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1.
Sci Rep ; 11(1): 8100, 2021 04 14.
Artigo em Inglês | MEDLINE | ID: mdl-33854115

RESUMO

Respiratory rhythm (RR) during sniffing is known to couple with hippocampal theta rhythm. However, outside of the short sniffing bouts, a more stable ~ 2 Hz RR was recently shown to rhythmically modulate non-olfactory cognitive processes, as well. The underlying RR coupling with wide-spread forebrain activity was confirmed using advanced techniques, creating solid premise for investigating how higher networks use this mechanism in their communication. Here we show essential differences in the way prefrontal cortex (PFC) and hippocampus (HC) process the RR signal from the olfactory bulb (OB) that may support dynamic, flexible PFC-HC coupling utilizing this input. We used inter-regional coherences and their correlations in rats, breathing at low rate (~ 2 Hz), outside of the short sniffing bouts. We found strong and stable OB-PFC coherence in wake states, contrasting OB-HC coherence which was low but highly variable. Importantly, this variability was essential for establishing PFC-HC synchrony at RR, whereas variations of RRO in OB and PFC had no significant effect. The findings help to understand the mechanism of rhythmic modulation of non-olfactory cognitive processes by the on-going regular respiration, reported in rodents as well as humans. These mechanisms may be impaired when nasal breathing is limited or in OB-pathology, including malfunctions of the olfactory epithelium due to infections, such as in Covid-19.


Assuntos
Ritmo Delta/fisiologia , Hipocampo/fisiologia , Bulbo Olfatório/fisiologia , Córtex Pré-Frontal/fisiologia , Taxa Respiratória/fisiologia , Animais , Comportamento Animal/fisiologia , Eletromiografia , Masculino , Atividade Motora , Vias Neurais/fisiologia , Ratos , Sono/fisiologia , Vigília/fisiologia
2.
Sao Paulo Med J ; 139(2): 170-177, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33681885

RESUMO

BACKGROUND: Healthcare institutions are confronted with large numbers of patient admissions during large-scale or long-term public health emergencies like pandemics. Appropriate and effective triage is needed for effective resource use. OBJECTIVES: To evaluate the effectiveness of the Pandemic Medical Early Warning Score (PMEWS), Simple Triage Scoring System (STSS) and Confusion, Uremia, Respiratory rate, Blood pressure and age ≥ 65 years (CURB-65) score in an emergency department (ED) triage setting. DESIGN AND SETTING: Retrospective study in the ED of a tertiary-care university hospital in Düzce, Turkey. METHODS: PMEWS, STSS and CURB-65 scores of patients diagnosed with COVID-19 pneumonia were calculated. Thirty-day mortality, intensive care unit (ICU) admission, mechanical ventilation (MV) need and outcomes were recorded. The predictive accuracy of the scores was assessed using receiver operating characteristic curve analysis. RESULTS: One hundred patients with COVID-19 pneumonia were included. The 30-day mortality was 6%. PMEWS, STSS and CURB-65 showed high performance for predicting 30-day mortality (area under the curve: 0.968, 0.962 and 0.942, respectively). Age > 65 years, respiratory rate > 20/minute, oxygen saturation (SpO2) < 90% and ED length of stay > 4 hours showed associations with 30-day mortality (P < 0.05). CONCLUSIONS: CURB-65, STSS and PMEWS scores are useful for predicting mortality, ICU admission and MV need among patients diagnosed with COVID-19 pneumonia. Advanced age, increased respiratory rate, low SpO2 and prolonged ED length of stay may increase mortality. Further studies are needed for developing the triage scoring systems, to ensure effective long-term use of healthcare service capacity during pandemics.


Assuntos
/terapia , Escore de Alerta Precoce , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pneumonia , Medição de Risco/métodos , Triagem/métodos , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea , /epidemiologia , Feminino , Humanos , Masculino , Pandemias , Pneumonia/diagnóstico , Pneumonia/epidemiologia , Taxa Respiratória/fisiologia , Estudos Retrospectivos , Turquia , Uremia/epidemiologia , Uremia/etiologia
3.
J Card Fail ; 27(3): 373-378, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33385524

RESUMO

The severe acute respiratory syndrome novel coronavirus-2 pandemic has established a new set of challenges to health care delivery. Remotely monitored physiologic sensors on implantable cardiac devices can provide insight into the differential diagnosis of dyspnea in the heart failure population. We report on a unique pattern of sensor deviations that seem to occur specifically with severe acute respiratory syndrome novel coronavirus-2 infection.


