Relationship between motor-cognitive functions and hemodynamic response of individuals with chronic stroke during and after an acute bout of aerobic exercise / Relação entre as funções motoras cognitivas e a resposta hemodinâmica de indivíduos com AVC crônico durante e após uma sessão aguda de exercícios aeróbicos

BACKGROUNG: Individuals post-stroke commonly presents functional and cardiorespiratory deficits besides a physical inactivity lifestyle in the chronic phase of disease. Considering this, there is a hypothesis that hemodynamic responses could be affected by motor, cognitive and cardiorespiratory deficits during the aerobic exercise. In order to identify functional conditions that can influence the aerobic performance of these individuals, correlations between functional variables and hemodynamic responses during and after the aerobic exercise were studied. As a secondary purpose, the ability of return to hemodynamic resting state were also analyzedMETHODS: In this experimental study, after being evaluated about their motor and cognitive function, balance and prognosis, forty participants underwent a 30-minute aerobic exercise session on a treadmill. Training heart rate, arterial blood pressure, oxygen pulse saturation, heart rate, and respiratory rate were measured before begin the exercise session, every five minutes during the exercise and five minutes after itRESULTS: Cardiorespiratory parameters within normality limits in all phases of the exercise and the capacity of returning to the resting state were observed. Moderate inverse correlations were found between Berg Scale and oxygen pulse saturation (r =-0.401, p = 0.01), between MMSE and diastolic blood pressure (r = -0.406, p = 0.009), age and diastolic blood pressure (r = -0.435, p = 0.005) and between injury time and RR (r = -0.454, p = 0.003). Relationship between the lesion side and the 20 minutes phase of aerobic exercise was also observed (p = 0.042CONCLUSION: Post- stroke individuals present moderate correlation between hemodynamic and respiratory responses during aerobic exercise and balance, muscle strength, injury time, age and side of lesion. They also have the capacity to return to their cardiorespiratory and cardiovascular resting state right after the activity besides their cardiorespiratory deficits

INTRODUÇÃO: Indivíduos pós-AVC comumente apresentam déficits funcionais e cardiorrespiratórios, além de estilo de vida de inatividade física na fase crônica da doença. Diante disso, existe a hipótese de que as respostas hemodinâmicas possam ser afetadas por déficits motores, cognitivos e cardiorrespiratórios durante o exercício aeróbio. Para identificar as condições funcionais que podem influenciar o desempenho aeróbio desses indivíduos, foram estudadas as correlações entre as variáveis funcionais e as respostas hemodinâmicas durante e após o exercício aeróbio. Como objetivo secundário, a capacidade de retorno ao estado de repouso hemodinâmico também foi analisadaMÉTODO: Neste estudo experimental, após serem avaliados quanto à função motora e cognitiva, equilíbrio e prognóstico, quarenta participantes foram submetidos a uma sessão de exercício aeróbio de 30 minutos em esteira. A frequência cardíaca, pressão arterial, saturação periférica de oxigênio, frequência cardíaca e frequência respiratória de treinamento foram medidas antes do início da sessão de exercício, a cada cinco minutos durante o exercício e cinco minutos apósRESULTADOS: Foram observados parâmetros cardiorrespiratórios dentro dos limites da normalidade em todas as fases do exercício e capacidade de retorno ao estado de repouso. Correlações inversas moderadas foram encontradas entre Escala de Berg e saturação do pulso de oxigênio (r = -0,401, p = 0,01), entre MEEM e pressão arterial diastólica (r = -0,406, p = 0,009), idade e pressão arterial diastólica (r = -0,435, p = 0,005) e entre o tempo de lesão e FR (r = -0,454, p = 0,003). Também foi observada relação entre o lado da lesão e a fase de 20 minutos do exercício aeróbio (p = 0,042CONCLUSÃO: Indivíduos pós-AVE apresentam correlação moderada entre as respostas hemodinâmicas e respiratórias durante o exercício aeróbio e equilíbrio, força muscular, tempo de lesão, idade e lado da lesão. Eles também têm a capacidade de retornar ao estado de repouso cardiorrespiratório e cardiovascular logo após a atividade, apesar de seus déficits cardiorrespiratórios

Performance of the Pandemic Medical Early Warning Score (PMEWS), Simple Triage Scoring System (STSS) and Confusion, Uremia, Respiratory rate, Blood pressure and age ≥ 65 (CURB-65) score among patients with COVID-19 pneumonia in an emergency department triage setting: a retrospective study

ABSTRACT 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.

