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Emerg Med Clin North Am ; 39(3): 493-508, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34215399


Anatomically, the airway is ever changing in size, anteroposterior alignment, and point of most narrow dimension. Special considerations regarding obesity, chronic and acute illness, underlying developmental abnormalities, and age can all affect preparation and intervention toward securing a definitive airway. Mechanical ventilation strategies should focus on limiting peak inspiratory pressures and optimizing lung protective tidal volumes. Emergency physicians should work toward minimizing risk of peri-intubation hypoxemia and arrest. With review of anatomic and physiologic principles in the setting of a practical approach toward evaluating and managing distress and failure, emergency physicians can successfully manage critical pediatric airway encounters.

Síndrome do Desconforto Respiratório/terapia , Insuficiência Respiratória/terapia , Manuseio das Vias Aéreas , COVID-19/terapia , Criança , Anormalidades Craniofaciais/complicações , Cuidados Críticos , Desenho de Equipamento , Capacidade Residual Funcional , Parada Cardíaca/terapia , Humanos , Hipnóticos e Sedativos/uso terapêutico , Intubação Intratraqueal/métodos , Laringoscópios , Laringoscopia/métodos , Laringe/anatomia & histologia , Doenças Neuromusculares/terapia , Ventilação não Invasiva , Oxigenoterapia , Medicina de Emergência Pediátrica , Obesidade Pediátrica/complicações , Respiração com Pressão Positiva , Gravação em Vídeo
Fisioter. Bras ; 22(3): 290-305, Jul 15, 2021.
Artigo em Português | LILACS | ID: biblio-1284263


Introduction: Coronary artery bypass grafting (CABG) causes changes in the respiratory musculature that affects functional capacity and postoperative complications (POC). Inspiratory muscle training (IMT) is a tool used for these patients, but it is not known what the best form is to increase strength. Objective: To investigate whether IMT with a linear pressure load device is superior to the inspiratory incentive on functional capacity and muscle strength of patients undergoing CABG. Methods: This is a clinical trial. Patients were assessed preoperatively for inspiratory muscle pressure (MIP), expiratory pressure (MEP), peak expiratory flow (PEF), six-minute walk test (6MWT) and functional independence measure (FIM). After surgery, they were divided into three groups: control group (CG), training group with linear pressure load (IMT) and inspiratory incentive group (IG). On the day of discharge, all patients had their previous variables reassessed. Results: The study included 56 patients, 31 (55.4%) were male and an average age of 55 ± 12 years. There was a significant reduction in all variables, in relation to MIP, the IMT showed a higher value in the postoperative period 83 ± 19 cmH2O, against 70 ± 15 cmH2O in the CG and 80 ± 15 cmH2O in the IG (p < 0.001). The same behavior was observed in MEP, 77 ± 12 cm H2O in IMT, 67 ± 14 cmH2O in CG and 75 ± 10 cmH2O in IG (p < 0.001). Regarding the 6 MWT, there was a lesser loss in the IMT from 434 ± 15 m to 398 ± 20 m in IG (p < 0.001). Conclusion: It is concluded that muscle training with a linear pressure load device is superior to training with incentive on functional capacity and muscle strength in patients undergoing CABG. (AU)

Introdução: A cirurgia de revascularização do miocárdio (CRM) causa alterações na musculatura respiratória que afetam a capacidade funcional e complicações pós-operatórias (DCP). O treinamento muscular inspiratório (TMI) é uma ferramenta utilizada por esses pacientes, mas não se sabe qual é a melhor forma de aumentar a força. Objetivo: Investigar se o TMI com dispositivo de carga de pressão linear é superior ao incentivo inspiratório na capacidade funcional e força muscular de pacientes submetidos à CRM. Métodos: Este é um ensaio clínico. Os pacientes foram avaliados no pré-operatório para pressão muscular inspiratória (PImáx), pressão expiratória (PEF), pico de fluxo expiratório (PFE), teste de caminhada de seis minutos (TC6) e medida de independência funcional (MIF). Após a cirurgia, eles foram divididos em três grupos: grupo controle (GC), grupo treinamento com carga linear de pressão (IMT) e grupo incentivo inspiratório (GI). No dia da alta, todos os pacientes tiveram suas variáveis anteriores reavaliadas. Resultados: O estudo incluiu 56 pacientes, 31 (55,4%) eram do sexo masculino e idade média de 55 ± 12 anos. Houve redução significativa em todas as variáveis, em relação à PImáx, o IMT apresentou valor maior no pós-operatório 83 ± 19 cmH2O, contra 70 ± 15 cmH2O no GC e 80 ± 15 cmH2O no GI (p < 0,001). O mesmo comportamento foi observado na PEmáx, 77 ± 12 cmH2O no IMT, 67 ± 14 cmH2O no GC e 75 ± 10 cmH2O no GI (p < 0,001). Em relação ao TC6, houve menor perda no TMI de 434 ± 15 metros para 398 ± 20 metros no GI (p < 0,001). Conclusão: Conclui-se que o treinamento muscular com dispositivo de carga pressórica linear é superior ao treinamento com incentivo inspiratório na capacidade funcional e da força muscular em pacientes submetidos à CRM. (AU)

