Navegando por Palavras-chave "Respiratory function tests"

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    Alterações espirométricas em doenças obstrutivas: afinal, o quanto é relevante?
    (Sociedade Brasileira de Pneumologia e Tisiologia, 2013-02-01) Soares, André Luis Pinto; Pereira, Carlos Alberto de Castro [UNIFESP]; Rodrigues, Silvia Carla Sousa [UNIFESP]; Universidade Federal do Rio Grande do Norte; Universidade Federal de São Paulo (UNIFESP); Hospital do Servidor Público Estadual de São Paulo
    OBJECTIVE: To establish the upper limits for changes in FEV1, slow vital capacity (SVC), FVC, and inspiratory capacity (IC) after placebo administration in patients with airflow obstruction. METHODS: One hundred and two adults with airflow obstruction (FEV1 = 62 ± 19% of predicted) were included in the study. All of the participants performed SVC and FVC maneuvers before and after the administration of placebo spray. The changes in FEV1, SVC, FVC, and IC were expressed as absolute values, percentage of change from baseline values, and percentage of predicted values, 95% CIs and 95th percentiles being calculated. Factor analysis was performed in order to determine how those changes clustered. RESULTS: Considering the 95% CIs and 95th percentiles and after rounding the values, we found that the upper limits for a significant response were as follows: FEV1 = 0.20 L, FVC = 0.20 L, SVC = 0.25 L, and IC = 0.30 L (expressed as absolute values); FEV1 = 12%, FVC = 7%, SVC = 10%, and IC = 15% (expressed as percentage of change from baseline values); and FEV1 = 7%, FVC = 6%, SVC = 7%, and IC = 12% (expressed as percentage of predicted values). CONCLUSIONS: In patients with airflow obstruction, IC varies more widely than do FVC and SVC. For IC, values greater than 0.30 L and 15% of change from the baseline value can be considered significant. For FVC, values greater than 0.20 L and 7% of change from the baseline value are significant. Alternatively, changes exceeding 0.20 L and 7% of the predicted value can be considered significant for FEV1 and FVC. On factor analysis, spirometric parameters clustered into three dimensions, expressing changes in flows, volumes, and dynamic hyperinflation.
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    Avaliação da capacidade funcional de exercício de pacientes com escoliose idiopática do adolescente no pós-operatório tardio
    (Universidade Federal de São Paulo (UNIFESP), 2015-09-10) Araujo, Geferson da Silva [UNIFESP]; Vidotto, Milena Carlos [UNIFESP]; http://lattes.cnpq.br/0334734747375995; http://lattes.cnpq.br/0206111611571178; Universidade Federal de São Paulo (UNIFESP)
    Patients with Adolescent Idiopathic Scoliosis (AIS) show reduced exercise functional capacity during the Incremental Shuttle Walk Test (ISWT), however, the effect of surgical procedure about this test isn?t known. Objective: To evaluate the Incremental Shuttle Walk Distance (ISWD) and physiological responses during ISWT in AIS patients in the late postoperative period. Simultaneously, we aimed to assess the respiratory muscle strength, lung function and to correlate the variables with Cobb angles. Methods: This study included twenty two adolescents with AIS in AIS Group (AG) and twenty one healthy subjects in Control Group (CG). In the first instance we evaluated: maximal inspiratory and expiratory pressures (MIP and MEP), forced vital capacity (FVC) and forced expiratory volume in one second (FEV1). Two ISWT were performed, but only second ISWD was analised. During the second test was used a gas analyzer to assess: Peak oxigen uptake (VO2), carbon dioxide output (VCO2), tidal volume (VT), respiratory rate (RR), heart rate (HR) and relations. Results: Significantly lower values were observed in AG for variables: VO2 (22 ± 5 vs. 27 ± 4 ml/kg/min), ISWD (567 ± 94 vs.604 ± 86m), FVC (2,70 ± 0,47 vs. 3,33 ± 0,52L) e FEV1 (2,41 ± 0,46 vs. 2,84 ± 0,52 L). There were no differences for MIP and MEP. There were significant correlations between ISWD, VO2 (r = 0,70) and VO2/Kg (r = 0,80), moreover, there were correlations between VO2 and OUES (Oxigen Uptake Efficiency Slope) with breathing pattern (r = 0,51 e r = 0,65, respectively), but it was significantly lower in AG. Moderate correlations were observed between VO2 and OUES (r = 0,67), furthermore, there were moderate correlations between main thoracic curve with VO2 (r = -0,41) and VO2/Kg (r= -0,61). Conclusion: AIS patients in the late postoperative period have significantly reduced exercise functional capacity associated with reduced lung function, residual spinal curve and cardiovascular deconditioning.
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    Avaliação da disfunção e da incapacidade nas pneumoconioses
    (Sociedade Brasileira de Pneumologia e Tisiologia, 2006-05-01) Neder, Jose Alberto [UNIFESP]; Bagatin, Ericson; Nery, Luiz Eduardo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Estadual de Campinas (UNICAMP)
    The determination of functional consequences (dysfunction) and their impact on daily life (incapacitation) is central to the evaluation of patients with occupational respiratory diseases. The present review addresses the fundamentals underlying the instruments used to determine the degree of dysfunction, including clinical aspects, as well as those related to pulmonary function and, in some circumstances, exercise tolerance. In particular, a multifactorial system of classifying the degree of dysfunction is presented, with the objective of informing decisions related to the awarding of retirement benefits in Brazil.
