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1.
PLoS One ; 15(12): e0243971, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33332454

RESUMO

BACKGROUND: Expiratory flow-initiated pressure-controlled inverse ratio ventilation (EF-initiated PC-IRV) reduces physiological dead space. We hypothesised that EF-initiated PC-IRV would be lung protective compared with volume-controlled ventilation (VCV). METHODS: Twenty-eight men undergoing robot-assisted laparoscopic radical prostatectomy were enrolled in this randomised controlled trial. The EF-initiated PC-IRV group (n = 14) used pressure-controlled ventilation with the volume guaranteed mode. The inspiratory to expiratory (I:E) ratio was individually adjusted by observing the expiratory flow-time wave. The VCV group (n = 14) used the volume control mode with a 1:2 I:E ratio. The Mann-Whitney U test was used to compare differences in the serum cytokine levels. RESULTS: There were no significant differences in serum IL-6 between the EF-initiated PC-IRV (median 34 pg ml-1 (IQR 20.5 to 63.5)) and VCV (31 pg ml-1 (24.5 to 59)) groups (P = 0.84). The physiological dead space rate (physiological dead space/expired tidal volume) was significantly reduced in the EF-initiated PC-IRV group as compared with that in the VCV group (0.31 ± 0.06 vs 0.4 ± 0.07; P<0.001). The physiological dead space rate was negatively correlated with the forced vital capacity (% predicted) in the VCV group (r = -0.85, P<0.001), but not in the EF-initiated PC-IRV group (r = 0.15, P = 0.62). Two patients in the VCV group had permissive hypercapnia with low forced vital capacity (% predicted). CONCLUSIONS: There were no differences in the lung-protective properties between the two ventilatory strategies. However, EF-initiated PC-IRV reduced physiological dead space rate; thus, it may be useful for reducing the ventilatory volume that is necessary to maintain normocapnia in patients with low forced vital capacity (% predicted) during robot-assisted laparoscopic radical prostatectomy.


Assuntos
Expiração/fisiologia , Pulmão/fisiologia , Respiração com Pressão Positiva , Respiração Artificial/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Ventilação com Pressão Positiva Intermitente , Masculino , Pessoa de Meia-Idade , Troca Gasosa Pulmonar/fisiologia , Volume de Ventilação Pulmonar/fisiologia , Adulto Jovem
5.
Am J Physiol Lung Cell Mol Physiol ; 319(2): L289-L293, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32491950

RESUMO

When using a new noninvasive method for measuring the efficiency of pulmonary gas exchange, a key measurement is the oxygen deficit, defined as the difference between the end-tidal alveolar Po2 and the calculated arterial Po2. The end-tidal Po2 is measured using a rapid gas analyzer, and the arterial Po2 is derived from pulse oximetry after allowing for the effect of the Pco2 on the oxygen affinity of hemoglobin. In the present report we show that the values of end-tidal Po2 and Pco2 are highly reproducible, providing a solid foundation for the measurement of the oxygen deficit. We compare the oxygen deficit with the classical ideal alveolar-arterial Po2 difference (A-aDO2) as originally proposed by Riley, and now extensively used in clinical practice. This assumes Riley's criteria for ideal alveolar gas, namely no ventilation-perfusion inequality, the same Pco2 as arterial blood, and the same respiratory exchange ratio as the whole lung. It transpires that, in normal subjects, the end-tidal Po2 is essentially the same as the ideal value. This conclusion is consistent with the very small oxygen deficit that we have reported in young normal subjects, the significantly higher values seen in older normal subjects, and the much larger values in patients with lung disease. We conclude that this noninvasive measurement of the efficiency of pulmonary exchange is identical in many respects to that based on the ideal alveolar Po2, but that it is easier to obtain.


