Secuelas respiratorias clínicas, funcionales y tomográficas de pacientes hospitalizados por COVID-19 a seis meses del diagnóstico: estudio SECUELAR-19 / Clinical, functional and tomographic respiratory sequels of patients hospitalized for COVID-19 at six month of diagnosis: SECUELAR-19 trial

Resumen Introducción: Hay información escasa sobre la evolución de los enfermos hospitalizados por neumonía por COVID-19 a mediano plazo. El objetivo de este estudio fue determinar en pacientes con neumonía moderada (NM) o grave (NG) por COVID-19, el impacto clínico, funcional respiratorio y tomográfico a los 6 meses. Métodos: Se realizó análisis según grupos de NM y NG, desaturadores (PD) en la prueba de cami nata de 6 minutos y presencia del patrón tomográfico de alta resolución (TACAR) símil fibrótico. Se compararon los resultados a los 3 y 6 meses. Resultados: Se incluyeron 129 pacientes, edad 57±11 años, comorbilidades frecuentes (hipertensión arterial 38.1%, diabetes 30.4% y respiratorias 18.6%). Al comparar 3 y 6 meses se ob servó mejoría de la calidad de vida en NM y NG. Los PD presentaron menor metraje caminado, peor calidad de vida y mayor presencia de patrón símil fibrótico. Este patrón se relacionó con la caída de la FVC 80% en NM y NG (p = 0.048 y p = 0.007), y con PD (p = 0.002). En el análisis multivariado, el patrón símil fibrótico s e asoció a la reducción de la CVF con OR = 4.44 (1.94-10.18, p<0.01) y a la desaturación, OR = 5.01 (1.63-15.42, p<0.01). En esta cohorte se observó mayor compromiso funcional y tomográfico en los PD. El patrón símil fibrótico se relacionó con peor evolución funcional y oximétrica. Discusión: Es importante el seguimiento de los pacientes con NG, los PD y los que presentan patrón fibrótico al alta de neumonía por COVID-19.

Abstract Introduction: There is scarce information about middle-term evolution of hospitalized patients who suffer from pneumonia caused by COVID-19. The objective of this study is to determine the clinical, respiratory, tomographic and functional impact on COVID-19 patients with moderate (MP) to severe (SP) pneumonia after six months of acute infection. Methods: Analysis was carried out by MP and SP groups, desaturators during the 6-minute-walking test and the presence of fibrotic like pattern on HRCT. Outcomes at 3 and 6 months were compared. Results: The analysis included 129 patients, between 57 ± 11 years old. Frequent comorbidities were: arterial hypertension 38.1%, diabetes 30.4%, respiratory 18.6%). Comparing 3 and 6 months, improvement in quality of life was observed in MP and SP. The DP walked less meters in the MWT, worsened life quality and more fibrotic like pattern. The fibrotic pattern was related to the fall of CVF < 80% on MP and SP (p = 0.048 and p = 0.007), and with DP (p = 0.002). On multivariated analysis, the fibrotic like pattern was associated to the reduction of CVF with OR = 4.44 (1.94-10.18, p<0.01) and desaturation OR = 5.01(1.63-15.42, p < 0.01). On this cohort it was observed more functional and tomographic compromise on the DP The fibrotic like pattern was related to worse functional evolution and oximetry. Discussion: Follow-up after discharge of COVID-19 patients with SP, DP or fibrotic changes in HCRT is underlined.

HOSPITAL BASED 4 WEEK PHYSICAL THERAPY PROGRAM RESULTS AFTER ACUTE MYOCARDIAL INFARCTION / Шинэ санаа Шинэ нээлт

@#BACKGROUND: Early physical therapy plays important role in improving functional capacity, activities of daily life, and quality of life after acute myocardial infarction. OBJECTIVE: We aimed to describe effects of 4 weeks physical therapy program after acute myocardial infarction. METHODS: In our study, 20 men participated in physical therapy program for 14 days after PCI surgery. The patients were diagnosed with myocardial infarction and aged 56.45±8.1. Their BMI was 27.39±3.61and waist circumference was 98±9.28. Exercise program was scheduled 3 times a week with each session consisting of 34-70% intensity exercises for 60 minutes. Exercise type is aerobic (warming up for 10 minutes, walking, bicycling and cooling down stretch for 10 minutes). RESULTS: For the 6-minute walking test (p=0.01) there was significant difference between before and after 4 weeks’ exercise program. CONCLUSION: The hospital based 4 weeks exercise program improved the functional capacity for pci patients.