Subfenótipos baseados em dados clínicos de beira-leito de pacientes críticos com COVID-19: um estudo de coorte / Bedside clinical data subphenotypes of critically ill COVID-19 patients: a cohort study

RESUMO Objetivo: Identificar apresentações mais graves de COVID-19. Métodos: Pacientes consecutivamente admitidos à unidade de terapia intensiva foram submetidos à análise de clusters por meio de método de explorações sequenciais Resultados: Analisamos os dados de 147 pacientes, com média de idade de 56 ± 16 anos e Simplified Acute Physiological Score 3 de 72 ± 18, dos quais 103 (70%) demandaram ventilação mecânica e 46 (31%) morreram na unidade de terapia intensiva. A partir do algoritmo de análise de clusters, identificaram-se dois grupos bem definidos, com base na frequência cardíaca máxima [Grupo A: 104 (IC95% 99 - 109) batimentos por minuto versus Grupo B: 159 (IC95% 155 - 163) batimentos por minuto], frequência respiratória máxima [Grupo A: 33 (IC95% 31 - 35) respirações por minuto versus Grupo B: 50 (IC95% 47 - 53) respirações por minuto] e na temperatura corpórea máxima [Grupo A: 37,4 (IC95% 37,1 - 37,7)ºC versus Grupo B: 39,3 (IC95% 39,1 - 39,5)ºC] durante o tempo de permanência na unidade de terapia intensiva, assim como a proporção entre a pressão parcial de oxigênio no sangue e a fração inspirada de oxigênio quando da admissão à unidade de terapia intensiva [Grupo A: 116 (IC95% 99 - 133) mmHg versus Grupo B: 78 (IC95% 63 - 93) mmHg]. Os subfenótipos foram distintos em termos de perfis inflamatórios, disfunções orgânicas, terapias de suporte, tempo de permanência na unidade de terapia intensiva e mortalidade na unidade de terapia intensiva (com proporção de 4,2 entre os grupos). Conclusão: Nossos achados, baseados em dados clínicos universalmente disponíveis, revelaram dois subfenótipos distintos, com diferentes evoluções de doença. Estes resultados podem ajudar os profissionais de saúde na alocação de recursos e seleção de pacientes para teste de novas terapias.

Abstract Objective: To identify more severe COVID-19 presentations. Methods: Consecutive intensive care unit-admitted patients were subjected to a stepwise clustering method. Results: Data from 147 patients who were on average 56 ± 16 years old with a Simplified Acute Physiological Score 3 of 72 ± 18, of which 103 (70%) needed mechanical ventilation and 46 (31%) died in the intensive care unit, were analyzed. From the clustering algorithm, two well-defined groups were found based on maximal heart rate [Cluster A: 104 (95%CI 99 - 109) beats per minute versus Cluster B: 159 (95%CI 155 - 163) beats per minute], maximal respiratory rate [Cluster A: 33 (95%CI 31 - 35) breaths per minute versus Cluster B: 50 (95%CI 47 - 53) breaths per minute], and maximal body temperature [Cluster A: 37.4 (95%CI 37.1 - 37.7)°C versus Cluster B: 39.3 (95%CI 39.1 - 39.5)°C] during the intensive care unit stay, as well as the oxygen partial pressure in the blood over the oxygen inspiratory fraction at intensive care unit admission [Cluster A: 116 (95%CI 99 - 133) mmHg versus Cluster B: 78 (95%CI 63 - 93) mmHg]. Subphenotypes were distinct in inflammation profiles, organ dysfunction, organ support, intensive care unit length of stay, and intensive care unit mortality (with a ratio of 4.2 between the groups). Conclusion: Our findings, based on common clinical data, revealed two distinct subphenotypes with different disease courses. These results could help health professionals allocate resources and select patients for testing novel therapies.

Cardiac Autonomic Modulation of Healthy Individuals and Patients with Chronic Obstructive Pulmonary Disease During Spontaneous and Controlled Breathing

Abstract Background: Lung diseases and different forms of breathing may interfere with cardiac autonomic modulation (CAM). Objective: To compare CAM in individuals with chronic obstructive pulmonary disease (COPD) with healthy individuals during spontaneous breathing (SB) and controlled breathing (CB). Methods: Cross-sectional study involving 30 individuals selected by convenience, divided into COPD group (n = 19) and control group (CG; n = 12). All participants were submitted to heart beat recordings during five minutes at rest (SB) and another five minutes during CB performed at six cycles/min. CAM was made by assessment of the heart rate variability (HRV) through time domain (TD) and frequency domain (FD). Comparisons between groups were performed by Mann Whitney test, and significance level was set at p < 0.05. Results: During SB, HRV TD and FD indices were higher in the controls than in the COPD group, respectively - RR intervals (53.2 ms versus 36.6 ms), RMSSD (42.1 ms versus 26.6 ms) (p < 0.05), total power (28322.8 ms2/Hz versus 2011.6 ms2/Hz), and high-frequency band (800.5 ms(2) versus 330.7 ms2). During CB, the CG also showed higher values for the TD parameters pNN50 (11.7% versus 5.1%), RMSSD (48.3 ms versus 26.7 ms), and SD of RRi (64.9 ms versus 44.7 ms), as well as for the low-frequency component of FD analysis (2848.6 ms2 versus 1197.9 ms2). Conclusion: COPD patients have different CAM when compared with healthy individuals during spontaneous (SB) and controlled breathing (CB).