Assuntos
Artérias/metabolismo , Pulmão/metabolismo , Oxigênio/metabolismo , Troca Gasosa Pulmonar/fisiologia , Dióxido de Carbono/metabolismo , Hemoglobinas/metabolismo , Humanos , Pulmão/fisiopatologia , Pneumopatias/metabolismo , Pneumopatias/fisiopatologia , Oximetria/métodos , Respiração
8.
Undersea Hyperb Med ; 47(2): 177-179, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32574432

RESUMO

Recently the internet has been abuzz with new ideas to treat COVID-19, including hyperbaric oxygen (HBO2) therapy, undoubtedly driven by the fact that until recently there have been few therapeutic options for this highly contagious and often lethal infection. . . . Refractory hypoxemia is certainly treatable with hyperbaric oxygen due to the obvious effect of increasing inspired oxygen partial pressure (PO2), the major reason for using HBO2 for its established indications. However, the length of time during which patients can safely be administered HBO2 inside a chamber is limited, due to practical issues of confinement and isolation from other necessary medical interventions, but also because of oxygen toxicity.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Oxigenação Hiperbárica/métodos , Pneumonia Viral/terapia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/fisiopatologia , Humanos , Hipóxia/etiologia , Hipóxia/fisiopatologia , Hipóxia/terapia , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/fisiopatologia , Troca Gasosa Pulmonar/fisiologia
9.
Lancet Respir Med ; 8(8): 765-774, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32569585

RESUMO

BACKGROUND: The COVID-19 pandemic is challenging advanced health systems, which are dealing with an overwhelming number of patients in need of intensive care for respiratory failure, often requiring intubation. Prone positioning in intubated patients is known to reduce mortality in moderate-to-severe acute respiratory distress syndrome. We aimed to investigate feasibility and effect on gas exchange of prone positioning in awake, non-intubated patients with COVID-19-related pneumonia. METHODS: In this prospective, feasibility, cohort study, patients aged 18-75 years with a confirmed diagnosis of COVID-19-related pneumonia receiving supplemental oxygen or non-invasive continuous positive airway pressure were recruited from San Gerardo Hospital, Monza, Italy. We collected baseline data on demographics, anthropometrics, arterial blood gas, and ventilation parameters. After baseline data collection, patients were helped into the prone position, which was maintained for a minimum duration of 3 h. Clinical data were re-collected 10 min after prone positioning and 1 h after returning to the supine position. The main study outcome was the variation in oxygenation (partial pressure of oxygen [PaO2]/fractional concentration of oxygen in inspired air [FiO2]) between baseline and resupination, as an index of pulmonary recruitment. This study is registered on ClinicalTrials.gov, NCT04365959, and is now complete. FINDINGS: Between March 20 and April 9, 2020, we enrolled 56 patients, of whom 44 (79%) were male; the mean age was 57·4 years (SD 7·4) and the mean BMI was 27·5 kg/m2 (3·7). Prone positioning was feasible (ie, maintained for at least 3 h) in 47 patients (83·9% [95% CI 71·7 to 92·4]). Oxygenation substantially improved from supine to prone positioning (PaO2/FiO2 ratio 180·5 mm Hg [SD 76·6] in supine position vs 285·5 mm Hg [112·9] in prone position; p<0·0001). After resupination, improved oxygenation was maintained in 23 patients (50·0% [95% CI 34·9-65·1]; ie, responders); however, this improvement was on average not significant compared with before prone positioning (PaO2/FiO2 ratio 192·9 mm Hg [100·9] 1 h after resupination; p=0·29). Patients who maintained increased oxygenation had increased levels of inflammatory markers (C-reactive protein: 12·7 mg/L [SD 6·9] in responders vs 8·4 mg/L [6·2] in non-responders; and platelets: 241·1 × 103/µL [101·9] vs 319·8 × 103/µL [120·6]) and shorter time between admission to hospital and prone positioning (2·7 days [SD 2·1] in responders vs 4·6 days [3·7] in non-responders) than did those for whom improved oxygenation was not maintained. 13 (28%) of 46 patients were eventually intubated, seven (30%) of 23 responders and six (26%) of 23 non-responders (p=0·74). Five patients died during follow-up due to underlying disease, unrelated to study procedure. INTERPRETATION: Prone positioning was feasible and effective in rapidly ameliorating blood oxygenation in awake patients with COVID-19-related pneumonia requiring oxygen supplementation. The effect was maintained after resupination in half of the patients. Further studies are warranted to ascertain the potential benefit of this technique in improving final respiratory and global outcomes. FUNDING: University of Milan-Bicocca.