Assuntos
/fisiopatologia , Insuficiência Cardíaca/fisiopatologia , Monitorização Fisiológica/instrumentação , Transdutores , Idoso , Dispneia/fisiopatologia , Febre/fisiopatologia , Frequência Cardíaca/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Taxa Respiratória/fisiologia
4.
Fisioterapia (Madr., Ed. impr.) ; 42(6): 301-307, nov.-dic. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-197909

RESUMO

ANTECEDENTES Y OBJETIVO: La fisioterapia respiratoria (FR) es ampliamente utilizada para el manejo de disfunciones respiratorias infantiles, sin embargo, estudios dirigidos a objetivar este efecto son escasos. Por tanto, el objetivo de este estudio fue evaluar el efecto de una sesión de FR sobre la obstrucción bronquial en niños/as menores de 3 años. MATERIALES Y MÉTODOS: Estudio exploratorio. Fueron incluidos un total de 39 menores de 3 años (26 niños y 13 niñas) con diagnóstico de síndrome bronquial obstructivo (SBO). El nivel de obstrucción bronquial fue valorado mediante el score de Tal modificado antes y después de una sesión de FR. Mediante la prueba de Wilcoxon se compararon los niveles de obstrucción bronquial pre y postintervención en todo el grupo, según género y edad. RESULTADOS: Se observó una reducción significativa del grado de obstrucción bronquial en todo el grupo, varones, mujeres, menores y mayores de 9 meses (p < 0,05) posterior a una sesión de FR. CONCLUSIÓN: Una sesión de FR fue efectiva en disminuir el grado de obstrucción bronquial en niños/as con diagnóstico de SBO menores de 3 años


BACKGROUND AND OBJECTIVE: Chest physical therapy (CPT) is widely used for the management of childhood respiratory disorders, however, studies that quantify this effect are scarce. Therefore, the aim of this study was to assess the effect of a single chest physical therapy (CPT) session on the bronchial obstruction of children younger than three years old. MATERIAL AND METHODS: This is an exploratory study. Thirty nine children younger than three years old (26 males and 13 females) with syndrome of bronchial obstruction (SBO) were included. The level of bronchial obstruction was measured with the modified Score of Tal before and after a single CPT session. Through the Wilcoxon test, comparisons of the bronchial obstruction levels were made of the whole group, males, females, and in those younger and older than 9 months as well. RESULTS: Significant reductions in bronchial obstruction levels were seen in all the children, an effect that was also seen in the males, females, and in those younger and older than 9 months (p<.05) after a single CPT session. CONCLUSION: A single CPT session was effective in reducing the bronchial obstruction levels in children with SBO, younger than three years old


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Obstrução das Vias Respiratórias/reabilitação , Modalidades de Fisioterapia/instrumentação , Obstrução das Vias Respiratórias/diagnóstico , Taxa Respiratória/fisiologia , Cianose , Sons Respiratórios/fisiologia
5.
PLoS One ; 15(12): e0244963, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33378363

RESUMO

The COVID-19 pandemic disrupted the world in 2020 by spreading at unprecedented rates and causing tens of thousands of fatalities within a few months. The number of deaths dramatically increased in regions where the number of patients in need of hospital care exceeded the availability of care. Many COVID-19 patients experience Acute Respiratory Distress Syndrome (ARDS), a condition that can be treated with mechanical ventilation. In response to the need for mechanical ventilators, designed and tested an emergency ventilator (EV) that can control a patient's peak inspiratory pressure (PIP) and breathing rate, while keeping a positive end expiratory pressure (PEEP). This article describes the rapid design, prototyping, and testing of the EV. The development process was enabled by rapid design iterations using additive manufacturing (AM). In the initial design phase, iterations between design, AM, and testing enabled a working prototype within one week. The designs of the 16 different components of the ventilator were locked by additively manufacturing and testing a total of 283 parts having parametrically varied dimensions. In the second stage, AM was used to produce 75 functional prototypes to support engineering evaluation and animal testing. The devices were tested over more than two million cycles. We also developed an electronic monitoring system and with automatic alarm to provide for safe operation, along with training materials and user guides. The final designs are available online under a free license. The designs have been transferred to more than 70 organizations in 15 countries. This project demonstrates the potential for ultra-fast product design, engineering, and testing of medical devices needed for COVID-19 emergency response.


