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1.
Arq Bras Cir Dig ; 33(4): e1557, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33503117

RESUMO

BACKGROUND: Water-perfused high resolution manometry system. High-resolution manometry is more costly but clinically superior to conventional manometry. Water-perfused systems may decrease costs, but it is unclear if they are as reliable as solid-state systems, and reference values are interchangeable. AIM: To validate normal values for a new water-perfusion high-resolution manometry system. METHODS: Normative values for a 24-sensors water perfused high-resolution manometry system were validated by studying 225 individuals who underwent high resolution manometry for clinical complaints. Patients were divided in four groups: group 1 - gastroesophageal reflux disease; group 2 - achalasia; group 3 - systemic diseases with possible esophageal manifestation; and group 4 - dysphagia. RESULTS: In group 1, a hypotonic lower esophageal sphincter was found in 49% of individuals with positive 24 h pH monitoring, and in 28% in pH-negative individuals. In groups 2 and 3, aperistalsis was found in all individuals. In group 4, only one patient (14%) had normal high-resolution manometry. CONCLUSIONS: The normal values determined for this low-cost water-perfused HRM system with unique peristaltic pump and helicoidal sensor distribution are discriminatory of most abnormalities of esophageal motility seen in clinical practice.


Assuntos
Esfíncter Esofágico Inferior , Esôfago/fisiologia , Motilidade Gastrointestinal/fisiologia , Manometria/métodos , Adulto , Acalasia Esofágica , Refluxo Gastroesofágico , Humanos , Manometria/instrumentação , Pessoa de Meia-Idade , Peristaltismo , Valores de Referência , Reprodutibilidade dos Testes , Água
2.
PLoS One ; 15(9): e0228761, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32991595

RESUMO

There is a need for a lower cost manometry system for assessing anorectal function in primary and secondary care settings. We developed an index finger-based system (termed "digital manometry") and tested it in healthy volunteers, patients with chronic constipation, and fecal incontinence. Anorectal pressures were measured in 16 participants with the digital manometry system and a 23-channel high-resolution anorectal manometry system. The results were compared using a Bland-Altman analysis at rest as well as during maximum squeeze and simulated defecation maneuvers. Myoelectric activity of the puborectalis muscle was also quantified simultaneously using the digital manometry system. The limits of agreement between the two methods were -7.1 ± 25.7 mmHg for anal sphincter resting pressure, 0.4 ± 23.0 mmHg for the anal sphincter pressure change during simulated defecation, -37.6 ± 50.9 mmHg for rectal pressure changes during simulated defecation, and -20.6 ± 172.6 mmHg for anal sphincter pressure during the maximum squeeze maneuver. The change in the puborectalis myoelectric activity was proportional to the anal sphincter pressure increment during a maximum squeeze maneuver (slope = 0.6, R2 = 0.4). Digital manometry provided a similar evaluation of anorectal pressures and puborectalis myoelectric activity at an order of magnitude less cost than high-resolution manometry, and with a similar level of patient comfort. Digital Manometry provides a simple, inexpensive, point of service means of assessing anorectal function in patients with chronic constipation and fecal incontinence.


Assuntos
Canal Anal/fisiopatologia , Constipação Intestinal/diagnóstico , Incontinência Fecal/diagnóstico , Manometria/instrumentação , Reto/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Constipação Intestinal/fisiopatologia , Estudos Transversais , Eletromiografia , Incontinência Fecal/fisiopatologia , Feminino , Voluntários Saudáveis , Humanos , Masculino , Manometria/economia , Manometria/métodos , Pessoa de Meia-Idade , Diafragma da Pelve/fisiopatologia , Pressão , Dispositivos Eletrônicos Vestíveis/economia
3.
Cir Cir ; 88(1): 7-14, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31967613

RESUMO

Background: Measurement of intra-abdominal pressure (IAP) is realized with the Kron's method. However, this technique has drawbacks like an infusion of water into the bladder of the patient. Objective: The prove a new novel disposable sensor in the way to measure the IAP (DSIAP) this one addresses some limitations of the Kron method. Materials and methods: The DSIAP was tested in vitro and clinical settings. The proposed technique was compared with Kron's method through Pearson correlation and Bland-Altman analysis. For in vitro tests, 159 measurements were taken performed by simulating the IAP in the bladder. For the clinical test, 20 pairs of measurements were made in patients with routine IAP monitoring in the intensive care unit. Results: In vitro measurements showed a strong correlation between the DSIAP and the reference (r = 0.99, p-value < 2.2 × 10-16). The bias and 95% confidence intervals were 0.135 and -0.821-1.091 cmH2O, respectively. Measurements in patients with DSIAP versus Kron's method shown a very good correlation (r = 0.973, p-value < 5.46 × 10-13), while the bias and confidence intervals were 0.018 and -3.461-3.496 mmHg, respectively. Conclusions: The results suggest that the proposed DSIAP showed a profile similar to pressure transducers already in clinical use while overcoming some limitations of the former.


