovery in patients with COPD.

Perfil dos pacientes com DPOC que melhoram a capacidade de exercício após treinamento / Profile of patients with COPD who improve exercise capacity after training

Introdução: Fatores associados à melhora no incremental shuttle walking test (ISWT), em pacientes com DPOC não estão claros. Objetivo: Identificar o perfil dos pacientes com melhor desempenho no ISWT após treinamento físico. Métodos: Quarenta e dois pacientes com DPOC foram separados em dois grupos: melhora (GM) no ISWT (≥20 metros) e não melhora (GNM). Foram avaliados: espirometria, ISWT, teste da caminhada de seis minutos (TC6min), sensação de dispneia, dados antropométricos e de gravidade da doença. Resultados: Após treinamento, houve melhora na distância do ISWT (P=0,03). O GM apresentou pior desempenho no ISWT (P<0,0001) e maior sensação de dispneia (P=0,04) antes do treinamento. Os integrantes do GM e do GNM não apresentaram diferenças em relação aos dados antropométricos, bem como de gravidade da doença. Conclusões: Pacientes com mais sintomas e pior desempenho no ISWT inicial parecem ser os que mais melhoram sua capacidade máxima de exercício após treinamento físico.

Introduction: Factors associated with improvement in the incremental shuttle walking test (ISWT), in COPD patients, are not clear. Objective: To identify the profile of patients with better performance in the ISWT after physical training. Methods: Forty-two patients with COPD were separated into two groups: improvement (IG) in the ISWT (≥20 meters), and no improvement (NIG). Spirometry, ISWT, six-minute walk test (6MWT), sensations of dyspnea, anthropometric data and disease severity were evaluated. Results: After training, there was an improvement in the ISWT (P = 0.03). Patients from the IG showed poorer performance in the ISWT (P <0.0001) and greater sensation of dyspnea (P = 0.04) before training. Participants in the IG and NIG did not show any differences in anthropometric data and disease severity. Conclusions: Patients with more symptoms and poorer performance on the initial ISWT seem to be the ones who improve more after physical training.

Relationship between sniff nasal inspiratory pressure and BODE index in patients with COPD.

PURPOSE: The aims of this study were to investigate the relationship between sniff nasal inspiratory pressure (SNIP) and severity of chronic obstructive pulmonary disease (COPD) as defined by the BODE index, and to investigate the capacity of different SNIP cutoffs to predict a BODE index score ≥5 (i.e., worse disease severity). METHODS: Thirty-eight subjects with COPD (21 men, 66 ± 8 years, forced expiratory volume in the first second (FEV(1)) 42 ± 16 % predicted) underwent assessments of SNIP, airflow limitation, body mass index (BMI), dyspnea (Medical Research Council scale), and exercise capacity (6-min walking test, 6MWT). The BODE index was calculated, and patients were separated into two groups according to the BODE quartiles (1 and 2, or 3 and 4). RESULTS: Patients from quartiles 3 and 4 presented lower values of SNIP than patients from quartiles 1 and 2 (73 ± 18 vs 56 ± 21 cmH(2)O, respectively; p = 0.01). There was significant and inverse correlation between SNIP and the BODE index (r = -0.62; p<0.001). A logistic regression model revealed that a SNIP value below 63 cmH(2)O presented higher sensitivity and specificity (70 and 67 %, respectively) for predicting a BODE score equivalent to quartiles 3 or 4. CONCLUSION: SNIP is moderately and significantly related to COPD severity as assessed by the BODE index. Moreover, the cutoff point of 63 cmH2O showed the best combination of sensitivity and specificity for predicting worse scores in the BODE index.

[Prevalence of mouth breathing in children from an elementary school]. / Prevalência de respiradores bucais em crianças de idade escolar.