Humanos , Modalidades de Fisioterapia , Força Muscular , Revascularização Miocárdica , Período Pós-Operatório , Capacidade Residual Funcional
Physiol Meas ; 42(6)2021 06 29.
Artigo em Inglês | MEDLINE | ID: mdl-34116513


Objective. Total lung capacity (TLC) assessment outside of a research laboratory is challenging. We describe a novel method for measuring TLC that is both simple and based only on portable equipment, and report preliminary data in healthy subjects.Approach. We developed an open circuit system to administer a known amount of oxygen to a subject in a single maximal inspiratory maneuver. Oxygen fraction, expired and inspired flows were continuously monitored to allow a precise computation of the mass balance. Values of TLC and functional residual capacity (FRC) were compared with standard methods (body plethysmography and multiple-breath helium dilution). Twenty healthy subjects participated to the study, eleven of which performed the maneuver twice to assess test-retest reliability.Main results.There was high agreement in TLC between the proposed method and the two standard methods (R2 > 0.98, bias not different from 0, and 95% limits of agreements <± 0.4 l for both). Test-retest reliability was high (intraclass correlation coefficient >0.99 and no bias). Results were similar for FRC, with a slightly higher variability due its sensitivity to changes in posture or breathing pattern.Significance.Single-breath oxygen dilution is accurate and reliable in assessing TLC and FRC in healthy subjects. The technique is appealing for time- or resource-limited settings, such as field physiological research expeditions or mass screenings.

Pulmão , Oxigênio , Capacidade Residual Funcional , Voluntários Saudáveis , Humanos , Medidas de Volume Pulmonar , Reprodutibilidade dos Testes , Capacidade Pulmonar Total
J Appl Physiol (1985) ; 131(1): 107-118, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34043468


Recent studies indicate limited utility of nitrogen multiple-breath washout (N2MBW) in infancy and advocate for using sulfur hexafluoride (SF6) MBW in this age-group. Modern N2MBW systems, such as EXHALYZER D (ECO MEDICS AG, Duernten, Switzerland), use O2 and CO2 sensors to calculate N2 concentrations (in principle, N2% = 100 - CO2% - O2%). High O2 and CO2 concentrations have now been shown to significantly suppress signal output from the other sensor, raising apparent N2 concentrations. We examined whether improved EXHALYZER D N2 signal, accomplished after thorough examination of this CO2 and O2 interaction on gas sensors and its correction, leads to better agreement between N2MBW and SF6MBW in healthy infants and toddlers. Within the same session, 52 healthy children aged 1-36 mo [mean = 1.30 (SD = 0.72) yr] completed SF6MBW and N2MBW recordings (EXHALYZER D, SPIROWARE version 3.2.1) during supine quiet sleep. SF6 and N2 SPIROWARE files were reanalyzed offline with in-house software using identical algorithms as in SPIROWARE with or without application of the new correction factors for N2MBW provided by ECO MEDICS AG. Applying the improved N2 signal significantly reduced mean [95% confidence interval (CI)] differences between N2MBW and SF6MBW recorded functional residual capacity (FRC) and lung clearance index (LCI): for FRC, from 26.1 (21.0, 31.2) mL, P < 0.0001, to 1.18 (-2.3, 4.5) mL, P = 0.5, and for LCI, from 1.86 (1.68, 2.02), P < 0.001, to 0.44 (0.33, 0.55), P < 0.001. Correction of N2 signal for CO2 and O2 interactions on gas sensors resulted in markedly closer agreement between N2MBW and SF6MBW outcomes in healthy infants and toddlers.NEW & NOTEWORTHY Modern nitrogen multiple-breath washout (N2MBW) systems such as EXHALYZER D use O2 and CO2 sensors to calculate N2 concentrations. New corrections for interactions between high O2 and CO2 concentrations on the gas sensors now provide accurate N2 signals. The correct N2 signal led to much improved agreement between N2MBW and sulfur hexafluoride (SF6) MBW functional residual capacity (FRC) and lung clearance index (LCI) in 52 sleeping healthy infants and toddlers, suggesting a role for N2MBW in this age-group.