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    Capacidade cardiorrespiratória de crianças e adolescentes com doença falciforme submetidas a teste de esforço submáximo
    (Universidade Federal de São Paulo (UNIFESP), 2017-03-27) Cobra, Carolina Lemos Nogueira [UNIFESP]; Braga, Josefina Aparecida Pellegrini [UNIFESP]; Johnston, Cintia; Wandalsen, Gustavo Falbo [UNIFESP]; http://lattes.cnpq.br/3003850834415505; http://lattes.cnpq.br/4807350957191775; http://lattes.cnpq.br/7645872510889651; http://lattes.cnpq.br/6774558143894982; Universidade Federal de São Paulo (UNIFESP)
    Objective: To evaluate the cardiorespiratory capacity of children and adolescentes with sickle cell disease submitted to a submaximal physical effort test. Methods: A unicentric, transversal and analytic study comparing 88 children and adolescentes with sickle cell disease (SCD group) with 49 healthy children and adolescentes (control group - CG), aged (patients and controls) from 6 to 18 years. Both groups were submitted to the following evaluations: cardiorespiratory capacity by the submaximal physical effort test Six-Minute Step Test - TD6', evaluated before, during (3 and 6 minutes) and after (10 minutes); heart rate (HR) and transcutaneous pulse oximetry oxygen saturation (SpO2). After the test the number of steps taken was evaluated, and the degree of fatigue and dyspnea, graduated by the scale of dyspnea and effort of Borg. Pulmonary function was evaluated before and after bronchodilator inhalation, by Spirometry. Statistical analysis: the groups were paired by age, sex, weight, height and BMI. Parametric and non-parametric methods were used depending the variables studied. Tests were considered significant when p<0.05. Results: There was no significant statistical difference in the demographic characteristics between the SCD group and the CG group. Mean age and BMI per group (SCD vs CG) 10.6 vs 9.8 years (p= 0.117) and 17.7 vs 18.8 kg/m² (p= 0,101). Comparing the spirometry parameters of SCD vs GC groups, it was observed the following diagnoses - Normal: 47 (66.2%) vs 37 (90.2%); Obstructive response to BD: 7 (9.9%) vs 2 (4.9%); Obstructive without BD response: 12 (16.9%) vs 0 (0%); Restrictive: 5 (7%) vs 2 (4.9%) p=0.003. In TD6 it was observed a significant statistical difference between SCD and CG groups regarding HR, SpO2. The number of steps taken by SCD group 126 (72-206) was lower than CG group 145 (89-289) (p <0.001). Conclusions: In this study, children and adolescents with SCD presented a cardiorespiratory response to submaximal exercise below that predicted in comparison to healthy children and adolescents with the same age and weightstature characteristics. The pulmonary function of the SCD group was predominantly obstructive pulmonary alteration not responsive to bronchodilator inhalation.
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    Capacidade inspiratória, limitação ao exercício, e preditores de gravidade e prognóstico, em doença pulmonar obstrutiva crônica
    (Sociedade Brasileira de Pneumologia e Tisiologia, 2007-08-01) Freitas, Clarice Guimarães de; Pereira, Carlos Alberto de Castro [UNIFESP]; Viegas, Carlos Alberto de Assis; Universidade de Brasília; Universidade Federal de São Paulo (UNIFESP); Universidade de Brasília Faculdade de Medicina
    OBJECTIVE: To correlate the postbronchodilator (post-BD) inspiratory capacity (IC), % of predicted, with other markers of severity and prognostic factors in chronic obstructive pulmonary disease (COPD). METHODS: Eighty stable patients with COPD performed forced vital capacity and slow vital capacity maneuvers, as well as the 6-min walk test, prior to and after receiving albuterol spray (400 µg). Patients were divided into four groups, based on post-BD forced expiratory volume in one second. Several variables were tested to establish correlations with the post-BD distance walked, using univariate and multivariate analysis. Post-BD IC was found to correlated with Global Initiative for Chronic Obstructive Lung Disease (GOLD) staging and with the Body mass index, airway Obstruction, Dyspnea, and Exercise capacity (BODE) index. RESULTS: Multivariate regression analysis revealed that the distance walked, % predicted, correlated significantly with the IC post-BD, % predicted (p = 0.001), long-term oxygen use (p = 0.014), and number of medications used in the treatment (p = 0.044). IC < 70% was observed in 56% patients in GOLD stages 3 or 4 vs. 20% in GOLD 1 or 2 (p < 0.001). IC < 70% was observed in (60%) patients with BODE score 3 or 4 vs. (33%) BODE score 1 or 2 (p = 0.02). CONCLUSION: Post-BD IC% predicted is the best functional predictor of distance walked and is significantly associated with GOLD staging and BODE index. Therefore, We propose that the inspiratory capacity should be added to the routine evaluation of the COPD patients.