Assuntos
/terapia , Desenho de Equipamento/métodos , Respiração Artificial/instrumentação , Ventiladores Mecânicos/efeitos adversos , Animais , Humanos , Respiração Artificial/métodos , Mecânica Respiratória/fisiologia , Taxa Respiratória/fisiologia , Suínos
6.
PLoS One ; 15(12): e0243939, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33370375

RESUMO

BACKGROUND: Current cardiorespiratory monitoring equipment can cause injuries and infections in neonates with fragile skin. Impulse-radio ultra-wideband (IR-UWB) radar was recently demonstrated to be an effective contactless vital sign monitor in adults. The purpose of this study was to assess heart rates (HRs) and respiratory rates (RRs) in the neonatal intensive care unit (NICU) using IR-UWB radar and to evaluate its accuracy and reliability compared to conventional electrocardiography (ECG)/impedance pneumography (IPG). METHODS: The HR and RR were recorded in 34 neonates between 3 and 72 days of age during minimal movement (51 measurements in total) using IR-UWB radar (HRRd, RRRd) and ECG/IPG (HRECG, RRIPG) simultaneously. The radar signals were processed in real time using algorithms for neonates. Radar and ECG/IPG measurements were compared using concordance correlation coefficients (CCCs) and Bland-Altman plots. RESULTS: From the 34 neonates, 12,530 HR samples and 3,504 RR samples were measured. Both the HR and RR measured using the two methods were highly concordant when the neonates had minimal movements (CCC = 0.95 between the RRRd and RRIPG, CCC = 0.97 between the HRRd and HRECG). In the Bland-Altman plot, the mean biases were 0.17 breaths/min (95% limit of agreement [LOA] -7.0-7.3) between the RRRd and RRIPG and -0.23 bpm (95% LOA -5.3-4.8) between the HRRd and HRECG. Moreover, the agreement for the HR and RR measurements between the two modalities was consistently high regardless of neonate weight. CONCLUSIONS: A cardiorespiratory monitor using IR-UWB radar may provide accurate non-contact HR and RR estimates without wires and electrodes for neonates in the NICU.


Assuntos
Aptidão Cardiorrespiratória/fisiologia , Frequência Cardíaca/fisiologia , Monitorização Fisiológica , Taxa Respiratória/fisiologia , Eletrocardiografia/métodos , Estudos de Viabilidade , Feminino , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Radar , Processamento de Sinais Assistido por Computador/instrumentação
7.
J Clin Sleep Med ; 16(10): 1811-1813, 2020 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-33063660

RESUMO

None: A middle-aged man with obstructive sleep apnea who had been treated with continuous positive airway pressure developed COVID-19. An analysis of airflow records from the continuous positive airway pressure machine revealed a rise in his respiratory rate on the night before the onset of COVID-19-related symptoms, while his nocturnal respiratory rate had been stable during the 18-month period prior to the presently reported episode. The present case suggests that a rise in respiratory rate detected using continuous positive airway pressure machine data could be an important sign of impending acute illness, such as COVID-19. Studies to elucidate the usefulness of this method are warranted.