Application of handgrip strength test for evaluating mobility in patients with stable chronic obstructive pulmonary disease(COPD) / 中华护理杂志

Objective To explore the reliability of handgrip strength test for evaluating mobility in patients with stable chronic obstructive pulmonary disease.Methods Sixty-one COPD patients in stable stage were measured for handgrip strength and 6-minute walking test(6MWT).The receiver operating characteristic curve(ROC) was calculated to determine the best cutoff points of handgrip strength.Results Handgrip strength was (33.72-±7.47) kgf,6MWD was (437.06±97.96) m,handgrip strength was moderately correlated with 6MWD (r=0.404,P=0.001).6MWD≥350 m was used to classify two groups,and there was significant difference between two groups(P＜0.05).Area under the curv e was 0.722,and the best cutoff points was 32.8 kgf.Conclusion Handgrip strength test can be a useful tool to quickly identify mobility in patients with stable COPD.

Efeitos de um programa de exercício físico em pacientes com doença arterial obstrutiva periférica / Effects of physical exercise program in patients with obstructive peripheral arterial disease

O objetivo do estudo foi estratificar os fatores de risco cardiovasculares (FR) e avaliar os efeitos de um programa de exercício físico (PEF) por três meses em pacientes diagnosticados com doença arterial obstrutiva periférica (DAOP) através do teste de caminhada de 6 minutos (TC6), utilizando como parâmetro a distância total percorrida (DTP), tempo inicial da dor (TID), tempo final da dor (TFD) e tempo total da dor (TTD). O estudo foi composto por 12 voluntários, encaminhados para o programa de Reabilitação Física. Para estratificar os FR houve aplicação de questionário contendo pergunta objetivas com opção de sim ou não sobre tabagismo, diabetes mellitus, etilismo, hipertensão arterial, sedentarismo, hereditariedade, dislipidemia e obesidade, adotou-se o índice de massa corpórea. O TC6 foi realizado em um corredor de 22 metros e o paciente foi orientado a informar aos avaliadores o momento de início da dor (TID) e somente parar quando a dor tornar-se insuportável para continuar a caminhada. O TFD foi estabelecido quando o paciente retornou ao TC6. Ao final do teste foi calculada a DTP que o paciente atingiu. O teste de ANOVA foi utilizado para comparar as condições pré e pós-reabilitação, tendo nível de significância quando p<0,05. Observou-se que todos os pacientes mostraram-se sedentários, 58,3% são dislipidêmicos, 50% são tabagistas, hipertensos e apresentam hereditariedade. Houve diferença significativa na DTP (327,7±83,3 vs 431,7±90,5), TID (01:52±0:36 vs 02:59±0:41) e TTD (01:55±0:14 vs 00:45±0:36) pré e pós-reabilitação. O PEF para pacientes com DAOP se mostrou eficaz na DTP, TID, TTD.

Tolerancia al ejercicio en pacientes posquirúrgicos cardiovasculares luego de la intervención con un programa de rehabilitación cardiaca fase II / Exercise tolerance in post-surgical cardiovascular patients after intervention with cardiac rehabilitation program phase II

