Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.632
Filtrar
1.
Cochrane Database Syst Rev ; 12: CD006112, 2020 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-33331663

RESUMO

BACKGROUND: Cystic fibrosis is the most common autosomal recessive disease in white populations, and causes respiratory dysfunction in the majority of individuals. Numerous types of respiratory muscle training to improve respiratory function and health-related quality of life in people with cystic fibrosis have been reported in the literature. Hence a systematic review of the literature is needed to establish the effectiveness of respiratory muscle training (either inspiratory or expiratory muscle training) on clinical outcomes in cystic fibrosis. This is an update of a previously published review. OBJECTIVES: To determine the effectiveness of respiratory muscle training on clinical outcomes in people with cystic fibrosis. SEARCH METHODS: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials register comprising of references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. Date of most recent search: 11 June 2020. A hand search of the Journal of Cystic Fibrosis and Pediatric Pulmonology was performed, along with an electronic search of online trial databases. Date of most recent search: 05 October 2020. SELECTION CRITERIA: Randomised controlled studies comparing respiratory muscle training with a control group in people with cystic fibrosis. DATA COLLECTION AND ANALYSIS: Review authors independently selected articles for inclusion, evaluated the methodological quality of the studies, and extracted data. Additional information was sought from trial authors where necessary. The quality of the evidence was assessed using the GRADE system. MAIN RESULTS: Authors identified 20 studies, of which 10 studies with 238 participants met the review's inclusion criteria. There was wide variation in the methodological and written quality of the included studies. Four of the 10 included studies were published as abstracts only and lacked concise details, thus limiting the information available. Eight studies were parallel studies and two of a cross-over design. Respiratory muscle training interventions varied dramatically, with frequency, intensity and duration ranging from thrice weekly to twice daily, 20% to 80% of maximal effort, and 10 to 30 minutes, respectively. Participant numbers ranged from 11 to 39 participants in the included studies; five studies were in adults only, one in children only and four in a combination of children and adults. No differences between treatment and control were reported in the primary outcome of pulmonary function (forced expiratory volume in one second and forced vital capacity) or postural stability (very low-quality evidence). Although no change was reported in exercise capacity as assessed by the maximum rate of oxygen use and distance completed in a six minute walk test, a 10% improvement in exercise duration was found when working at 60% of maximal effort in one study (n = 20) (very low-quality evidence). In a further study (n = 18), when working at 80% of maximal effort, health-related quality of life improved in the mastery and emotion domains (very low-quality evidence). With regards to the review's secondary outcomes, one study (n = 11) found a change in intramural pressure, functional residual capacity and maximal inspiratory pressure following training (very low-quality evidence). Another study (n=36) reported improvements in maximal inspiratory pressure following training (P < 0.001) (very low-quality evidence). A further study (n = 22) reported that respiratory muscle endurance was longer in the training group (P < 0.01). No studies reported significant differences on any other secondary outcomes. Meta-analyses could not be performed due to a lack of consistency and insufficient detail in reported outcome measures. AUTHORS' CONCLUSIONS: There is insufficient evidence to suggest whether this intervention is beneficial or not. Healthcare practitioners should consider the use of respiratory muscle training on a case-by-case basis. Further research of reputable methodological quality is needed to determine the effectiveness of respiratory muscle training in people with cystic fibrosis. Researchers should consider the following clinical outcomes in future studies; respiratory muscle function, pulmonary function, exercise capacity, hospital admissions, and health-related quality of life. Sensory-perceptual changes, such as respiratory effort sensation (e.g. rating of perceived breathlessness) and peripheral effort sensation (e.g. rating of perceived exertion) may also help to elucidate mechanisms underpinning the effectiveness of respiratory muscle training.


Assuntos
Exercícios Respiratórios/métodos , Fibrose Cística/terapia , Inalação/fisiologia , Músculos Respiratórios/fisiologia , Adulto , Criança , Fluxo Expiratório Forçado , Humanos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Capacidade Vital
2.
Medicine (Baltimore) ; 99(43): e22884, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120832

RESUMO

Delirium is a neuropsychiatric syndrome commonly encountered in critically ill patients, and systemic inflammation has been strongly implicated to underlie its pathophysiology. This study aimed to investigate the predictive value of the platelet-to-lymphocyte ratio (PLR) for delirium in the intensive care unit (ICU).In this retrospective observational study, we analyzed the clinical and laboratory data of 319 ICU patients from October 2016 to December 2017. Using the Locally Weighted Scatterplot Smoothing technique, a PLR knot was detected at a value of approximately 100. Logistic regression was used to investigate the association between the PLR and delirium.Of the 319 patients included in this study, 29 (9.1%) were diagnosed with delirium. In the delirium group, the duration of mechanical ventilation was significantly longer than that in the no-delirium group (40.2 ±â€Š65.5 vs. 19.9 ±â€Š26.5 hours, respectively; P < .001). A multiple logistic regression analysis showed that PLR > 100 (odds ratio [OR]: 1.003, 95% confidence interval [CI]: 1.001-1.005), age (OR: 2.76, 95% CI: 1.110-6.861), and the ratio of arterial oxygen partial pressure to the inspired oxygen fraction (OR: 0.996, 95% CI: 0.992-0.999) were independent predictors of delirium.In our study, a high PLR value on ICU admission was associated with a higher incidence of delirium. Owing to easy calculability, the PLR could be a useful delirium predictive index in ICUs, thereby enabling early interventions to be implemented.