O uso do canto como terapêutica na reabilitação respiratória em idosos institucionalizados / The use of singing as a therapeutic in respiratory rehabilitation in institutionalized elderly / El uso del canto como terapéutica en la rehabilitación respiratoria en los ancianos institucionalizados

Objetivo: avaliar os efeitos do canto na função respiratória, cardíaca e qualidade de vida em idosos institucionalizados. Método: pesquisa quase experimental e sem grupo controle, com a avaliação de 11 idosos institucionalizados no tempo 0 (pré aplicação) e no tempo 1 (pós aplicação) entre maio a agosto de 2017. As variáveis analisadas foram: função respiratória (capacidade inspiratória, obstrução das vias aéreas, expansibilidade torácica e saturação periférica de oxigênio), função cardíaca (pressão arterial e frequência cardíaca), função neurológica (mini exame do estado mental) e a qualidade de vida (escala de qualidade de vida de Flanagan). Resultados: houve melhora significativa na capacidade inspiratória (p= 0,001) e nos valores de obstrução das vias aéreas (p = 0,008). Conclusão: o canto é uma atividade coadjuvante no tratamento fisioterapêutico para mobilizar volumes, capacidades pulmonares e diminuir obstrução do fluxo aéreo atenuando os efeitos da senescência em idosos institucionalizados.(AU)

Objective: to evaluate the effects of singing in respiratory and cardiac functions and quality of life in institutionalized elderly. Method: almost experimental and non-control group, with the evaluation of 11 institutionalized elderly at time 0 (pre-application) and at time 1 (post application) between May and August 2017. The variables analyzed were respiratory function (inspiratory capacity, airway obstruction, thoracic expandability and peripheral oxygen saturation), cardiac function (blood pressure and heart rate), neurological function (mini mental status examination), and quality of life (quality of life scale of Flanagan). Results: there was a significant improvement in the respiratory capacity (p= 0,001) and airways obstruction values (p= 0,008). Conclusion: singing is a supporting activity in the physiotherapy treatment to mobilize volumes, pulmonary capacities and decrease airflow obstruction attenuating senescence's effects in institutionalized elderly.(AU)

Objetivo: evaluar los efectos del canto en la función respiratoria, cardiaca y calidad de vida en ancianos institucionalizados. Método: investigación casi experimental y sin grupo control, con la evaluación de 11 ancianos institucionalizados en el tiempo 0 (pre-aplicación) y en el tiempo 1 (post aplicación) entre mayo a agosto de 2017. Las variables analizadas fueron: función respiratoria (capacidad inspiratoria, obstrucción de las mismas las vías aéreas, la expansibilidad torácica y la saturación periférica de oxígeno), la función cardiaca (presión arterial y frecuencia cardíaca), la función neurológica (mini examen del estado mental) y la calidad de vida (escala de calidad de vida de Flanagan). Resultados: hubo una mejora significativa en la capacidad inspiratoria (p = 0,001) y en los valores de obstrucción de las vías aéreas (p = 0,008). Conclusión: el canto es una actividad coadyuvante en el tratamiento fisioterapéutico para movilizar volúmenes y capacidades pulmonares y disminuir obstrucción del flujo aéreo atenuando los efectos de la senescencia en ancianos institucionalizados.(AU)

Study of chronic diseases (Edoc): methodological aspects / Estudo das doenças crônicas (Edoc): aspectos metodológicos

ABSTRACT OBJECTIVE: Describe the sampling design and other methodological aspects of the Study of Chronic Diseases (Edoc). METHODS: Edoc comprises two household surveys with distinct populations, one with adults aged 18 to 59 years (Edoc-A) and another with older adults aged 60 years or more (Edoc-I), living in Rio Branco, Acre. The selection of the participants used complex samples by clusters in two stages of selection, census enumeration areas (CEA) and household. In the first stage, common to both surveys, 40 CEAs were selected with probability proportional to size, and in the second stage, independent for each survey, households were selected with equal probability, and all the residents eligible for each survey were selected. Sampling weights were estimated by the inverse of the product of inclusion probabilities at each stage and then calibrated to produce unbiased population estimates. Interviews were held with questionnaires about socioeconomic and demographic conditions, life habits and health conditions. Anthropometric measures focused on measures of body height, girths and mass, while the vital signs analyzed were blood pressure, heart rate and respiratory rate. Blood and urine samples were collected for analysis. RESULTS: The Edoc comprised 1,701 participants, 685 of Edoc-A and 1,016 of Edoc-I. Considering the loss of information of some participants and the need of studying specific themes with production of population inferences, 16 subsamples of complete information by theme were generated and two subsamples were exclusive of Edoc-I. CONCLUSIONS: The Edoc has as important developments the analyses of epidemiological profile of the population from the capital of the state of Acre, contributing to the production of knowledge in public health with useful information for decisions in public health policies.