The objective of this article is to identify the prevalence of mouth breathing in children from an elementary school. 496 questionnaires were answered by 1st and 4th grade children's parents or sponsors in order to identify mouth-breathing. There were questions about habits, sleeping, behavior, eating, personal care and breathing. Mann-Whitney and the Chi-square tests were used to compare the variables between mouth-breathing and nose-breathing among the groups. To measure the exposure effect of the explanatory variables on mouth breathing, the test of logistic regression was used and its magnitude was calculated through Odds Ratio. The statistical significance was set at 5%, and the rate of returned questionnaires was 84.5%. The prevalence of the mouthbreathing over this population was 56.8%. The average age was 7 years old (6-9). There was no significant statistical difference between genders, considering 49.1% male and 50.9% female. The final model of logistic regression identified the variables dribble, sleeps well (negative association) and snores as factors that predict the occurrence of the mouth-breathing. The prevalence of mouthbreathing was similar to related in the literature. The variables dribble, sleeps well (negative association) and snores may be factors that predict the occurrence of mouth-breathing.

Prevalência de respiradores bucais em crianças de idade escolar / Prevalence of mouth breathing in children from an elementary school

Pretende-se identificar a prevalência de respiradores bucais em crianças de uma escola do ensino fundamental. Foram aplicados 496 questionários aos pais ou responsáveis das crianças de 1ª à 4ª série de uma escola fundamental, para identificar respiradores bucais. O questionário incluía questões sobre hábitos, sono, comportamento, alimentação, cuidados pessoais e respiração. Para comparar as variáveis entre respiradores bucais e nasais, foi utilizado o teste de Mann-Whitney e qui-quadrado. Para medir o efeito da exposição das variáveis explicativas sobre o desfecho primário, foi utilizada regressão logística e sua magnitude foi calculada por meio do odds ratio. A significância estatística foi estipulada em 5 por cento. A taxa de devolução dos questionários foi de 84,5 por cento. A prevalência de respiração bucal nessa população foi 56,8 por cento. A mediana de idade foi sete anos (6-9). Não houve diferença estatisticamente significante entre os gêneros, 49,1 por cento masculino e 50,9 por cento feminino. O modelo final de regressão logística identificou as variáveis baba, dorme bem (associação negativa) e ronca como fatores que predizem a ocorrência da respiração bucal. A prevalência de respiradores bucais foi semelhante à encontrada na literatura pesquisada. As variáveis babar, roncar e dormir bem (associação negativa) podem predizer a ocorrência da respiração bucal.

The objective of this article is to identify the prevalence of mouth breathing in children from an elementary school. 496 questionnaires were answered by 1st and 4th grade children's parents or sponsors in order to identify mouth-breathing. There were questions about habits, sleeping, behavior, eating, personal care and breathing. Mann-Whitney and the Chi-square tests were used to compare the variables between mouth-breathing and nose-breathing among the groups. To measure the exposure effect of the explanatory variables on mouse breathing, the test of logistic regression was used and its magnitude was calculated through Odds Ratio. The statistical significance was set at 5 percent, and the rate of returned questionnaires was 84.5 percent. The prevalence of the mouthbreathing over this population was 56.8 percent. The average age was 7 years old (6-9). There was no significant statistical difference between genders, considering 49.1 percent male and 50.9 percent female. The final model of logistic regression identified the variables dribble, sleeps well (negative association) and snores as factors that predict the occurrence of the mouth-breathing. The prevalence of mouthbreathing was similar to related in the literature. The variables dribble, sleeps well (negative association) and snores may be factors that predict the occurrence of mouth-breathing.

Preoperative physiotherapy in prevention of pulmonary complications in pediatric cardiac surgery.

OBJECTIVE: To evaluate the occurrence and risk of pulmonary complications in children who underwent pre-and postoperative physiotherapeutic intervention in cardiac surgeries, as well as to compare these patients to those who underwent only postoperative physiotherapeutic intervention. METHODS: A randomized controlled trial was performed with 135 patients from 6 years of age and younger with congenital heart disease who had undergone cardiac surgery. Patients were randomly assigned to the intervention group (G1) in which they underwent pre- and postoperative physiotherapy or to the control group (G2) in which they underwent only postoperative physiotherapy. Mann-Whitney and the Chi-square tests were used to compare the variables between the groups. The magnitude of the absolute risk was calculated by the number of patients needed to treat. Statistical significance was set at 5% (P<0.05). RESULTS: 17 patients (25%) in G1, and 29 patients (43.3%) in G2 presented pulmonary complications (P= 0.025), pneumonia was the most frequent complication, and among the 17 patients in G1, seven (10.3%) developed pneumonia, six (8.8%) developed atelectasis, and four (5.9%) presented complications due to both complications. In G2, 13 patients (19.4%) developed pneumonia, eight (11.9%) developed atelectasis, and eight (11.9%) developed pneumonia associated with atelectasis. Absolute risk reduction for the primary outcome was of 18.3% and the number of needed to treat was 5.5. CONCLUSION: Preoperative respiratory physiotherapy significantly reduced the risk of pulmonary complications in postoperative pediatric cardiac surgery.