Assuntos
Plaquetas/citologia , Estado Terminal/psicologia , Delírio/sangue , Linfócitos/citologia , Idoso , Monitorização Transcutânea dos Gases Sanguíneos/métodos , Estudos de Casos e Controles , China/epidemiologia , Delírio/diagnóstico , Delírio/epidemiologia , Delírio/fisiopatologia , Feminino , Humanos , Incidência , Inflamação/metabolismo , Inflamação/patologia , Inalação/fisiologia , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Oxigênio/análise , Valor Preditivo dos Testes , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos
3.
Spinal Cord Ser Cases ; 6(1): 87, 2020 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-32943611

RESUMO

INTRODUCTION: Respiratory complications (RC) are a leading cause of death after spinal cord injury (SCI) due to compromised immune function and respiratory muscle weakness. Thus, individuals with SCI are at high risk of developing COVID-19 related RC. Results of a SCI clinical trial showed a supervised respiratory muscle training (RMT) program decreased risk of developing RC. The feasibility of conducting unsupervised RMT is not well documented. Four publications (n = 117) were identified in which unsupervised RMT was performed. Significant improvements in respiratory outcomes were reported in two studies: Maximal Inspiratory and Expiratory Pressure (MIP40% and MEP25%, respectively), Peak Expiratory Flow (PEF9%), seated and supine Forced Vital Capacity (FVC23% and 26%, respectively), and Peak Cough Flow (28%). This review and case report will attempt to show that an inspiratory muscle training (IMT) home exercise program (HEP) is feasible and may prepare the respiratory system for RC associated with COVID-19 in patients with SCI. CASE PRESENTATION: A 23-year-old with tetraplegia (P1), history of mechanical ventilation, and hospitalization for RC, completed 27 IMT HEP sessions in one month. MIP and sustained MIP (SMIP) increased from baseline by 28% and 26.5%, respectively. Expiratory volumes and rates also improved (FVC, FEV1, and PEF: 11.7%, 8.3%, and 14.2%, respectively). DISCUSSION: The effects of COVID-19 on patients with SCI remains inconclusive, but recent literature and the results of this case suggest that unsupervised IMT is feasible and may limit the severity of RC in patients with SCI who contract COVID-19.


Assuntos
Betacoronavirus , Exercícios Respiratórios/métodos , Infecções por Coronavirus/prevenção & controle , Inalação/fisiologia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Infecções Respiratórias/prevenção & controle , Traumatismos da Medula Espinal/terapia , Infecções por Coronavirus/fisiopatologia , Humanos , Masculino , Pneumonia Viral/fisiopatologia , Quadriplegia/complicações , Quadriplegia/fisiopatologia , Quadriplegia/terapia , Infecções Respiratórias/fisiopatologia , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/fisiopatologia , Adulto Jovem
4.
PLoS One ; 15(8): e0237848, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32817715

RESUMO

Dust masks are widely used to prevent the inhalation of particulate matter into the human respiratory organs in polluted air environments. The filter of a dust mask inherently obstructs the natural respiratory air flows, and this flow resistance is mainly responsible for the discomfort experienced when wearing a dust mask. In atmospheric conditions seriously contaminated with fine dust, it is recommended that common citizens wear a dust mask in their everyday lives, yet many people are reluctant to wear a dust mask owing to the discomfort experienced when wearing it for a long time. Understanding of physical reasons for the discomfort is thus crucial in designing a dust mask, but remains far from clear. This study presents a technique to quantify the wearing comfort of dust masks. By developing a respiration simulator to measure the pressure loss across a dust mask, we assessed the energy costs to overcome flow resistance when breathing through various types of dust masks. The energy cost for a single inhalation varies with the mask type in a range between 0 and 10 mJ. We compared the results with the survey results of 40 people about the wearing comfort of the dust masks, which revealed that the wearing comfort crucially depends on the energy cost required for air inhalation though the dust mask. Using the measured energy cost during inhalation as a parameter to quantify the wearing comfort, we present a comprehensive evaluation of the performance of dust masks in terms of not only the filtering performance but also the wearing comfort. Our study suggests some design principles for dust mask filters, auxiliary electric fans, and check valves.