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    Comparação das equações de valores de referência da função pulmonar mais utilizadas no Brasil: impacto no estadiamento da DPOC
    (Universidade Federal de São Paulo (UNIFESP), 2010-06-30) Pereira, Marcella Cristiane Silveira [UNIFESP]; Jardim, José Roberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objective: To compare the absolute values of FVC and FEV1 found in a random sample of a Brazilian population over 40 years of age with values of equations most used in Brazil. To compare the values in percentage of predicted of FVC and FEV1 of the selected equations with the PLATINO equation ones. To evaluate the change in COPD staying when using different reference equations. Material and Methods: We conducted a retrospective study from a representative sample of residents in the metropolitan region of Sao Paulo, aged .40 years, from the PLATINO study. For comparison of the FVC and FEV1, were subtracted from the predicted values of each equation the absolute values obtained from each individual, considering the equation inadequate wherever there was a difference of up to 0.15 L as defined by ATS. We also evaluated the difference between the values of FVC and VEF1 in percentage of predicted of the equations with the PLATINO equation, considering as a limit a difference .3% (ATS). The diagnosis of COPD was defined as FEV1/FVC <0.70 after bronchodilator, and the comparison of staging was performed using the FEB1 in percentage of predicted in each equation, with reference to the percentage expected from the PLATINO equation. T-student test, chi-squared and the intraclass correlation coefficient were used to evaluate the performance of FVC and FEV1 in different equations and data are presented as mean, standard deviation, standard error and confidence interval of 95%. Results: After evaluating 178 healthy subjects, we observed that the equations that show less difference between the predicted value and the absolute value for both FEV1 and FVC in both sexes were Roca et al., Pereira et al. 2006, Enright et al. and PLATINO. The Knudson et al. equation underestimated the absolute values for both FVC and FEV1. In comparison with PLATINO equation, the percentage of predicted for FVC and FEV1, the equation showing the lowest difference was NHANES III, except for FVC male, who showed a wide variability. We evaluated 152 patients with COPD, observing staging changes in 29.6% in relation to the difference equations, being Knudson et al. the equation that showed the greatest number of changes. Conclusion: There is a great variability among the reference equations. The equations showing less variability and better intraclass correlation coefficient were Roca et al., Caucasian NHANES III et al., Enright et al. and PLATINO, which are the ones that should be recommended to be used for the Brazilian population. There is a change in the COPD staging when different equations are applied, suggesting that the use of a single equation for the treatment of the patient would avoid possible alterations in treatment.
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    Efeitos do treinamento muscular inspiratório na função pulmonar de pacientes com Ataxia Telangiectasia
    (Universidade Federal de São Paulo (UNIFESP), 2011-03-30) Félix, Erika [UNIFESP]; Costa-Carvalho, Beatriz Tavares [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Background: Ataxia Telangiectasia (A-T) is an autosomal recessive syndrome, characterized by defects in DNA repair or replication which is caused by a mutation in a gene on the chromosome 11. The typical manifestations are cerebellar ataxia, telangiectasia and progressive muscular weakness. Besides, they also have a restrictive ventilatory pattern due to gradual loss of muscle strength, resulting in increased susceptibility to lung infections and severe respiratory failure. Although there is a lot of data about the effects of inspiratory muscle training in patients with chronic pulmonary diseases, there are no studies that correlate its effects specifically in A-T patients. Objective: To evaluate the effects of IMT on inspiratory muscle strength and its impact on pulmonary function and on quality of life of patients with A-T. Methods: This is a controlled, longitudinal intervention. We have selected 11 patients with A-T and 9 healthy controls matched for age and sex. A-T patients and controls underwent an inicial evaluation protocol that included: (i) measuring of ventilometry to obtain the minute volume (MV), tidal volume (VT), vital capacity (VC), respiratory rate (f) and ( ii) manovacuometry assessing the maximum inspiratory pressure (MIP) and maximal expiratory pressure (MEP). In this same phase, patients with A-T underwent further evaluation of (iii) quality of life using the SF-36 and (iv) application of the Borg scale for assessment of perceived shortness of breath. These same parameters were evaluated in the A-T group in the post-IMT period. The IMT protocol was initiated with a load of 40% of MIP, with weekly increases of 5%, up to 60% of MIP, which is the target load. The IMT was performed for 20 minutes daily during 24 weeks. Results: A-T patients, when compared with the control group, showed a significant difference in weight and height (36.91 ± 91vs 54.22 ± 8.80, p = 0.001), MIP and MEP in absolute terms (p <0.001) as percentage of predicted (p <0.001 and p = 0.009), and VC (p <0.001), respectively. In the post-IMT period, A-T patients showed a significant increase in VT (476.5 ± 135 ml vs 583.3 ± 66 ml, p = 0.015), VC (1664 ± 463 ml/kg vs 2145 ± 750 ml/kg , p = 0.002), MIP (22.2 ± 2 cmH2O vs 38 ± 9 cmH2O, p <0.001), MEP (29 ± 7 cmH2O vs 40 ± 8 cmH2O, p = 0.001), and significant decrease in f (23 , 3 ± 6 rpm vs 20.4 ± 4 rpm, p = 0.018) compared to baseline IMT. There was a decrease in the Borg/dyspnoea ratio (p = 0.022) and improvement in the domains of the SF-36 related to general health (p = 0.009) and vitality (p = 0.014). Conclusion: IMT was significantly effective in increasing muscle strength, with subsequent improvement in lung function in patients with A-T and should be considered an adjunctive therapy to drug treatment to improve quality of life of these patients.