Assuntos
Equipamentos Descartáveis , Hipertensão Intra-Abdominal/diagnóstico , Transdutores de Pressão , Abdome , Adulto , Intervalos de Confiança , Desenho de Equipamento , Humanos , Técnicas In Vitro/métodos , Manometria/instrumentação , México , Pessoa de Meia-Idade , Pressão , Padrões de Referência , Valores de Referência , Bexiga Urinária , Adulto Jovem
4.
World Neurosurg ; 133: e18-e25, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31394360

RESUMO

BACKGROUND: Intracranial pressure monitoring remains the foundation for prevention of secondary injury after traumatic brain injury and is most commonly performed using an external ventricular drain or intraparenchymal pressure monitor. The Integra Flex ventricular catheter combines an external ventricular catheter with a pressure transducer embedded in the tip of the catheter to allow continuous pressure readings while simultaneously draining cerebrospinal fluid. Discrepancies between measurements from the continuously reported internal pressure transducer and intermittently assessed and externally transduced ventricular drain prompted an analysis and characterization of pressures transduced from the same ventricular source. METHODS: More than 500 hours of high-resolution (125 Hz) continuous recordings were manually reviewed to identify 73 hours of simultaneous measurements (clamped external ventricular drain) from internal and external transducers in patients with traumatic brain injury. RESULTS: A significant positive bias was found in pressure readings obtained from external relative to internal measurements. The 2 methods of measurement generally correlated poorly with each other and variably. Although proportional bias was found with Bland-Altman analysis, coherence revealed rare shifts in the external transducer as a major source of discrepancy. Infrequent changes in the 0-level of the external transducer were found to be the primary source of discrepancy. Relative to the observed differences, no significant trend was observed over time between the 2 modalities. CONCLUSIONS: This study suggests that the internal pressure transducer may be a more reliable estimate of intracranial pressure relative to bedside external transducers due to the inherent behavioral requirement of leveling.


Assuntos
Lesões Encefálicas Traumáticas/fisiopatologia , Erros de Diagnóstico , Drenagem/instrumentação , Hipertensão Intracraniana/diagnóstico , Pressão Intracraniana , Manometria/instrumentação , Transdutores de Pressão , Lesões Encefálicas Traumáticas/complicações , Cateteres , Humanos , Hipertensão Intracraniana/etiologia , Hipertensão Intracraniana/prevenção & controle , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/métodos , Transdutores de Pressão/classificação
5.
Neurourol Urodyn ; 39(2): 721-731, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31873956

RESUMO

AIMS: Evaluate the intra- and inter-rater reliability of maximal voluntary contraction (MVC) of pelvic floor muscle (PFM) assessment by unidigital and bidigital vaginal palpation. As a secondary aim, evaluate the construct validity of vaginal palpation and a manometer. METHODS: A total of 120 women were recruited and allocated into three groups according to age (group 1 [G1]: 18-35; G2: 36-59; G3: ≥60 years). Examiner A conducted an interview and examiners B and C performed evaluations of PFM function using both unidigital and bidigital vaginal palpation. Seven to 10 days later, examiner B repeated both types of vaginal palpation and measured the MVC pressure with a Peritron. Reliability was analyzed using Cohen's linear weighted Kappa (κw ). The construct validity was calculated using the Spearman's correlation (rs ). RESULTS: Intra-rater reliability of unidigital and bidigital palpation was κw = 0.75 and κw = 0.58 in G1, κw = 0.59 and κw = 0.73 in G2, and κw = 0.79 and κw = 0.86 in G3, respectively. Inter-rater reliability of unidigital and bidigital palpation was κw = 0.52 and κw = 0.48 in G1, κw = 0.47 and κw = 0.52 in G2, and κw = 0.50 and κw = 0.64 in G3, respectively. Spearman's correlation coefficients were significant at rs = 0.79 and rs = 0.80 for unidigital and bidigital vaginal palpation, respectively. CONCLUSIONS: Unidigital or bidigital vaginal palpation were indicated to evaluate G1 and G2 but bidigital palpation was more reliable in G3 when two examiners performed the evaluation. For the assessment conducted by one examiner, unidigital palpation was more reliable in G1 while bidigital palpation was more reliable in G2 and G3. Both unidigital and bidigital palpation have high measures of validity.