Assuntos
Betacoronavirus , Pressão Positiva Contínua nas Vias Aéreas/estatística & dados numéricos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Taxa Respiratória/fisiologia , Apneia Obstrutiva do Sono/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Polissonografia/métodos
8.
BMC Res Notes ; 13(1): 421, 2020 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-32894167

RESUMO

OBJECTIVE: The advent of new technologies has made it possible to explore alternative ventilator manufacturing to meet the worldwide shortfall for mechanical ventilators especially in pandemics. We describe a method using rapid prototyping technologies to create an electro-mechanical ventilator in a cost effective, timely manner and provide results of testing using an in vitro-in vivo testing model. RESULTS: Rapid prototyping technologies (3D printing and 2D cutting) were used to create a modular ventilator. The artificial manual breathing unit (AMBU) bag connected to wall oxygen source using a flow meter was used as air reservoir. Controlled variables include respiratory rate, tidal volume and inspiratory: expiratory (I:E) ratio. In vitro testing and In vivo testing in the pig model demonstrated comparable mechanical efficiency of the test ventilator to that of standard ventilator but showed the material limits of 3D printed gears. Improved gear design resulted in better ventilator durability whilst reducing manufacturing time (< 2-h). The entire cost of manufacture of ventilator was estimated at 300 Australian dollars. A cost-effective novel rapid prototyped ventilator for use in patients with respiratory failure was developed in < 2-h and was effective in anesthetized, healthy pig model.


Assuntos
Desenho de Equipamento/métodos , Respiração Artificial/instrumentação , Ventiladores Mecânicos/provisão & distribução , Anestesia Geral/métodos , Animais , Infecções por Coronavirus/terapia , Volume de Reserva Expiratória/fisiologia , Feminino , Humanos , Volume de Reserva Inspiratória/fisiologia , Modelos Biológicos , Pandemias , Pneumonia Viral/terapia , Impressão Tridimensional/instrumentação , Respiração Artificial/economia , Respiração Artificial/métodos , Taxa Respiratória/fisiologia , Suínos , Volume de Ventilação Pulmonar/fisiologia , Ventiladores Mecânicos/economia
9.
PLoS One ; 15(9): e0238946, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32956397

RESUMO

BACKGROUND: The origin of low frequency cerebral hemodynamic fluctuations (CHF) in the resting state remains unknown. Breath-by breath O2-CO2 exchange ratio (bER) has been reported to correlate with the cerebrovascular response to brief breath hold challenge at the frequency range of 0.008-0.03Hz in healthy adults. bER is defined as the ratio of the change in the partial pressure of oxygen (ΔPO2) to that of carbon dioxide (ΔPCO2) between end inspiration and end expiration. In this study, we aimed to investigate the contribution of respiratory gas exchange (RGE) metrics (bER, ΔPO2 and ΔPCO2) to low frequency CHF during spontaneous breathing. METHODS: Twenty-two healthy adults were included. We used transcranial Doppler sonography to evaluate CHF by measuring the changes in cerebral blood flow velocity (ΔCBFv) in bilateral middle cerebral arteries. The regional CHF were mapped with blood oxygenation level dependent (ΔBOLD) signal changes using functional magnetic resonance imaging. Temporal features and frequency characteristics of RGE metrics during spontaneous breathing were examined, and the simultaneous measurements of RGE metrics and CHF (ΔCBFv and ΔBOLD) were studied for their correlation. RESULTS: We found that the time courses of ΔPO2 and ΔPCO2 were interdependent but not redundant. The oscillations of RGE metrics were coherent with resting state CHF at the frequency range of 0.008-0.03Hz. Both bER and ΔPO2 were superior to ΔPCO2 in association with CHF while CHF could correlate more strongly with bER than with ΔPO2 in some brain regions. Brain regions with the strongest coupling between bER and ΔBOLD overlapped with many areas of default mode network including precuneus and posterior cingulate. CONCLUSION: Although the physiological mechanisms underlying the strong correlation between bER and CHF are unclear, our findings suggest the contribution of bER to low frequency resting state CHF, providing a novel insight of brain-body interaction via CHF and oscillations of RGE metrics.