Pulmão , Nitrogênio , Testes Respiratórios , Pré-Escolar , Capacidade Residual Funcional , Humanos , Lactente , Testes de Função Respiratória , Hexafluoreto de Enxofre
Int J Sport Nutr Exerc Metab ; 31(4): 345-349, 2021 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-34010808


The BodPod® (COSMED, Concord, CA) uses predicted (pTGV) or measured thoracic gas volume (mTGV) during estimations of percentage body fat (%BF). In young adults, there is inconsistent evidence on the variation between pTGV and mTGV, and the effect of sex as a potential covariate on this relationship is unknown. This study examined the difference between TGV assessments and its effect on %BF and potential sex differences that may impact this relationship. A retrospective analysis of BodPod® pTGV and mTGV for 95 men and 86 women ages 18-30 years was performed. Predicted TGV was lower than mTGV for men (-0.49 ± 0.7 L; p < .0001). For men, %BF derived by pTGV was lower than that by mTGV (-1.3 ± 1.8%; p < .0001). For women, no differences were found between pTGV and mTGV (-0.08 ± 0.6 L; p > .05) or %BF (-0.03 ± 0.2%; p > .05). The two-predictor model of sex and height was able to account for 57.9% of the variance in mTGV, F(2, 178) = 122.5, p < .0001. Sex corrected for the effect of height was a significant predictor of mTGV (ß = 0.483 L, p < .0001). There is bias for pTGV to underestimate mTGV in individuals with a large mTGV, which can lead to significant underestimations of %BF in young adults; this was especially evident for men in this study. Sex is an important covariate that should be considered when deciding to use pTGV. The results indicate that TGV should be measured whenever possible for both men and women ages 18-30 years.

Tecido Adiposo/anatomia & histologia , Composição Corporal/fisiologia , Pletismografia Total/métodos , Fatores Sexuais , Adiposidade , Adulto , Viés , Temperatura Corporal/fisiologia , Calibragem , Feminino , Capacidade Residual Funcional/fisiologia , Humanos , Masculino , Estudos Retrospectivos , Volume de Ventilação Pulmonar/fisiologia , Adulto Jovem
Fisioterapia (Madr., Ed. impr.) ; 43(1): 19-29, ene.-feb. 2021. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-202435


INTRODUCCIÓN: La Global Obstructive Lung Disease (GOLD) anualmente actualiza la guía para manejo de la EPOC, introduciendo cambios en la clasificación por letras, evaluación de síntomas o severidad de la obstrucción. Esto ha motivado el interés en indagar sobre las diferencias entre grupos en variables clínicas, calidad de vida relacionada con la salud (CVRS) y capacidad funcional. OBJETIVO: Determinar las diferencias en variables clínicas, supervivencia, de capacidad funcional, de ansiedad/depresión y CVRS en pacientes con enfermedad pulmonar obstructiva crónica (EPOC) de acuerdo a la clasificación GOLD 2018 en una clínica de Cali. MÉTODOS: Estudio observacional, analítico y transversal; se incluyeron 128 pacientes con diagnóstico de EPOC divididos en 3 grupos: GOLD-B, GOLD-C y GOLD-D. RESULTADOS: La edad media de los grupos fue 71 años y el 61% eran hombres. Las hospitalizaciones fueron más prevalentes en el grupo GOLD-C y GOLD-D, con 100% y 86% respectivamente, valor p < 0,001, con diferencias significativas en la supervivencia p < 0,001. La capacidad funcional evidenció una mayor distancia en el grupo GOLD-C con 344m y la menor distancia para el grupo GOLD-B con 271m, encontrando diferencia estadísticamente significativa. No se encontraron diferencias estadísticamente significativas en la ansiedad y la depresión. Al comparar los 3 grupos los pacientes GOLD-C tenían mejor CVRS en el cuestionario SGRQ; media de 37±15, GOLD-B de 45±16 y GOLD-D 55±15, con valor p = 0,002. CONCLUSIÓN: El grupo GOLD-C presentó mayor superviviencia, capacidad funcional y calidad de vida; por otra parte el grupo GOLD-D tuvo peor condición clínica, capacidad funcional y calidad de vida

INTRODUCTION: The Global Obstructive Lung Disease (GOLD) annually updates the COPD management guide, introducing changes in letter classification, symptom assessment, or severity of obstruction. This has motivated interest in investigating differences among groups in clinical variables, quality of life related to health (QOLRH) and functional capacity. OBJECTIVE: To determine the differences in clinical variables, survival, functional capacity, anxiety/depression and QOLRH in patients with chronic obstructive pulmonary disease (COPD) according to the GOLD 2018 classification in a Clinic in Cali (Colombia). METHODS: An observational, analytical and cross-sectional study including 128 patients (61% men) with a mean age of 71 years and diagnosis of COPD divided into three groups; GOLD-B, GOLD-C and GOLD-D. RESULTS: Hospitalizations were more prevalent in the GOLD-C and GOLD-D groups at 100% and 86% respectively, p value <.001, with significant differences in survival P<.001. Group GOLD-C showed greater functional capacity at 344 meters with a shorter distance for group GOLD-B at 271m, a statistically significant difference was found. No statistically significant differences were found in anxiety and depression. When comparing the three groups the GOLD- C patients had better QOLRH in the SGRQ questionnaire; mean of 37±15, (GOLD-B) of 45±16 and GOLD-D 55±15 with a P value=.002. CONCLUSION: Group GOLD-C showed greater survival, functional capacity and quality of life and GOLD-D had worse clinical condition, functional capacity and quality of life

Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Doença Pulmonar Obstrutiva Crônica/reabilitação , Ansiedade/epidemiologia , Depressão/epidemiologia , Exercícios Respiratórios/estatística & dados numéricos , Capacidade Residual Funcional/fisiologia , Testes de Função Respiratória/estatística & dados numéricos , Qualidade de Vida/psicologia , Perfil de Impacto da Doença , Progressão da Doença , Exacerbação dos Sintomas , Estudos Transversais , Doença Pulmonar Obstrutiva Crônica/psicologia
J Transl Med ; 19(1): 36, 2021 01 19.
Artigo em Inglês | MEDLINE | ID: mdl-33468154


BACKGROUND: The functional residual capacity (FRC) determines the oxygenating capacity of the lung and is heavily affected in the clinical context of the acute respiratory distress syndrome. Nitrogen-wash-in/wash-out methods have been used to measure FRC. These methods have rarely been validated against exactly known volumes. The aim of the study was to assess the accuracy and precision of the N2 washout/washin method in measuring FRC, by comparing it with set volumes in a lung simulator. METHODS: We conducted a diagnostic bench study in the Intensive Care Unit and Radiology Department of a tertiary hospital in Switzerland. Using a fully controllable high fidelity lung simulator (TestChest®), we set the functional residual capacity at 1500 ml, 2000 ml and 2500 ml and connected to the GE Carestation respirator, which includes the nitrogen washout/washin technique (INview™ tool). FRC was then set to vary by different levels of PEEP (5, 8, 12 and 15 cmH2O). The main outcome measures were bias and precision of the TestChest® when compared to the results from the washout/washin technique, according to the results of a Bland Altman Analysis. We verified our findings with volumetric computed tomography. RESULTS: One hundred and thirty-five nitrogen-wash-in/wash-out measurements were taken at three levels of FIO2 (0.4, 0.5, 0.6). The CT volumetry reproduced the set end-expiratory volumes at the Simulator with a bias of 4 ml. The nitrogen-wash-in/wash-out method had a bias of 603 ml with acceptable limits of agreement (95% CI 252 to - 953 ml). Changes were detected with a concordance rate of 97%. CONCLUSIONS: We conclude that the TestChest® simulator is an accurate simulation tool, concerning the simulation of lung volumes. The nitrogen wash-in/wash out method correlated positively with FRC changes, despite a relatively large bias in absolute measurements. The reference volumes in the lung simulator verified with CT volumetry were very close to their expected values. The reason for the bias could not be determined.

Respiração com Pressão Positiva , Síndrome do Desconforto Respiratório , Capacidade Residual Funcional , Humanos , Medidas de Volume Pulmonar , Nitrogênio
Curr Opin Pulm Med ; 27(2): 132-140, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33394747


PURPOSE OF REVIEW: Obesity is an increasing world-wide public health concern. Obesity both causes respiratory symptoms and contributes to many cardiorespiratory diseases. The effects of obesity on commonly used lung function tests are reviewed. RECENT FINDINGS: The effects of obesity on lung function are attributed both to mechanical factors and to complex metabolic effects that contribute to a pro-inflammatory state. The effects of obesity on lung function correlate with BMI and correlate even better when the distribution of excess adipose tissue is taken into account, with central obesity associated with more prominent abnormalities. Obesity is associated with marked decreases in expiratory reserve volume and functional residual capacity. Total lung capacity, residual volume, and spirometry are less affected by obesity and are generally within the normal range except with severe obesity. Obesity decreases total respiratory system compliance primarily because of decreased lung compliance, with only mild effects on chest wall compliance. Obesity is associated with impaired gas transfer with decreases in oxygenation and varied but usually mild effects on diffusing capacity for carbon monoxide, while the carbon monoxide transfer coefficient is often increased. SUMMARY: Obesity has significant effects on lung function. The relative contribution of the mechanical effects of obesity and the production of inflammatory cytokines by adipose tissue on lung function needs further study.

Pulmão , Obesidade , Volume de Reserva Expiratória , Capacidade Residual Funcional , Humanos , Pulmão/fisiopatologia , Medidas de Volume Pulmonar , Obesidade/complicações
Anaesthesia ; 76(5): 623-628, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33465816


Negative-pressure ventilation may have several advantages compared with positive-pressure ventilation. Negative-pressure ventilation simulates natural lung movements, does not require tracheal intubation and may reduce the incidence of barotrauma and adverse cardiovascular events. A group of engineers, doctors and nurses designed and bench-tested the Exovent, a new, lightweight, torso-only, negative-pressure ventilatory support system. We aimed to test the comfort, nursing acceptability and ventilatory support capabilities of the Exovent in healthy adult volunteers. We measured the effect of continuous negative extra-thoracic pressure on functional reserve capacity and the efficacy of ventilation produced by a combination of negative-pressure ventilation and negative end-expiratory pressure. Six members of the development team volunteered to test the device. The application of continuous negative extra-thoracic pressure did not change tidal volumes from baseline levels; however, functional reserve capacity increased by a mean (SD) of 1.1 (0.05) .cmH2 O-1 (p = 0.0002). The combination of negative-pressure ventilation and negative end-expiratory pressure produced effective ventilation, with the resting tidal volume being exceeded by the application of -4 cmH2 O of extra-thoracic negative pressure. All the volunteers found the experience comfortable and none had ventilator dysynchrony. The Exovent allowed good nursing and monitoring access and was comfortable in both the semi-recumbent and prone positions. The Exovent delivered effective continuous negative extra-thoracic pressure and negative-pressure ventilation plus negative end-expiratory pressure to healthy adults. Further trials are needed to investigate the clinical utility of the device.