Assuntos
Manometria/métodos , Contração Muscular/fisiologia , Palpação/métodos , Vagina/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Feminino , Humanos , Manometria/instrumentação , Pessoa de Meia-Idade , Variações Dependentes do Observador , Diafragma da Pelve/fisiologia , Reprodutibilidade dos Testes , Adulto Jovem
6.
Clin Transl Gastroenterol ; 10(12): e00108, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31800543

RESUMO

INTRODUCTION: Defecation is a complex process that can be easily disturbed. Defecatory disorders may be diagnosed using specialized investigation, including anorectal manometry (ARM) and the balloon expulsion test (BET). Recently, we developed a simulated stool named Fecobionics that integrates several tests and assesses pressures, orientation, and bending during evacuation. The aim was to evaluate the feasibility and performance of Fecobionics for assessing defecatory physiology in normal subjects. METHODS: Physiological expulsion parameters were assessed in an interventional study design. The 10-cm-long Fecobionics probe contained pressure sensors at the front and rear and inside a bag and 2 motion processor units. The bag was distended in the rectum of 20 presumed normal subjects (15 female/5 male) until urge to defecate. ARM-BET was also performed. Three subjects used +2 minutes to evacuate BET, and 1 subject had a high fecal incontinence score. Therefore, the normal group consisted of 16 subjects (13 female/3 male aged 25-78 years). RESULTS: All subjects reported that Fecobionics evacuation was similar to normal defecation. Fecobionics expulsion pressure signatures demonstrated 5 phases, reflecting rectal pressure, anal relaxation, and anal passage. Preload-afterload loop diagrams demonstrated clockwise contraction cycles. The expulsion duration for BET and Fecobionics was 16 ± 2 and 23 ± 5 seconds (P > 0.2), respectively. The duration of the Fecobionics and BET expulsions was associated (P < 0.001). The change in bending of Fecobionics during defecation was 40 ± 3°. DISCUSSION: Fecobionics obtained reliable data under physiological conditions. Agreement was found for comparable variables between ARM-BET and Fecobionics but not for other variables. The study suggests that Fecobionics is safe and effective in evaluation of key defecatory parameters.


Assuntos
Defecação/fisiologia , Manometria/instrumentação , Reto/fisiologia , Adulto , Idoso , Constipação Intestinal/fisiopatologia , Estudos de Viabilidade , Incontinência Fecal/diagnóstico , Incontinência Fecal/fisiopatologia , Feminino , Voluntários Saudáveis , Humanos , Masculino , Manometria/métodos , Pessoa de Meia-Idade , Reprodutibilidade dos Testes
7.
Arch Osteoporos ; 14(1): 106, 2019 10 31.
Artigo em Inglês | MEDLINE | ID: mdl-31673807

RESUMO

We investigated the correlation between abdominal trunk muscle strength and spinal deformities in middle-aged and older women. The results indicated that abdominal trunk muscle weakness, older age, and low lumbar bone mineral density were significant risk factors associated with the presence of OVFs in the lower thoracic and lumbar spine. PURPOSE: We developed an innovative exercise device for the abdominal trunk muscles that also measures muscle strength. We investigated the correlation between the strength and thoracolumbar spinal deformity in middle-aged and older women. METHODS: This study included 206 consecutive female patients who were 50 years or older and scheduled to undergo surgery for degenerative diseases of the lower extremities. Patients with a history of symptomatic osteoporotic vertebral fractures (OVFs) requiring treatments were excluded. Before surgery, patients underwent physical measurements including abdominal trunk muscle strength using our device, full-spine standing radiography, and bone mineral density measurement of the lumbar spine (L-BMD). According to radiographic findings of the radiogram, patients were divided into four groups: control group (n = 134), listhesis group (n = 29), scoliosis group (n = 19), and fracture group (n = 24). The Tukey-Kramer honestly significant difference test was used to compare all measurements among the four groups. To identify factors associated with the presence of OVFs, a multivariate logistic regression analysis was performed. RESULTS: The average abdominal trunk muscle strength in the fracture group was significantly lower than that of the control group. The multivariate analysis revealed that abdominal trunk muscle weakness, older age, and a low L-BMD were associated with OVF findings. CONCLUSIONS: Abdominal trunk muscle weakness in middle-aged and older women was associated with OVF. The strength measurement can be a risk assessment of OVF.