Assuntos
Inalação/fisiologia , Máscaras/normas , Respiração , Dispositivos de Proteção Respiratória/normas , Adulto , Poeira/prevenção & controle , Orelha/fisiologia , Feminino , Filtração/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Material Particulado
6.
Int J Sports Med ; 41(7): 484-491, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32252100

RESUMO

This prospective experimental study aimed to compare effects of 3 different home-based postoperative respiratory muscle training protocols - inspiratory, expiratory and combined, in the patients' postoperative recovery, regarding safety and respiratory muscle function, pulmonary function, physical fitness, physical activity (PA), dyspnoea and quality of life (QoL). Patients were divided in four groups Usual Care (UCare), inspiratory (IMT), expiratory (EMT) or combined muscle training (CombT) according to group allocation. Significant treatment*time interactions were found for maximal inspiratory pressure (MIP) (p=0.014), sedentary PA (SEDPA) (p=0.003), light PA (LIGPA) (p=0.045) and total PA (p=0.035). Improvements were observed for MIP in CombT (p=0.001), IMT (p=0.001), EMT (p=0.050). SEDPA reduced in EMT (p=0.001) and IMT (p=0.006), while LIGPA increased in both groups (p=0.001), as well as Total PA (p=0.005 and p=0.001, respectively). In UCare, CombT, and EMT, QoL improved only for Usual Activities. In conclusion, the addition of respiratory muscle training to physiotherapy usual care is safe and effective to increase MIP and contribute to improve physical activity. The CombT showed greater improvement on MIP, while IMT compared to EMT, was more effective to improve physical activity.


Assuntos
Exercícios Respiratórios/métodos , Neoplasias Pulmonares/cirurgia , Toracotomia/reabilitação , Idoso , Aptidão Cardiorrespiratória , Exercício Físico , Expiração/fisiologia , Feminino , Humanos , Inalação/fisiologia , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/métodos , Estudos Prospectivos , Qualidade de Vida
7.
Biomed Res Int ; 2020: 7530498, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32185217

RESUMO

Objective: To investigate the pulmonary function responses to respiratory muscle training (RMT) in individuals with tetraplegia and provide a systematic review of the included studies. Methods: Computerized retrieval of randomized controlled trials (RCT) in PubMed, Embase, and the Cochrane Library on the improvement of respiratory function in patients with spinal cord injury by RMT was conducted until May 2019. Two researchers independently screened the literature, extracted the data, and evaluated the risk of bias in the included studies. Articles were scored for their methodological quality using the Cochrane Collaboration risk of bias assessment tool. Results: Sixteen studies were identified. A significant benefit of RMT was revealed for five outcomes: force vital capacity (FVC, WMD: -0.43, 95% CI -0.84 to -0.03, P = 0.037), vital capacity (VC, WMD: -0.40, 95% CI -0.69 to -0.12, P = 0.037), vital capacity (VC, WMD: -0.40, 95% CI -0.69 to -0.12, P = 0.037), vital capacity (VC, WMD: -0.40, 95% CI -0.69 to -0.12, P = 0.037), vital capacity (VC, WMD: -0.40, 95% CI -0.69 to -0.12, P = 0.037), vital capacity (VC, WMD: -0.40, 95% CI -0.69 to -0.12. Conclusion: Our findings demonstrate that RMT can effectively improve spinal cord injury pulmonary function of the patient, which is marked by increasing respiratory strength, function, and endurance. Limited by the quantity and quality of the included studies, the above conclusion needs to be verified by more high-quality studies.


Assuntos
Exercícios Respiratórios , Músculos Respiratórios/fisiopatologia , Traumatismos da Medula Espinal/fisiopatologia , Expiração/fisiologia , Humanos , Inalação/fisiologia , Pulmão/fisiopatologia , Força Muscular/fisiologia , Capacidade Vital/fisiologia
8.
Am J Respir Crit Care Med ; 201(9): 1086-1098, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32097569

RESUMO

Rationale: Monitoring and controlling respiratory drive and effort may help to minimize lung and diaphragm injury. Airway occlusion pressure (P0.1) is a noninvasive measure of respiratory drive.Objectives: To determine 1) the validity of "ventilator" P0.1 (P0.1vent) displayed on the screen as a measure of drive, 2) the ability of P0.1 to detect potentially injurious levels of effort, and 3) how P0.1vent displayed by different ventilators compares to a "reference" P0.1 (P0.1ref) measured from airway pressure recording during an occlusion.Methods: Analysis of three studies in patients, one in healthy subjects, under assisted ventilation, and a bench study with six ventilators. P0.1vent was validated against measures of drive (electrical activity of the diaphragm and muscular pressure over time) and P0.1ref. Performance of P0.1ref and P0.1vent to detect predefined potentially injurious effort was tested using derivation and validation datasets using esophageal pressure-time product as the reference standard.Measurements and Main Results: P0.1vent correlated well with measures of drive and with the esophageal pressure-time product (within-subjects R2 = 0.8). P0.1ref >3.5 cm H2O was 80% sensitive and 77% specific for detecting high effort (≥200 cm H2O ⋅ s ⋅ min-1); P0.1ref ≤1.0 cm H2O was 100% sensitive and 92% specific for low effort (≤50 cm H2O ⋅ s ⋅ min-1). The area under the receiver operating characteristics curve for P0.1vent to detect potentially high and low effort were 0.81 and 0.92, respectively. Bench experiments showed a low mean bias for P0.1vent compared with P0.1ref for most ventilators but precision varied; in patients, precision was lower. Ventilators estimating P0.1vent without occlusions could underestimate P0.1ref.Conclusions: P0.1 is a reliable bedside tool to assess respiratory drive and detect potentially injurious inspiratory effort.