Assuntos
Circulação Cerebrovascular/fisiologia , Taxa Respiratória/fisiologia , Adulto , Velocidade do Fluxo Sanguíneo/fisiologia , Encéfalo/fisiologia , Dióxido de Carbono/sangue , Feminino , Voluntários Saudáveis , Hemodinâmica/fisiologia , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Artéria Cerebral Média/fisiologia , Oxigênio/sangue , Pressão Parcial , Respiração , Descanso/fisiologia , Ultrassonografia Doppler Transcraniana/métodos , Vasodilatação/fisiologia
10.
PLoS One ; 15(8): e0237736, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32817703

RESUMO

AIMS: To assess the impact of two different respiratory rates in hemodynamic, perfusion and ventilation parameters in a pediatric animal model of cardiac arrest (CA). METHODS: An experimental randomized controlled trial was carried out in 50 piglets under asphyxial CA. After ROSC, they were randomized into two groups: 20 and 30 respirations per minute (rpm). Hemodynamic, perfusion and ventilation parameters were measured 10 minutes after asphyxia, just before ROSC and at 5, 15, 30 and 60 minutes after ROSC. Independent medians test, Kruskal-Wallis test and χ2 test, were used to compare continuous and categorical variables, respectively. Spearman's Rho was used to assess correlation between continuous variables. A p-value <0.05 was considered significant. RESULTS: Arterial partial pressure of carbon dioxide (PaCO2) was significantly lower in the 30 rpm group after 15 minutes (41 vs. 54.5 mmHg, p <0.01), 30 minutes (39.5 vs. 51 mmHg, p < 0.01) and 60 minutes (36.5 vs. 48 mmHg, p = 0.02) of ROSC. The percentage of normoventilated subjects (PaCO2 30-50 mmHg) was significantly higher in the 30 rpm group throughout the experiment. pH normalization occurred faster in the 30 rpm group with significant differences at 60 minutes (7.40 vs. 7.34, p = 0.02). Lactic acid levels were high immediately after ROSC in both groups, but were significantly lower in the 20 rpm group at 30 (3.7 vs. 4.7 p = 0.04) and 60 minutes (2.6 vs. 3.6 p = 0.03). CONCLUSIONS: This animal model of asphyxial CA shows that a respiratory rate of 30 rpm is more effective to reach normoventilation than 20 rpm in piglets after ROSC. This ventilation strategy seems to be safe, as it does not cause hyperventilation and does not affect hemodynamics or cerebral tissue perfusion.


Assuntos
Asfixia/terapia , Parada Cardíaca/terapia , Taxa Respiratória/fisiologia , Ventilação/normas , Animais , Pressão Arterial/fisiologia , Asfixia/fisiopatologia , Dióxido de Carbono/metabolismo , Modelos Animais de Doenças , Parada Cardíaca/fisiopatologia , Humanos , Ácido Láctico/metabolismo , Pediatria , Estatísticas não Paramétricas , Suínos/fisiologia
12.
Life Sci ; 257: 118113, 2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-32687919

RESUMO

AIMS: To create a low-cost ventilator that could be constructed with readily-available hospital equipment for use in emergency or low-resource settings. MAIN METHODS: The novel ventilator consists of an inspiratory limb composed of an elastic flow-inflating bag encased within a non-compliant outer sheath and an expiratory limb composed of a series of two, one-way bidirectional splitter valves derived from a self-inflating bag system. An Arduino Uno microcontroller controls a solenoid valve that can be programmed to open and close to produce a set respiratory rate and inspiratory time. Using an ASL 5000 Lung Simulator, we obtained flow, pressure, and volume waveforms at different lung compliances. KEY FINDINGS: At a static lung compliance of 50 mL/cm H2O and an airway resistance of 6 cm H2O/L/s, ventilated at a PIP and PEEP of 16 and 5 cm H2O, respectively, tidal volumes of approximately 540 mL were achieved. At a static lung compliance of 20 mL/cm H2O and an airway resistance of 6 cm H2O/L/s, ventilated at a PIP and PEEP of 38 and 15 cm H2O, respectively, tidal volumes of approximately 495 mL were achieved. SIGNIFICANCE: This novel ventilator is able to safely and reliably ventilate patients with a range of pulmonary disease in a simulated setting. Opportunities exist to utilize our ventilator in emergency situations and low-resource settings.


Assuntos
Infecções por Coronavirus/fisiopatologia , Pneumonia Viral/fisiopatologia , Respiração Artificial/instrumentação , Respiração Artificial/métodos , Resistência das Vias Respiratórias/fisiologia , Betacoronavirus/patogenicidade , Humanos , Pulmão/fisiologia , Pandemias , Taxa Respiratória/fisiologia , Volume de Ventilação Pulmonar/fisiologia , Ventiladores Mecânicos/provisão & distribução
13.
Rev Lat Am Enfermagem ; 28: e3264, 2020.
Artigo em Português, Espanhol, Inglês | MEDLINE | ID: mdl-32491124

RESUMO

OBJECTIVE: to compare the time for performance of dry and traditional bed bathing and its effects on transcutaneous arterial oxygen saturation and respiratory rates in critical adult patients. METHOD: pilot study of a randomized, open, crossover clinical trial, performed with 15 adult critically ill patients. Each patient received a dry and a traditional bed bath. Analysis of variance with repeated measures was used, adopting p-value ≤ 0.05. RESULTS: most patients were male (73.3%), white (66.7%), with a mean age of 69.7 years. The dry bath was faster (20.0 minutes) than the traditional bath (30.0 minutes) (p<0.001). There was no significant difference between the patients' saturation means between baths (p=0.381), with 94.7% for the dry bath and 95.2% for the traditional bath. During the traditional bath, the patients' respiratory rate mean was higher (24.2 incursions per minute) and statistically different (p<0.001) from the value obtained for the dry bath (20.5 incursions per minute). CONCLUSION: the dry bath had a shorter duration than did the traditional bath, resulting in less patient exposure. The traditional bed bath had a negative effect on patients' respiratory rate, increasing it. Brazilian Registry of Clinical Trials (ReBEC): RBR-5qwkqd.


Assuntos
Banhos/métodos , Estado Terminal/enfermagem , Taxa Respiratória/fisiologia , Idoso , Idoso de 80 Anos ou mais , Banhos/enfermagem , Estudos Cross-Over , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto
15.
A A Pract ; 14(8): e01253, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32496430

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic has rapidly exposed health care system inadequacies. Hospital ventilator shortages in Italy compelled US physicians to consider creative solutions, such as using Y-pieces or T-pieces, to preclude the need to make decisions of life or death based on medical equipment availability. We add to current knowledge and testing capacity for ventilator splitters by reporting the ability to examine the functionality of ventilator splitters by using 2 high-fidelity lung simulators. Data obtained by the high-fidelity lung simulators included: tidal volume, respiratory rate, minute ventilation, peak inspiratory pressure, peak plateau pressure, and positive end-expiratory pressure.


Assuntos
Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Respiração Artificial/instrumentação , Ventiladores Mecânicos/provisão & distribução , Infecções por Coronavirus/epidemiologia , Desenho de Equipamento , Humanos , Manequins , Pandemias , Pneumonia Viral/epidemiologia , Respiração com Pressão Positiva , Taxa Respiratória/fisiologia , Volume de Ventilação Pulmonar
16.
Int J Neural Syst ; 30(6): 2050028, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32498643

RESUMO

The cortical and subcortical circuit regulating both cognition and cardiac autonomic interactions are already well established. This circuit has mainly been analyzed from cortex to heart. Thus, the heart rate variability (HRV) is usually considered a reflection of cortical activity. In this paper, we investigate whether HRV changes affect cortical activity. Short-term local autonomic changes were induced by three breathing strategies: spontaneous (Control), normal (NB) and slow paced breathing (SB). We measured the performance in two cognition domains: executive functions and processing speed. Breathing maneuvres produced three clearly differentiated autonomic states, which preconditioned the cognitive tasks. We found that the SB significantly increased the HRV low frequency (LF) power and lowered the power spectral density (PSD) peak to 0.1[Formula: see text]Hz. Meanwhile, executive function was assessed by the working memory test, whose accuracy significantly improved after SB, with no significant changes in the response times. Processing speed was assessed by a multitasking test. Consistently, the proportion of correct answers (success rate) was the only dependent variable affected by short-term and long-term breath pacing. These findings suggest that accuracy, and not timing of these two cognitive domains would benefit from short-term SB in this study population.


Assuntos
Sistema Nervoso Autônomo/fisiologia , Função Executiva/fisiologia , Frequência Cardíaca/fisiologia , Memória de Curto Prazo/fisiologia , Desempenho Psicomotor/fisiologia , Tempo de Reação/fisiologia , Taxa Respiratória/fisiologia , Adulto , Humanos
17.
BMJ ; 369: m1501, 2020 05 20.
Artigo em Inglês | MEDLINE | ID: mdl-32434791

RESUMO

OBJECTIVE: To provide an overview and critical appraisal of early warning scores for adult hospital patients. DESIGN: Systematic review. DATA SOURCES: Medline, CINAHL, PsycInfo, and Embase until June 2019. ELIGIBILITY CRITERIA FOR STUDY SELECTION: Studies describing the development or external validation of an early warning score for adult hospital inpatients. RESULTS: 13 171 references were screened and 95 articles were included in the review. 11 studies were development only, 23 were development and external validation, and 61 were external validation only. Most early warning scores were developed for use in the United States (n=13/34, 38%) and the United Kingdom (n=10/34, 29%). Death was the most frequent prediction outcome for development studies (n=10/23, 44%) and validation studies (n=66/84, 79%), with different time horizons (the most frequent was 24 hours). The most common predictors were respiratory rate (n=30/34, 88%), heart rate (n=28/34, 83%), oxygen saturation, temperature, and systolic blood pressure (all n=24/34, 71%). Age (n=13/34, 38%) and sex (n=3/34, 9%) were less frequently included. Key details of the analysis populations were often not reported in development studies (n=12/29, 41%) or validation studies (n=33/84, 39%). Small sample sizes and insufficient numbers of event patients were common in model development and external validation studies. Missing data were often discarded, with just one study using multiple imputation. Only nine of the early warning scores that were developed were presented in sufficient detail to allow individualised risk prediction. Internal validation was carried out in 19 studies, but recommended approaches such as bootstrapping or cross validation were rarely used (n=4/19, 22%). Model performance was frequently assessed using discrimination (development n=18/22, 82%; validation n=69/84, 82%), while calibration was seldom assessed (validation n=13/84, 15%). All included studies were rated at high risk of bias. CONCLUSIONS: Early warning scores are widely used prediction models that are often mandated in daily clinical practice to identify early clinical deterioration in hospital patients. However, many early warning scores in clinical use were found to have methodological weaknesses. Early warning scores might not perform as well as expected and therefore they could have a detrimental effect on patient care. Future work should focus on following recommended approaches for developing and evaluating early warning scores, and investigating the impact and safety of using these scores in clinical practice. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017053324.


Assuntos
Cuidados Críticos/métodos , Hospitais/estatística & dados numéricos , Pacientes Internados/estatística & dados numéricos , Adulto , Idoso , Pressão Sanguínea , Deterioração Clínica , Cuidados Críticos/estatística & dados numéricos , Morte , Escore de Alerta Precoce , Feminino , Parada Cardíaca/epidemiologia , Frequência Cardíaca/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Oxiemoglobinas/metabolismo , Prognóstico , Taxa Respiratória/fisiologia , Temperatura , Reino Unido/epidemiologia , Estados Unidos/epidemiologia
18.
Can J Anaesth ; 67(10): 1393-1404, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32440906

RESUMO

Pulmonary complications are the most common clinical manifestations of coronavirus disease (COVID-19). From recent clinical observation, two phenotypes have emerged: a low elastance or L-type and a high elastance or H-type. Clinical presentation, pathophysiology, pulmonary mechanics, radiological and ultrasound findings of these two phenotypes are different. Consequently, the therapeutic approach also varies between the two. We propose a management algorithm that combines the respiratory rate and oxygenation index with bedside lung ultrasound examination and monitoring that could help determine earlier the requirement for intubation and other surveillance of COVID-19 patients with respiratory failure.