Assuntos
Betacoronavirus , Infecções por Coronavirus/fisiopatologia , Pneumonia Viral/fisiopatologia , Decúbito Ventral , Troca Gasosa Pulmonar/fisiologia , /fisiopatologia , Adolescente , Adulto , Idoso , Infecções por Coronavirus/terapia , Cuidados Críticos/métodos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/terapia , Estudos Prospectivos , /virologia , Mecânica Respiratória/fisiologia , Adulto Jovem
10.
Int J Sports Med ; 41(9): 574-581, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32353881

RESUMO

Over recent decades the association between metabolic and gas exchange parameters during exercise has become evident. Different "thresholds" (such as lactate thresholds, critical power, EMG thresholds) and intensity domains appear to be linked to an upper limit of oxygen uptake steady state (V̇O2SS). The aim of this study was to investigate whether MLSS is associated with the upper limit for a V̇O2SS. Forty-five subjects underwent one incremental test and 4-6 30-minute MLSS tests on a cycle ergometer. A three-component model was used to describe V̇O2 response at PMLSS and just above PMLSS+1. To evaluate the results, breath-by-breath V̇O2 and lactate (LA) values were analyzed using the intraclass correlation coefficient (ICC), increasing (k-) values and the Wilcoxon test. According to the calculated k-values of LA and VO2 at PMLSS and PMLSS+1, no significant increase of VO2 occurred during both intensities (PMLSS and PMLSS+1) from minute 10 to minute 30, confirming the existence of a V̇O2SS. Additionally, the ICC of 0.94 confirmed high accordance of the VO2 kinetics at both intensities (PMLSS and PMLSS+1). This study shows that power output at MLSS workload does not represent an accurate cut for an upper limit of V̇O2SS.


Assuntos
Limiar Anaeróbio/fisiologia , Exercício Físico/fisiologia , Ácido Láctico/sangue , Troca Gasosa Pulmonar/fisiologia , Adulto , Teste de Esforço , Feminino , Humanos , Masculino , Resistência Física/fisiologia , Adulto Jovem
11.
Med Sci (Paris) ; 36(4): 382-388, 2020 Apr.
Artigo em Francês | MEDLINE | ID: mdl-32356715

RESUMO

As burden of chronic respiratory diseases is constantly increasing, improving in vitro lung models is essential in order to reproduce as closely as possible the complex pulmonary architecture, responsible for oxygen uptake and carbon dioxide clearance. The study of diseases that affect the respiratory system has benefited from in vitro reconstructions of the respiratory epithelium with inserts in air/liquid interface (2D) or in organoids able to mimic up to the arborescence of the respiratory tree (3D). Recent development in the fields of pluripotent stem cells-derived organoids and genome editing technologies has provided new insights to better understand pulmonary diseases and to find new therapeutic perspectives.


Assuntos
Técnicas de Cultura de Células , Pulmão/citologia , Organoides/citologia , Células Epiteliais Alveolares/citologia , Células Epiteliais Alveolares/fisiologia , Animais , Bioengenharia/métodos , Bioengenharia/tendências , Dióxido de Carbono/farmacologia , Dióxido de Carbono/fisiologia , Técnicas de Cultura de Células/métodos , Técnicas de Cultura de Células/tendências , Células Cultivadas , Edição de Genes/métodos , Edição de Genes/tendências , Humanos , Pulmão/patologia , Pulmão/fisiologia , Modelos Biológicos , Organoides/patologia , Organoides/fisiologia , Oxigênio/farmacologia , Oxigênio/fisiologia , Troca Gasosa Pulmonar/fisiologia , Mucosa Respiratória/citologia , Mucosa Respiratória/efeitos dos fármacos , Tecidos Suporte/química
13.
Am J Physiol Lung Cell Mol Physiol ; 318(6): L1211-L1221, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32294391

