Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 9.814
Filtrar
1.
Eur J Endocrinol ; 184(2): 289-298, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33513126

RESUMO

Background: Diabetes mellitus is an established risk factor for cardiovascular diseases. Even impaired levels of glucose and insulin might harm organ function prior to diabetes onset. Whether serum glucose or insulin plays a direct role in cardiac dysfunction or lung volume reduction remains unclear. The aim was to investigate the relationship between glucose and insulin with the right ventricle and lung volumes within KORA-MRI FF4 study. Methods: From the KORA-MRI FF4 cohort study 337 subjects (mean age 55.7 ± 9.1 years; 43% women) underwent a whole-body 3T MRI scan. Cardiac parameters derived from a cine-steady-state free precession sequence using cvi42. MRI-based lung volumes derived semi-automatically using an in-house algorithm. Fasting serum glucose, fasting insulin levels, and HOMA index were calculated in all study subjects. Linear regression analyses were performed to assess the relationships between glucose and insulin levels with right ventricle volumes and lung volumes adjusted for age, sex, BMI, and cardiovascular risk factors. Results: In univariate and multivariate-adjusted models, high serum insulin was inversely associated with end-diastolic volume (ß = -12.43, P < 0.001), end-systolic volume (ß = -7.12, P < 0.001), stroke volume (ß = -5.32, P < 0.001), but not with ejection fraction. The association remained significant after additional adjustment for lung volumes. Similarly, serum insulin was inversely associated with lung volume (ß = -0.15, P = 0.04). Sensitivity analysis confirmed results after excluding subjects with known diabetes. Conclusions: Serum insulin was inversely associated with right ventricle function and lung volumes in subjects from the general population free of cardiovascular disease, suggesting that increased insulin levels may contribute to subclinical cardiopulmonary circulation impairment.


Assuntos
Insulina/sangue , Pulmão/patologia , Função Ventricular Direita/fisiologia , Adulto , Idoso , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/fisiopatologia , Estudos de Coortes , Feminino , Alemanha , Testes de Função Cardíaca , Humanos , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Medidas de Volume Pulmonar , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Fatores de Risco
2.
PLoS One ; 16(1): e0245578, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33465155

RESUMO

COVID-19 pandemic sets the healthcare system to a shortage of ventilators. We aimed at assessing tidal volume (VT) delivery and air recirculation during expiration when one ventilator is divided into 2 test-lungs. The study was performed in a research laboratory in a medical ICU of a University hospital. An ICU (V500) and a lower-level ventilator (Elisée 350) were attached to two test-lungs (QuickLung) through a dedicated flow-splitter. A 50 mL/cmH2O Compliance (C) and 5 cmH2O/L/s Resistance (R) were set in both A and B test-lungs (A C50R5 / B C50R5, step1), A C50-R20 / B C20-R20 (step 2), A C20-R20 / B C10-R20 (step 3), and A C50-R20 / B C20-R5 (step 4). Each ventilator was set in volume and pressure control mode to deliver 800mL VT. We assessed VT from a pneumotachograph placed immediately before each lung, pendelluft air, and expiratory resistance (circuit and valve). Values are median (1st-3rd quartiles) and compared between ventilators by non-parametric tests. Between Elisée 350 and V500 in volume control VT in A/B test- lungs were 381/387 vs. 412/433 mL in step 1, 501/270 vs. 492/370 mL in step 2, 509/237 vs. 496/332 mL in step 3, and 496/281 vs. 480/329 mL in step 4. In pressure control the corresponding values were 373/336 vs. 430/414 mL, 416/185 vs. 322/234 mL, 193/108 vs. 176/ 92 mL and 422/201 vs. 481/329mL, respectively (P<0.001 between ventilators at each step for each volume). Pendelluft air volume ranged between 0.7 to 37.8 ml and negatively correlated with expiratory resistance in steps 2 and 3. The lower-level ventilator performed closely to the ICU ventilator. In the clinical setting, these findings suggest that, due to dependence of VT to C, pressure control should be preferred to maintain adequate VT at least in one patient when C and/or R changes abruptly and monitoring of VT should be done carefully. Increasing expiratory resistance should reduce pendelluft volume.