Assuntos
Infecções por Coronavirus/complicações , Pulmão/diagnóstico por imagem , Pneumonia Viral/complicações , Insuficiência Respiratória/diagnóstico por imagem , Ultrassonografia , Doença Aguda , Algoritmos , Infecções por Coronavirus/diagnóstico por imagem , Humanos , Pulmão/fisiopatologia , Pulmão/virologia , Oxigênio/metabolismo , Pandemias , Fenótipo , Pneumonia Viral/diagnóstico por imagem , Sistemas Automatizados de Assistência Junto ao Leito , Insuficiência Respiratória/virologia , Taxa Respiratória/fisiologia
19.
J Clin Neurosci ; 77: 67-74, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32417125

RESUMO

BACKGROUND: Severe intractable tics, which are associated with Tourette syndrome and chronic tic disorder (TS/CTD), severely affect the quality of life. Common less-invasive treatments are often unable to attenuate tics with deep brain stimulation currently being the only effective treatment. We aimed to assess the anti-tic effect of deep slow nasal respiration with tight lip closure using patients with TS/CTD. METHODS: We retrospectively analyzed 10 consecutive patients (9 men, 1 woman; 23-41 years old). We instructed the patients to perform the procedure for 120 s and to obtain a video recording of before and during the procedure. The videos were used to count tics and determine lip competency or incompetency. The counted tics were rated using the modified Rush Video Rating Scale. RESULTS: Compared with before the procedure, there were significantly lower frequencies of motor and phonic tics, as well as video scored, during the procedure. Eight patients presented with lip incompetency before the procedure and none after the procedure (P = 0.041). There were no side effects associated with the procedure. CONCLUSION: Our findings indicate that deep slow nasal respiration with tight lip closure ameliorates tics in patients with TS/CTD. In accordance with our results, lip opening and oral breathing could be causes of tics, in addition to heritability. Therefore, this novel procedure could improve tics. Furthermore, our findings could contribute toward the development of tic treatments and elucidate their pathophysiology regarding the reward system, hypersensitivity, autonomic nerves, and nasal airway.


Assuntos
Exercícios Respiratórios/métodos , Lábio , Taxa Respiratória/fisiologia , Índice de Gravidade de Doença , Transtornos de Tique/terapia , Adulto , Feminino , Humanos , Masculino , Qualidade de Vida/psicologia , Estudos Retrospectivos , Transtornos de Tique/fisiopatologia , Transtornos de Tique/psicologia , Fatores de Tempo , Síndrome de Tourette/fisiopatologia , Síndrome de Tourette/psicologia , Síndrome de Tourette/terapia , Resultado do Tratamento , Gravação em Vídeo/métodos , Adulto Jovem
20.
Sci Rep ; 10(1): 6722, 2020 04 21.
Artigo em Inglês | MEDLINE | ID: mdl-32317734

RESUMO

Measuring respiratory resistance and elastance as a function of time, tidal volume, respiratory rate, and positive end-expiratory pressure can guide mechanical ventilation. However, current measurement techniques are limited since they are assessed intermittently at non-physiological frequencies or involve specialized equipment. To this end, we introduce ZVV, a practical approach to continuously track resistance and elastance during Variable Ventilation (VV), in which frequency and tidal volume vary from breath-to-breath. ZVV segments airway pressure and flow recordings into individual breaths, calculates resistance and elastance for each breath, bins them according to frequency or tidal volume and plots the results against bin means. ZVV's feasibility was assessed clinically in five human patients with acute lung injury, experimentally in five mice ventilated before and after lavage injury, and computationally using a viscoelastic respiratory model. ZVV provided continuous measurements in both settings, while the computational study revealed <2% estimation errors. Our findings support ZVV as a feasible technique to assess respiratory mechanics under physiological conditions. Additionally, in humans, ZVV detected a decrease in resistance and elastance with time by 12.8% and 6.2%, respectively, suggesting that VV can improve lung recruitment in some patients and can therefore potentially serve both as a dual diagnostic and therapeutic tool.


Assuntos
Ventilação Pulmonar/fisiologia , Mecânica Respiratória/fisiologia , Taxa Respiratória/fisiologia , Lesão Pulmonar Aguda/fisiopatologia , Animais , Simulação por Computador , Impedância Elétrica , Humanos , Masculino , Camundongos Endogâmicos C57BL , Modelos Biológicos
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