Introducción y objetivos: La enfermedad cardiovascular constituye la primera causa de muerte y de gastos sanitarios debido a sus consecuencias. En prevención secundaria, los programas de rehabilitación cardiaca mejoran el estado funcional y la calidad de vida, e incrementan la supervivencia. Métodos y materiales: Estudio observacional, descriptivo y prospectivo, en el que se incluyeron 31 pacientes (19 hombres y 14 mujeres), con edad promedio de 64 ± 11 años. El test de caminata de 6 minutos sirvió para estimar el consumo de oxígeno máximo indirecto (VO2máx). Se midió la frecuencia cardiaca y se estimó el doble producto como indicadores hemodinámicos. Las pruebas se realizaron antes y después de 12 sesiones de entrenamiento entre el 50 y 70% de la frecuencia cardiaca máxima, 60 min, 3 veces por semana, durante un mes. Resultados: Luego de la intervención, se observaron mayores valores en el VO2 (9,6 ± 2 mL/kg-1/min-1 vs. 11,09 ± 1,9 mL/kg-1/min-1; p = 0,002) y en la distancia alcanzada en el test (244,5 ± 80,1 m vs. 303,2 ± 78,1 m; p = 0,002). No hubo diferencias en los indicadores hemodinámicos (p > 0,05). Conclusiones: El programa de rehabilitación cardiaca reportó una mejoría de tolerancia al ejercicio para los pacientes posquirúrgicos cardiovasculares en promedio del 14%, sin modificar la función hemodinámica.

Introduction and objectives:Cardiovascular disease is the leading cause of death and medical expenses due to its consequences. In secondary prevention, cardiac rehabilitation programs improve functional status, quality of life and overall survival. Methods and materials: An observational, descriptive and prospective study was performed. Thirty one subjects (19 male, 14 female), mean age 64 ± 11 years. The 6-minute walk test served to estimate the indirect maximal oxygen consumption (VO2max). We measured the heart rate and double product was estimated as hemodynamic indicators. The tests were performed before and after 12 training sessions at between 50 and 70% of maximum heart rate, for 60 min, 3 times a week, during one month. Results: After the intervention we observed higher values of VO2 (9.6 ± 2.0 mL.kg-1.min-1 vs. 11.09 ± 1.9 mL.kg-1.min-1; p = 0.002) and a longer distance achieved in the walking test (244.5 ± 80.1 m vs. 303.2 ± 78.1 m; P = .002). There were no differences in hemodynamic indicators (P > .05). Conclusions: Cardiac rehabilitation program reported an improvement in exercise tolerance in post-surgical cardiovascular patients in a 14% of the cases. It did not show a variation in hemodynamic function.

Test de caminata de seis minutos y función pulmonar en pacientes con bronquiolitis obliterante post infecciosa / Six minute walking test and pulmonary function in patients with post infectious bronchiolitis obliterans

Introduction: Post-infectious bronchiolitis obliterans (BO) is a chronic respiratory disease that is established as a consequence of a lung infection produced by adenovirus. The clinical and radiological evidence as well as spirometric variables are the cornerstones of diagnosis; however, the functional impact of lung damage, assessed through the six minute walking test (6MWT), has been scarcely studied in this group of patients, notwithstanding it has been recommended in the Chilean guidelines. The aim of the study is to evaluate the correlation between spirometric variables and 6MWT performance in patients diagnosed with BO. Patients and Methods: Correlation study conducted in pediatric pulmonary rehabilitation program of Guillermo Grant Benavente Hospital from Concepción. Chile. Records of spirometry (FEV1, FVC, FEV1/FVC and FEF25-75) and 6MWT(Distance walked (DW), heart rate, oxygen saturation, dyspnea and leg fatigue) of 22 children and adolescents diagnosed with BO were selected. The absolute values of spirometric and 6MWT variables were compared with reference values of Knudson et al and Gatica et al respectively. Results are expressed by median and range (maximum and minimum). In the statistical analysis, normality test (Kolmogorov-Smirnov), non-parametric test (Wilcoxon, Mann-Whitney) and correlation analysis (Rho-Spearman) were done by SPSS 11.5 with significance of p < 0.05. Results: The spirometry was obstructive in all patients, advanced ventilatory limitation was found in 9 children, moderate in 4, mild in 3 and minimum in 6. The WD was 597 m (750-398), 9% below the predicted value according to age (p < 0.003). The WD was lower in those with greater severity in spirometric impairment (p = 0.012). The WD expressed as a percentage of predicted value showed a significant correlation with % FEV1 (r = 0.70, p = 0.0001), FEV1/FVC ratio (r = 0.58, p = 0.004) and FEF25-75% (r = 0.70, p = 0.0001). On the other hand only saturation at the end of 6MWT showed significant correlation with % FVC (r = 0.44, p = 0.04). Conclusion: Performance during the 6MWT was positively correlated with spirometry, validating the 6MWT as a tool to assess the functional impact of lung damage in patients with BO. Future prospective studies are needed to evaluate the correlation between lung function and exercise tolerance in these patients.