Assuntos
/terapia , Respiração Artificial/métodos , Ventiladores Mecânicos/efeitos adversos , Feminino , Humanos , Complacência Pulmonar , Medidas de Volume Pulmonar , Masculino , Pressões Respiratórias Máximas , Respiração Artificial/efeitos adversos , Respiração Artificial/instrumentação , Ventiladores Mecânicos/normas
3.
Medicine (Baltimore) ; 99(51): e23646, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33371099

RESUMO

ABSTRACT: This study identified the effects of pursed-lip breathing (PLB), forward trunk lean posture (FTLP), and combined PLB and FTLP on total and compartmental lung volumes, and ventilation in patients with chronic obstructive pulmonary disease (COPD). Sixteen patients with mild to moderate COPD performed 2 breathing patterns of quiet breathing (QB) and PLB during FTLP and upright posture (UP). The total and compartmental lung volumes and ventilation of these 4 tasks (QB-UP, PLB-UP, QB-FTLP, PLB-FTLP) were evaluated using optoelectronic plethysmography. Two-way repeated measures ANOVA was used to identify the effect of PLB, FTLP, and combined strategies on total and compartmental lung volumes and ventilation. End-expiratory lung volume of ribcage compartment was significantly lower in PLB-UP than QB-UP and those with FTLP (P < .05). End-inspiratory lung volume (EILV) and end-inspiratory lung volume of ribcage compartment were significantly greater during PLB-FTLP and PLB-UP than those of QB (P < .05). PLB significantly and positively changed end-expiratory lung volume of abdominal compartment (EELVAB ) end-expiratory lung volume, EILVAB, tidal volume of pulmonary ribcage, tidal volume of abdomen, and ventilation than QB (P < .05). UP significantly increased tidal volume of pulmonary ribcage, tidal volume of abdomen, and ventilation and decreased EELVAB, end-expiratory lung volume, and EILVAB than FTLP (P < .05). In conclusion, combined PLB with UP or FTLP demonstrates a positive change in total and compartmental lung volumes in patients with mild to moderate COPD.


Assuntos
Exercícios Respiratórios , Postura , Doença Pulmonar Obstrutiva Crônica/reabilitação , Ventilação Pulmonar , Terapia Respiratória/métodos , Idoso , Estudos Transversais , Humanos , Medidas de Volume Pulmonar , Pessoa de Meia-Idade
4.
Isr Med Assoc J ; 22(12): 770-774, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33381950

RESUMO

BACKGROUND: The single-breath diffusing capacity of the lungs (DLCOSB) test measures the extent to which carbon monoxide (CO) passes from the lung air sacs into the blood. The accessible alveolar volume (VASB) is measured by inert gas during a 10-second period. The single-breath transfer coefficient of the lung for carbon monoxide (KCOSB) is the DLCOSB divided by VASB. Cystic fibrosis (CF) disease comprises progressive airway obstruction with bronchiectasis and parenchyma fibrosis. Yet, the KCOSB appears insignificant in the assessment of pulmonary function in CF. OBJECTIVES: To challenge the precision of normal KCOSB in CF. METHODS: The authors collected pulmonary function tests (PFT) data from 74 confirmed CF patients (mean age 26 ± 10 years) with various levels of pulmonary disease severity. Tests included spirometry, DLCOBP, and body plethysmography (BP). Anatomical dead space was calculated by deducting anatomical dead space from total lung capacity TLC(BP) to establish alveolar volume (VABP) and to determine KCOBP. We also included individual data of arterial pCO2 blood-gas level. RESULTS: KCOSB values were normal or higher in most patients, regardless of patient FEV1 value (R2 = 0.2204; P < 0.02). In contrast, the measurements of KCOBP were low corresponding with low FEV1 values, and negatively correlated with the elevation of trapped air and pCO2 levels (R2 = 0.1383; P = 0.0133, P > 0.05, respectively). CONCLUSIONS: The 10- second perfusion time of the inert gas during DLCOSB represent the communicative alveolar volume in CF patients with advanced pulmonary disease. The findings justify the use of DLCOSB with the deterioration of FEV1 and elevation of pCO2 levels.


Assuntos
Fibrose Cística/complicações , Pneumopatias/etiologia , Capacidade de Difusão Pulmonar , Adolescente , Adulto , Criança , Fibrose Cística/fisiopatologia , Feminino , Humanos , Pneumopatias/fisiopatologia , Medidas de Volume Pulmonar , Masculino , Pessoa de Meia-Idade , Pletismografia Total , Testes de Função Respiratória , Espirometria , Adulto Jovem
5.
Emerg Med Clin North Am ; 38(4): 857-869, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981622

RESUMO

The obesity pandemic now affects hundreds of millions of people worldwide. As obesity rates continue to increase, emergency physicians are called on with increasing frequency to resuscitate obese patients. This article discusses important anatomic, physiologic, and practical challenges imposed by obesity on resuscitative care. Impacts on hemodynamic monitoring, airway and ventilator management, and pharmacologic therapy are discussed. Finally, several important clinical scenarios (trauma, cardiac arrest, and sepsis), in which alterations to standard treatments may benefit obese patients, are highlighted.