Assuntos
Músculos Abdominais/fisiologia , Força Muscular , Fraturas por Osteoporose/etiologia , Fraturas da Coluna Vertebral/etiologia , Idoso , Densidade Óssea , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Manometria/instrumentação , Pessoa de Meia-Idade , Dinamômetro de Força Muscular , Músculo Esquelético , Radiografia , Medição de Risco , Fatores de Risco , Vértebras Torácicas/diagnóstico por imagem
8.
Best Pract Res Clin Anaesthesiol ; 33(2): 127-138, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31582093

RESUMO

Arterial blood pressure monitoring is a major part of the decision-making process for every anesthetic. It is important to recognize the advantages, disadvantages, and limitations of available measurement modalities as well as have some understanding of the engineering principles on which these measurements are based. Oscillometry is by far the most common modality used but is limited by its intermittent nature and inaccuracy during hypotension and hypertension. Arterial catheterization is the gold standard for measuring blood pressure but is an invasive procedure that is expensive and not without risk of harm to the patient. Volume clamp and tonometric technologies are relatively new and allow for continuous noninvasive monitoring of the blood arterial waveform, but their accuracy when compared with oscillometry is not well described, and they have not been widely incorporated into standard practice. Additional research is needed to determine whether continuous noninvasive blood pressure monitors can improve outcomes.


Assuntos
Determinação da Pressão Arterial/métodos , Pressão Sanguínea/fisiologia , Manometria/métodos , Monitorização Intraoperatória/métodos , Assistência Perioperatória/métodos , Determinação da Pressão Arterial/instrumentação , Humanos , Manometria/instrumentação , Monitorização Intraoperatória/instrumentação , Assistência Perioperatória/instrumentação
9.
IEEE Trans Biomed Circuits Syst ; 13(6): 1525-1534, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31634846

RESUMO

Wearable monitors for measuring vital signs such as blood pressure will greatly impact the medical field. This work presents a millimeter-wave, radar-based system for performing accurate measurements of arterial pulse waveforms without contacting the region that is pulsing. Electromagnetic and radar-system simulation models are utilized to demonstrate the viability and safety of this approach. This is followed by hardware/software implementation and a study on 12 human subjects. Measured radial arterial waveforms exhibit signal strengths that are well above the noise floor of the system and a morphology that would be expected in an arterial pulse. Finally, comparison of the radar-based signals with a reference tonometer indicates a strong correlation between waveforms, as well as similar spectral signatures. The results observed suggest a millimeter-wave based approach for arterial pulse detection is very promising for future applications in pulse wave analysis and pulse transit time measurement for blood pressure tracking.


Assuntos
Pressão Sanguínea , Frequência Cardíaca , Manometria/instrumentação , Adulto , Idoso , Desenho de Equipamento , Humanos , Manometria/métodos , Pessoa de Meia-Idade , Análise de Onda de Pulso , Radar , Dispositivos Eletrônicos Vestíveis
11.
J Gastroenterol ; 54(12): 1078-1082, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31388756

RESUMO

BACKGROUND: The values of the parameters in the Chicago classification measured by a high-resolution manometry (HRM) system with the Unisensor catheter (Starlet) are significantly different from those measured by the ManoScan. The contraction vigor is categorized by values of the distal contractile integral (DCI) in the Chicago classification v3.0; however, reference values of the DCI in the Starlet and the clinical impact of the different reference values in the Starlet and ManoScan on diagnosing esophageal motility disorders are not known. METHODS: We evaluated data from a previous report in which ManoScan and Starlet were compared in the same subjects. The DCI values in each system were compared and reference DCI values were calculated. Moreover, diagnoses assessed by Starlet using reference values in ManoScan were compared with those using calculated reference values and those assessed by ManoScan. RESULTS: There was a significant positive correlation between the DCI values measured by ManoScan and those measured by Starlet (r = 0.80, p < 0.01). Based on a linear functional relationship considering measurement errors, the reference DCI values for diagnosing failed, weak and hypercontractile contraction vigor were calculated as 590.6, 1011.3 and 10,085.8 mmHg-s-cm, respectively, in the Starlet. Therefore, the proposed reference values in the Starlet were 500, 1000 and 10,000 mmHg-s-cm, respectively. When the reference values in the ManoScan were used in the Starlet data, approximately 30% of subjects were diagnosed inappropriately. This issue was resolved using the proposed reference values in the Starlet. CONCLUSION: Recognizing systemic differences in HRM systems is important.