RESUMO OBJETIVO: Descrever o desenho amostral e os demais aspectos metodológicos do Estudo das Doenças Crônicas (Edoc). MÉTODOS: O Edoc compreende duas pesquisas domiciliares com populações distintas, uma com adultos de 18 a 59 anos (Edoc-A) e outra com idosos de 60 anos ou mais (Edoc-I), residentes em Rio Branco, Acre. A seleção dos participantes usou amostras complexas por conglomerados em dois estágios de seleção, setor censitário e domicílio. No primeiro estágio, comum às duas pesquisas, foram selecionados 40 setores censitários com probabilidade proporcional ao tamanho, e no segundo estágio, independente para cada pesquisa, foram selecionados os domicílios com equiprobabilidade, sendo todos os residentes elegíveis para cada pesquisa selecionados. Os pesos amostrais foram calculados pelo inverso do produto das probabilidades de inclusão em cada estágio e posteriormente calibrados para produzir inferências populacionais. Foram realizadas entrevistas com questionários sobre condições socioeconômicas e demográficas, hábitos de vida e condições de saúde. Mensurações antropométricas centraram-se em medidas de estatura, massa e perímetros corporais, enquanto os sinais vitais analisados foram pressão sanguínea, frequência cardíaca e frequência respiratória. Amostras de sangue e urina foram coletadas para análise em laboratório especializado. RESULTADOS: O Edoc compreendeu 1.701 participantes, 685 do Edoc-A e 1.016 do Edoc-I. Considerando a perda de informação pontual de alguns participantes e a necessidade do estudo de temas específicos com produção de inferências populacionais, foram realizadas 16 subamostras de informações completas por tema de análise, sendo duas exclusivas do Edoc-I. CONCLUSÕES: O Edoc tem como desdobramentos importantes as análises do perfil epidemiológico da população da capital do estado do Acre, contribuindo para a produção de conhecimentos em saúde coletiva com informações úteis para decisões em políticas públicas de saúde.

Influence of expiratory positive airway pressure on cardiac autonomic modulation at rest and in submaximal exercise in COPD patients

The aim of this study was to evaluate the effect of expiratory positive airway pressure (EPAP) on heart rate variability (HRV) indices at rest and during 6-min walk test (6MWT) in chronic obstructive pulmonary disease (COPD) patients. Fifteen moderate to severe COPD patients were randomized and evaluated with and without (Non-EPAP) a 5 cmH2O EPAP device. Respiratory rate (RR) was collected at rest (5 min), during the 6MWT (5 min), and at recovery (5 min). Indices of HRV were computed in the time domain, in the frequency domain, and nonlinear analysis. For EPAP and Non-EPAP during the 6MWT, we found an increased mean heart rate (HR) (P=0.001; P=0.001) while mean RR (P=0.001; P=0.015) and RR tri index decreased (P=0.006; P=0.028). Peripheral oxygen saturation (P=0.019) increased at rest only in the EPAP group. In EPAP, correlations were found between forced expiratory volume in 1 s (FEV1) and low frequency (LF) sympathetic tonus (P=0.05; r=-0.49), FEV1 and high frequency (HF) parasympathetic tonus at rest (P=0.05; r=0.49), lactate at rest and LF during the 6MWT (P=0.02; r=-0.57), and lactate at rest and HF during 6MWT (P=0.02; r=0.56). Through a linear regression model, we found that lactate at rest explained 27% of the alterations of LF during 6MWT. The use of 5 cmH2O EPAP improved autonomic cardiac modulation and its complexity at rest in COPD patients. Although it did not influence the performance of the 6MWT, the EPAP device caused alterations in resting lactate concentration with an effect on sympatho-vagal control during the test.

Chronotropic incompetence in Chagas disease: effectiveness of blended sensor (volume/minute and accelerometer) / Competência cronotrópica em chagásicos: eficácia do duplo sensor (volume/minuto e acelerômetro)

AbstractIntroduction:Technological progress of pacemakers has allowed the association of two or more sensors in one heart rate system response. The accelerometer sensor measures the intensity of the activity; it has a relatively rapid response to the beginning of it, however, it may present insufficient response to less strenuous or of less impact exercise. The minute ventilation sensor changes the pacing rate in response to changes in respiratory frequency in relation to tidal volume, allowing responses to situations of emotional stress and low impact exercises.Objective:To evaluate the cardiorespiratory response of the accelerometer with respect to the blended sensor (BS=accelerometer sensor+minute ventilation sensor) to exercise in chagasic patients undergoing cardiopulmonary exercise test.Methods:This was a prospective, observational, randomized, cross-sectional study. Patients who met the inclusion criteria were selected. The maximum heart rate of the sensor was programmed by age (220-age). The results were analyzed through t test with paired samples (P<0.05).Results:Sample was comprised of 44 patients, with a mean age of 66±10.4 years, 58% were female, 54% as first implant, in 74% were functional class I and 26% were functional class II, left ventricular ejection fraction was 58±7. As for the cardiopulmonary test, maximum expected heart rate and VO2 were not achieved in both the accelerometer sensor and the blended sensor, however, metabolic equivalent in the blended sensor was higher than the expected, all data with P<0.001.Conclusion:Even though the maximal heart rate was not reached, the blended sensor provided a physiological electrical sequence when compared to the accelerometer sensor, providing better physical fitness test in cardiopulmonary hemodynamics and greater efficiency.