Assuntos
Obesidade/complicações , Ressuscitação/métodos , Manuseio das Vias Aéreas/métodos , Analgésicos/administração & dosagem , Antibacterianos/administração & dosagem , Composição Corporal , Fármacos Cardiovasculares/administração & dosagem , Doenças Cardiovasculares/complicações , Relação Dose-Resposta a Droga , Serviço Hospitalar de Emergência , Parada Cardíaca/terapia , Humanos , Hipnóticos e Sedativos/administração & dosagem , Medidas de Volume Pulmonar , Consumo de Oxigênio , Farmacocinética , Respiração com Pressão Positiva , Sepse/complicações , Sepse/terapia , Ferimentos e Lesões/complicações , Ferimentos e Lesões/terapia
7.
Anesthesiology ; 133(4): 705-707, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32826404
8.
Anesthesiology ; 133(5): 1060-1076, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-32796202

RESUMO

BACKGROUND: Pulmonary atelectasis is frequent in clinical settings. Yet there is limited mechanistic understanding and substantial clinical and biologic controversy on its consequences. The authors hypothesize that atelectasis produces local transcriptomic changes related to immunity and alveolar-capillary barrier function conducive to lung injury and further exacerbated by systemic inflammation. METHODS: Female sheep underwent unilateral lung atelectasis using a left bronchial blocker and thoracotomy while the right lung was ventilated, with (n = 6) or without (n = 6) systemic lipopolysaccharide infusion. Computed tomography guided samples were harvested for NextGen RNA sequencing from atelectatic and aerated lung regions. The Wald test was used to detect differential gene expression as an absolute fold change greater than 1.5 and adjusted P value (Benjamini-Hochberg) less than 0.05. Functional analysis was performed by gene set enrichment analysis. RESULTS: Lipopolysaccharide-unexposed atelectatic versus aerated regions presented 2,363 differentially expressed genes. Lipopolysaccharide exposure induced 3,767 differentially expressed genes in atelectatic lungs but only 1,197 genes in aerated lungs relative to the corresponding lipopolysaccharide-unexposed tissues. Gene set enrichment for immune response in atelectasis versus aerated tissues yielded negative normalized enrichment scores without lipopolysaccharide (less than -1.23, adjusted P value less than 0.05) but positive scores with lipopolysaccharide (greater than 1.33, adjusted P value less than 0.05). Leukocyte-related processes (e.g., leukocyte migration, activation, and mediated immunity) were enhanced in lipopolysaccharide-exposed atelectasis partly through interferon-stimulated genes. Furthermore, atelectasis was associated with negatively enriched gene sets involving alveolar-capillary barrier function irrespective of lipopolysaccharide (normalized enrichment scores less than -1.35, adjusted P value less than 0.05). Yes-associated protein signaling was dysregulated with lower nuclear distribution in atelectatic versus aerated lung (lipopolysaccharide-unexposed: 10.0 ± 4.2 versus 13.4 ± 4.2 arbitrary units, lipopolysaccharide-exposed: 8.1 ± 2.0 versus 11.3 ± 2.4 arbitrary units, effect of lung aeration, P = 0.003). CONCLUSIONS: Atelectasis dysregulates the local pulmonary transcriptome with negatively enriched immune response and alveolar-capillary barrier function. Systemic lipopolysaccharide converts the transcriptomic immune response into positive enrichment but does not affect local barrier function transcriptomics. Interferon-stimulated genes and Yes-associated protein might be novel candidate targets for atelectasis-associated injury.


Assuntos
Imunidade Celular/genética , Imunidade Celular/imunologia , Atelectasia Pulmonar/genética , Atelectasia Pulmonar/imunologia , Transcriptoma/genética , Animais , Feminino , Medidas de Volume Pulmonar/métodos , Atelectasia Pulmonar/diagnóstico por imagem , Ovinos
10.
Arch. bronconeumol. (Ed. impr.) ; 56(3): 157-162, mar. 2020. ilus, tab, graf
Artigo em Inglês | IBECS | ID: ibc-FGT-4797