Introducción: La bronquiolitis obliterante (BO) post infecciosa es una enfermedad respiratoria crónica que se establece como secuela de una infección pulmonar principalmente por adenovirus. La evidencia clínica, espirométrica y radiológica son los pilares del diagnóstico, sin embargo, pese a estar sugerido en las actuales guías nacionales, la repercusión funcional del daño pulmonar a través del test de caminata de seis minutos (C6M) ha sido escasamente estudiado en este grupo de pacientes. El objetivo de este estudio es evaluar la correlación entre variables espirométricas y resultado del C6M en una muestra de pacientes con BO. Pacientes y Métodos: Estudio correlacional donde fueron seleccionados los registros de espirometría (VEF1, CVF, VEF1/CVF y FEF25-75) y de C6M (Distancia caminada (DC), frecuencia cardíaca, saturación de oxígeno, disnea y fatiga de piernas) de 22 niños y adolescentes con diagnóstico de BO ingresados al programa de rehabilitación respiratoria infantil del Hospital Dr. Guillermo Grant Benavente de Concepción. Los valores absolutos de las variables espirométricas y C6M se compararon con valores predichos de Knudson y Gatica respectivamente. En el análisis estadístico se realizaron pruebas de normalidad (Kolmogorov-Smirnov), de contraste (Wilcoxon y Mann-Whitney) y análisis de correlación (Rho-Spearman). Los resultados se expresan en mediana, rango máximo y mínimo. Se consideró significativo p < 0,05. Resultados: En la espirometría se encontró alteración ventilatoria obstructiva de grado avanzado en 9, moderada en 4, leve en 6 y mínima en 3 niños. La DC fue de 597 m (750-398), 9% por debajo del valor predicho para la edad (p < 0,003). La DC fue menor en aquellos con mayor grado severidad en la alteración espirométrica (p = 0,012). La DC expresada en porcentaje del valor predicho mostró una correlación significativa con % VEF1 (r = 0,70;p = 0,0001), índice VEF1/CVF (r = 0,58;p = 0,004) y % FEF25-75 (r = 0,70;p = 0,0001). Sólo la saturación al final del C6M se correlacionó significativamente con % CVF (r = 0,44; p = 0,04). Conclusión: El rendimiento durante el C6Mse correlacionó con espirometría, validando al C6M como herramienta para valorar la repercusión funcional del daño pulmonar en pacientes con BO. Futuros estudios son necesarios para confirmar esta correlación.

Teste de caminhada de seis minutos para avaliação de mulheres com fatores de risco cardiovascular / Six minute walk test on cardiovascular risk factors women evaluation

INTRODUÇÃO: A atividade física é uma das formas de prevenção ao aparecimento de fatores de risco cardiovascular, como a hipertensão arterial sistêmica (HAS) e o diabetes mellitus (DM). Uma das formas de avaliar é o teste de caminhada de seis minutos (TC6), que é um teste submáximo, simples de ser realizado, de baixo custo e alta reprodutibilidade. OBJETIVOS: Comparar o desempenho funcional de mulheres portadoras de risco cardiovascular, por meio do TC6. MÉTODOS: 45 mulheres foram alocadas em três grupos: G1 (com diagnóstico de HAS DM), G2 (diagnóstico de HAS) e G3 (voluntárias saudáveis). Inicialmente, as voluntárias realizaram o TC6 com caráter de aprendizado e uma hora depois o teste com caráter avaliativo. Considerou-se como variáveis pré e pós-teste a saturação periférica de oxigênio, a frequência cardíaca, a pressão arterial, a glicose e a distância percorrida. A análise estatística foi realizada com significância estipulada de p < 0,05. RESULTADOS: Todos os grupos aumentaram significativamente a distância percorrida no teste avaliativo, e tiveram acréscimo na pressão arterial e redução do índice glicêmico. CONSIDERAÇÕES FINAIS: O TC6 pode ser utilizado para avaliação da capacidade funcional de mulheres portadoras de HAS e DM como fatores de risco cardiovascular, demonstrando-se seguro e submáximo.