ResumoIntrodução:O progresso tecnológico dos marca passos permitiu a associação de dois ou mais sensores em um único sistema de resposta de frequência cardíaca. O sensor acelerômetro afere a intensidade da atividade, possui uma resposta relativamente rápida ao início da mesma, porém pode apresentar respostas insuficientes a exercícios físicos menos intensos ou de menor impacto. O sensor volume-minuto altera a taxa de estimulação cardíaca em resposta à variação da frequência respiratória quanto ao volume corrente, permitindo, assim, respostas a situações de estresse emocional e exercícios de baixo impacto.Objetivo:Avaliar a resposta cardiorrespiratória do acelerômetro em relação ao duplo sensor ao exercício em pacientes chagásicos submetidos ao teste ergoespirométrico.Métodos:Pesquisa prospectiva, observacional, randomizada e cruzada. Foram selecionados pacientes que preenchiam os critérios de inclusão. A frequência cardíaca máxima do sensor foi programada por idade (220-idade). Os resultados obtidos foram analisados pelo Teste T com amostras pareadas (P<0,05).Resultados:Amostra de 44 pacientes, com idade média de 66±10,4, com 58% do sexo feminino, 54% como primeiro implante, classe funcional I em 74% e II em 26%, fração de ejeção do ventrículo esquerdo de 58±7. Quanto ao ergoespirométrico, a frequência cardíaca máxima prevista e a VO2 máxima prevista não foram atingidas tanto no sensor acelerômetro quanto no sensor volume-minuto, contudo, o equivalente metabólico no sensor volume- minuto foi superior à prevista, todos os dados com P<0,001.Conclusão:Apesar da frequência cardíaca máxima não ter sido atingida, o duplo sensor proporcionou uma sequência elétrica mais fisiológica quando comparado ao sensor acelerômetro.

Validation of the Portuguese version of the Evidence-Based Practice Questionnaire / Validação da versão portuguesa do Questionário de Eficácia Clínica e Prática Baseada em Evidências / Validación de la versión portuguesa del Cuestionario de Eficacia Clínica y Práctica Basada en Evidencias

OBJECTIVES: to describe the process of translation and linguistic and cultural validation of the Evidence Based Practice Questionnaire for the Portuguese context: Questionário de Eficácia Clínica e Prática Baseada em Evidências (QECPBE). METHOD: a methodological and cross-sectional study was developed. The translation and back translation was performed according to traditional standards. Principal Components Analysis with orthogonal rotation according to the Varimax method was used to verify the QECPBE's psychometric characteristics, followed by confirmatory factor analysis. Internal consistency was determined by Cronbach's alpha. Data were collected between December 2013 and February 2014. RESULTS: 358 nurses delivering care in a hospital facility in North of Portugal participated in the study. QECPBE contains 20 items and three subscales: Practice (α=0.74); Attitudes (α=0.75); Knowledge/Skills and Competencies (α=0.95), presenting an overall internal consistency of α=0.74. The tested model explained 55.86% of the variance and presented good fit: χ2(167)=520.009; p = 0.0001; χ2df=3.114; CFI=0.908; GFI=0.865; PCFI=0.798; PGFI=0.678; RMSEA=0.077 (CI90%=0.07-0.08). CONCLUSION: confirmatory factor analysis revealed the questionnaire is valid and appropriate to be used in the studied context. .

OBJETIVOS: descrever o processo de tradução e validação linguística e cultural para o contexto português do Questionário de Eficácia Clínica e Prática Baseada em Evidências (QECPBE). MÉTODO: desenvolveu-se um estudo metodológico e transversal. Foi efetuada tradução e retroversão, de acordo com os padrões usuais. Na determinação das características psicométricas do QECPBE utilizou-se a Análise de Componentes Principais com rotação ortogonal, segundo o método Varimax, seguida de análise fatorial confirmatória. A consistência interna foi determinada pelo valor alfa de Cronbach. A coleta de dados ocorreu entre dezembro de 2013 e fevereiro de 2014. RESULTADOS: participaram 358 enfermeiros que exercem a prática clínica num centro hospitalar do norte de Portugal. O QECPBE apresenta 20 itens e três subescalas: Práticas (α=0,74); Atitudes (α=0,75); Conhecimentos/Habilidades e Competências (α=0,95), apresentando consistência interna global de α=0,74. No modelo testado obteve-se variância explicada de 55,86%. O modelo demonstrou um bom ajuste: χ2(167)=520,009; p=0,0001; χ2df=3,114; CFI=0,908; GFI=0,865; PCFI=0,798; PGFI=0,678; RMSEA=0,077 (IC90%=0,07-0,08). CONCLUSÃO: através da análise fatorial confirmatória realizada demonstrou-se que o questionário é válido e adequado para utilização no contexto estudado. .