RESUMO

INTRODUCTION: Respiratory morbidities of preterm infants can cause significant ventilatory impairment thus compromising the aerobic capacity in childhood and adolescence. Therefore, the present study was conducted to evaluate the aerobic capacity in school age preterm children with VLBW and its associated factors. METHODS: A cross-sectional study was conducted among preterm born with VLBW and term children, both aged 6-9 years. An individualized symptom-limited treadmill testing protocol performed aerobic capacity. Measured variables: oxygen pulse (PuO2), percentage of maximum heart rate for age (%HR max), tidal volume/inspiratory capacity ratio (TV/IC), oxygen consumption (VO2) peak, and the ratio of the anaerobic threshold of gas exchange to the predicted percentage of maximum VO2 (VO2@LA/%VO2 max.pred.) were compared between groups. Univariate and multiple linear regression analyses were used to determine the factors associated with aerobic capacity. RESULTS: Thirty-four preterm and 32 term children were included. Similar VO2 peak and the other variables were observed. The development of bronchopulmonary dysplasia (BPD) and being obese/overweight was positively associated with %HR max. The Z-score for height/age and birth weight < 1000 g was positively associated with PuO2 and peak VO2, and negatively associated with overweight/obesity and female sex. CONCLUSIONS: Aerobic capacity was similar in both groups. Sex, development of BPD, birth weight < 1000 g and factors related to body growth, such as Z-score for height/age and overweight/obesity, were associated with aerobic capacity in preterm children with VLBW


INTRODUCCIÓN: Las enfermedades respiratorias de los niños prematuros pueden causar importantes impedimentos ventilatorios que comprometen la capacidad aeróbica en la infancia y en la adolescencia. El presente estudio se llevó a cabo para evaluar la capacidad aeróbica de niños prematuros en edad escolar de muy bajo peso al nacer (BPN) y los factores asociados. MÉTODOS: Se llevó a cabo un estudio transversal con niños prematuros de muy BPN y con niños a término, ambos grupos con edades comprendidas entre los 6 y 9 años. Las siguientes variables se compararon entre los 2 grupos: el pulso de oxígeno (PuO2), el porcentaje de frecuencia cardíaca máxima (%FC máx.), la relación entre el volumen corriente y la capacidad inspiratoria (TV/IC), el consumo pico de oxígeno (VO2) y la relación entre el umbral anaeróbico de intercambio de gas y el porcentaje estimado de VO2 máximo (VO2@LA/%VO2 máx. pred.). Se llevaron a cabo análisis de regresión lineal univariante y multivariante para determinar los factores asociados con la capacidad aeróbica. RESULTADOS: Se incluyeron 34 niños prematuros y 32 niños a término. Se registraron valores similares de VO2 pico y de otras variables. El desarrollo de displasia broncopulmonar (BPD) y de obesidad/sobrepeso mostró una asociación positiva con el %FC máx. El Z-score para la altura/edad y el peso al nacer < 1.000 g se asoció positivamente con la SaO2 y el VO2 y negativamente con el sobrepeso/obesidad y el sexo femenino. CONCLUSIONES: La capacidad aeróbica fue similar entre los 2 grupos. El sexo, el desarrollo de BPD, peso al nacer < 1.000 g y factores relacionados con el crecimiento corporal, tales como el Z-score para la altura/edad y para el sobrepeso/obesidad se asociaron con la capacidad aeróbica en niños prematuros de muy BPN


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Criança , Recém-Nascido Prematuro/fisiologia , Recém-Nascido de Peso Extremamente Baixo ao Nascer/fisiologia , Ventilação Voluntária Máxima/fisiologia , Medidas de Volume Pulmonar , Estudos Transversais , Fatores de Risco
11.
PLoS One ; 15(2): e0225019, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32097413

RESUMO

Small animal imaging has become essential in evaluating new cancer therapies as they are translated from the preclinical to clinical domain. However, preclinical imaging faces unique challenges that emphasize the gap between mouse and man. One example is the difference in breathing patterns and breath-holding ability, which can dramatically affect tumor burden assessment in lung tissue. As part of a co-clinical trial studying immunotherapy and radiotherapy in sarcomas, we are using micro-CT of the lungs to detect and measure metastases as a metric of disease progression. To effectively utilize metastatic disease detection as a metric of progression, we have addressed the impact of respiratory gating during micro-CT acquisition on improving lung tumor detection and volume quantitation. Accuracy and precision of lung tumor measurements with and without respiratory gating were studied by performing experiments with in vivo images, simulations, and a pocket phantom. When performing test-retest studies in vivo, the variance in volume calculations was 5.9% in gated images and 15.8% in non-gated images, compared to 2.9% in post-mortem images. Sensitivity of detection was examined in images with simulated tumors, demonstrating that reliable sensitivity (true positive rate (TPR) ≥ 90%) was achievable down to 1.0 mm3 lesions with respiratory gating, but was limited to ≥ 8.0 mm3 in non-gated images. Finally, a clinically-inspired "pocket phantom" was used during in vivo mouse scanning to aid in refining and assessing the gating protocols. Application of respiratory gating techniques reduced variance of repeated volume measurements and significantly improved the accuracy of tumor volume quantitation in vivo.