Pulmão/fisiologia , Respiração Artificial/instrumentação , Adulto , Feminino , Capacidade Residual Funcional , Humanos , Masculino , Respiração Artificial/métodos , Volume de Ventilação Pulmonar
Sci Rep ; 10(1): 16203, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33004894


Currently, no clinical studies have compared the inspiratory and expiratory volumes of unilateral lung or of each lobe among supine, standing, and sitting positions. In this prospective study, 100 asymptomatic volunteers underwent both low-radiation-dose conventional (supine position, with arms raised) and upright computed tomography (CT) (standing and sitting positions, with arms down) during inspiration and expiration breath-holds and pulmonary function test (PFT) on the same day. We compared the inspiratory/expiratory lung/lobe volumes on CT in the three positions. The inspiratory and expiratory bilateral upper and lower lobe and lung volumes were significantly higher in the standing/sitting positions than in the supine position (5.3-14.7% increases, all P < 0.001). However, the inspiratory right middle lobe volume remained similar in the three positions (all P > 0.15); the expiratory right middle lobe volume was significantly lower in the standing/sitting positions (16.3/14.1% decrease) than in the supine position (both P < 0.0001). The Pearson's correlation coefficients (r) used to compare the total lung volumes on inspiratory CT in the supine/standing/sitting positions and the total lung capacity on PFT were 0.83/0.93/0.95, respectively. The r values comparing the total lung volumes on expiratory CT in the supine/standing/sitting positions and the functional residual capacity on PFT were 0.83/0.85/0.82, respectively. The r values comparing the total lung volume changes from expiration to inspiration on CT in the supine/standing/sitting positions and the inspiratory capacity on PFT were 0.53/0.62/0.65, respectively. The study results could impact preoperative CT volumetry of the lung in lung cancer patients (before lobectomy) for the prediction of postoperative residual pulmonary function, and could be used as the basis for elucidating undetermined pathological mechanisms. Furthermore, in addition to morphological evaluation of the chest, inspiratory and expiratory upright CT may be used as an alternative tool to predict lung volumes such as total lung capacity, functional residual capacity, and inspiratory capacity in situation in which PFT cannot be performed such as during an infectious disease pandemic, with relatively more accurate predictability compared with conventional supine CT.

Capacidade Residual Funcional/fisiologia , Pulmão/fisiologia , Postura Sentada , Posição Ortostática , Decúbito Dorsal , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Expiração , Feminino , Humanos , Pulmão/diagnóstico por imagem , Medidas de Volume Pulmonar , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Testes de Função Respiratória
CorSalud ; 12(3): 327-335, jul.-set. 2020. graf
Artigo em Espanhol | LILACS | ID: biblio-1154038


RESUMEN La fibrilación auricular (FA), epidemia esperada en las próximas décadas, es comúnmente causada por la cardiopatía isquémica y la hipertensión arterial, también se asocia con el sobrepeso y la obesidad. El ejercicio físico (EF) se considera una medida que corrige los factores de riesgo cardiovascular y, por tanto, se recomienda en la prevención de las enfermedades cardiovasculares, y forma parte integral de la rehabilitación cardíaca. Aunque se ha señalado que el EF puede incrementar el riesgo de FA, los beneficios cardiovasculares de la actividad física regular son incuestionables. Se ha comprobado un mejor estado de salud y una mayor expectativa de vida en atletas de resistencia. El EF ligero o moderado protege contra la FA, lo que puede estar asociado a un mejoramiento de las funciones sistólica y diastólica del ventrículo izquierdo, así como a una disminución de la rigidez arterial. La rehabilitación cardíaca con EF, es una indicación aprobada actualmente en pacientes con insuficiencia cardíaca crónica, con FA o sin ella, la cual está demostrado que incrementa la capacidad funcional y la calidad de vida, así como que reduce la mortalidad general y las hospitalizaciones.

ABSTRACT Atrial fibrillation (AF), an expected epidemic in the coming decades, is commonly caused by ischemic heart disease and high blood pressure, and it is also associated with overweight and obesity. Physical exercise (PE) is considered a way to correct cardiovascular risk factors and it is therefore recommended in the prevention of cardiovascular diseases. It is also an integral part of cardiac rehabilitation. Although it has been noted that PE can increase the risk of AF, the cardiovascular benefits of regular physical activity are unquestionable. An improved health status and a longer life expectancy have been proven in endurance athletes. Mild or moderate PE protects against AF, which may be associated with an improved left ventricular systolic and diastolic function, as well as with a decreased arterial stiffness. Cardiac rehabilitation with PE is a currently approved indication in patients with chronic heart failure, with or without AF, which is shown to increase functional capacity and life quality, as well as to reduce overall mortality and hospitalizations.