OBJETIVOS: describir el proceso de traducción y validación lingüística y cultural para el contexto portugués del Cuestionario de Eficacia Clínica y Práctica Basada en Evidencias (CECPBE). MÉTODO: se desarrolló un estudio metodológico y transversal. Fue efectuada traducción y retroversión de acuerdo con los estándares usuales. En la determinación de las características psicométricas del CECPBE se utilizó el Análisis de Componentes Principales con rotación ortogonal, según el método Varimax, seguido por análisis factorial confirmatorio. La consistencia interna fue determinada por el valor alfa de Cronbach. La recolección de datos ocurrió entre diciembre de 2013 y febrero de 2014. RESULTADOS: participaron 358 enfermeros que ejercían la práctica clínica en un centro hospitalario en el norte de Portugal. El CECPBE presenta 20 ítems y tres subescalas: Prácticas (α=0,74); Actitudes (α=0,75); Conocimientos/Habilidades y Competencias (α=0,95), presentando consistencia interna global de α=0,74. En el modelo probado se obtuvo variancia explicada de 55,86%. El modelo demostró un buen ajuste: χ2(167)=520,009; p=0,0001; χ2df=3,114; CFI=0,908; GFI=0,865; PCFI=0,798; PGFI = 0,678; RMSEA = 0,077 (IC90%=0,07-0,08). CONCLUSIÓN: a través del análisis factorial confirmatorio se demostró que el cuestionario es válido y adecuado para utilización en el contexto estudiado. .

Hospitalización diurna como modelo de atención de salud en pacientes adultos inmunocompetentes con neumonía adquirida en la comunidad / Respiratory day hospital care for immunocompetent adult patients with community-acquired pneumonia

Background: Day hospitals can reduce health care costs without increasing the risks of patients with lower respiratory tract infection. Aim: To report the experience of a respiratory day hospital care delivered to adult patients with community-acquired pneumonia (CAP) in a public hospital. Material and Methods: During the fall and winter of 2011 and 2012, adult patients with CAP of intermediate risk categories were assessed in the emergency room, their severity was stratified according to confusion, respiratory rate, blood pressure, 65 years of age or older (CRB-65) score and the Chilean CAP Clinical Guidelines, and were admitted to the respiratory day hospital. Results: One hundred seventeen patients aged 67 ± 16 years, (62% females) with CAP were attended in the respiratory day hospital. Ninety percent had comorbidities, especially chronic obstructive pulmonary disease in 58%, heart disease in 32%, diabetes in 16% and asthma in 13%. Their most important risk factors were age over 65 years in 60%, comorbidities in 88%, failure of antibiotic treatment in 17%, loss of autonomy in 21%, vital sign abnormalities in 60%, mental confusion in 5%, multilobar CAP in 23%, pleural effusion in 15%, hypoxemia in 41% and a serum urea nitrogen over 30 mg/dL in 16%. Patients stayed an average of seven days in the day hospital with oxygen, hydration, chest physiotherapy and third-generation cephalosporins (89%) associated with quinolones (52%) or macrolides (4%). Thirteen patients required noninvasive ventilation, eight patients were hospitalized because of clinical deterioration and three died in hospital. Conclusions: Day hospital care reduced hospital admission rates of patients with lower respiratory tract infections.

Preoperative therapy restores ventilatory parameters and reduces length of stay in patients undergoing myocardial revascularization / Fisioterapia pré-operatória restabelece parâmetros ventilatórios e reduz tempo de internação após revascularização do miocárdio

Introduction: The frequency of surgical procedures has increased steadily in recent decades, including the myocardial revascularization. Objectives: To demonstrate the importance of physiotherapy in the preoperative period of cardiac surgery in relation to the reduction of hospital stay, changes in lung volumes and respiratory muscle strength. Methods: We conducted a prospective study with patients undergoing myocardial revascularization, the Hospital das Clínicas da Universidade Estadual Paulista (UNESP)/Botucatu - SP. We evaluated 70 patients of both genders, aged between 40 and 75 years, subdivided into two groups: group I - 35 patients of both genders, who received a written protocol guidance, breathing exercises and respiratory muscle training in the preoperative period and group II - 35 patients of both genders, who received only orientation of the ward on the day of surgery. This study was approved by the Ethics Committee of UNESP / Botucatu - SP. Results: Maximal inspiratory pressure in third postoperative day and fifth postoperative day and significant difference between groups, being better for the intervention group. Expiratory pressure was significant in fifth postoperative day in the intervention group compared to controls. The difference of length of hospital stay in the postoperative was found between the groups with shorter hospital stay in the group receiving preoperative therapy. Conclusion: Physical therapy plays an important role in the preoperative period, so that individuals in the intervention group more readily restored the parameters evaluated before surgery, in addition, there was a decrease in the time of the postoperative hospital stay. Thus, it is thought the cost-effectiveness of a program of preoperative physiotherapy. .