Assuntos
Neoplasias Pulmonares/diagnóstico por imagem , Técnicas de Imagem de Sincronização Respiratória/métodos , Microtomografia por Raio-X/métodos , Animais , Confiabilidade dos Dados , Modelos Animais de Doenças , Medidas de Volume Pulmonar , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Imagens de Fantasmas , Sensibilidade e Especificidade , Microtomografia por Raio-X/instrumentação
12.
Pediatr Pulmonol ; 55(3): 697-705, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31951681

RESUMO

AIMS: Cardiac surgery has improved life expectancy of patients with congenital heart diseases (CHDs). Exercise capacity is an important determinant of survival in patients with CHDs. There is a lack of studies focusing on the role of resting respiratory performance in reducing exercise tolerance in these patients. OBJECTIVES: To determine the prevalence and severity of respiratory functional impairment in different types of corrected/palliated CHDs, and its impact on an exercise test. MATERIALS AND METHODS: Retrospective single-center study involving 168 corrected/palliated patients with CHD and 52 controls. Patients CHD were divided into subgroups according to the presence of native pulmonary blood flow or total cavopulmonary connection (TCPC). All subjects performed complete pulmonary function tests and gas diffusion; patients with CHD also performed cardiopulmonary exercise test (CPX). RESULTS: Mean values of lung volumes were within the normal range in all CHD groups. Comparing to controls, patients with the reduced pulmonary flow and with TCPC had the highest reduction in lung volumes. CPX was reduced in all groups, most severely in TCPC, and it was correlated to decreased dynamic volumes in all CHD groups except in TCPC. Younger age at intervention and number of surgical operations negatively affected lung volumes. CONCLUSIONS: Respiratory function is within the normal range in our patients with different CHDs at rest but altered in all CHDs during exercise when cardiorespiratory balance is likely to be inadequate. Comparing the different groups, patients with reduced pulmonary flow and TCPC are the most impaired.


Assuntos
Tolerância ao Exercício , Exercício Físico/fisiologia , Cardiopatias Congênitas/fisiopatologia , Pulmão/fisiopatologia , Pré-Escolar , Teste de Esforço , Feminino , Cardiopatias Congênitas/cirurgia , Humanos , Lactente , Medidas de Volume Pulmonar , Masculino , Artéria Pulmonar/fisiopatologia , Respiração , Estudos Retrospectivos
13.
Br J Anaesth ; 124(3): 345-353, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31952649

RESUMO

BACKGROUND: Bedside lung volume measurement could personalise ventilation and reduce driving pressure in patients with acute respiratory distress syndrome (ARDS). We investigated a modified gas-dilution method, the inspired sinewave technique (IST), to measure the effective lung volume (ELV) in pigs with uninjured lungs and in an ARDS model. METHODS: Anaesthetised mechanically ventilated pigs were studied before and after surfactant depletion by saline lavage. Changes in PEEP were used to change ELV. Paired measurements of absolute ELV were taken with IST (ELVIST) and compared with gold-standard measures (sulphur hexafluoride wash in/washout [ELVSF6] and computed tomography (CT) [ELVCT]). Measured volumes were used to calculate changes in ELV (ΔELV) between PEEP levels for each method (ΔELVIST, ΔELVSF6, and ΔELVCT). RESULTS: The coefficient of variation was <5% for repeated ELVIST measurements (n=13 pigs). There was a strong linear relationship between ELVIST and ELVSF6 in uninjured lungs (r2=0.97), and with both ELVSF6 and ELVCT in the ARDS model (r2=0.87 and 0.92, respectively). ELVIST had a mean bias of -12 to 13% (95% limits=±17 - 25%) compared with ELVSF6 and ELVCT. ΔELVIST was concordant with ΔELVSF6 and ΔELVCT in 98-100% of measurements, and had a mean bias of -73 to -77 ml (95% limits=±128 - 186 ml) compared with ΔELVSF6 and -1 ml (95% limits ±333 ml) compared with ΔELVCT. CONCLUSIONS: IST provides a repeatable measure of absolute ELV and shows minimal bias when tracking PEEP-induced changes in lung volume compared with CT in a saline-lavage model of ARDS.