RESUMO

Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is used as rescue therapy for severe cardiopulmonary failure. We tested whether the ratio of CO2 elimination at the lung and the V-A ECMO (V˙co2ECMO/V˙co2Lung) would reflect the ratio of respective blood flows and could be used to estimate changes in pulmonary blood flow (Q˙Lung), i.e., native cardiac output. Four healthy pigs were centrally cannulated for V-A ECMO. We measured blood flows with an ultrasonic flow probe. V˙co2ECMO and V˙co2Lung were calculated from sidestream capnographs under constant pulmonary ventilation during V-A ECMO weaning with changing sweep gas and/or V-A ECMO blood flow. If ventilation-to-perfusion ratio (V˙/Q˙) of V-A ECMO was not 1, the V˙co2ECMO was normalized to V˙/Q˙ = 1 (V˙co2ECMONorm). Changes in pulmonary blood flow were calculated using the relationship between changes in CO2 elimination and V-A ECMO blood flow (Q˙ECMO). Q˙ECMO correlated strongly with V˙co2ECMONorm (r2 0.95-0.99). Q˙Lung correlated well with V˙co2Lung (r2 0.65-0.89, P < = 0.002). Absolute Q˙Lung could not be calculated in a nonsteady state. Calculated pulmonary blood flow changes had a bias of 76 (-266 to 418) mL/min and correlated with measured Q˙Lung (r2 0.974-1.000, P = 0.1 to 0.006) for cumulative ECMO flow reductions. In conclusion, V˙co2 of the lung correlated strongly with pulmonary blood flow. Our model could predict pulmonary blood flow changes within clinically acceptable margins of error. The prediction is made possible with normalization to a V˙/Q˙ of 1 for ECMO. This approach depends on measurements readily available and may allow immediate assessment of the cardiac output response.


Assuntos
Oxigenação por Membrana Extracorpórea , Pulmão/irrigação sanguínea , Artéria Pulmonar/fisiologia , Troca Gasosa Pulmonar/fisiologia , Veias Pulmonares/fisiologia , Fluxo Sanguíneo Regional/fisiologia , Animais , Modelos Animais de Doenças , Feminino , Masculino , Suínos
15.
Anesthesiology ; 132(5): 1257-1276, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32149776

RESUMO

This review focuses on the use of veno-venous extracorporeal membrane oxygenation for respiratory failure across all blood flow ranges. Starting with a short overview of historical development, aspects of the physiology of gas exchange (i.e., oxygenation and decarboxylation) during extracorporeal circulation are discussed. The mechanisms of phenomena such as recirculation and shunt playing an important role in daily clinical practice are explained.Treatment of refractory and symptomatic hypoxemic respiratory failure (e.g., acute respiratory distress syndrome [ARDS]) currently represents the main indication for high-flow veno-venous-extracorporeal membrane oxygenation. On the other hand, lower-flow extracorporeal carbon dioxide removal might potentially help to avoid or attenuate ventilator-induced lung injury by allowing reduction of the energy load (i.e., driving pressure, mechanical power) transmitted to the lungs during mechanical ventilation or spontaneous ventilation. In the latter context, extracorporeal carbon dioxide removal plays an emerging role in the treatment of chronic obstructive pulmonary disease patients during acute exacerbations. Both applications of extracorporeal lung support raise important ethical considerations, such as likelihood of ultimate futility and end-of-life decision-making. The review concludes with a brief overview of potential technical developments and persistent challenges.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Troca Gasosa Pulmonar/fisiologia , Insuficiência Respiratória/fisiopatologia , Insuficiência Respiratória/terapia , Animais , Dióxido de Carbono/fisiologia , Circulação Extracorpórea/métodos , Humanos , Respiração Artificial/métodos , Lesão Pulmonar Induzida por Ventilação Mecânica/etiologia , Lesão Pulmonar Induzida por Ventilação Mecânica/fisiopatologia
16.
PLoS One ; 15(3): e0230147, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32160252

RESUMO

OBJECTIVES: When patients with acute respiratory distress syndrome are moved out of an intensive care unit, the ventilator often requires changing. This procedure suppresses positive end expiratory pressure and promotes lung derecruitment. Clamping the endotracheal tube may prevent this from occurring. Whether or not such clamping maintains positive end-expiratory pressure has never been investigated. We designed a bench study to explore this further. HOW THE STUDY WAS DONE: We used the Elysee 350 ventilator in 'volume controlled' mode with a positive end-expiratory pressure of 15 cmH2O, connected to an endotracheal tube with an 8 mm internal diameter inserted into a lung model with 40 ml/cmH2O compliance and 10 cmH2O/L/s resistance. We measured airway pressure and flow between the distal end of the endotracheal tube and the lung model. We tested a plastic, a metal, and an Extra Corporeal Membrane Oxygenation clamp, each with an oral/nasal, a nasal, and a reinforced endotracheal tube. We performed an end-expiratory hold then clamped the endotracheal tube and disconnected the ventilator. We measured the change in airway pressure and volume for 30 s following the disconnection of the ventilator. RESULTS: Airway pressure decreased thirty seconds after disconnection with all combinations of clamp and endotracheal tube. The largest fall in airway pressure (-17.486 cmH2O/s at 5 s and -18.834 cmH2O/s at 30 s) was observed with the plastic clamp combined with the reinforced endotracheal tube. The smallest decrease in airway pressure (0 cmH2O/s at 5 s and -0.163 cmH2O/s at 30 s) was observed using the Extra Corporeal Membrane Oxygenation clamp with the nasal endotracheal tube. CONCLUSIONS: Only the Extra Corporeal Membrane Oxygenation clamp was efficient. Even with an Extra Corporeal Membrane Oxygenation clamp, it is important to limit the duration the ventilator is disconnected to a few seconds (ideally 5 s).


Assuntos
Intubação Intratraqueal/métodos , Respiração com Pressão Positiva/métodos , Respiração Artificial/métodos , Humanos , Unidades de Terapia Intensiva , Pulmão/fisiologia , Modelos Biológicos , Pressão , Troca Gasosa Pulmonar/fisiologia , Respiração , Mecânica Respiratória/fisiologia , Volume de Ventilação Pulmonar/fisiologia , Ventiladores Mecânicos
18.
J Sports Sci Med ; 19(1): 95-101, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32132832

RESUMO

The aim of this study was to investigate the circulatory, respiratory, and metabolic effects of induced hypercapnia via added respiratory dead space (ARDS) during moderate-intensity swimming in recreational swimmers. A mixed-sex sample of 22 individuals was divided into homogeneous experimental (E) and control (C) groups controlled for maximal oxygen uptake (VO2max). The intervention involved 50 min of front crawl swimming performed at 60% VO2max twice weekly for 6 consecutive weeks. ARDS was induced via tube breathing (1000 ml) in group E. An incremental exercise test was administered pre- and post-intervention to assess cardiorespiratory fitness (CRF) by measuring VO2max, carbon dioxide volume, respiratory minute ventilation, respiratory exchange ratio (RER), and heart rate at 50, 100, 150, 200 W and at maximal workload. Body mass index (BMI), fat mass (FM), and fat-free mass (FFM) were also measured. The mean difference in glycerol concentration (ΔGLY) was assessed after the first and last swimming session. No significant between-group differences were observed at post-intervention. No within-group differences were observed at post-intervention except for RER which increased in group E at maximal workload. A 6-week swimming intervention with ARDS did not enhance CRF. The RER increase in group E is not indicative of a substrate shift towards increased lipid utilization. No change in ΔGLY is evident of a lack of enhanced triglyceride hydrolyzation that was also confirmed by similar pre- and post-intervention BMI, FM, and FMM.


