Efectos del entrenamiento muscular inspiratorio sobre la función respiratoria y el equilibrio en supervivientes de ictus: un ensayo clínico controlado aleatorizado / Effects of inspiratory muscle training on respiratory function and balance in stroke survivors: a randomized controlled trial

INTRODUCCIÓN: Tras un ictus, los pacientes con hemiparesia y/o hemiplejía van a presentar una asimetría notable del tronco y la pelvis, y una disminución de la estabilidad postural y el equilibrio, lo que afecta, como consecuencia, a la función respiratoria. OBJETIVO: Analizar los efectos del entrenamiento muscular inspiratorio (EMI) sobre la función pulmonar, la fuerza muscular inspiratoria, el control postural y del tronco y el equilibrio en supervivientes de ictus. MATERIALES Y MÉTODOS: Dieciséis pacientes supervivientes de ictus en fase subaguda participaron en un ensayo clínico controlado aleatorizado (experimental = 8; placebo = 8). El grupo experimental recibió un programa de EMI, cinco días a la semana, una vez al día, durante ocho semanas, con una intensidad progresiva del 15 al 60% de la PImáx. El grupo placebo realizó el mismo programa, pero con una carga fija de 7 cmH2O. Se evaluaron la fuerza muscular inspiratoria presión inspiratoria máxima (PImáx), la función pulmonar (capacidad vital forzada, volumen espirado en el primer segundo, flujo espiratorio máximo y ventilación voluntaria máxima), el control del tronco (test de control del tronco), y el control postural y el equilibrio Postural Scale for Stroke Patients (PASS) y escala de Berg. RESULTADOS: Los grupos experimental y placebo presentaron incrementos significativos en la PImáx, con diferencia entre grupos. Existió una correlación negativa y moderada entre el valor de la PImáx inicial y el porcentaje de cambio (PImáx) (r = 0,572; p = 0,021). Se observaron incrementos significativos en la ventilación voluntaria máxima (L/m) en el grupo experimental, e incrementos en la PASS en ambos grupos, pero sin diferencias significativas entre grupos. CONCLUSIONES: El entrenamiento muscular inspiratorio, aunque de baja intensidad, es efectivo para mejorar la fuerza muscular inspiratoria en pacientes supervivientes de ictus. Sin embargo, los efectos sobre el control postural y el equilibrio permanecen inciertos

INTRODUCTION: After a stroke, patients with hemiparesis and / or hemiplegia will present a notable asymmetry of the trunk and pelvis, and decreased postural stability and balance, affecting, consequently, respiratory function. OBJECTIVE. The objective of this study is to analyze the effects of inspiratory muscle training (IMT) on lung function, inspiratory muscle strength, postural and trunk control and balance in stroke survivors in the subacute phase. MATERIALS AND METHODS: 16 survivors of stroke in the subacute phase participated in RCT (experimental = 8; placebo = 8). The experimental group received IMT program, 5 days a week, once a day, for 8 weeks, with a progressive intensity from 15% to 60% of the PImax. The placebo group performed the same program, but with a fixed load of 7cmH20. Inspiratory muscle strength (PImax), lung function (FVC, FEV1, PEF, VMV), trunk control (TCT), and postural control and balance (PASS and Berg Scale) were evaluated. RESULTS: Experimental and placebo groups showed significant increases in PImax, with a difference between groups. There was a moderate and negative correlation between the initial PImax value and the percentage change (PImax) (r = 0.572; p = 0.021). Significant increases in VMV (l/m) were observed in the experimental group, and increases in PASS in both groups, but without significant differences between groups. CONCLUSIONS: Inspiratory muscle training, although low intensity, is effective in improving inspiratory muscle strength in stroke survivors. However, the effects on postural control and balance remain uncertain

Usefulness of serial monitoring of B-type natriuretic peptide for the detection of acute rejection after heart transplantation.

Serum B-type natriuretic peptide (BNP) is increased after heart transplantation (HT), but it has not been well established whether BNP could be used to detect acute rejection in asymptomatic patients after HT. A total of 259 routine endomyocardial biopsy specimens from 50 consecutive patients after HT (83% men; age 50 +/- 15 years) were studied. Serial BNP measurements were performed at the time of each biopsy. BNP was evaluated as an absolute level (picograms per milliliter) and percentage of change from the previous biopsy (BNP - BNP at previous biopsy)/BNP at previous biopsy] x 100). Rejection was defined as grade > or =2R International Society of Heart and Lung Transplantation grading system. BNP correlated independently with time after HT (p <0.001), pulmonary artery systolic pressure (p <0.001), creatinine (p = 0.001), and age (p = 0.0012). Asymptomatic rejection was found in 15 biopsy specimens (6%), for which absolute BNP (106 pg/ml; interquartile range [IQR] 67 to 495) did not differ from nonrejection biopsy specimens (92 pg/ml; IQR 49 to 230; p = 0.286). BNP percentage of change showed a median of +60% (IQR -29 to +154%) in rejection versus -17% (IQR -47 to +19%) in nonrejection biopsy specimens (p = 0.009). After multivariable adjustment, BNP percentage of change was a consistent predictor of rejection (+10%; odds ratio 1.05, 95% confidence interval 1.01 to 1.09, p = 0.021). Receiver-operator characteristic analysis showed an area under the curve of 0.71 (95% confidence interval 0.643 to 0.768) and identified percentage of change <+38% as an optimal cut-off point, with a negative predictive value of 97%. In conclusion, serial monitoring of BNP, evaluated as a percentage of change, may be a useful noninvasive tool in the clinical management of rejection.