Introdução: Procedimentos cirúrgicos aumentaram progressivamente nas últimas décadas, inclusive a revascularização do miocárdio(RM). Objetivos: Demonstrar a importância da fisioterapia no préoperatório de cirurgia cardíaca, em relação à redução do tempo de internação hospitalar, alteração de volumes pulmonares e força muscular respiratória. Métodos: Foi realizado estudo clínico prospectivo, com pacientes submetidos à revascularização do miocárdio, no Hospital das Clínicas da Universidade Estadual PaulistaUNESP / Botucatu - SP. Foram avaliados 70 pacientes de ambos os gêneros, com faixa etária entre 40 a 75 anos, randomizados por meio programa computadorizado em dois grupos: Grupo I - 35 pacientes de ambos os sexos, que receberam um protocolo de orientação por escrito, exercícios respiratórios e treinamento muscular respiratório no pré-operatório e Grupo II - 35 pacientes de ambos os gêneros, que receberam apenas orientação de rotina da enfermaria no dia da cirurgia. Trabalho foi aprovado pelo Comitê de Ética da Universidade Estadual PaulistaUNESP / Botucatu - SP. Resultados: A avaliação das pressões inspiratórias máximas evidenciou aumento significativo no terceiro dia pós-operatório e quinto dia pós-operatório para o grupo de intervenção e análise das pressões expiratórias máximas apresentou valores significativos apenas no quinto dia pós-operatório para o grupo intervenção em relação ao grupo controle, observando-se ainda que o grupo submetido ao protocolo de tratamento fisioterapêutico pré-operatório apresentou menor tempo de internação hospitalar. Conclusão: A fisioterapia ...

Pressure support-ventilation versus spontaneous breathing with "T-Tube" for interrupting the ventilation after cardiac operations / Pressão de suporte ventilatório versus respiração espontânea em "Tubo-T" para a interrupção da ventilação após as operações cardíacas

OBJECTIVE: To compare pressure-support ventilation with spontaneous breathing through a T-tube for interrupting invasive mechanical ventilation in patients undergoing cardiac surgery with cardiopulmonary bypass. METHODS: Adults of both genders were randomly allocated to 30 minutes of either pressure-support ventilation or spontaneous ventilation with "T-tube" before extubation. Manovacuometry, ventilometry and clinical evaluation were performed before the operation, immediately before and after extubation, 1h and 12h after extubation. RESULTS: Twenty-eight patients were studied. There were no deaths or pulmonary complications. The mean aortic clamping time in the pressure support ventilation group was 62 ± 35 minutes and 68 ± 36 minutes in the T-tube group (P=0.651). The mean cardiopulmonary bypass duration in the pressure-support ventilation group was 89 ± 44 minutes and 82 ± 42 minutes in the T-tube group (P=0.75). The mean Tobin index in the pressure support ventilation group was 51 ± 25 and 64.5 ± 23 in the T-tube group (P=0.153). The duration of intensive care unit stay for the pressure support ventilation group was 2.1 ± 0.36 days and 2.3 ± 0.61 days in the T-tube group (P=0.581). The atelectasis score in the T-tube group was 0.6 ± 0.8 and 0.5 ± 0.6 (P=0.979) in the pressure support ventilation group. The study groups did not differ significantly in manovacuometric and ventilometric parameters and hospital evolution. CONCLUSION: The two trial methods evaluated for interruption of mechanical ventilation did not affect the postoperative course of patients who underwent cardiac operations with cardiopulmonary bypass.

OBJETIVO: Comparar a pressão de suporte ventilatório com a respiração espontânea em "Tubo-T" para interrupção da ventilação invasiva em pacientes submetidos à operação cardíaca. MÉTODOS: Adultos de ambos os sexos foram alocados para pressão de suporte ventilatório por 30 minutos ou o mesmo período de ventilação espontânea com "Tubo-T" antes da extubação. Realizou-se manovacuometria, ventilometria e avaliação clínica antes da operação, imediatamente antes e após a extubação, 1h e 12h após extubação. RESULTADOS: Vinte e oito pacientes foram estudados. Não ocorreram mortes ou complicações respiratórias. O tempo de pinçamento da aorta no grupo suporte ventilatório foi 62 ± 35 minutos e de 68 ± 36 minutos para o "Tubo-T" (P=0,651). O tempo de CEC no grupo suporte ventilatório foi 89 ± 44 minutos e para o "Tubo-T" de 82 ± 42 minutos (P=0,75). O índice de Tobin para o grupo suporte ventilatório foi 51 ± 25 e para o grupo "Tubo-T", 64,5 ± 23 (P=0,153). O tempo na unidade de terapia intensiva para o grupo suporte ventilatório foi 2,1 ± 0,36 dias e para o grupo "Tubo-T", 2,3±0,61 dias (P=0,581). O escore de atelectasia para o grupo "Tubo-T" foi 0,6 ± 0,8 e para o suporte ventilatório foi 0,5 ± 0,6 (P=0,979). Não houve diferença significativa na evolução clínica e nos valores de gasometria, manovacuometria e ventilometria entre ambos os grupos. CONCLUSÃO: O método utilizado para testar a adequação da interrupção da ventilação mecânica invasiva não afetou a evolução pós-operatória dos pacientes submetidos a operações cardíacas com circulação extracorpórea.