Assuntos
Pressão do Ar , Monitoramento Biológico/normas , Inalação/fisiologia , Respiração com Pressão Positiva/normas , Guias de Prática Clínica como Assunto , Respiração Artificial/normas , Trabalho Respiratório/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes
9.
Am J Physiol Lung Cell Mol Physiol ; 318(2): L452-L458, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31913645

RESUMO

Airway smooth muscle (ASM) is continuously strained during breathing at tidal volume. Whether this tidal strain influences the magnitude of the bronchodilator response to a deep inspiration (DI) is not clearly defined. The present in vitro study examines the effect of tidal strain on the bronchodilator effect of DIs. ASM strips from sheep tracheas were mounted in organ baths and then subjected to stretches (30% strain), simulating DIs at varying time intervals. In between simulated DIs, the strips were either held at a fixed length (isometric) or oscillated continuously by 6% (length oscillations) to simulate tidal strain. The contractile state of the strips was also controlled by adding either methacholine or isoproterenol to activate or relax ASM, respectively. Although the time-dependent gain in force caused by methacholine was attenuated by length oscillations, part of the acquired force in the oscillating condition was preserved postsimulated DIs, which was not the case in the isometric condition. Consequently, the bronchodilator effect of simulated DIs (i.e., the decline in force postsimulated versus presimulated DIs) was attenuated in oscillating versus isometric conditions. These findings suggest that an ASM operating in a dynamic environment acquired adaptations that make it refractory to the decline in contractility inflicted by a larger strain simulating a DI.


Assuntos
Adaptação Fisiológica , Broncodilatadores/metabolismo , Inalação/fisiologia , Músculo Liso/fisiologia , Traqueia/fisiologia , Animais , Elasticidade , Ovinos , Estresse Mecânico
10.
Can J Vet Res ; 84(1): 24-32, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31949326

RESUMO

The objective of this study was to document tidal variations in tracheal height during normal respiration in 19 healthy adult (> 1 y old) small-breed dogs (< 10 kg) using fluoroscopy and radiography. Each dog underwent tracheal fluoroscopic examination on inspiration and expiration while in a standing position (F-S) and in right lateral recumbency (F-RL), followed by radiographic projections obtained in right lateral recumbency. The percent variation in tracheal height during maximal inspiration and expiration was determined at 3 different locations [cervical region (CR), thoracic inlet (TI), and intrathoracic (IT) region]. When all imaging procedures and sites of measurement were considered, tracheal height varied during physiologic inspiration and expiration from 0% to 21.1%, with a mean of 4.5%. The mean percent variation in tracheal height was not significantly different among imaging modalities (F-S versus F-RL versus radiography) (P = 0.16) or measurement sites (CR versus TI versus IT) (P = 0.89). The body condition score (BCS) (P = 0.96), age (P = 0.95), and breed (P = 0.19) did not significantly influence the mean percent variation in tracheal height. The average variation in tracheal height during maximal physiological inspiration and expiration is small (< 6%) in most healthy adult small-breed dogs as assessed by fluoroscopy and radiography, although tracheal height may vary by as much as 21.1% in some healthy individuals. Inspiratory and expiratory radiographs acquired in right lateral recumbency provide an accurate assessment of tracheal height as an alternative to fluoroscopy.


Assuntos
Cães/anatomia & histologia , Expiração/fisiologia , Inalação/fisiologia , Traqueia/anatomia & histologia , Traqueia/diagnóstico por imagem , Animais , Tamanho Corporal , Cães/classificação , Cães/fisiologia , Feminino , Fluoroscopia/veterinária , Masculino , Radiografia Torácica/veterinária , Traqueia/fisiologia
11.
Trials ; 21(1): 81, 2020 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-31937322

RESUMO

BACKGROUND: High-flow nasal cannula (HFNC) oxygen therapy has been widely used in critically ill patients. Despite the effectiveness of HFNC as a treatment, optimal methods to withdraw HFNC after recovery from preexisting conditions have not been investigated to date. In this study, we will evaluate the safety and efficacy of simultaneous reduction of flow and fraction of inspired oxygen (FiO2) compared with sequential reduction of either flow first or FiO2 reduction first in patients with HFNC. METHODS/DESIGN: This is a prospective, investigator-initiated, randomized controlled trial with three experimental intervention groups. A total of 100 adult patients receiving HFNC and satisfying weaning criteria will be enrolled and randomly assigned to one of the following groups: flow reduction (FR) first, FiO2 reduction (OR) first, or simultaneous reduction (SR). In the FR group, flow will be reduced first by 10 L/min/h. When it reaches 20 L/min, FiO2 will then be reduced by 0.1 /h until it reaches 0.3. In the OR group, the FiO2 will be gradually reduced first by 0.1 /h until it reaches 0.3, then flow will be reduced by 10 L/min until it reaches 20 L/min. Finally, in the SR group, both the flow and FiO2 will be gradually reduced simultaneously by 10 L/min and 0.1/h, respectively. Weaning will proceed only when patients satisfy the weaning criteria at every weaning point. When the HFNC weaning-off targets are reached (20 L/min and 0.3 for flow and FiO2, respectively), the patient will be transferred to conventional oxygen therapy (mainly low-flow nasal prongs). The primary outcome is the time to successful weaning from HFNC for 24 h. Secondary outcomes will include the success or failure rate in weaning off HFNC and changes in arterial blood gas analyses, intolerance rate, length of hospital stay, and in-hospital mortality. DISCUSSION: This study will be the first clinical trial to investigate the safety and efficacy of three different methods of weaning in adult patients receiving HFNC. Once this study is completed, we expect to be able to suggest the better strategy for withdrawal of HFNC based on the results. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03845244. Registered on 19 February 2019.