Assuntos
Respiração com Pressão Positiva/métodos , /terapia , Animais , Modelos Animais de Doenças , Medidas de Volume Pulmonar/métodos , Testes Imediatos , Reprodutibilidade dos Testes , /etiologia , Solução Salina , Sus scrofa , Tomografia Computadorizada por Raios X
14.
Evolution ; 74(2): 245-255, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31943148

RESUMO

At least 26 species of crocodylian populate the globe today, but this richness represents a minute fraction of the diversity and disparity of Crocodyliformes. Fossil forms are far more varied, spanning from erect, fully terrestrial species to flippered, fully marine species. To quantify the influence of a marine habitat on the directionality, rate, and variance of evolution of body size in Crocodyliformes and thereby identify underlying selective pressures, we compiled a database of body sizes for 264 fossil and modern species of crocodyliform covering terrestrial, semi-aquatic, and marine habitats. We find increases in body size coupled with increases in strength of selection and decreases in variance following invasions of marine habitats but not of semiaquatic habitats. A model combining constraints from thermoregulation and lung capacity provides a physiological explanation for the larger minimum and average sizes of marine species. It appears that constraints on maximum size are shared across Crocodyliformes, perhaps through factors such as the allometric scaling of feeding rate versus basal metabolism with body size. These findings suggest that broad-scale patterns of body size evolution and the shapes of body size distributions within higher taxa are often determined more by physiological constraints than by ecological interactions or environmental fluctuations.


Assuntos
Jacarés e Crocodilos/fisiologia , Evolução Biológica , Tamanho Corporal/fisiologia , Ecossistema , Fósseis/anatomia & histologia , Jacarés e Crocodilos/anatomia & histologia , Animais , Regulação da Temperatura Corporal , Medidas de Volume Pulmonar , Modelos Biológicos
15.
Respir Res ; 21(1): 27, 2020 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-31959169

RESUMO

BACKGROUND AND OBJECTIVE: Reduced physical capacity (PC) and physical activity (PA) are common in COPD patients and associated with poor outcome. However, they represent different aspects of physical functioning and interventions do not affect them in the same manner. To address this, a new PC-PA quadrant concept was recently generated to identify clinical characteristics of sub-groups of physical functioning. The objective of this study was to I) proof the new concept and to verify their differentiating clinical characteristics, II) evaluate the consistency of the concept over time, III) assess whether patients changed their quadrant affiliation over time, IV) and to test if changes in quadrant affiliations are associated with changes in clinical characteristics. METHODS: In a longitudinal, prospective, non-interventional cohort with mild to very severe COPD patients, PC and PA as well as respiratory variables, COPD-specific health status, comorbidities, survival, and exacerbations were yearly assessed. RESULTS: Data from 283 patients were analysed at baseline. Mean (min/max) follow-up time was 2.4 (0.5/6.8) years. The PC-PA quadrants could be characterized as follows: I) "can't do, don't do": most severe and symptomatic, several comorbidities II) "can do, don't do": severe but less symptomatic, several comorbidities III) "can't do, do do": few patients, severe and symptomatic, less comorbidities IV) "can do, do do": mildest and less symptomatic, less comorbidities, lowest exacerbation frequency. Of the 172 patients with at least one follow-up, 58% patients never changed their quadrant affiliation, while 17% declined either PC, PA or both, 11% improved their PC, PA or both, and 14% showed improvement and decline in PC, PA or both during study period. None of the clinical characteristics or their annual changes showed consistent significant and relevant differences between all individual sub-groups. CONCLUSION: Our findings suggest that there are no clinical characteristics allowing to distinguish between the PC-PA quadrants and the concept seems not able to illustrate disease process. However, the already low PA but preserved PC in the "can do, don't do" quadrant raises the question if regularly assessment of PA in clinical practice would be more sensitive to detect progressive deterioration of COPD compared to the commonly used PC. CLINICAL TRIAL REGISTRATION: www.ClinicalTrials.gov, NCT01527773.