Educação Física e Treinamento , Fibrilação Atrial , Exercício Físico , Capacidade Residual Funcional , Reabilitação Cardíaca , Insuficiência Cardíaca
J Appl Physiol (1985) ; 129(4): 891-900, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32816641


Preterm newborns commonly receive intermittent positive pressure ventilation (iPPV) at birth, but the optimal approach that facilitates uniform lung aeration is unknown, particularly in a partially aerated lung. As both inflation time and exogenous surfactant facilitate uniform lung aeration, we investigated whether they can improve lung aeration and lung mechanics in a partially aerated lung immediately after birth. Preterm rabbit kittens (29 days of gestation, term ~32 days) were delivered by caesarean section and partial lung aeration was created by intubating and mechanically ventilating the right lung. The tube was then withdrawn to ventilate both lungs using inflation times of 0.2 s or 1.0 s, with or without exogenous surfactant (200 mg/kg; Curosurf) and a tidal volume (Vt) of 8 mL/kg. Simultaneous phase contrast X-ray imaging and plethysmography were used to measure lung aeration and mechanics. Kittens ventilated with longer inflation times (1.0 s) reached their target Vt with fewer inflations, required lower inflation pressures (28.5 ± 1.1 vs. 33.5 ± 1.3 cmH2O, P = 0.01) and had higher dynamic lung compliances (0.54 ± 0.3 vs. 0.40 ± 0.3 cmH2O·mL-1·kg-1, P = 0.003). Surfactant increased functional residual capacity (FRC; 31.9 ± 3.2 vs. 18.0 ± 3.9 mL/kg, P = 0.02) and the proportion of the Vt entering the previously unaerated lung but had no effect on dynamic lung compliance. Combining early surfactant treatment with longer inflation times increases FRC levels, improves dynamic lung compliance, reduces inflation pressures and markedly increases the proportion of the lungs being ventilated during iPPV in preterm kittens with a partially aerated lung.NEW & NOTEWORTHY Preterm newborns commonly receive intermittent positive pressure ventilation (iPPV) at birth, but the optimal approach that facilitates uniform lung aeration is unknown, particularly in a partially aerated lung. Using phase contrast X-ray imaging, we showed that combining a long inflation time (1.0 s) with surfactant improved lung mechanics and aeration in the immediate newborn period. The current clinical practice of using short inflation times during iPPV might be suboptimal and a different approach is needed.

Cesárea , Pulmão , Animais , Animais Recém-Nascidos , Gatos , Feminino , Capacidade Residual Funcional , Gravidez , Coelhos , Volume de Ventilação Pulmonar
J Int Med Res ; 48(6): 300060520920426, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32529868


OBJECTIVE: Measurement of positive end-expiratory pressure (PEEP)-induced recruitment lung volume using passive spirometry is based on the assumption that the functional residual capacity (FRC) is not modified by the PEEP changes. We aimed to investigate the influence of PEEP on FRC in different models of acute respiratory distress syndrome (ARDS). METHODS: A randomized crossover study was performed in 12 pigs. Pulmonary (n = 6) and extra-pulmonary (n = 6) ARDS models were established using an alveolar instillation of hydrochloric acid and a right atrium injection of oleic acid, respectively. Low (5 cmH2O) and high (15 cmH2O) PEEP were randomly applied in each animal. FRC and recruitment volume were determined using the nitrogen wash-in/wash-out technique and release maneuver. RESULTS: FRC was not significantly different between the two PEEP levels in either pulmonary ARDS (299 ± 92 mL and 309 ± 130 mL at 5 and 15 cmH2O, respectively) or extra-pulmonary ARDS (305 ± 143 mL and 328 ± 197 mL at 5 and 15 cmH2O, respectively). The recruitment volume was not significantly different between the two models (pulmonary, 341 ± 100 mL; extra-pulmonary, 351 ± 170 mL). CONCLUSIONS: PEEP did not influence FRC in either the pulmonary or extra-pulmonary ARDS pig model.