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    Efeitos do treinamento muscular inspiratório pré-operatório na força muscular respiratória e na função pulmonar em pacientes submetidos à correção cirúrgica de valvopatias
    (Universidade Federal de São Paulo (UNIFESP), 2010) Barros, Cassia Fabiane de [UNIFESP]; Vidotto, Milena Carlos [UNIFESP]; http://lattes.cnpq.br/0334734747375995; http://lattes.cnpq.br/5643111801630618; Universidade Federal de São Paulo (UNIFESP)
    Introdução: As cardiopatias valvares, ou simplesmente valvopatias, são condições de apresentação clínica bastante variável. Muitos pacientes apresentam-se assintomáticos por décadas, enquanto outros exibem sintomas de insuficiência cardíaca, justificando as intervenções cirúrgicas. Quando submetidos à cirurgia cardíaca estão sujeitos a complicações pulmonares pós-operatórias devido às alterações da mecânica ventilatória causadas pelo procedimento cirúrgico. O objetivo deste estudo foi avaliar os efeitos de um programa de treinamento muscular inspiratório realizado no pré-operatório. Materiais e Métodos: A amostra foi composta por pacientes da Enfermaria de Cirurgia Cardiovascular do Hospital da Santa Casa da Misericórdia de Santos, que eram candidatos à cirurgia de correção valvar. Estes foram avaliados prospectivamente e incluídos no estudo mediante os critérios de inclusão e exclusão. Todos os pacientes foram submetidos à avaliação inicial composta por avaliação da função pulmonar, da força muscular respiratória, da composição corporal, do nível de atividade física habitual e da qualidade de vida. Os pacientes foram submetidos ao programa de treinamento muscular inspiratório (TMI) no pré-operatório.Sendo realizado durante o período de internação que precede a cirurgia, diariamente, com duração de trinta minutos, e intensidade de 40% da pressão inspiratória máxima (Pimax), graduada em um aparelho denominado Threshold® IMT. O treinamento foi realizado na enfermaria do hospital, semanalmente foi reavaliada a PImax e reajustada a carga de treinamento. Os pacientes foram reavaliados no dia anterior à cirurgia quanto força muscular respiratória. Após o processo cirúrgico, foram reavaliados quanto função pulmonar e força muscular respiratória e, coletados dados sobre a duração da ventilação mecânica, a presença de complicações cardiovasculares e complicações pulmonares, tempo de internação na unidade de terapia intensiva (UTI) e enfermaria e óbito. Resultados: Foram avaliados oito pacientes com média de idade 39,5(±15,9), igualmente distribuído quanto ao sexo. Na avaliação inicial 50% dos pacientes apresentaram valores de capacidade vital forçada (CVF) e volume expiratório forçado no primeiro segundo (VEF1) abaixo do valor previsto, todos os pacientes apresentaram valores abaixo do previsto para Pimax. Os pacientes submetidos ao TMI durante o período de internação pré-operatório apresentaram aumento significante (p<0,05) da PImax após o período de treinamento. Não houve diferença significante da função pulmonar e da força de músculos respiratórios quando comparado o pré-operatório e o pós-operatório. Conclusões: Os pacientes valvopatas desse estudo demonstraram características de doentes restritivos quanto à função pulmonar, força muscular inspiratória abaixo do predito, baixa qualidade de vida quanto à limitação por aspecto físico e capacidade funcional, e sedentarismo. Após a realização de um programa de treinamento muscular inspiratório foi observado aumento significante de Pressão Inspiratória Máxima, e uma tendência a não queda significante nos valores de função pulmonar e força muscular respiratória no pós-operatório
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    Efeitos sistêmicos da hipoxemia noturna em pacientes com doença pulmonar obstrutiva crônica sem síndrome da apnéia obstrutiva do sono
    (Sociedade Brasileira de Pneumologia e Tisiologia, 2008-08-01) Mueller, Paulo de Tarso Guerrero; Gomes, Marcílio Delmondes; Viegas, Carlos Alberto de Assis; Neder, Jose Alberto [UNIFESP]; Universidade Federal de Mato Grosso do Sul; Clínica de Neurologia e Distúrbios do Sono; Universidade de Brasília; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: To study the effects of nocturnal hypoxemia in patients with chronic obstructive pulmonary disease without obstructive sleep apnea syndrome. METHODS: We studied 21 patients-10 desaturators and 11 nondesaturators-submitted to arterial blood gas analysis, polysomnography, spirometry, cardiopulmonary exercise testing (cycle ergometer), and hand-grip dynamometry, as well as measurements of maximal inspiratory pressure, maximal expiratory pressure, and C-reactive protein (CRP) levels. Patients with arterial oxygen tension > 60 mmHg were included; those with an apnea-hypopnea index > 5 events/hour of sleep were excluded. Maximal oxygen uptake, maximal power, systolic blood pressure, diastolic blood pressure (DBP), and maximal heart rate were measured during exercise in order to detect hemodynamic alterations. Patients presenting CRP levels above 3 mg/L were considered CRP-positive. RESULTS: Minimal peripheral oxygen saturation during sleep was significantly higher among nondesaturators (p = 0.03). More desaturators presented CRP > 3 mg/L (p < 0.05). No differences were observed in terms of any variables, However, mean peripheral oxygen saturation during sleep correlated with DBP and maximal inspiratory pressure (p < 0.001 and p = 0.001, respectively). CONCLUSIONS: Although nocturnal hypoxemia does not reduce exercise capacity or hand-grip strength in patients with mild/moderate COPD, its effect on maximal exercise DBP seems to depend on the degree of hypoxemia. In addition, there is a positive relationship between maximal inspiratory pressure and mean peripheral oxygen saturation during sleep, as well as evidence of pronounced inflammatory activation in patients with nocturnal hypoxemia.