Assuntos
Transtornos da Motilidade Esofágica/diagnóstico , Manometria/métodos , Adulto , Desenho de Equipamento , Feminino , Humanos , Masculino , Manometria/instrumentação , Pessoa de Meia-Idade , Valores de Referência
12.
Neurogastroenterol Motil ; 31(12): e13704, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31407459

RESUMO

BACKGROUND: High-resolution colonic manometry is an emerging technique that has provided new insights into the pathophysiology of functional colorectal diseases. Prior studies have been limited by bulky, non-ambulatory acquisition systems, which have prevented mobilization during prolonged recordings. METHODS: A novel ambulatory acquisition system for fiber-optic high-resolution colonic manometry was developed. Benchtop validation against a standard non-ambulatory system was performed using standardized calibration metrics. Clinical feasibility studies were conducted in three patients undergoing right hemicolectomy. RESULTS: Pressure profiles obtained from benchtop testing were near-identical using the ambulatory and the non-ambulatory systems. Clinical studies successfully demonstrated ambulatory data capture with patients freely mobilizing postoperatively during continuous recordings of >60 hours. The occurrence (P = .56), amplitude (P = .65), velocity (P = .10), and extent (P = .12) of colonic motor patterns were similar to those obtained in non-ambulatory studies. CONCLUSIONS: A novel ambulatory system for high-resolution colonic manometry has been developed and validated. This technique will facilitate prolonged ambulatory recordings of colonic motor activity, assisting with investigations into the role of colonic motility in disease states.


Assuntos
Colo/fisiologia , Tecnologia de Fibra Óptica/instrumentação , Motilidade Gastrointestinal/fisiologia , Manometria/instrumentação , Monitorização Ambulatorial/instrumentação , Idoso , Idoso de 80 Anos ou mais , Colectomia , Desenho de Equipamento , Estudos de Viabilidade , Feminino , Humanos , Masculino , Manometria/métodos , Pessoa de Meia-Idade , Monitorização Ambulatorial/métodos , Período Pós-Operatório , Período Pós-Prandial/fisiologia
13.
Rehabilitacion (Madr) ; 53(3): 146-154, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31370941

RESUMO

OBJECTIVE: To determine whether a short 6-session protocol of tonic/ phasic exercises can enhance quality of life and muscular strength in patients with urinary incontinence (UI). MATERIAL AND METHODS: A prospective before-after study was performed in 67 patients with UI referred to the Rehabilitation Department of the Santa Cristina University Hospital in Madrid, Spain. In the initial assessment, the patient's personal details, predisposing factors and type of UI were registered. Patients received lifestyle recommendations. The ICIQ-SF/I-QOL questionnaires/scales were completed at the beginning and end of treatment. The manometric evaluation was registered in the first and last assessment by the MYOMED® 932 equipment. The protocol consisted of a 30-minute session of tonic/phasic exercises (15minutes each) twice weekly for a maximum of 6 sessions, supervised by a physiotherapist. RESULTS: The mean age was 52.1±12.7 years and 94% of the patients (n=63) were women. The maximum and mean strength of the pelvic floor contraction was 26.4±15.6 and 5.3±3.9mmHg, respectively, which significantly increased after treatment to 35.5±19.6 and 7.6±4.4mmHg (P<.0001). The ICIQ-SF score was 10.1±5 and significantly decreased to 6.6±4.6 (P<0.0001). The I-QOL score significantly increased from 66.1±21.9 to 77.9±18.1 points (P<.0001). The I-QOL ALB subscale (avoidance and limiting behaviour) increased from 63.7±22.6 to 77.3±17.8 (P<.0001); the I-QoL PSI subscale (psychosocial impact) increased from 73.8±23.9 to 82.5±18.7 (P=.0004); and the I-QOL SE subscale (social embarrassment) increased from 56.5±23.7 to 70.5±22.1 (P<.0001). CONCLUSION: Manometric feedback reduces UI and improves both quality of life and manometric values. This short 6-session protocol could be applied in other public and private centres and could provide economic benefits to the health system and to patients.


Assuntos
Retroalimentação Fisiológica , Manometria/métodos , Qualidade de Vida , Incontinência Urinária/reabilitação , Adulto , Estudos Controlados Antes e Depois , Feminino , Humanos , Masculino , Manometria/instrumentação , Pessoa de Meia-Idade , Contração Muscular/fisiologia , Força Muscular , Diafragma da Pelve , Estudos Prospectivos , Resultado do Tratamento , Incontinência Urinária/fisiopatologia
14.
Sci Rep ; 9(1): 9716, 2019 07 04.
Artigo em Inglês | MEDLINE | ID: mdl-31273265

RESUMO

The aim of this study was to compare radial pulse characteristics between primary dysmenorrhea (PD) patients and healthy subjects throughout the menstrual cycle. A total of 48 females aged 20 to 29 years participated, and all subjects were assigned to two groups according to their visual analogue scale scores. The radial pulse of each subject was obtained using a pulse tonometric device during menstrual, follicular, and luteal phases. In addition, various pulse analysis indices were used to estimate the pulse characteristics. The pulse tension index (PTI) and pulse depth index (PDI) in the patient group were significantly lower than those in the healthy group during the menstrual phase (P < 0.01 and <0.001, respectively). According to univariate logistic regression results, the PTI, PDI and optimal applied pressure (OAP) were significantly correlated with PD, and the model based on the PTI and OAP performed best (AUC = 0.828). This study is the first to analyze pulse tension inferred from the PTI and to apply this parameter to clinical practice. The results of this study confirmed the possibility of quantitatively measuring pulse tension and suggest that the PTI and OAP can serve as potential clinical indicators for pain disorders.


Assuntos
Dismenorreia/diagnóstico , Manometria/métodos , Menstruação , Artéria Radial/fisiopatologia , Adulto , Estudos de Casos e Controles , Feminino , Voluntários Saudáveis , Frequência Cardíaca , Humanos , Manometria/instrumentação , Ciclo Menstrual , Análise de Onda de Pulso , Adulto Jovem
15.
Crit Care ; 23(1): 217, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196203

RESUMO

BACKGROUND: Oesophageal pressure (PES) is used for calculation of lung and chest wall mechanics and transpulmonary pressure during mechanical ventilation. Measurements performed with a balloon catheter are suggested as a basis for setting the ventilator; however, measurements are affected by several factors. High-resolution manometry (HRM) simultaneously measures pressures at every centimetre in the whole oesophagus and thereby provides extended information about oesophageal pressure. The aim of the present study was to evaluate the factors affecting oesophageal pressure using HRM. METHODS: Oesophageal pressure was measured using a high-resolution manometry catheter in 20 mechanically ventilated patients (15 in the ICU and 5 in the OR). Different PEEP levels and different sizes of tidal volume were applied while pressures were measured continuously. In 10 patients, oesophageal pressure was also measured using a conventional balloon catheter for comparison. A retrospective analysis of oesophageal pressure measured with HRM in supine and sitting positions in 17 awake spontaneously breathing patients is also included. RESULTS: HRM showed large variations in end-expiratory PES (PESEE) and tidal changes in PES (ΔPES) along the oesophagus. Mean intra-individual difference between the minimum and maximum end-expiratory oesophageal pressure (PESEE at baseline PEEP) and tidal variations in oesophageal pressure (ΔPES at tidal volume 6 ml/kg) recorded by HRM in the different sections of the oesophagus was 23.7 (7.9) cmH2O and 7.6 (3.9) cmH2O respectively. Oesophageal pressures were affected by tidal volume, level of PEEP, part of the oesophagus included and patient positioning. HRM identified simultaneous increases and decreases in PES within a majority of individual patients. Compared to sitting position, supine position increased PESEE (mean difference 12.3 cmH2O), pressure variation within individual patients and cardiac artefacts. The pressure measured with a balloon catheter did not correspond to the average pressure measured with HRM within the same part of the oesophagus. CONCLUSIONS: The intra-individual variability in PESEE and ΔPES is substantial, and as a result, the balloon on the conventional catheter is affected by many different pressures along its length. Oesophageal pressures are not only affected by lung and chest wall mechanics but are a complex product of many factors, which is not obvious during conventional measurements. For correct calculations of transpulmonary pressure, factors influencing oesophageal pressures need to be known. HRM, which is available at many hospitals, can be used to increase the knowledge concerning these factors. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02901158.


Assuntos
Esôfago/fisiologia , Intubação Intratraqueal/instrumentação , Manometria/instrumentação , Pressão , Pesos e Medidas/instrumentação , Adulto , Idoso , Feminino , Humanos , Intubação Intratraqueal/métodos , Intubação Intratraqueal/tendências , Pulmão/fisiopatologia , Complacência Pulmonar/fisiologia , Masculino , Manometria/métodos , Manometria/tendências , Pessoa de Meia-Idade , Respiração Artificial/instrumentação , Respiração Artificial/métodos , Mecânica Respiratória/fisiologia , Suécia , Pesos e Medidas/normas
17.
Minerva Anestesiol ; 85(9): 1003-1013, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31124620

RESUMO

The performance of a precise and safe peripheral nerve blockade (PNB) can currently rely on the aid of the ultrasounds and nerve stimulators. The injection pressure monitoring may be beneficial to perform a safer procedure. This review focuses on the pressures measured during PNB among studies conducted on animal, and human models. From a deep research among the PubMed/MEDLINE database for all reports published in English between January 2004 and November 2018, we selected 15 original papers. We excluded those that were reviews, case-reports, recommendations and correspondences, that did not match with object of our study. We highlighted the available systems for monitoring injection pressures and classified the reports on the basis of the model used for the respective study (animals, humans, in vitro). Intraneural injections were associated with lower pressures than perineural ones. High injection pressures registered at the needle tip were associated with an increased risk of nerve damage. To date, a precise cut-off pressure value has not yet emerged from the literature for a safe PNBs, but based on the recent literature, it can be stated that the threshold of 15 psi is an acceptable value under which a perineural injection can be performed during a PNB to achieve a safer procedure. So it is desirable to make further studies in order to assess them. In the future, the monitoring of the pressure could allow the use of a minimal quantity of anesthetic, empowering the safety of the nerve blocks. Moreover, the sensitive system should not be invasive and it should not hinder the job of the anesthetists.


Assuntos
Injeções , Manometria/métodos , Bloqueio Nervoso/métodos , Animais , Cadáver , Humanos , Técnicas In Vitro , Bombas de Infusão , Injeções/efeitos adversos , Injeções/instrumentação , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/prevenção & controle , Mamíferos , Manometria/instrumentação , Agulhas , Bloqueio Nervoso/efeitos adversos , Bloqueio Nervoso/instrumentação , Traumatismos dos Nervos Periféricos/etiologia , Traumatismos dos Nervos Periféricos/prevenção & controle , Seringas , Ultrassonografia de Intervenção
18.
Arq Gastroenterol ; 56(1): 79-83, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31141075

RESUMO

BACKGROUND: Digital rectal examination (DRE) is part of the physical examination, is also essential for the colorectal surgeon evaluation. A good DRE offers precious information related to the patient's complaints, which will help in decision making. It is simple, quick and minimally invasive. In many centers around the world, the DRE is still the only method to evaluate the anal sphincter prior to patient's management. On the other hand, anorectal manometry (ARM) is the main method for objective functional evaluation of anal sphincter pressures. The discrepancy of DRE depending on the examiner to determine sphincter tonus in comparison to ARM motivated this study. OBJECTIVE: To compare the DRE performed by proficient and non-experienced examiners to sphincter pressure parameters obtained at ARM, depending on examiners expertise. METHODS: Thirty-six consecutive patients with complaints of fecal incontinence or chronic constipation, from the anorectal physiology clinic of the University of São Paulo School of Medicine, were prospectively included. Each patient underwent ARM and DRE performed by two senior colorectal surgeons and one junior colorectal surgeon prior to the ARM. Patient's history was blinded for the examiner's knowledge, also the impressions of each examiner were blinded from the others. For the DRE rest and squeeze pressures were classified by an objective scale (DRE scoring system) that was compared to the parameters of the ARM for the analysis. The results obtained at the ARM were compared to the DRE performed by the seniors and the junior colorectal surgeons. STATISTICAL ANALYSIS: Descriptive analysis was performed for all parameters. For the rest and squeeze pressures the Gamma index was used for the comparison between the DRE and ARM, which varied from 0 to 1. The closer to 1 the better was the agreement. RESULTS: The mean age was 48 years old and 55.5% of patients were female. The agreement of rest anal pressures between the ARM and the DRE performed by the senior proficient examiners was 0.7 (CI 95%; 0.32-1.0), while for the junior non-experienced examiner was 0.52 (CI 95%; 0.09-0.96). The agreement of squeeze pressures was 0.96 (CI 95%; 0.87-1.0) for the seniors and 0.52 (CI 95%; 0.16-0.89) for the junior examiner. CONCLUSION: More experienced colorectal surgeons used to DRE had a more significant agreement with the ARM, thereafter would have more appropriate therapeutic management to patients with sphincter functional problems. ARM, therefore, persists as an important exam to objectively evaluate the sphincter complex, justifying its utility in the clinical practice.