INTRODUCTION: The practice of physical activities is one of the options used for cardiovascular risks prevention, such as systemic arterial hypertension (SAH) and diabetes mellitus (DM). One of the ways to make an evaluation of it is the 6-minute-walk test (6MWT), which is a submaximal test, simple to be done, of low cost and high productive. OBJECTIVES: To compare the functional acting of women's organism with cardiovascular risk, through the 6MWT. METHODS: 45 women were allocated in 3 groups: G1 (with SAH DM diagnostic), G2 (SAH diagnostic) and G3 (healthy volunteers). Initially the volunteers made the 6MWT for learning and one hour later for evaluation. Saturation of peripheral oxygen, cardiac frequency, arterial blood pressure, glucose and distance made were considered as pre- and post-tests. The statistic analysis was made with stipulated relevance of p < 0,05. RESULTS: All groups that increased the distance made during the evaluation test, had higher blood pressure and reduction of the glucose indication. CONCLUSIONS: 6MWT can be used for evaluation of the functional acting of women's organism with SAH and DM as cardiovascular risk factors, being safe and submaximal.

La ventilación no invasiva mejora los resultados en las pruebas de ejercicio en pacientes con enfermedad pulmonar obstructiva crónica / Non-invasive ventilation improves the outcome of exercise in COPD patients

Existen pocos estudios sobre el efecto de la Ventilación de doble nivel de presión positiva (VNI) sobre el ejercicio en pacientes con EPOC. El objetivo fue evaluar el impacto de la VNI en la respuesta a ejercicios máximos ysubmáximos en pruebas de campo en pacientes con EPOC. Fueron incluidos pacientes con EPOC (definición GOLD). Se les realizó una prueba de 6 minutos (según normativas de ATS), de escalera (Girish et al., Chest 2001) y ShuttleTest (Singh et al., Thorax 1992) con medición de escala de Borg de miembros inferiores y disnea, saturación arterial y frecuencia cardíaca. A través de una máscara nasal, se adaptó VNI con promedio 15 cmH2O de IPAP y 4 cmH2O de EPAP, y luego se realizaronlas mismas pruebas de ejercicio. Fueron evaluados 11 pacientes con EPOC: mediana edad: 61 años (IC25-75%, 58-75), sexo masculino 72%, FVC: 65% (IC25-75%, 60,1-70); FEV1: 37,4(IC25-75%, 33,97-42,5); FEV1/FVC: 46 (IC25-75%, 42,5-52,5); PaO2:68 mmHg (IC25-75%,63-75,3); PaCO2:40mmHg (IC25-75%,39-41).En la prueba de 6 minutos, se observó que la VNI aumentaba la distancia caminada en 61.78 % (p=0.001) la distancia caminada y la carga (kg.m) en 16,55% (p=0.002). No había cambios significativos en los síntomas (fatiga y disnea) por escala de Borg. En la prueba de escalera, se observó que la VNI incrementaba la velocidad de ascensoen 11,81% (p=0.05), sin cambios significativos en los síntomas o la altura ascendida. En el shuttle test, se observó que la VNI aumenta la distancia caminada en 30.6% (p=0.001), sin cambio significativos en los síntomas.En conclusión, se observó una significativa mejoría en las distancias caminadas y mayor velocidad de ascenso en la de escalera. Es la primera comunicación del efecto de la VNIsobre pruebas de escalera en pacientes con EPOC.