Fisioterapia pré-operatória na prevenção das complicações pulmonares em cirurgia cardíaca pediátrica / Preoperative physiotherapy in prevention of pulmonary complications in pediatric cardiac surgery

OBJETIVO: Avaliar a incidência e o risco de complicações pulmonares em crianças submetidas a intervenção fisioterapêutica pré e pós-operatória nas cirurgias cardíacas, bem como comparar com aquelas submetidas apenas a intervenção fisioterapêutica pós-operatória. MÉTODOS: Ensaio clínico aleatório, que incluiu 135 pacientes de zero a 6 anos com cardiopatias congênitas, submetidos à cirurgia cardíaca. Os pacientes foram aleatorizados para grupo intervenção (G1), que realizou fisioterapia pré e pós-operatória, ou para grupo controle (G2), somente fisioterapia pós-operatória. Para comparar as variáveis entre os grupos foi utilizado o teste de Mann-Whitney e o Qui quadrado. Foi calculado o risco absoluto e sua magnitude por meio do número necessário para tratar. A significância estatística foi estipulada em 5% (P<0,05). RESULTADOS: No G1, 17 (25%) pacientes tiveram complicação pulmonar e, no G2, foram 29 (43,3%) (p=0,025). A complicação mais freqüente foi pneumonia e, dos 17 pacientes do G1 que complicaram, sete (10,3%) desenvolveram pneumonia, seis (8,8%) atelectasia e quatro (5,9%) associação das duas. No G2, 13 (19,4%) pacientes tiveram pneumonia, oito (11,9%), atelectasia, e oito (11,9%), pneumonia associada à atelectasia. A redução do risco absoluto para o desfecho primário foi de 18,3% e o número necessário para tratar foi calculado em 5,5. CONCLUSÃO: A fisioterapia respiratória pré-operatória reduziu significativamente o risco de desenvolvimento de complicações pulmonares no pós-operatório de cirurgia cardíaca pediátrica.

OBJECTIVE: To evaluate the occurrence and risk of pulmonary complications in children who underwent pre-and postoperative physiotherapeutic intervention in cardiac surgeries, as well as to compare these patients to those who underwent only postoperative physiotherapeutic intervention. METHODS: A randomized controlled trial was performed with 135 patients from 6 years of age and younger with congenital heart disease who had undergone cardiac surgery. Patients were randomly assigned to the intervention group (G1) in which they underwent pre- and postoperative physiotherapy or to the control group (G2) in which they underwent only postoperative physiotherapy. Mann-Whitney and the Chi-square tests were used to compare the variables between the groups. The magnitude of the absolute risk was calculated by the number of patients needed to treat. Statistical significance was set at 5% (P<0.05). RESULTS: 17 patients (25%) in G1, and 29 patients (43.3%) in G2 presented pulmonary complications (P= 0.025), pneumonia was the most frequent complication, and among the 17 patients in G1, seven (10.3%) developed pneumonia, six (8.8%) developed atelectasis, and four (5.9%) presented complications due to both complications. In G2, 13 patients (19.4%) developed pneumonia, eight (11.9%) developed atelectasis, and eight (11.9%) developed pneumonia associated with atelectasis. Absolute risk reduction for the primary outcome was of 18.3% and the number of needed to treat was 5.5. CONCLUSION: Preoperative respiratory physiotherapy significantly reduced the risk of pulmonary complications in postoperative pediatric cardiac surgery.