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    Effects of Pilates mat exercises on muscle strength and on pulmonary function in patients with cystic fibrosis
    (Soc Brasileira Pneumologia Tisiologia, 2014-09-01) Franco, Caroline Buarque; Ribeiro, Antonio Fernando; Morcillo, Andre Moreno; Zambon, Mariana Porto; Almeida, Marina Buarque; Rozov, Tatiana [UNIFESP]; Universidade Estadual de Campinas (UNICAMP); Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)
    Objective: To analyze the effects of Pilates mat exercises in patients with cystic fibrosis (CF). Methods: This was a clinical trial involving 19 CF patients recruited from either the CF Outpatient Clinic of the State University at Campinas Hospital de Clinicas or the Children's Institute of the University of So Paulo School of Medicine Hospital das Clinicas. All of the patients performed Pilates mat exercises for four months (one 60-min session per week). the variables studied (before and after the intervention) were respiratory muscle strength, MIP, MEP, FVC, and FEV1. Results: After the intervention, MIP was significantly higher in the male patients (p = 0.017), as were MIP and MEP in the female patients (p = 0.005 and p = 0.007, respectively). There were no significant differences between the pre- and post-intervention values of FVC or FEV1, neither in the sample as a whole nor among the patients of either gender. Conclusions: Our results show that Pilates mat exercises have beneficial effects on respiratory muscle strength in CF patients.
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    Escalas de risco de Torrington e Henderson e de Epstein: aplicabilidade e efetividade nas ressecções pulmonares
    (Sociedade Brasileira de Pneumologia e Tisiologia, 2005-08-01) Stanzani, Fabiana [UNIFESP]; Oliveira, Maria Alenita De [UNIFESP]; Forte, Vicente [UNIFESP]; Faresin, Sonia Maria [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: To compare the incidences of pulmonary and cardiopulmonary postoperative complications estimated using, respectively, the scoring systems devised by Torrington and Henderson and by Epstein in a populational sample undergoing lung resection for the treatment of lung cancer. METHODS: Prospective data from patients submitted to resection of one or more pulmonary lobes were selected from the databases of two tertiary-care hospitals. The outcome measures were pulmonary complications, cardiac complications and mortality rates. Fisher's exact test was used to evaluate the concordance between the predicted and observed complications. RESULTS: The Torrington and Henderson scoring system was applied to 50 patients, in which the risk was found to be mild in 12, moderate in 32, and high in 6. Although accurately identifying patients at high risk, the Torrington and Henderson scale underestimated the rate of postoperative cardiopulmonary complications in the mild and moderate risk categories (p = 0.0003 and p = 0.0006, respectively). The Epstein scoring system was applied to 38 patients, 4 of which were found to be at high risk, and 34 of which were found to be at mild risk. The Epstein scale also underestimated the risk in the patients (the majority) that were classified as being at mild risk (p < 0.0001) and yet, like the Torrington and Henderson scale, accurately identified those at high risk. CONCLUSION: Neither of the two scoring systems analyzed were found to be appropriate for predicting the risk of pulmonary and cardiopulmonary complications in most cases.
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    Evaluation of a method for assessing pulmonary function in laryngectomees
    (Pacini Editore, 2011-08-01) Castro, Mario Augusto Ferrari de; Dedivitis, Rogério Aparecido [UNIFESP]; Macedo, Alex Gonçalves [UNIFESP]; Fdn Lusiada UNILUS; Ana Costa Hosp; Hosp Heliopolis; Irmandade Santa Casa da Misericordia Santos; Universidade Federal de São Paulo (UNIFESP)
    In total laryngectomies the impairment of pulmonary function reflects the sum of pre- and post-operative ventilatory changes. Objective information on the respiratory condition in laryngectomees, as assessed in the pulmonary function laboratory is somewhat limited, perhaps because of difficulties related to methodology. The aim of our study was to evaluate the reproducibility of a method employed to assess the pulmonary function in laryngectomized patients. The experimental extra-tracheal device was set up with a silicone adapter through a cardboard tube to the skin around the tracheostoma. Pulmonary function tests included measurements of forced vital capacity, force expiratory volume at 1 second and Tiffeneau index in 3 consecutive evaluations, in 11 patients who underwent total laryngectomy. The control group comprised 11 patients, not laryngectomized, evaluated by conventional spirometry. Those responsible for evaluating were asked to report possible technical failures and to demonstrate the reproducibility of the curves resulting from the tests. The use of the silicone adapter and skin adhesive provided a complete, airtight seal of the system, in all cases. The presence of the tracheo-oesophageal prosthesis did not negatively affect the test results. All patients attributed a maximum value, both for comfort and acceptance, of the device. The values are comparable in both groups, thus indicating the accuracy of the proposed methodology. All examinations were reproducible. After total laryngectomy, pulmonary function testing, with an extra-tracheal device, is not only reliable but also easy to perform in a routine out-patient setting. The methodology did not present air leaks and was, therefore, well accepted by all patients tested.