Clinical and fiberoptic endoscopic assessment of swallowing in patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease is characterized by progressive and partially reversible obstruction of pulmonary airflow. AIM: To characterize swallowing in patients with chronic obstructive pulmonary disease and correlate the findings with the degree chronic obstructive pulmonary disease, heart and respiratory rate, oxygen saturation, and smoking. METHOD: We conducted a prospective cohort study of 19 patients (12 men and 7 women; age range, 50-85 years) with confirmed medical diagnosis of chronic obstructive pulmonary disease. This study was performed in 2 stages (clinical evaluation and functional assessment using nasolaryngofibroscopy) on the same day. During both stages, vital signs were checked by medical personnel. RESULTS: Clinical evaluation of swallowing in all patients showed the clinical signs of cough. The findings of nasolaryngofibroscopy highlighted subsequent intraoral escape in 5 patients (26.5%). No patient had tracheal aspiration. There was no association of subsequent intraoral escape with degree of chronic obstructive pulmonary disease, heart and respiratory rate, oxygen saturation, or smoking. CONCLUSION: In patients with chronic obstructive pulmonary disease, there was a prevalence of oral dysphagia upon swallowing and nasolaryngofibroscopy highlighted the finding of subsequent intraoral escape. There was no correlation between intraoral escape and the degree of chronic obstructive pulmonary disease, heart and respiratory rate, oxygen saturation, or smoking...

The panic disorder respiratory ratio: a dimensional approach to the respiratory subtype

OBJECTIVE: The respiratory ratio is a dimensional construct of the respiratory subtype of panic disorder (PD). The respiratory subtype has been correlated with an increased sensitivity to CO2 inhalation, positive family history of PD and low comorbidity with depression. The objective of our study was to determine whether the respiratory ratio is correlated with CO2-induced panic attacks and other clinical and demographic features. METHODS: We examined 91 patients with PD and submitted them to a double-breath 35% CO2 challenge test. The respiratory ratio was calculated based on the Diagnostic Symptom Questionnaire (DSQ) scores recorded in a diary in the days preceding the CO2 challenge. The scores of the respiratory symptoms were summed and divided by the total DSQ score. RESULTS: The respiratory ratio was correlated with CO2 sensitivity, and there was a non-statistically significant trend towards a correlation with a family history of PD. CONCLUSIONS: The positive correlation between the respiratory ratio and the anxiety elicited by the CO2 inhalation indicates that the intensity of respiratory symptoms may be proportional to the sensitivity to carbon dioxide.

Deep breathing heart rate variability is associated with respiratory muscle weakness in patients with chronic obstructive pulmonary disease

BACKGROUND: A synchronism exists between the respiratory and cardiac cycles. However, the influence of the inspiratory muscle weakness in chronic obstructive pulmonary disease (COPD) on cardiac autonomic control is unknown. The purpose of the present investigation was to evaluate the influence of respiratory muscle strength on autonomic control in these patients. METHODS: Ten chronic obstructive pulmonary disease patients (69±9 years; FEV1/FVC 59±12 percent and FEV1 41±11 percent predicted) and nine age-matched healthy volunteers (64±5 years) participated in this study. Heart-rate variability (HRV) was obtained at rest and during respiratory sinusal arrhythmia maneuver (RSA-M) by electrocardiograph. RESULTS: Chronic obstructive pulmonary disease patients demonstrated impaired cardiac autonomic modulation at rest and during RSA-M when compared with healthy subjects (p<0.05). Moreover, significant and positive correlations between maximal inspiratory pressure (MIP) and the inspiratory-expiratory difference (ΔIE) (r = 0.60, p<0.01) were found. CONCLUSION: Patients with chronic obstructive pulmonary disease presented impaired sympathetic-vagal balance at rest. In addition, cardiac autonomic control of heart rate was associated with inspiratory muscle weakness in chronic obstructive pulmonary disease. Based on this evidence, future research applications of respiratory muscle training may bring to light a potentially valuable target for rehabilitation.