Cambios en Mecánica Respiratoria en Usuarios Pediátricos en Ventilación Mecánica Post Cirugía de Cardiopatía Congénita Sometidos a Kinesiología Respiratoria versus Succión Endotraqueal. Revisión Estructurada / Changes in Respiratory Mechanics in Pediatric Users on Mechanical Ventilation Post Congenital Heart Disease Surgery Undergoing Respiratory Kinesiology versus Endotracheal Suction. Structured Review

Introducción. Las cardiopatías congénitas (CC) en Chile corresponden a la segunda causa de muerte en menores de 1 año, requiriendo cirugías paliativas y/o correctivas el 65% de estas. En el post operatorio frecuentemente se utiliza ventilación mecánica invasiva (VM) y succión endotraqueal (SET) para remover secreciones. Sin embargo, la kinesiología respiratoria (KTR) ha mostrado mejoras significativas en la distensibilidad toracopulmonar (Cest) y resistencia de vía aérea (Rva) en otros grupos de usuarios pediátricos y adultos en VM. Objetivo. Comparar los cambios en la Cest y Rva en usuarios pediátricos en VM post cirugía de cardiopatía congénita (CCC) sometidos a KTR versus SET exclusiva. Métodos. Revisión sistemática de estudios publicados en bases de datos PUBMED, PeDro, Scielo y Google Scholar que comparan el uso de KTR ó SET sobre los cambios en mecánica ventilatoria en usuarios pediátricos en VM post cirugía de cardiopatía congénita, limitados a inglés, español y portugués, excluyendo a sujetos con traqueostomía o con oxigenación por membrana extracorpórea. Se utilizó guía PRISMA para la selección de artículos. Se revisaron 397 artículos y se seleccionó 1 artículo extra de los artículos sugeridos. Se eliminó 1 artículo por duplicidad. Por títulos y resúmenes se seleccionaron 2 artículos, los cuales al leer el texto completo fueron retirados debido a que la población no correspondía a cardiópatas. Resultados. El final de artículos seleccionados fue de 0 artículos, debido a lo cual se removió el operador Booleano "NOT", y se removió la población de cardiopatías. De este modo quedaron 2 artículos seleccionados para la revisión cualitativa final donde se compara KTR versus SET, y KTR en kinesiólogos especialistas y no especialistas, mostrando ambos aumento en la Cest y disminución de la Rva a favor de la KTR, hasta los 30 minutos post intervención. Conclusiones. No se encontraron artículos que demuestren cambios en Cest y Rva con el uso de KTR + SET versus SET exclusiva, en usuarios pediátricos ventilados posterior a CCC. Con la remoción de filtros seleccionamos 2 artículos que demuestran aumento de Cest y disminución de Rva en sujetos pediátricos en VM, uno comparando con SET, y por grupos de especialistas y no especialistas en respiratorio. Se sugieren estudios primarios para evaluar los efectos de esta intervención en esta población.

Introduction. Congenital heart diseases (CHD) are the second general cause for children death under 1 year. In Chile, approximately 65% CHD need surgery, could was palliative or corrective. In the postoperative period, invasive mechanical ventilation (MV) is frequently used as a life support method, but it is associated with complications. Tracheal suction (SET) is regularly used to remove secretions; however, respiratory chest physiotherapy (KTR) has shown significant improvements in thoraco-pulmonary compliance and airway resistance in other groups of pediatrics and adult's users in MV. Objetive. to compare changes in thoraco-pulmonary compliance and airway resistance in pediatric subjects under mechanical ventilation after congenital heart disease surgery comparing chest physiotherapy and exclusive tracheal suction. Methods. systematic review of studies published in PUBMED, PeDro, Scielo and Google Scholar databases who compares KTR or SET use on changes in ventilatory mechanics in pediatric users under MV after congenital heart disease surgery, limited to English, Spanish and Portuguese languages, excluding user with tracheostomy or extracorporeal membrane of oxygenation. It was use the PRISMA guide to articles selection. A search was carried out, with a total of 397 articles reviewed (English: PubMed = 3, PeDro = 8, Scholar = 383; Spanish: Scholar = 3, Scielo = 0; and Portuguese: Scielo = 0). One extra article was selected from the suggested articles, and 1 article was eliminated due to duplication. By titles and abstracts, 2 articles were selected, but the population did not correspond to heart disease. Results. the final selected articles were 0 articles. By this reason, it were removed: Boolean operator "NOT", and congenital heart disease population. Thus, 2 articles were selected for the final qualitative review where it was compares KTR versus SET, and KTR by specialist and non-specialist. Both articles shown improvement in compliance and resistance until 30 minutes post intervention. The CC population was in a 40 to 60% range in both studies. Conclusions. it was no found articles that demonstrate changes in compliance and resistance in the airway with the use of KTR + SET versus exclusive SET in pediatric users after CCC connected to MV. After filter remotion, we found 2 studies shown improves in increase compliance and reduce resistance in pediatric user in MV, ones comparing with SET, and the other one comparing between specialists in respiratory pediatric physiotherapy and not specialists. It suggests to made primary clinical studies about this intervention in CC population.