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    Força dos músculos respiratórios em crianças e adolescentes com asma: similar à de indivíduos saudáveis?
    (Sociedade Brasileira de Pneumologia e Tisiologia, 2012-06-01) Oliveira, Cilmery Marly Gabriel de [UNIFESP]; Lanza, Fernanda de Cordoba [UNIFESP]; Solé, Dirceu [UNIFESP]; Universidade Estadual de Ciências da Saúde de Alagoas; Universidade Nove de Julho Programa de Pós-Graduação em Ciências da Reabilitação; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: To compare children/adolescents with mild or moderate asthma and healthy subjects in terms of respiratory muscle strength, correlating it with spirometric variables in the former group. METHODS: This was a cross-sectional study involving individuals 6-16 years of age and clinically diagnosed with mild/moderate asthma, together with a group of healthy, age- and gender-matched subjects. We determined spirometric values, as well as MIP and MEP, and we selected three reproducible measurements (variation < 10%). RESULTS: We evaluated 75 patients with asthma and 90 controls. The mean age was 10.0 ± 2.6 years. There were no statistically significant differences between the controls and the asthma group regarding MIP (-89.7 ± 26.7 cmH2O vs. -92.2 ± 26.3 cmH2O; p = 0.541) or MEP (79.2 ± 22.9 cmH2O vs. 86.4 ± 24.0 cmH2O; p = 0.256). The groups were subdivided by age (children and adolescents: 6-12 and 13-16 years of age, respectively). Within the asthma group, there was a significant difference between the child and adolescent subgroups in terms of MEP (74.1 ± 24.1 cmH2O vs. 92.1 ± 21.9 cmH2O; p < 0.001) but not MIP (p = 0.285). Within the control group, there were significant differences between the child and adolescent subgroups in terms of MIP (-79.1 ± 17.7 cmH2O vs. -100.9 ± 28.1 cmH2O; p < 0.001) and MEP (73.9 ± 18.7 cmH2O vs. 90.9 ± 28.1cmH2O; p < 0.001). In the asthma group, spirometric variables did not correlate with MIP or MEP. CONCLUSIONS: In our sample, asthma was found to have no significant effect on respiratory muscle strength.
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    Influence of heart failure on resting lung volumes in patients with COPD
    (Soc Brasileira Pneumologia Tisiologia, 2016) de Souza, Aline Soares [UNIFESP]; Sperandio, Priscila Abreu [UNIFESP]; Mazzuco, Adriana [UNIFESP]; Alencar, Maria Clara [UNIFESP]; Arbex, Flavio Ferlin [UNIFESP]; de Oliveira, Mayron Faria [UNIFESP]; O'Donnell, Denis Eunan; Neder, Jose Alberto [UNIFESP]
    Objective: To evaluate the influence of chronic heart failure (CHF) on resting lung volumes in patients with COPD, i.e., inspiratory fraction-inspiratory capacity (IC)/TLC-and relative inspiratory reserve-[1 − (end-inspiratory lung volume/TLC)]. Methods: This was a prospective study involving 56 patients with COPD-24 (23 males/1 female) with COPD+CHF and 32 (28 males/4 females) with COPD only-who, after careful clinical stabilization, underwent spirometry (with forced and slow maneuvers) and whole-body plethysmography. Results: Although FEV1, as well as the FEV1/FVC and FEV1/slow vital capacity ratios, were higher in the COPD+CHF group than in the COPD group, all major "static" volumes-RV, functional residual capacity (FRC), and TLC-were lower in the former group (p < 0.05). There was a greater reduction in FRC than in RV, resulting in the expiratory reserve volume being lower in the COPD+CHF group than in the COPD group. There were relatively proportional reductions in FRC and TLC in the two groups; therefore, IC was also comparable. Consequently, the inspiratory fraction was higher in the COPD+CHF group than in the COPD group (0.42 ± 0.10 vs. 0.36 ± 0.10; p < 0.05). Although the tidal volume/IC ratio was higher in the COPD+CHF group, the relative inspiratory reserve was remarkably similar between the two groups (0.35 ± 0.09 vs. 0.44 ± 0.14; p < 0.05). Conclusions: Despite the restrictive effects of CHF, patients with COPD+CHF have relatively higher inspiratory limits (a greater inspiratory fraction). However, those patients use only a part of those limits, probably in order to avoid critical reductions in inspiratory reserve and increases in elastic recoil.