Respiração com Pressão Positiva/métodos , Síndrome do Desconforto Respiratório/terapia , Espirometria/métodos , Animais , Estudos Cross-Over , Modelos Animais de Doenças , Capacidade Residual Funcional/fisiologia , Humanos , Pulmão/fisiopatologia , Síndrome do Desconforto Respiratório/diagnóstico , Síndrome do Desconforto Respiratório/etiologia , Síndrome do Desconforto Respiratório/fisiopatologia , Suínos , Porco Miniatura
Resuscitation ; 153: 71-78, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32504770


AIM OF THE STUDY: Establishing functional residual capacity (FRC) during positive pressure ventilation (PPV) of apnoeic neonates is critical for survival. This may be difficult due to liquid-filled airways contributing to low lung compliance. The objectives were to describe initial PPV, changes in lung compliance and establishment of FRC in near-term/term neonates ≥36 weeks gestation at birth. METHODS: Observational study of all neonatal resuscitations between 01.07.13 and 30.06.18 in a Tanzanian referral hospital. Perinatal events and characteristics were observed and recorded by trained research assistants. PPV were performed using self-inflating bag-masks without positive end-expiratory pressure (PEEP). Ventilation signals (pressure/flow), expired CO2 (ECO2) and heart rate were recorded by resuscitation monitors. RESULTS: 19,587 neonates were born, 1451 received PPV, of these 821 of median (p25, p75) birthweight 3180 (2844, 3500) grams and gestation 38 (37, 40) weeks had ≥20 ventilations and complete datasets. There was a significant increase in expired volume (from 3.3 to 6.0 ml/kg), ECO2 (0.3-2.4%), lung compliance (0.13-0.19 ml/kg/mbar) and heart rate (109-138 beats/min) over the first 20 PPVs. Inflation volume, time, and peak inflation pressure (PIP) were stable around 12-13 ml/kg, 0.45 s, and 36 mbar, respectively. CONCLUSIONS: The combination of increasing expired volumes, ECO2, and heart rate with decreasing inflation/expired volume ratios and constant PIP, suggests establishment of FRC during the first 20 PPVs in near-term/term neonates using a self-inflating bag-mask without PEEP, the most common device worldwide for ventilating non-breathing neonates. Initial lung compliance is low, and with short inflation times, higher than recommended PIP seem necessary to deliver adequate tidal volumes.

Insuflação , Ressuscitação , Capacidade Residual Funcional , Humanos , Recém-Nascido , Respiração com Pressão Positiva , Volume de Ventilação Pulmonar
Respiration ; 99(5): 369-381, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32396905


BACKGROUND: Reference values derived from existing diaphragm ultrasound protocols are inconsistent, and the association between sonographic measures of diaphragm function and volitional tests of respiratory muscle strength is still ambiguous. OBJECTIVE: To propose a standardized and comprehensive protocol for diaphragm ultrasound in order to determine lower limits of normal (LLN) for both diaphragm excursion and thickness in healthy subjects and to explore the association between volitional tests of respiratory muscle strength and diaphragm ultrasound parameters. METHODS: Seventy healthy adult subjects (25 men, 45 women; age 34 ± 13 years) underwent spirometric lung function testing, determination of maximal inspiratory and expiratory pressure along with ultrasound evaluation of diaphragm excursion and thickness during tidal breathing, deep breathing, and maximum voluntary sniff. Excursion data were collected for amplitude and velocity of diaphragm displacement. Diaphragm thickness was measured in the zone of apposition at total lung capacity (TLC) and functional residual capacity (FRC). All participants underwent invasive measurement of transdiaphragmatic pressure (Pdi) during different voluntary breathing maneuvers. RESULTS: Ultrasound data were successfully obtained in all participants (procedure duration 12 ± 3 min). LLNs (defined as the 5th percentile) for diaphragm excursion were as follows: (a) during tidal breathing: 1.2 cm (males; M) and 1.2 cm (females; F) for amplitude, and 0.8 cm/s (M) and 0.8 cm/s (F) for velocity, (b) during maximum voluntary sniff: 2.0 cm (M) and 1.5 cm (F) for amplitude, and 6.7 (M) cm/s and 5.2 cm/s (F) for velocity, and (c) at TLC: 7.9 cm (M) and 6.4 cm (F) for amplitude. LLN for diaphragm thickness was 0.17 cm (M) and 0.15 cm (F) at FRC, and 0.46 cm (M) and 0.35 cm (F) at TLC. Values for males were consistently higher than for females, independent of age. LLN for diaphragmatic thickening ratio was 2.2 with no difference between genders. LLN for invasively measured Pdi during different breathing maneuvers are presented. Voluntary Pdi showed only weak correlation with both diaphragm excursion velocity and amplitude during forced inspiration. CONCLUSIONS: Diaphragm ultrasound is an easy-to-perform and reproducible diagnostic tool for noninvasive assessment of diaphragm excursion and thickness. It supplements but does not replace respiratory muscle strength testing.