Patência nasal em crianças respiradoras orais / Nasal patency in mouth breathing children

RESUMO Vários estudos mostram a importância da avaliação quantitativa na patência nasal e do estado funcional das vias aéreas superiores para fornecer informações clínicas e diagnósticas em indivíduos respiradores orais, as quais são de grande interesse para a fonoaudiologia. O objetivo deste estudo foi avaliar o efeito da irrigação de solução salina nasal nas vias aéreas superiores através da aeração nasal e rinomanometria anterior ativa em crianças respiradoras orais. Estudo de série de oito casos, realizado em crianças com idades entre 7 e 10 anos, com diagnóstico clínico otorrinolaringológico de respiração oral. O estudo consistiu em três etapas: avaliação inicial; intervenção e avaliação final. Foram aplicados os questionários do Índice de Identificação dos Sinais e Sintomas da Respiração Oral e qualidade de vida específica para doenças em pacientes pediátricos com queixas sinonasais. Realizaram-se as avaliações da aeração nasal e o exame da rinomanometria anterior ativa. A intervenção foi realizada por meio da irrigação de solução salina nasal com 10 ml. Em seguida, os pacientes foram reavaliados pela avaliação da aeração nasal e rinomanometria, para comparar os resultados. Em relação à avaliação da aeração nasal e rinomanometria, das 16 medidas comparativas entre pré e pós-irrigação nasal, constataram-se mudanças significativas na aeração nasal e na resistência nasal. A irrigação nasal resultou em melhora nas medidas da aeração nasal, enquanto para o fluxo nasal da rinomanometria, as medidas permaneceram inalteradas entre pré e pós-irrigação nasal.

ABSTRACT Several studies have shown the importance of quantitative assessment in nasal patency and functional status of the upper airways to provide clinical and diagnostic information in oral breather individuals, which are of great interest to speech therapy. The aim of the study was to evaluate the effect of nasal saline solution irrigation on the upper airways through nasal aeration and active anterior rhinomanometry in oral breathing children. This was an eight case series study, carried out in children aged 7 to 10 years with an otorhinolaryngological clinical diagnosis of mouth breathing. The study consisted of three stages: (I) initial evaluation; (II) intervention; and (III) final evaluation. The questionnaires of the Index for the Identification of Oral Breathing Signs and Symptoms and disease-specific quality of life in pediatric patients with sinonasal complaints were applied, nasal aeration assessments and the anterior active rhinomanometry exam were carried out. The intervention was performed by irrigating nasal saline solution with 10ml. Afterwards, they were re-evaluated by nasal aeration evaluation and rhinomanometry to compare the results. Regarding nasal aeration and rhinomanometry evaluation, from the 16 comparative measurements between pre and post nasal irrigation, we obtained significant changes in nasal aeration and nasal resistance. Nasal irrigation resulted in improvement in nasal aeration measurements while nasal flow measurements from rhinomanometry remained unchanged considering pre and post nasal irrigation.

Efficacy of Yupingfeng granule combined with cetirizine in the treatment of allergic rhinitis and its effects on serum inflammatory factor level / 中国基层医药