Assuntos
Cânula/estatística & dados numéricos , Estado Terminal/terapia , Oxigenoterapia/métodos , Oxigênio/uso terapêutico , Adulto , Gasometria/estatística & dados numéricos , Mortalidade Hospitalar/tendências , Humanos , Inalação/fisiologia , Tempo de Internação/estatística & dados numéricos , Ventilação não Invasiva/métodos , Avaliação de Resultados em Cuidados de Saúde , Oxigênio/administração & dosagem , Consumo de Oxigênio/fisiologia , Oxigenoterapia/instrumentação , Estudos Prospectivos , Segurança , Suspensão de Tratamento/estatística & dados numéricos
12.
Br J Radiol ; 93(1106): 20190549, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31778311

RESUMO

OBJECTIVE: To test the hypothesis that there is a measureable upward motion of the diaphragm during prolonged breath-holds that could have a detrimental effect on image quality in liver MRI and to identify factor that potentially influence the magnitude of this motion. METHODS: 15 healthy volunteers underwent MRI examination using prolonged breath-holds in the maximum inspiratory position and a moderate inspiratory position. Coronal T1 weighted three-dimensional gradient echo sequences of the entire thorax were acquired every 6 s during breath-holding allowing the calculation of total lung volume and the measurement of the absolute position of the dome of the liver. The potential impact of subject's gender, body mass index, and total lung capacity on the change in lung volume/diaphragmatic motion was assessed using random coefficient regression. RESULTS: All volunteers demonstrated a slow reduction of the total lung volume during prolonged breath-holding up to 123 ml. There was a measurable associated upward shift of the diaphragm, measuring up to 5.6 mm after 24 s. There was a positive correlation with female gender (p = 0.037) and total lung volume (p = 0.005) and a negative association with BMI (p = 0.012) for the maximum inspiratory position only. CONCLUSION: There is a measureable reduction of lung volumes with consecutive upward shift of the diaphragm during prolonged breath-holding which likely contributes to motion artifacts in liver MRI. ADVANCES IN KNOWLEDGE: There is a measureable gas exchange-related reduction of lung volumes with consecutive upward shift of the diaphragm during prolonged breath-holding which likely contributes to motion artifacts in liver MRI. Correcting for this predictable upward shift has potential to improve image quality.The magnitude of this effect does not seem to be related to gender, BMI or total lung capacity if a moderate inspiratory position is used.


Assuntos
Abdome/fisiologia , Suspensão da Respiração , Fígado , Adulto , Artefatos , Diafragma/fisiologia , Feminino , Voluntários Saudáveis , Humanos , Inalação/fisiologia , Medidas de Volume Pulmonar , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Movimento/fisiologia , Troca Gasosa Pulmonar/fisiologia , Adulto Jovem
13.
Mult Scler Relat Disord ; 37: 101492, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31707233

RESUMO

BACKGROUND: Respiratory training using Threshold Inspiratory Muscle Trainer (IMT) has not been examined adequately in multiple sclerosis (MS). The primary objective in this study of persons with advanced MS was to investigate the training effect of IMT. The secondary objective was to evaluate the retention of IMT benefits. METHODS: This study was a repeated measures within-subject design (before-after trial).. Participants were recruited from a long-term care facility specialized in progressive neurologic conditions. Thirty-six non-ambulatory persons with advanced MS volunteered. Inspiratory muscle exercise using the threshold IMT were performed daily for 10 weeks at 3 sets of 15 repetitions per day. Resistance was progressed weekly based on perceived rate of exertion and symptoms. Primary outcome measures were maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) that were measured at baseline, after 5 and 10 weeks of IMT exercises (training period), and at 4 and 8 weeks after the IMT training ended (retention). Linear mixed-effect regression models with time (i.e. weeks from baseline) as the fixed factor and participants as the random effect factor were applied separately to test each hypothesis. Effect size was calculated using partial eta square (η2p). Two-tailed significance level was p < 0.05. RESULTS: Participants were 60.5 ±â€¯8.6 years old. Expanded Disability Status Scale was 8.5 ±â€¯0.4. Baseline MIP were 25.9 ±â€¯16.4 cmH2O (33.2% %± 19.8% of predicted values) and MEP were 23.5 ±â€¯15.7 cmH2O (25.8% %± 14.4% of predicted values). Compared to the baseline, MIP increased significantly to 30.1 ±â€¯17.9 cmH2O (38.9% %± 22.4% of predicted values) and 30.6 ±â€¯17.6 cmH2O (39.6% %± 22.3% of predicted values) after 5 (p < 0.05) and 10 weeks (p < 0.05) of IMT exercises. MIP improvements were retained in an 8-week washout period. MEP did not differ significantly by time. CONCLUSION: In persons with advanced MS, 10-week IMT training increased inspiratory muscle strength. This study is the first to demonstrate the retention of benefits following daily IMT exercises at 8 weeks after training ended.