Assuntos
Atitude Frente a Saúde , Exercício Físico/fisiologia , Exercício Físico/psicologia , Doença Pulmonar Obstrutiva Crônica/metabolismo , Doença Pulmonar Obstrutiva Crônica/psicologia , Idoso , Gasometria/métodos , Estudos de Coortes , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Medidas de Volume Pulmonar/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/terapia
17.
Rheumatology (Oxford) ; 59(4): 790-798, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-31504916

RESUMO

OBJECTIVE: To investigate the natural history of fibrotic lung disease in recipients of a single lung transplant for scleroderma-associated interstitial lung disease (ILD). METHODS: Global ILD (including ground glass, nodular opacities and fibrosis) was categorized into severity quintiles on first and last post-transplant CT scans, and percent fibrosis by manual contouring was also determined, in nine single lung transplant recipients. Quantitative mean lung densities and volumes for the native and allograft lungs were also acquired. RESULTS: In the native lung, global ILD severity quintile worsened in two cases and percent fibrosis worsened in four cases (range 5-28%). In the lung allograft, one case each developed mild, moderate and severe ILD; of these, new fibrotic ILD (involving <10% of lung) occurred in two cases and acute cellular rejection occurred in one. The average change in native lung density over time was +2.2 Hounsfield Units per year and lung volume +1.4 ml per year, whereas the allograft lung density changed by -5.5 Hounsfield Units per year and total volume +27 ml per year (P = 0.011 and P = 0.039 for native vs allograft density and volume comparisons, respectively). CONCLUSIONS: While the course of ILD in the native and transplanted lungs varied in this series, these cases illustrate that disease progression is common in the native lung, suggesting that either the immune process continues to target autoantigens or ongoing fibrotic pathways are active in the native lung. Mild lung disease may occur in the allograft after several years due to either allograft rejection or recurrent mild ILD.


Assuntos
Aloenxertos/diagnóstico por imagem , Rejeição de Enxerto/diagnóstico por imagem , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Transplante de Pulmão/métodos , Pulmão/diagnóstico por imagem , Fibrose Pulmonar/diagnóstico por imagem , Escleroderma Sistêmico/diagnóstico por imagem , Adulto , Bronquiolite Obliterante/diagnóstico por imagem , Bronquiolite Obliterante/epidemiologia , Progressão da Doença , Feminino , Rejeição de Enxerto/epidemiologia , Humanos , Estudos Longitudinais , Doenças Pulmonares Intersticiais/etiologia , Doenças Pulmonares Intersticiais/cirurgia , Medidas de Volume Pulmonar , Masculino , Pessoa de Meia-Idade , Fibrose Pulmonar/etiologia , Fibrose Pulmonar/cirurgia , Recidiva , Escleroderma Sistêmico/complicações , Tomografia Computadorizada por Raios X
18.
Respir Physiol Neurobiol ; 271: 103287, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31494306

RESUMO

PURPOSE: Remote ischemic preconditioning (RIP) may protect remote organs from ischemia-reperfusion-injury (IRI) in surgical and non-surgical patients. There are few data available on RIP and lung function, especially not in healthy volunteers. The null-hypothesis was tested that RIP does not have an effect on pulmonary function when applied on healthy volunteers that were breathing spontaneously and did not experience any intervention. After approval of the Ethics Committee and informed consent of the study subjects, 28 healthy non-smoking volunteers were included and randomized in either the RIP group (n = 13) or the control group (n = 15). In the RIP group, lower limb ischemia was induced by inflation of a blood pressure cuff to a pressure 20 mmHg above the systolic blood pressure. After five minutes the blood pressure cuff was released for five minutes rest. The procedure was repeated three times resulting in 40 min ischemia and reperfusion. Capillary blood samples were taken, and lung function tests were performed at baseline (T1) and 60 min (T2) and 24 h (T3) after RIP. The control group was treated in the same fashion, but the RIP procedure was replaced by a sham protocol. RESULTS: 60 min after RIP capillary pO2 decreased significantly and returned to baseline level after 24 h in the RIP group. This did not occur in the control group. Capillary pCO2, variables of lung function tests and pulmonary capillary blood volume remained unchanged throughout the experiment in both groups. CONCLUSION: Oxygenation is impaired early after RIP which is possibly induced by transient ventilation-perfusion inequality. No late effects of RIP were observed. The null hypothesis has to be rejected that RIP has no effect on respiratory variables in healthy volunteers.