Objective:To investigate the efficacy of Yupingfeng granule combined with cetirizine in the treatment of allergic rhinitis and its effects on serum inflammatory factor level. Methods:A total of 162 patients with allergic rhinitis admitted to Zhejiang Provincial Hospital of Chinese Medicine from January 2021 to March 2022 were included in this prospective controlled study. They were randomly divided into a control group and an observation group ( n = 81/group). The control group was treated with cetirizine and the observation group was treated with Yupingfeng granule combined with cetirizine. All patients were treated for 4 weeks. Clinical efficacy was compared between the two groups after 4 weeks of treatment. Main symptom score, nasal function indexes (total nasal airway resistance, nasal minimal cross-sectional area, and 0-5 cm nasal cavity volume), levels of inflammatory factors (interleukin-4, interleukin-6, and interleukin-10), and Rhinoconjunctivitis Quality of Life Questionnaire scores were compared between the two groups before and after 4 weeks of treatment. Results:Total response rate in the observation group was significantly higher than that in the control group [92.59% (75/81) vs. 79.01% (64/81), χ2 = 6.13, P < 0.05]. After 4 weeks of treatment, the scores of nasal congestion, nasal itching, and sneezing in the observation group were (0.63 ± 0.20) points, (0.70 ± 0.21) points, and (0.54 ± 0.17) points, which were significantly lower than (1.07 ± 0.23) points, (1.08 ± 0.24) points, and (0.89 ± 0.22) points in the control group ( t = 12.99, 10.72, 11.33, all P < 0.05). After 4 weeks of treatment, total nasal airway resistance in the observation group was significantly lower than that in the control group [(0.17 ± 0.05) kPa·s -1·L -1vs. (0.26 ± 0.06) kPa·s -1·L -1, t = 10.37, P < 0.05]. Nasal minimal cross-sectional area and 0-5 cm nasal cavity volume in the observation group were (0.94 ± 0.17) cm 2 and (9.74 ± 0.89) cm 3, respectively, which were significantly higher than (0.76 ± 0.10) cm 2 and (8.43 ± 0.78) cm 3 in the control group ( t = 8.21, 9.96, both P < 0.05). After 4 weeks of treatment, serum levels of interleukin-4 and interleukin-6 in the observation group were (67.79 ± 9.94) ng/L and (6.74 ± 1.42) ng/L, respectively, which were significantly lower than (104.31 ± 14.45) ng/L and (10.29 ± 2.56) ng/L in the control group ( t = 18.74, 10.91, both P < 0.05). Serum level of interleukin-10 in the observation group was significantly higher than that in the control group [(17.97 ± 2.54) ng/L vs. (12.48 ± 2.46) ng/L, t = 13.97, P < 0.05]. After 4 weeks of treatment, Rhinoconjunctivitis Quality of Life Questionnaire score in the observation group was significantly lower than that in the control group [(27.43 ± 8.82) points vs. (38.95 ± 7.76) points, t = 8.82, P < 0.05). Conclusion:Yupingfeng granule combined with cetirizine is highly effective on allergic rhinitis. The combined therapy can reduce clinical symptoms and inflammatory reactions, improve nasal function, and thereby improve quality of life.

Effectiveness of functional orthodontic appliances in obstructive sleep apnea treatment in children: literature review / Eficácia dos aparelhos ortodônticos funcionais no tratamento da apneia obstrutiva do sono em crianças: revisão da literatura

Abstract Introduction: Obstructive sleep apnea syndrome is a common condition in childhood and if left untreated can result in many health problems. An accurate diagnosis of the etiology is crucial for obstructive sleep apnea treatment success. Functional orthodontic appliances that stimulate mandibular growth by forward mandibular positioning are an alternative therapeutic option in growing patients. Objective: To perform a literature review about the effects of functional orthodontic appliances used to correct the mandibular deficiency in obstructive sleep apnea treatment. Methods: The literature search was conducted in June 2020 using Cochrane Library; PubMed, EBSCO (Dentistry & Oral Sciences Source), LILACS Ovid; SciELO Web of Science; EMBASE Bireme and BBO Bireme electronic databases. The search included papers published in English, until June 2020, whose methodology referred to the types and effects of functional orthopedic appliances on obstructive sleep apnea treatment in children. Results: The search strategy identified thirteen articles; only four articles were randomized clinical studies. All studies using the oral appliances or functional orthopedic appliances for obstructive sleep apnea in children resulted in improvements in the apnea-hypopnea index score. The cephalometric (2D) and tomographic (3D) evaluations revealed enlargement of the upper airway and increase in the upper airspace, improving the respiratory function in the short term. Conclusion: Functional appliances may bean alternative treatment for obstructive sleep apnea, but it cannot be concluded that they are effective in treating pediatric obstructive sleep apnea. There are significant deficiencies in the existing evidence, mainly due to absence of control groups, small sample sizes, lack of randomization and no long-term results.