Assuntos
Exercícios Respiratórios , Inalação/fisiologia , Força Muscular/fisiologia , Avaliação de Resultados em Cuidados de Saúde , Músculos Respiratórios/fisiologia , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Testes de Função Respiratória , Índice de Gravidade de Doença
14.
Am J Respir Crit Care Med ; 201(8): 976-983, 2020 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-31810378

RESUMO

Rationale: Sleep deprivation can alter endurance of skeletal muscles, but its impact on respiratory command is unknown.Objectives: We aimed to assess the effect of sleep deprivation on respiratory motor output and inspiratory endurance.Methods: Inspiratory endurance was investigated twice in random order, following a normal sleep night and a sleepless night. Healthy participants were asked to breathe as long as possible until task failure against a moderate inspiratory threshold constraint. Transdiaphragmatic pressure and diaphragm electrical activity were measured throughout the trial to assess pressure output of the diaphragm and overall respiratory motor output. Cortical contribution to respiratory motor output was assessed by measurement of preinspiratory motor potential amplitude and by cervical magnetic simulation.Measurements and Main Results: Twenty healthy male participants were studied. Time to task failure was significantly shorter after sleep deprivation than after normal sleep: (30 min [interquartile range [IQR], 17-41] vs. 60 min [IQR, 45-60], P = 0.002). At the beginning of the trial, preinspiratory motor potential amplitude was significantly lower in the sleep-deprivation condition (4.5 µV [IQR, 2.5-6.4] vs. 7.3 µV [IQR, 4.3-10.4], P = 0.02) and correlated significantly with the duration of the endurance trial. In the sleep-deprivation condition, preinspiratory motor potential amplitude, electrical activity of the diaphragm, pressure output of the diaphragm, and Vt decreased and the respiratory rate increased significantly from the beginning to the end of the trial. Such decreases did not occur in the normal-sleep condition.Conclusions: One night of sleep deprivation reduces respiratory motor output by altering its cortical component with subsequent reduction of inspiratory endurance by half. These results suggest that altered sleep triggers severe brain dysfunctions that could precipitate respiratory failure.


Assuntos
Diafragma/fisiopatologia , Inalação/fisiologia , Fadiga Muscular/fisiologia , Resistência Física/fisiologia , Privação do Sono/fisiopatologia , Adulto , Voluntários Saudáveis , Humanos , Masculino , Respiração , Músculos Respiratórios/fisiopatologia
15.
Am J Respir Crit Care Med ; 201(4): 414-422, 2020 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-31644879

RESUMO

Rationale: In patients with chronic obstructive pulmonary disease (COPD), increased activity of neck inspiratory muscles has been reported as a compensatory response to hyperinflation-related diaphragmatic dysfunction. The persistence of this activity during sleep could attenuate sleep-related hypoventilation and also negatively impact sleep and clinical outcomes.Objectives: To assess the persistence of neck-muscle activity during sleep in patients with COPD recovering from severe exacerbations (i.e., requiring hospitalization) and its impact on sleep quality and recurrence of exacerbations.Methods: Video polysomnography with neck-muscle EMG was performed in patients with COPD who were recovering from a severe exacerbation. The follow-up period lasted 6 months to record the next severe exacerbation.Measurements and Main Results: Twenty-nine patients were included in the study (median [25th-75th percentile] age, 71 [64-72] yr; 55% male; body mass index, 24 [21-29]; FEV1% predicted, 37 [29-45]; and BODE [body mass index, airflow obstruction, dyspnea, and exercise] index, 6 [5-7]). Twenty-six of these patients exhibited sleep-related neck-muscle activity, which was intermittent (limited to stage 3 sleep) in 17 and permanent throughout sleep in 9. α-Delta EEG activity during stage 3 sleep was observed in 87% of the patients. Compared with patients with no or intermittent neck-muscle activity, those with permanent neck-muscle activity showed more disrupted sleep, had experienced more exacerbations in the previous year, and suffered their next severe exacerbation earlier.Conclusions: Sleep-related neck-muscle activity occurs frequently in patients with COPD who are recovering from a severe exacerbation and seems to negatively affect sleep quality and prognosis; therefore, identification of this activity might improve COPD management after a severe exacerbation.