Assuntos
Canal Anal/fisiopatologia , Exame Retal Digital/métodos , Manometria/instrumentação , Adulto , Competência Clínica , Constipação Intestinal/diagnóstico , Constipação Intestinal/fisiopatologia , Incontinência Fecal/diagnóstico , Incontinência Fecal/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tono Muscular , Valor Preditivo dos Testes , Pressão , Estudos Prospectivos , Índice de Gravidade de Doença
19.
Int Urogynecol J ; 30(12): 2061-2067, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-30888456

RESUMO

INTRODUCTION AND HYPOTHESIS: To determine whether pressure readings measured with air-filled catheter (AFC) and water-filled catheter (WFC) systems are equivalent during cystometric assessment, especially in case of pressure measurements at Valsalva manoeuvres and coughs. METHODS: Twenty-five subjects were recruited. The commercially available 7-Fr TDOC AFC, which simultaneously reads water and air pressures in the bladder and rectum, was used to compare filling and voiding data recordings. Data were compared using paired t-tests, Bland-Altman plots and linear correlation methods, respectively. RESULTS: Pressure readings measured by the two systems showed a good correlation at Valsalva manoeuvres [R2 = 0.988, 0.968 for vesical pressure (Pves) and abdominal pressure (Pabd), respectively] and at coughs (R2 = 0.972, 0.943 for Pves and Pabd, respectively). There was a statistically significant difference between the two different measurement modalities at coughs (p < 0.01), initial resting pressure (p < 0.01) and the maximum pressure at detrusor overactivity (p < 0.01). This indicated that the difference between the two measurement modalities during Valsalva manoeuvres could reach up to 5.2 cmH2O and 8.1 cmH2O in Pves and Pabd measurements, respectively. During coughs, the difference could reach up to 20 cmH2O and 19.5 cmH2O in Pves and Pabd measurements, respectively. CONCLUSIONS: Pressure recordings from AFC and WFC systems appear to be interchangeable for some urodynamics parameters such as Pves at Valsalva manoeuvres if the baseline pressure is compensated, but not for fast-changing pressure signals such as coughs. This has to be considered when pressures are being taken with the AFC.


Assuntos
Ar/análise , Manometria/instrumentação , Cateteres Urinários , Doenças Urológicas/diagnóstico , Água/análise , Adulto , Tosse , Desenho de Equipamento , Feminino , Humanos , Masculino , Manometria/métodos , Pessoa de Meia-Idade , Pressão , Reto/fisiopatologia , Reprodutibilidade dos Testes , Bexiga Urinária/fisiopatologia , Cateterismo Urinário/instrumentação , Manobra de Valsalva , Adulto Jovem
20.
Dysphagia ; 34(6): 821-833, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-30840137

RESUMO

The characteristics of the flows of boluses with different consistencies, i.e. different rheological properties, through the pharynx have not been fully elucidated. The results obtained using a novel in vitro device, the Gothenburg Throat, which allows simultaneous bolus flow visualisation and manometry assessments in the pharynx geometry, are presented, to explain the dependence of bolus flow on bolus consistency. Four different bolus consistencies of a commercial food thickener, 0.5, 1, 1.5 and 2 Pa s (at a shear rate of 50 s-1)-corresponding to a range from low honey-thick to pudding-thick consistencies on the National Dysphagia Diet (NDD) scale-were examined in the in vitro pharynx. The bolus velocities recorded in the simulator pharynx were in the range of 0.046-0.48 m/s, which is within the range reported in clinical studies. The corresponding wall shear rates associated with these velocities ranged from 13 s-1 (pudding consistency) to 209 s-1 (honey-thick consistency). The results of the in vitro manometry tests using different consistencies and bolus volumes were rather similar to those obtained in clinical studies. The in vitro device used in this study appears to be a valuable tool for pre-clinical analyses of thickened fluids. Furthermore, the results show that it is desirable to consider a broad range of shear rates when assessing the suitability of a certain consistency for swallowing.


Assuntos
Deglutição , Manometria/métodos , Deglutição/fisiologia , Alimentos , Humanos , Técnicas In Vitro , Manometria/instrumentação , Viscosidade
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