RESUMO
Background: Congenital heart disease (CHD) entails structural defects in the morphogenesis of the heart or its main vessels. Analyzing exercise capacity of children and adolescents with CHD is important to improve their functional condition and quality of life, since it can allow timely intervention on poor prognostic factors associated with higher risk of morbidity and mortality. Objective: To describe exercise capacity in children and adolescents with CHD compared with healthy controls. Methods: A systematic review was carried out. Randomized clinical trials and observational studies were included assessing exercise capacity through direct and indirect methods in children and adolescents between 5 and 17 years-old. A sensitive analysis was performed including studies with CHD repaired participants. Additionally, it was sub-analyzed by age range (< and ≥ 12 years old). Two independent reviewers analyzed the studies, extracted the data, and assessed the quality of the evidence. Results: 5619 articles were found and 21 were considered for the review. Eighteen articles used the direct exercise capacity measurement method by cardiopulmonary exercise test (CPET). The CHD group showed significant differences in peak oxygen consumption (VO2peak) with a value of -7.9 ml/Kg/min (95% CI: -9.9, -5.9, p = 0.00001), maximum workload (Wmax) -41.5 (95% CI: -57.9, -25.1 watts, p = 0.00001), ventilatory equivalent (VE/VCO2 ) slope 2.6 (95% CI: 0.3, 4.8), oxygen pulse (O2 pulse)-2.4 ml/beat (95% CI: -3.7, -1.1, p = 0.0003), and maximum heart rate (HRmax) -15 bpm (95% CI: -18, -12 bpm, p = 0.00001), compared with healthy controls. Adolescents (≥ 12 yrs) with CHD had a greater reduction in VO2peak (-10.0 ml/Kg/min (95% CI: -12.0, -5.3), p < 0.00001), Wmax (-45.5 watts (95% CI: -54.4, -36.7), p < 0.00001) and HRmax (-21 bpm (95% CI: -28, -14), p<0.00001). Conclusion: Suffering CHD in childhood and adolescence is associated with lower exercise capacity as shown by worse VO2peak, Wmax, VE/VCO2 slope, O2 pulse, and HRmax compared with matched healthy controls. The reduction in exercise capacity was greater in adolescents. Systematic Review Registration: www.crd.york.ac.uk/prospero/display_record.php?RecordID=208963, identifier: CRD42020208963.
RESUMO
Chest physiotherapy is currently an outstanding therapeutic tool for the management of pediatric respiratory patients. Many and varied techniques, manual and assisted, have been developed, some requiring patient collaboration. The development of knowledge and the pathophysiological understanding of respiratory diseases in recent years has generated the need to agree on the terminology, the fundamentals and the application of each of the kinesthetic techniques of respiratory treatment in the pediatric field. The objective of this document was to compile the available literature related to the physiological mechanisms, indications, procedural aspects and most frequently used techniques in our country, with the purpose of being a guideline for the clinical practice of professionals and students. The following techniques were included: prolonged slow expiration, slow expiration with glottis opened, autogenic drainage, assisted autogenic drainage, active cycle, compression/decompression, airway clearance, forced expiration techniques, cough and respiratory exercises.
La kinesiología respiratoria es actualmente una herramienta terapéutica destacada para el manejo de los pacientes respiratorios pediátricos. Se han desarrollado muchas y variadas técnicas, manuales y asistidas, algunas requiriendo colaboración del paciente. El desarrollo del conocimiento y la comprensión fisiopatológica de las enfermedades respiratorias en los últimos años ha generado la necesidad de consensuar la terminología, los fundamentos y la aplicación de cada una de las técnicas kinésicas de tratamiento respiratorio en el ámbito pediátrico. El objetivo de este documento fue recopilar la literatura disponible relacionada con los mecanismos fisiológicos, indicaciones, aspectos procedimentales y técnicas más utilizadas en nuestro país, con el propósito de ser una directriz que oriente la práctica clínica de profesionales y estudiantes en formación. Se incluyeron así las siguientes técnicas: espiración lenta prolongada, espiración lenta con glotis abierta, drenaje autógeno, drenaje autógeno asistido, ciclo activo, presión/descompresión, bloqueos torácicos, técnicas de espiración forzada, tos y ejercicios respiratorios.