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    Influência do dreno pleural sobre a dor, capacidade vital e teste de caminhada de seis minutos em pacientes submetidos à ressecção pulmonar
    (Sociedade Brasileira de Pneumologia e Tisiologia, 2008-12-01) Lima, Vanessa Pereira de [UNIFESP]; Bonfim, Daniela [UNIFESP]; Risso, Thais Telles [UNIFESP]; Paisani, Denise de Moraes [UNIFESP]; Fiore Junior, Julio Flavio; Chiavegato, Luciana Dias [UNIFESP]; Faresin, Sonia Maria [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Cidade de São Paulo
    OBJECTIVE: To evaluate the influence of pleural drainage on the distance covered on the six-minute walk test, pain intensity and vital capacity in patients submitted to pulmonary resection. METHODS: Thirteen consecutive patients from the Thoracic Surgery Infirmary of Hospital São Paulo, Brazil, submitted to closed pleural drainage (0.5-in multiperforated chest tube) in the postoperative period following pulmonary resection (lobectomy, segmentectomy and pulmonary nodule resection) were evaluated. The decision for chest tube removal followed clinical criteria defined by the surgical team, who did not participate in the study. Vital capacity, pain intensity (using a visual analog pain scale) and the distance covered on the six-minute walk test were determined 30 min prior to and 30 min after the removal of the chest tube. The statistical analysis was performed using paired t-tests, and the level of significance was set at 0.05. RESULTS: After the removal of the chest tube, the visual analog scale pain scores were significantly lower (3.46 cm vs. 1.77 cm; p = 0.001) and the distance covered on the six-minute walk test was significantly higher (374.34 m vs. 444.62 m; p = 0.03). Vital capacity prior to and after chest tube removal was not significantly affected (2.15 L and 2.25 L, respectively; p = 0.540). CONCLUSIONS: The results of the present study suggest that the presence of a chest tube is a factor significantly associated with postoperative pain and functional limitation in patients submitted to pulmonary resection.
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    Lung function in post-poliomyelitis syndrome: a cross-sectional study
    (Sociedade Brasileira de Pneumologia e Tisiologia, 2013-06-01) Lira, Claudio Andre Barbosa de; Minozzo, Fabio Carderelli; Sousa, Bolivar Saldanha; Vancini, Rodrigo Luiz [UNIFESP]; Andrade, Marilia dos Santos [UNIFESP]; Quadros, Abrahão Augusto Juviniano [UNIFESP]; Oliveira, Acary Souza Bulle [UNIFESP]; Silva, Antonio Carlos da [UNIFESP]; Federal University of Goias at Jatai; McGill University; Santa Casa de São Paulo Faculdade de Ciencias Medicas; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE:To compare lung function between patients with post-poliomyelitis syndrome and those with sequelae of paralytic poliomyelitis (without any signs or symptoms of post-poliomyelitis syndrome), as well as between patients with post-poliomyelitis syndrome and healthy controls.METHODS:Twenty-nine male participants were assigned to one of three groups: control; poliomyelitis (comprising patients who had had paralytic poliomyelitis but had not developed post-poliomyelitis syndrome); and post-poliomyelitis syndrome. Volunteers underwent lung function measurements (spirometry and respiratory muscle strength assessment). RESULTS:The results of the spirometric assessment revealed no significant differences among the groups except for an approximately 27% lower mean maximal voluntary ventilation in the post-poliomyelitis syndrome group when compared with the control group (p = 0.0127). Nevertheless, the maximal voluntary ventilation values for the post-poliomyelitis group were compared with those for the Brazilian population and were found to be normal. No significant differences were observed in respiratory muscle strength among the groups.CONCLUSIONS:With the exception of lower maximal voluntary ventilation, there was no significant lung function impairment in outpatients diagnosed with post-poliomyelitis syndrome when compared with healthy subjects and with patients with sequelae of poliomyelitis without post-poliomyelitis syndrome. This is an important clinical finding because it shows that patients with post-poliomyelitis syndrome can have preserved lung function.
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    Postoperative study of vital capacity and ventilation measurements following elective craniotomy
    (Associação Paulista de Medicina - APM, 2008-01-01) Sogame, Luciana Carrupt Machado [UNIFESP]; Faresin, Sonia Maria [UNIFESP]; Vidotto, Milena Carlos [UNIFESP]; Jardim, José Roberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    CONTEXT AND OBJECTIVE: Changes in pulmonary function commonly occur after general surgery. The aims were to evaluate vital capacity, tidal volume and respiratory frequency among patients undergoing elective craniotomy and to determine possible correlations of these parameters with surgery duration and etiology for neurosurgery. DESIGN AND SETTING: Prospective, open study at a tertiary university hospital. METHODS: Twenty-six patients underwent elective craniotomy for aneurysm clipping (11) or tumor resection (15). Vital capacity (VC), tidal volume (TV), minute volume (VE) and respiratory rate were determined before the operation and on the first to fourth postoperative days. RESULTS: There were significant decreases of 25% in VC, 22% in TV and 12% in VE (p < 0.05) and no significant increase in respiratory frequency (5%) on the first postoperative day. VE returned to baseline on the second postoperative day and TV on the third postoperative day, while VC was 8% lower on the fourth postoperative day, compared with before the operation (p < 0.05). VC reduction was significantly greater in patients undergoing aneurysm clipping (43%) than in patients undergoing tumor resection (14%) when surgery duration was more than four hours (p < 0.05), with no significant change when surgery duration was less than four hours. CONCLUSION: Reductions in VC, TV and VE were observed during the postoperative period in patients undergoing aneurysm clipping or tumor resection. The reductions in VC and TV were greater in patients undergoing craniotomy due to aneurysm and with longer surgery duration.