There are few exercise studies about the effect of bi-level non-invasive ventilation (NIV) on the exercise in COPD patients. The objective of the study was to evaluate the impact of NIV on the results of submaximal and maximal field exercise tests in COPD patients. The COPD patients were selected according to the GOLD definition. The study tests included: the six minute walking test (ATS guidelines), stair climbing test (Girish et al., Chest 2001) and shuttle test (Singh et al., Thorax 1992) which were measured with the Borg scale for legs and dyspnea, arterial saturation and heart rate. With a nasal mask, the NIV was adapted with pressure support ventilation through 15 cm H2O of IPAP and 4 cm H2O of EPAP. Then, the same exercise tests were performed. Eleven COPD patients were evaluated: age (median) 61 years (IC25-75%, 58-75), male sex 72%, FVC: 65% (IC25-75%, 60.1-70); FEV1: 37.4(IC25-75%, 33.97-42.5); FEV1/FVC: 46 (IC25-75%, 42.5-52.5); PaO2: 68 mmHg (IC25-75%,63-75.3); PaCO2: 40mmHg(IC25-75%, 39-41). The NIV increased the walked distance by 61.78% (p=0.001) and load (kg.m) by 16.55%(p=0.002) in the six minute walking test. There was no significant difference in the symptoms (dyspnea and fatigue) in the Borg scale. The NIV increased the ascent velocity by 11.81% (p=0.05) in the stair climbing test. No significant changes in symptoms and ascended height were observed. The NIV increased the walked distance by 30.6% (p=0.001), without significant changes in symptoms. As conclusion, distance increased significantly with NIV in the six minute walking test and shuttle test. A higher velocity was observed in the stair climbing test. This study was the first experience of NIV on the stair climbing test in COPD patients.

Healthy adults maximum oxygen uptake prediction from a six minute walking test.

Background: A parameter is needed in medical activities or services to determine functional capacity. This study is aimed to produce functional capacity parameter for Indonesian adult as maximum O2. Methods: This study used 123 Indonesian healthy adult subjects (58 males and 65 females) with a sedentary lifestyle, using a cross-sectional method. Results: Designed by using the followings: distance, body height, body weight, sex, age, maximum heart rate of six minute walking test and lung capacity (FEV and FVC), the study revealed a good correlation (except body weight) with maximum O2. Three new formulas were proposed, which consisted of eight, six, and five variable respectively. Test of the new formula gave result of maximum O2 that is relevant to the golden standard maximum O2 using Cosmed® C-Pex. Conclusion: The Nury formula is the appropriate predictor of maximum oxygen uptake for healthy Indonesians adult as it is designed using Indonesian subjects (Mongoloid) compared to the Cahalin’s formula (Caucasian). The Nury formula which consists of five variables is more applicable because it does not require any measurement tools neither specific competency.

The value of six-minute walking test on chronic bronchitis needing lung function screening / 中国医师进修杂志

Objective To study the relationship between the six-minute walking test (6-MWT) and pulmonary function in the diagnosis course of chronic bronchitis converting into chronic obstructive pulmonary disease (COPD). Methods Pulmonary function was detected in 360 patients with chronic bronchitis.Based on the results and diagnosis standard of COPD by Chinese Medical Association in 2002, the patients were divided into COPD group and pulmonary function normal group.Tbe walking distance in 6-MWT (6-MWD) was measured, and the mean value of twice tests was calculated to study the correlation between 6-MWT and pulmonary function, and 50 healthy volunteers were selected as control group. Results Most 6-MWD in COPD group were less than 420 meters(95.95%, 142/148 ), but those in pulmonary function normal group were more than or equalled to 420 meters mostly (97.17%, 206/212 ). However in patients with the 6-MWD more than or equalled to 420 meters , pulmonary function indexes such as the ratio of forced expiratory volume in one second and forced vital capacity( FVC ), FEV_1%, maximal ventilatory volume(MVV)were all significantly greater than those in patients with 6-MWD less than 420 meters, and there were significant differences (P<0.05). Compared with chronic bronchitis, the results of 6-MWD in control group was more than or equalled to 420 meters, but there was no significant difference (P>0.05 ). Conclusions 6-MWT is simple and feasible. However, it is a better indicator of the patients pulmonary function. The test would be an effective selecting examination for chronic bronchitis patients who are not willing to do puhnonary function test.