Assuntos
Volume Expiratório Forçado/fisiologia , Inalação/fisiologia , Músculos do Pescoço/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/etiologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Músculos Respiratórios/fisiopatologia , Sono/fisiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos
16.
Chest ; 157(2): 356-362, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31542451

RESUMO

BACKGROUND: The respiratory duty cycle (Ti/Ttot) can influence bronchoprovocation test results and nebulized drug delivery. The Ti/Ttot has not yet been examined in individuals with airway hyperresponsiveness (AHR) in typical bronchoprovocation test conditions. This study investigated the mean Ti/Ttot in participants with and without AHR and whether the Ti/Ttot changes with increasing bronchoconstriction. METHODS: Fifteen participants with AHR and fifteen participants without AHR completed this randomized crossover study. An ultrasonic spirometer was used for continuous measurement of the Ti/Ttot as participants inhaled room air or aerosolized solution. Each participant completed two methacholine challenges, one using a continuous-output vibrating mesh nebulizer/ultrasonic spirometer and one with the nebulizer only. Prior to each methacholine challenge, participants inhaled room air and aerosolized saline through the nebulizer/spirometer setup to record baseline Ti/Ttot data. RESULTS: The mean Ti/Ttot findings [95% CIs] during room air inhalation were 0.392 [0.378-0.406] and 0.447 [0.426-0.468] in participants with and without AHR, respectively (P < .001). The mean Ti/Ttot during saline inhalation were 0.389 [0.373-0.405] and 0.424 [0.398-0.450] in participants with and without AHR (P = .040). The Ti/Ttot showed a nonsignificant downward trend with progressive methacholine-induced bronchoconstriction. CONCLUSIONS: The mean Ti/Ttot in participants with AHR closely resembles the assumed Ti/Ttot of 0.40 recommended for standard use when calculating methacholine challenge results. Since the Ti/Ttot did not change significantly over the course of a methacholine challenge, the same Ti/Ttot can be used to calculate the dose of methacholine inhaled, regardless of the level of bronchoconstriction. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT03505489; URL: www.clinicaltrials.gov.


Assuntos
Testes de Provocação Brônquica/métodos , Hipersensibilidade Respiratória/fisiopatologia , Espirometria/métodos , Adolescente , Adulto , Broncoconstritores , Estudos de Casos e Controles , Estudos Cross-Over , Feminino , Volume Expiratório Forçado/fisiologia , Humanos , Inalação/fisiologia , Masculino , Cloreto de Metacolina , Pessoa de Meia-Idade , Distribuição Aleatória , Hipersensibilidade Respiratória/diagnóstico , Fatores de Tempo , Adulto Jovem
17.
Respir Physiol Neurobiol ; 271: 103257, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31542658

RESUMO

Deep inspirations are a widely studied topic due to their varied effectiveness as a bronchodilator in asthmatic and non-asthmatic patients. Specifically, they are known to be effective at reversing bronchoconstriction in non-asthmatic patients but may fail to prevent bronchoconstriction in asthmatic patients. Inspired by a recent study on the effect of deep inspirations on the rate of re-narrowing of an isolated airway, we investigate whether the latch-bridge dynamics of smooth muscle cross-bridge theory, coupled with non-linear compliance of the airway wall, can account for the reported results: namely that only the rate of renarrowing after DI is sensitive to the interval between deep inspirations, while other measures are unaffected. We develop and present length- and pressure-controlled protocols which mimic both the experiments performed in the study, as well as simulate in vivo conditions respectively. Both protocols are simulated and show qualitative agreement with the results reported by the experiments, suggesting that latch-bridge dynamics coupled with airway wall non-compliance may be sufficient to explain these results. Moreover pressure- and length-controlled protocols show important differences which should be considered when designing in vitro experiments to mimic in vivo conditions.


Assuntos
Broncoconstrição/fisiologia , Simulação por Computador , Inalação/fisiologia , Modelos Biológicos , Músculo Liso/fisiologia , Asma/fisiopatologia , Humanos
18.
J Oncol Pharm Pract ; 26(6): 1318-1323, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31822202

RESUMO

BACKGROUND: Exposure to inhalation of anticancer drugs is frequent in anticancer drug handling. Using an activated carbon mask with the ability to remove particulates and vapors of anticancer drugs may be effective. Mask fitting performance is important, because low fitting performance leads to inhalation via bypassing the mask filter (leak). This study evaluated the leak rate of multiple-shaped masks. METHODS: Activated carbon and nonactivated carbon masks of the pleated-type (like surgical mask) and cup-type were used. Four pharmacists wore the masks and a fitting tester was employed. The particle reduction rate of particles in ambient air was calculated using: particle count (outside - inside)/outside × 100 (%). Leak rate was calculated as the difference in the particle reduction rate due to the presence or the absence of a seal in the mask surroundings. RESULTS: Reduction rates of the pleated-type nonactivated carbon mask and the pleated-type activated carbon mask were 14.8% and 34.8% (mean). These values significantly increased to 85.6% and 83.3% upon sealing the mask surroundings. Particle reduction rates of the cup-type nonactivated carbon mask and activated carbon mask were 99.3% and 33.6%. When mask surroundings were sealed, these values were 99.6% and 39.2%. Leak rates of pleated-type nonactivated carbon mask, pleated-type activated carbon mask, cup-type nonactivated carbon mask, and cup-type activated carbon mask were 70.8%, 48.5%, 0.3%, and 5.6%, respectively. CONCLUSION: A difference was found in the leak rate between masks used in anticancer drug handling. Based on the low leak rate, the cup-type activated carbon mask was thought to be effective.