Assuntos
Aptidão Cardiorrespiratória , Metabolismo dos Lipídeos/fisiologia , Condicionamento Físico Humano/fisiologia , Espaço Morto Respiratório/fisiologia , Natação/fisiologia , Adulto , Índice de Massa Corporal , Dióxido de Carbono/fisiologia , Feminino , Glicerol/sangue , Frequência Cardíaca/fisiologia , Humanos , Masculino , Consumo de Oxigênio/fisiologia , Condicionamento Físico Humano/métodos , Troca Gasosa Pulmonar/fisiologia , Ventilação Pulmonar/fisiologia , Adulto Jovem
19.
J Surg Res ; 250: 88-96, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32028151

RESUMO

BACKGROUND: Ex vivo lung perfusion (EVLP) permits extended evaluation of donor lungs for transplant. However, the optimal EVLP duration of Lund protocol is unclear. Using human lungs rejected for clinical transplant, we sought to compare the results of 1 versus 2 h of EVLP using the Lund protocol. METHODS: Twenty-five pairs of human lungs rejected for clinical transplant were perfused with the Lund EVLP protocol. Blood gas analysis, lung compliance, bronchoscopy assessment, and perfusate cytokine analysis were performed at both 1 and 2 h. Recruitment was performed at both time points. Donor lung transplant suitability was determined at both time points. RESULTS: All cases were divided into four groups based on transplant suitability assessment at 1 h and 2 h of EVLP. In group A (n = 10), lungs were judged suitable for transplant at both 1 and 2 h of EVLP. In group B (n = 6), lungs were suitable at 1 h but nonsuitable at 2 h. In group C (n = 2), lungs were nonsuitable at 1 h but suitable at 2 h. Finally, in group D (n = 7), lungs were nonsuitable for transplant at both time points. In both groups B and C (n = 8), the transplant suitability assessment changed between 1 and 2 h of EVLP. CONCLUSIONS: In human lungs rejected for transplant, transplant suitability differed at 1 versus 2 h of EVLP in 32% of lungs studied. Evaluation of lungs with Lund protocol EVLP beyond 1 h may improve donor organ assessment.


Assuntos
Seleção do Doador/métodos , Transplante de Pulmão/normas , Pulmão/fisiologia , Perfusão , Transplantes/fisiologia , Adulto , Broncoscopia , Seleção do Doador/normas , Feminino , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Troca Gasosa Pulmonar/fisiologia , Fatores de Tempo , Transplantes/diagnóstico por imagem
20.
Res Q Exerc Sport ; 91(3): 478-487, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32004114

RESUMO

Purpose: This study analyzed the physiological response during Yo-Yo Intermittent Recovery Level 1 (YYIR1) test and re-test by in-field ergospirometry and time-series analyses of respiratory parameters. Methods: Ten moderately trained males (23.4 ± 2.01 years, VO2peak= 56.81 ± 10.75 mL·kg-1·min-1) completed three running trials including two separate YYIR1 tests and an independent maximal performance running test with time-series analyses of gas exchange parameters. Physiological response was assessed during all tests by determination of blood lactate levels (including calculation of individual lactate threshold), heart rate, oxygen consumption and respiratory exchange ratio (RER). Results: Modeling of YYIR1 test mean VO2 uptake kinetics over all participants revealed that VO2 increased rapidly after the individual lactate threshold (11.49 ± 0.66 km∙h-1 at 3.83 ± 0.42 mmol∙L-1) was reached with ~95% VO2peak at ~50% of the test duration (test, VO2 50%= 95.17 ± 8.74% of VO2peak; re-test, VO2 50%= 96.78 ± 7.04% of VO2peak). However, and despite identical YYIR1 test performance (1568 ± 364.6 m vs. 1568 ± 449.7 m, CV = 4.59%), mean VO2peak during YYIR1 test was 8.81 ± 5.6% higher than YYIR1 re-test (p = .027). Importantly, correlation of VO2peak with YYIR1 test performance was weak (R2 = 0.28, p = .115). Conclusions: We conclude that the YYIR1 test should not be used to estimate VO2peak. Further studies on direct determination of gas exchange parameters during different YYI test variants are warranted.


Assuntos
Teste de Esforço/métodos , Consumo de Oxigênio/fisiologia , Troca Gasosa Pulmonar/fisiologia , Corrida/fisiologia , Frequência Cardíaca/fisiologia , Humanos , Ácido Láctico/sangue , Estudos Longitudinais , Masculino , Reprodutibilidade dos Testes , Espirometria , Adulto Jovem
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