Assuntos
Precondicionamento Isquêmico/métodos , Pulmão/fisiologia , Troca Gasosa Pulmonar/fisiologia , Traumatismo por Reperfusão/fisiopatologia , Traumatismo por Reperfusão/terapia , Espirometria/métodos , Adolescente , Adulto , Feminino , Voluntários Saudáveis , Humanos , Perna (Membro)/irrigação sanguínea , Perna (Membro)/fisiologia , Medidas de Volume Pulmonar , Masculino , Estudos Prospectivos , Fatores de Tempo , Adulto Jovem
19.
Am J Respir Crit Care Med ; 201(2): 178-187, 2020 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-31577153

RESUMO

Rationale: Response to positive end-expiratory pressure (PEEP) in acute respiratory distress syndrome depends on recruitability. We propose a bedside approach to estimate recruitability accounting for the presence of complete airway closure.Objectives: To validate a single-breath method for measuring recruited volume and test whether it differentiates patients with different responses to PEEP.Methods: Patients with acute respiratory distress syndrome were ventilated at 15 and 5 cm H2O of PEEP. Multiple pressure-volume curves were compared with a single-breath technique. Abruptly releasing PEEP (from 15 to 5 cm H2O) increases expired volume: the difference between this volume and the volume predicted by compliance at low PEEP (or above airway opening pressure) estimated the recruited volume by PEEP. This recruited volume divided by the effective pressure change gave the compliance of the recruited lung; the ratio of this compliance to the compliance at low PEEP gave the recruitment-to-inflation ratio. Response to PEEP was compared between high and low recruiters based on this ratio.Measurements and Main Results: Forty-five patients were enrolled. Four patients had airway closure higher than high PEEP, and thus recruitment could not be assessed. In others, recruited volume measured by the experimental and the reference methods were strongly correlated (R2 = 0.798; P < 0.0001) with small bias (-21 ml). The recruitment-to-inflation ratio (median, 0.5; range, 0-2.0) correlated with both oxygenation at low PEEP and the oxygenation response; at PEEP 15, high recruiters had better oxygenation (P = 0.004), whereas low recruiters experienced lower systolic arterial pressure (P = 0.008).Conclusions: A single-breath method quantifies recruited volume. The recruitment-to-inflation ratio might help to characterize lung recruitability at the bedside.Clinical trial registered with www.clinicaltrials.gov (NCT02457741).


Assuntos
Medidas de Volume Pulmonar , Testes Imediatos , Respiração com Pressão Positiva/métodos , /fisiopatologia , Adulto , Idoso , Pressão Sanguínea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pressão , Estudos Prospectivos , Troca Gasosa Pulmonar , Reprodutibilidade dos Testes , Resultado do Tratamento
20.
Respir Physiol Neurobiol ; 271: 103315, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31586648

RESUMO

STUDY OBJECTIVES: Overlap syndrome occurs when obstructive sleep apnea (OSA) and chronic obstructive pulmonary disorder (COPD) coexist in the same patient. Although several studies highlighted the importance of clinical phenotyping in OSA, the trait contribution to OSA pathogenesis in overlap syndrome has not been investigated. With this pilot study, we aimed to measure OSA determinants and their relationship with functional respiratory parameters in a sample of patients with overlap syndrome. In particular, we hypothesize that patients with COPD have in the low arousal threshold a major contributor for the development of OSA. METHODS: Ten consecutive non-hypercapnic COPD patients (body mass index<35 kg/m2) suffering from overlap syndrome with no other relevant comorbidities underwent a phenotyping polysomnography. Traits were measured with CPAP dial-downs. RESULTS: Arousal threshold was found to be inversely associated to functional measures of lung air trapping and static hyperinflation. Particularly, correlations with residual volume (r2 = 0.49, p =  0.024) and residual volume to total lung capacity ratio (r2 = 0.48, p =  0.026) were evident. Only 20% of patients showed a high upper airway passive collapsibility as single pathological trait. In contrast, among those patients with multiple altered traits (6 out of 10), all had an elevated loop gain and 4 (∼65%) a low arousal threshold. CONCLUSIONS: High loop gain and particularly low arousal threshold seem important contributors to OSA pathogenesis and severity in patients with COPD. Recognizing in COPD patients these features as key traits may open avenues for personalized medicine in the field of overlap syndrome.


Assuntos
Nível de Alerta/fisiologia , Pulmão/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Mecânica Respiratória/fisiologia , Apneia Obstrutiva do Sono/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Síndrome de Sobreposição da Doença Pulmonar Obstrutiva Crônica e Asma/diagnóstico , Síndrome de Sobreposição da Doença Pulmonar Obstrutiva Crônica e Asma/fisiopatologia , Feminino , Humanos , Medidas de Volume Pulmonar/métodos , Masculino , Projetos Piloto , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Apneia Obstrutiva do Sono/diagnóstico , Espirometria/métodos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA