Estudo de dois métodos de avaliação das pressões respiratórias máximas em indivíduos com escoliose idiopática do adolescente
Data
2020-10-05
Autores
Pessoa, Thais de Oliveira 
Orientadores
Vidotto, Milena Carlos
Tipo
Trabalho de conclusão de curso
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: A escoliose idiopática do adolescente (EIA) é uma deformidade complexa da coluna vertebral de etiologia desconhecida, que ocasiona deformidade do gradil torácico e consequente diminuição da força dos músculos respiratórios. A força dos músculos respiratórios (FMR) pode ser medida a partir das pressões respiratórias máximas, utilizando a manovacuometria pelo método da capacidade pulmonar total e volume residual (CPT-VR) ou da capacidade residual funcional (CRF). Embora a American Thoracic Society (ATS) recomenda que a mensuração da força seja feita pela CRF, grande parte dos estudos realizam a técnica utilizando o método da CPT/VR. Acredita-se que maiores valores são obtidos na CPT/VR devido às forças extrínsecas aos músculos respiratórios, sendo a CRF uma manobra mais fidedigna de avaliar a FMR. Objetivo: Avaliar a FMR utilizando dois métodos de manovacuometria em indivíduos com EIA, além de avaliar possíveis diferenças nos valores das pressões respiratórias máximas utilizando as manobras CPT/VR e CRF nesta população. Métodos: Este foi um estudo transversal que recrutou adolescentes do sexo feminino com idade entre 10 a 18 anos diagnosticados com EIA. As medidas de pressão inspiratória máxima (PImáx) e pressão expiratória máxima (PEmáx) foram realizadas utilizando dois métodos, a partir da capacidade residual funcional (CRF) e a partir da CPT e VR. Em ambos os casos, houve a realização de três a cinco manobras, obtendo três manobras aceitáveis e duas reprodutíveis. O maior valor foi considerado para análise dos dados. Método estatístico: Os dados foram avaliados descritivamente. A normalidade das variáveis foi investigada pelo teste Shapiro-Wilk. Para comparação das médias ou medianas entre os dois métodos de manovacuometria no mesmo indivíduo foi utilizado o teste t pareado ou Wilcoxon, respectivamente. A probabilidade de erro alfa foi estipulada em 5%. Resultados: Os valores encontrados pelo teste de função pulmonar estão dentro do previsto para a idade. O valor médio da PImáx no método CPT-VR foi significantemente maior (-65±15 cmH2O) quando comparado ao método CRF (-56±17 cmH2O) ( p=0,013). Assim como o valor médio da PEmáx no método CPT-VR foi significantemente maior (65±12 cmH2O) quando comparado ao método CRF (56±15 cmH2O)( p=0,013). O método CPT-VR apresentou em média valores 14% maiores em relação ao método CRF tanto na PImáx como na PEmáx. A equação de referência descrita por Schmidt et. al (1999) não demonstrou-se eficaz para predizer os valores de PImáx e PEmáx obtidos pelo método CPT/VR na população estudada. Conclusão: Podemos afirmar que existe uma diferença importante entre os métodos de avaliação das pressões respiratórias máximas. O método CPT-VR apresenta valores maiores quando comparados ao método CRF em adolescentes com EIA.
Introduction: The Adolescent Idiopathic Scoliosis (AIS) is a complex deformity of the spinal column and unknown etiology. The AIS causes rib cage’s deformation and change the ventilation pattern, in consequence, the decrease of the respiratory muscle’s performance. The strength respiratory muscles can be measured from the maximum respiratory pressures, using manovacuometry by the method of total lung capacity and residual volume (TLC-RV) or functional residual capacity (FRC). The American Thoracic Society (ATS) recommends that the mensuration of the capacity should be verified by the FRC, there are many reviews that realize the TLC/RV method. It is supposed that the higher values are obtained in TLC/VR due the forces extrinsic to the respiratory muscles with the FRC being a more reliable maneuver to evaluate the strength of the respiratory muscles. Objective: To evaluate the strength of the respiratory muscles using two methods of manovacuometry on AIS’s individuals to verify the differences on the values of the maximum respiratory pressures using the TLC/RV and FRC maneuvers. Methods: Cross-sectional analytical study on female adolescents aged 10 to 18 years diagnosed with AIS. The measures of maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) were performed using two methods, from the functional residual capacity (FRC) and the TLC/RV, with the occlusion of the unidirectional valve of the manovacuometer. In both cases, there were between three to five maneuvers obtaining three acceptable and two reproducible maneuvers. The highest value was considered for data analysis. Statistical Method: The methods were descriptively availed. The normality of the variables was investigated by the Shapiro-Wilk test. To compare the means or medians between the two methods of manovacuometry in the same individual, the paired t test or Wilcoxon, respectively, were used. The alpha error probability was set at 5%. Results: The values founded by the pulmonary function test are exactly as the predicted for the age. The mean value of MIP in the CPT-VR method was significantly higher (-65±15 cmH2O) when compared to the CRF method (-56±17 cmH2O) (p = 0.013). Just as the mean MEP value in the CPT-VR method was significantly higher (65±12 cmH2O) when compared to the CRF method (56±15 cmH2O) (p = 0.013). The CPT-VR method showed, on average, 14% higher values compared to the CRF method in both MIP and MEP. The reference equation described by Schmidt et. al (1999) did not prove to be effective in predicting the values of MIP and MEP obtained by the CPT/ VR method in the studied population. Conclusion: It’s affirmed that there is an important difference between the methods of the maximum respiratory pressure’s appraisal. The TLC/VR method presents higher values when compared to the FRC method on adolescents with AIS
Introduction: The Adolescent Idiopathic Scoliosis (AIS) is a complex deformity of the spinal column and unknown etiology. The AIS causes rib cage’s deformation and change the ventilation pattern, in consequence, the decrease of the respiratory muscle’s performance. The strength respiratory muscles can be measured from the maximum respiratory pressures, using manovacuometry by the method of total lung capacity and residual volume (TLC-RV) or functional residual capacity (FRC). The American Thoracic Society (ATS) recommends that the mensuration of the capacity should be verified by the FRC, there are many reviews that realize the TLC/RV method. It is supposed that the higher values are obtained in TLC/VR due the forces extrinsic to the respiratory muscles with the FRC being a more reliable maneuver to evaluate the strength of the respiratory muscles. Objective: To evaluate the strength of the respiratory muscles using two methods of manovacuometry on AIS’s individuals to verify the differences on the values of the maximum respiratory pressures using the TLC/RV and FRC maneuvers. Methods: Cross-sectional analytical study on female adolescents aged 10 to 18 years diagnosed with AIS. The measures of maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) were performed using two methods, from the functional residual capacity (FRC) and the TLC/RV, with the occlusion of the unidirectional valve of the manovacuometer. In both cases, there were between three to five maneuvers obtaining three acceptable and two reproducible maneuvers. The highest value was considered for data analysis. Statistical Method: The methods were descriptively availed. The normality of the variables was investigated by the Shapiro-Wilk test. To compare the means or medians between the two methods of manovacuometry in the same individual, the paired t test or Wilcoxon, respectively, were used. The alpha error probability was set at 5%. Results: The values founded by the pulmonary function test are exactly as the predicted for the age. The mean value of MIP in the CPT-VR method was significantly higher (-65±15 cmH2O) when compared to the CRF method (-56±17 cmH2O) (p = 0.013). Just as the mean MEP value in the CPT-VR method was significantly higher (65±12 cmH2O) when compared to the CRF method (56±15 cmH2O) (p = 0.013). The CPT-VR method showed, on average, 14% higher values compared to the CRF method in both MIP and MEP. The reference equation described by Schmidt et. al (1999) did not prove to be effective in predicting the values of MIP and MEP obtained by the CPT/ VR method in the studied population. Conclusion: It’s affirmed that there is an important difference between the methods of the maximum respiratory pressure’s appraisal. The TLC/VR method presents higher values when compared to the FRC method on adolescents with AIS
Descrição
Citação
PESSOA, Thais de Oliveira. Estudo de dois métodos de avaliação das pressões respiratórias máximas em indivíduos com escoliose idiopática do adolescente. 2020. 34 f. Trabalho de conclusão de curso de graduação (Fisioterapia) - Instituto de Saúde e Sociedade, Universidade Federal de São Paulo, Santos, 2020.