Diafragma/diagnóstico por imagem , Força Muscular/fisiologia , Espirometria/métodos , Adulto , Diafragma/fisiologia , Feminino , Capacidade Residual Funcional , Voluntários Saudáveis , Humanos , Masculino , Pressões Respiratórias Máximas/métodos , Pessoa de Meia-Idade , Valores de Referência , Músculos Respiratórios/diagnóstico por imagem , Músculos Respiratórios/fisiologia , Capacidade Pulmonar Total , Ultrassonografia , Adulto Jovem
Arch. bronconeumol. (Ed. impr.) ; 56(5): 314-321, mayo 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-198122


Es frecuente observar lesiones trombóticas persistentes en los pacientes que sufren una embolia pulmonar. Estas lesiones pueden cursar con un espectro clínico amplio, desde un curso asintomático con recuperación funcional completa hasta la hipertensión pulmonar tromboembólica crónica. En los últimos años ha emergido el concepto de enfermedad tromboembólica crónica pulmonar para designar al subgrupo de pacientes con lesiones trombóticas persistentes que presentan síntomas con el esfuerzo y disfunción vascular pulmonar, pero que no muestran hipertensión pulmonar en reposo. La prevalencia de esta entidad es desconocida y los criterios para diagnosticarla no están definidos. El objetivo del presente artículo es analizar las secuelas que se producen tras una embolia pulmonar y revisar la información disponible sobre la enfermedad tromboembólica crónica, con especial énfasis en su diagnóstico y abordaje terapéutico

Persistent thrombotic lesions are common in patients with pulmonary embolism. These lesions occur on a clinical spectrum, ranging from an asymptomatic course with complete functional recovery to chronic thromboembolic pulmonary hypertension. The concept of chronic thromboembolic disease has emerged in recent years to describe a subgroup of patients with persistent thrombotic lesions who have symptoms on exertion and pulmonary vascular dysfunction, but no pulmonary hypertension at rest. The prevalence of this entity is unknown and the criteria for diagnosing it are not defined. The aim of this article is to analyze post- pulmonary embolism sequelae and review existing evidence on chronic thromboembolic disease, with special emphasis on its diagnosis and therapeutic approach

Humanos , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/terapia , Capacidade Residual Funcional/fisiologia , Medidas de Volume Pulmonar , Hipertensão Pulmonar/fisiopatologia , Embolia Pulmonar/fisiopatologia , Doença Crônica
Arq. ciências saúde UNIPAR ; 24(1): 21-26, jan-abr. 2020.
Artigo em Português | LILACS | ID: biblio-1095820


Mulheres submetidas à cirurgia de mastectomia podem apresentar algumas complicações, dentre elas, alterações respiratórias e prejuízo funcional. O objetivo deste estudo foi avaliar a cinemática da parede torácica e a capacidade funcional no pós-operatório de pacientes mastectomizadas sem tratamento neoadjuvante e adjuvante associados. Foram avaliadas 4 mulheres no grupo mastectomia (GM) e 4 mulheres no grupo controle (GC). Todas as participantes foram submetidas aos procedimentos de avaliação antropométrica, função pulmonar, força muscular respiratória, cinemática da parede torácica e capacidade funcional. O GM também foi submetido à avaliação de inspeção e palpação torácica. Os dados foram analisados por meio de estatística descritiva. Foi observado que o GM apresentou menor variação de volume corrente da parede torácica, com delta de variação de 22,03% a menos que o GC, sendo a maior redução de volume corrente evidenciada no compartimento de caixa torácica pulmonar, com redução de 41,57% em relação ao GC. O GM não apresentou alterações de função pulmonar, força muscular respiratória e capacidade funcional, apresentando valores de normalidade nessas avaliações. Portanto, mulheres submetidas ao procedimento cirúrgico de mastectomia, sem tratamento neoadjuvante e adjuvante associados, não apresentaram comprometimento da função pulmonar, da força muscular respiratória e da capacidade funcional, contudo foi verificado redução do volume pulmonar na região do procedimento cirúrgico.

Women submitted to a mastectomy surgery may present some complications, among them, respiratory changes and functional impairment. The purpose of this study was to evaluate the chest wall kinematics and functional capacity in the postoperative period of mastectomized patients without associated adjuvant and neoadjuvant treatment. A total of four (4) women in the mastectomy group (MG) and four (4) in the control group (CG) were evaluated. All participants were submitted to the procedures of anthropometric evaluation, pulmonary function, respiratory muscle strength, chest wall kinematics and functional capacity. Patients in MG were also submitted to an inspection and palpation evaluation of the chest and breasts. Database was analyzed using descriptive statistics. It was observed that the MG presented a smaller variation of tidal volume of the chest wall, with a variation delta of 22.03% less than CG, with the largest reduction in tidal volume evidenced in the pulmonary chest cavity compartment, with a reduction of 41.57% when compared to CG. The MG did not present alterations of pulmonary function, respiratory muscle strength and functional capacity, presenting values of normality in these evaluations. Therefore, women submitted to the surgical procedure of mastectomy without associated neoadjuvant and adjuvant treatment did not present any impairment of pulmonary function, respiratory muscle strength and functional capacity. However, a reduction could be observed in the pulmonary volume in the region of the surgical procedure.

Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Período Pós-Operatório , Testes de Função Respiratória , Mulheres/psicologia , Capacidade Residual Funcional , Mastectomia/reabilitação , Procedimentos Cirúrgicos Operatórios/reabilitação , Fenômenos Biomecânicos , Músculos Respiratórios/cirurgia , Neoplasias da Mama/cirurgia , Volume de Ventilação Pulmonar , Parede Torácica/cirurgia , Força Muscular , Caixa Torácica/cirurgia