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    Study of respiratory muscle strength, vital capacity, and ventilometry in the postoperative period of spinal surgery by posterior access
    (Lippincott Williams & Wilkins, 2006-05-20) Di Pietro, Telma Lissandra [UNIFESP]; Sogame, Luciana Carrupt Machado [UNIFESP]; Vidotto, Milena Carlos [UNIFESP]; Jardim, José Roberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Study Design. Prospective.Objective. To analyze tidal volume (TV), minute volume (VE), respiratory frequency (f), vital capacity (VC), maximal inspiratory (PImax), and expiratory (PEmax) pressures in patients submitted to spinal surgery for tumor or herniated disc by posterior access, and to investigate a possible association of respiratory function with surgery duration, site of surgical access, and diagnosis.Summary of Background Data. A reduction in pulmonary volumes is usually seen in patients submitted to thoracic or upper abdominal surgery, and recent studies have demonstrated such alterations during the postoperative period in patients submitted to craniotomy.Methods. A total of 45 patients (mean age, 42 +/- 14 years) were submitted to spinal surgery in an University Hospital, and TV, VC, MV, f, PImax, and PEmax were measured in the preoperative period, and in the first and second postoperative days.Results. Patients submitted to spinal surgery showed a decrease in the first and second postoperative days in VC, respectively (17% and 10%), TV (18% and 13%), PImax (17% and 12%), PEmax (12% and 7%), and an increase in f (18% and 12%) (P < 0.05). Reduction in TV, VC, PImax, and PEmax and the increase in f were associated with surgical time >= 240 minutes, diagnosis of tumor, and cervicothoracic surgical access (P < 0.05).Conclusions. Alterations in the respiratory function in the postoperative period of elective spinal surgery by posterior access for tumor removal or herniated disc were related to surgical time >= 240 minutes, tumor, or cervicothoracic surgical access.
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    Subxyphoid pleural drain confers lesser impairment in respiratory muscle strength, oxygenation and lower chest pain after off-pump coronary artery bypass grafting: a randomized controlled trial
    (Soc Brasil Cirurgia Cardiovasc, 2012-01-01) Cancio, Andreia S. A. [UNIFESP]; Guizilini, Solange [UNIFESP]; Bolzan, Douglas W. [UNIFESP]; Dauar, Renato B.; Succi, Jose E.; Paola, Angelo A. V. de [UNIFESP]; Camargo Carvalho, Antonio C. de [UNIFESP]; Gomes, Walter J. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Hosp Bandeirantes
    Objective: To evaluate respiratory muscle strength, oxygenation and chest pain in patients undergoing off-pump coronary artery bypass (OPCAB) using internal thoracic artery grafts comparing pleural drain insertion site at the subxyphoid region versus the lateral region.Methods: Forty patients were randomized into two groups in accordance with the pleural drain site. Group II (n = 19) - pleural drain exteriorized in the intercostal space; group (SI) (n = 21) chest tube exteriorized at the subxyphoid region. All patients underwent assessment of respiratory muscle strength (inspiratory and expiratory) on the pre, 1, 3 and 5 postoperative days (POD). Arterial blood gas analysis was collected on the pre and POD1. the chest pain sensation was measured 1, 3 and 5 POD.Results: A significant decrease in respiratory muscle strength (inspiratory and expiratory) was seen in both groups until POD5 (P<0.05). When compared, the difference between groups remained significant with greater decrease in the II (P<0.05). the blood arterial oxygenation fell in both groups (P<0.05), but the oxygenation was lower in the II (P<0.05). Referred chest pain was higher 1, 3 and 5 POD in the II group (P<0.05). the orotracheal intubation time and postoperative length of hospital stay were higher in the II group (P<0.05).Conclusion: Patients submitted to subxyphoid pleural drainage showed less decrease in respiratory muscle strength, better preservation of blood oxygenation and reduced thoracic pain compared to patients with intercostal drain on early OPCAB postoperative.
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    Validação de novos valores previstos brasileiros para a espirometria forçada na raça branca e comparação com os valores previstos obtidos por outras equações de referência
    (Sociedade Brasileira de Pneumologia e Tisiologia, 2007-10-01) Duarte, Andrezza Araújo de Oliveira; Pereira, Carlos Alberto de Castro [UNIFESP]; Rodrigues, Silvia Carla Sousa [UNIFESP]; Hospital do Servidor Público Estadual de São Paulo; Universidade Federal de São Paulo (UNIFESP); Hospital do Servidor Público Estadual de São Paulo Setor de Função Pulmonar
    OBJECTIVE: To compare the most recent (2006) predicted values of forced vital capacity and forced expiratory volume in one second for spirometry in Brazilians with those obtained using other reference equations and to validate the findings through comparisons with a new sample of normal Brazilians. METHODS: Forced spirometry was performed, in accordance with the Brazilian Thoracic Society guidelines, in 643 nonsmoking adult Caucasians. The predicted values obtained by Brazilian researchers in 1992 and those obtained by four groups of foreign researchers were compared with the new Brazilian predicted values obtained in 2006. In the second phase, the mean values obtained in 65 adult females and 79 adult males were compared with the predicted values obtained using the various reference equations. RESULTS: A t-test for paired samples revealed significant differences between the predicted values obtained using the six equations and those obtained using the 2006 Brazilian equation. In the second phase, the mean predicted values obtained by Crapo et al., as well as those obtained by Hankinson et al. for Mexican-Americans, were similar to those found in the new sample. However, when the predicted values obtained in the new sample were compared with those obtained by those authors, discrepancies were found, with high and low predicted values. The mean values obtained using the 2006 Brazilian equation presented the smallest differences in comparison with the mean values obtained in the new sample. CONCLUSIONS: These results underscore the importance of using prediction equations for spirometry that are appropriate for our population.