Assuntos
Antineoplásicos/efeitos adversos , Carbono , Desenho de Equipamento/normas , Máscaras/normas , Tamanho da Partícula , Desenho de Equipamento/métodos , Humanos , Inalação/fisiologia
19.
Int. j. odontostomatol. (Print) ; 14(3): 380-386, 2020. tab
Artigo em Espanhol | LILACS | ID: biblio-1114911

RESUMO

El objetivo de nuestro estudio de tipo longitudinal prospectivo simple de medidas repetidas fue determinar la variación del flujo aéreo nasal medido con un flujómetro nasal portátil, en niños entre 6 y 14 años de edad con compresión maxilar, después de la expansión rápida del maxilar (ERM). El trabajo constó de 16 niños diagnosticados con compresión maxilar y a quienes se les indicó una disyunción maxilar rápida. Los valores de la cantidad de expansión fueron registrados y la medición del flujo inspiratorio nasal máximo (FINM) se realizó antes de la ERM (T1), inmediatamente después (T2) y al cabo de 3 meses del período de retención (T3), manteniendo las mismas condiciones iniciales. El valor máximo y el promedio de las mediciones del FINM en T2 fueron significativamente mayores que en T1 (p-valor, 0,0056) y (p-valor 0,0062) respectivamente, mientras que entre T2 y T3 no existieron tales diferencias (p-valor: 0,3021) y (p-valor: 0,3315) respectivamente. Existe un aumento significativo en los valores del FINM inmediatamente después de la expansión rápida del maxilar que se mantienen en un período de tiempo de 3 meses.


The objective of our simple prospective longitudinal type study of repeated measures, was to determine the variation of nasal airflow measured with a portable nasal flow meter, in children between 6 and 14 years of age with maxillary compression, after rapid maxillary expansion (RME). The study consisted of 16 children diagnosed with maxillary compression and those who were identified with a rapid maxillary disjunction. The values of the amount of expansion were recorded and the measurement of the peak nasal inspiratory flow (PNIF) was performed before the ERM (T1), immediately after (T2) and after 3 months of retention period (T3), maintaining the same initial conditions. Results: the value maximum and average measurements of FINM in T2 were greater than in T1 (p-value, 0.0056) and (p-value 0.0062) respectively, while between T2 and T3 there were no differences (p value: 0.3021) and (p value: 0.3315) respectively. There is a significant increase in PNIF values immediately after rapid maxillary expansion that is in a period of 3 months.


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Inalação/fisiologia , Nariz/fisiologia , Má Oclusão/terapia , Seio Maxilar/cirurgia , Obstrução Nasal/fisiopatologia , Estudos Prospectivos , Estudos Longitudinais , Técnica de Expansão Palatina , Fluxômetros
20.
Crit Care ; 23(1): 369, 2019 11 21.
Artigo em Inglês | MEDLINE | ID: mdl-31752952

RESUMO

BACKGROUND: High inspiratory flow might damage the lungs by mechanisms not fully understood yet. We hypothesized that increasing inspiratory flow would increase lung stress, ventilation heterogeneity, and pendelluft in ARDS patients undergoing volume-controlled ventilation with constant tidal volume and that higher PEEP levels would reduce this phenomenon. METHODS: Ten ARDS patients were studied during protective volume-controlled ventilation. Three inspiratory flows (400, 800, and 1200 ml/s) and two PEEP levels (5 and 15 cmH2O) were applied in random order to each patient. Airway and esophageal pressures were recorded, end-inspiratory and end-expiratory holds were performed, and ventilation distribution was measured with electrical impedance tomography. Peak and plateau airway and transpulmonary pressures were recorded, together with the airway and transpulmonary pressure corresponding to the first point of zero end-inspiratory flow (P1). Ventilation heterogeneity was measured by the EIT-based global inhomogeneity (GI) index. Pendelluft was measured as the absolute difference between pixel-level inflation measured at plateau pressure minus P1. RESULTS: Plateau airway and transpulmonary pressure was not affected by inspiratory flow, while P1 increased at increasing inspiratory flow. The difference between P1 and plateau pressure was higher at higher flows at both PEEP levels (p < 0.001). While higher PEEP reduced heterogeneity of ventilation, higher inspiratory flow increased GI (p = 0.05), irrespective of the PEEP level. Finally, gas volume undergoing pendelluft was larger at higher inspiratory flow (p < 0.001), while PEEP had no effect. CONCLUSIONS: The present exploratory analysis suggests that higher inspiratory flow increases additional inspiratory pressure, heterogeneity of ventilation, and pendelluft while PEEP has negligible effects on these flow-dependent phenomena. The clinical significance of these findings needs to be further clarified.


Assuntos
Inalação/fisiologia , Pulmão/fisiologia , Respiração com Pressão Positiva/métodos , Ventilação Pulmonar/fisiologia , /terapia , Idoso , Estudos Cross-Over , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , /diagnóstico
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...