Resumo Introdução: A síndrome da apneia obstrutiva do sono é uma condição comum na infância e, se não tratada, pode resultar em muitos problemas de saúde. Um diagnóstico preciso da etiologia é crucial para o sucesso do tratamento dessa condição clínica. Aparelhos ortodônticos funcionais que estimulam o crescimento mandibular através do anteroposicionamento mandibular são uma opção terapêutica para pacientes em crescimento. Objetivo: Fazer uma revisão da literatura sobre os efeitos do aparelho ortodôntico funcional usado para corrigir a deficiência mandibular no tratamento da apneia obstrutiva do sono. Método: A pesquisa bibliográfica foi feita em junho de 2020 nos os bancos de dados eletrônicos da Cochrane Library; PubMed, EBSCO (Dentistry & Oral Sciences Source), Lilacs Ovid; SciELO Web of Science; Embase Bireme e BBO Bireme. A busca incluiu artigos publicados em inglês, até junho de 2020, cuja metodologia referia-se aos tipos e efeitos dos aparelhos ortopédicos funcionais no tratamento da apneia obstrutiva do sono em crianças. Resultados: A estratégia de busca identificou 19 artigos; apenas quatro eram estudos clínicos randomizados. Todos os estudos que usaram aparelhos orais ou aparelhos ortopédicos funcionais para apneia obstrutiva do sono em crianças resultaram em melhorias no índice de apneia-hipopneia. As avaliações cefalométrica (2D) e tomográfica (3D) mostraram alargamento das vias aéreas superiores e aumento do espaço das vias aéreas superiores, que melhoraram a função respiratória em curto prazo. Conclusão: Os aparelhos funcionais podem ser um tratamento opcional para apneia obstrutiva do sono, mas não é possível concluir que sejam eficazes na população pediátrica. Existem deficiências significativas nas evidências existentes, principalmente devido à ausência de grupos de controle, tamanho pequeno das amostras, falta de randomização e ausência de resultados em longo prazo.

Función pulmonar oscilometría de impulso en pediatría: procedimiento y aplicación clínica / Pulmonary function impulse oscillometry in pediatrics: procedure and clinical application

La Oscilometría de Impulso (IOS) es una técnica no invasiva que evalúa las propiedades mecánicas de todo el sistema respiratorio durante la respiración tranquila. Mide la impedancia total del sistema respiratorio, evaluando la resistencia total de la vía aérea, la resistencia de la vía aérea alta y las propiedades elásticas del pulmón. Detecta el compromiso de la vía aérea periférica en forma muy precoz, antes que la espirometría, y es útil en niños pequeños porque no requiere maniobras de espiración forzada. Permite evaluar la respuesta broncodilatadora y broncoconstrictora a través de pruebas de provocación bronquial para el diagnóstico de hiperreactividad bronquial. La IOS tiene un rol en la evaluación temprana y seguimiento de la función pulmonar en niños con enfermedades respiratorias crónicas, principalmente asma bronquial, displasia broncopulmonar y fibrosis quística. Este artículo revisa los aspectos fisiológicos, técnicos y aplicación clínica de la IOS, considerando las últimas recomendaciones para la estandarización del examen y las limitaciones que dificultan su interpretación .

Impulse Oscillometry (IOS) is a non-invasive technique that assesses the mechanical properties of the entire respiratory system during quiet breathing. It measures the total impedance of the respiratory system by evaluating total airway resistance, upper airway resistance, and elastic properties of the lung. It detects peripheral airway compromise very early, before spirometry, and is useful in young children because it does not require forced expiration maneuvers. It allows evaluating the bronchodilator and bronchoconstrictor response through bronchial provocation tests for the diagnosis of bronchial hyperreactivity. The IOS has a role in the early evaluation and monitoring of lung function in children with chronic respiratory diseases, mainly bronchial asthma, bronchopulmonary dysplasia and cystic fibrosis. This article reviews the physiological, technical, and clinical application aspects, considering the latest recommendations for the standardization of the test and the limitations that hinder its interpretation.

Model of single-sized endotracheal tube for adults / Modelo de tubo endotraqueal de tamanho único para adultos

ABSTRACT Objective To simulate different diameters of endotracheal tubes and to verify the fluid dynamics aspects by means of flow and resistance measurements. Methods Fluid dynamics software was used to calculate mean flow and airway resistance in endotracheal tube with a diameter of 6.0, 7.0, 7.5, 8.0, 9.0 and 10.0mm at normal body temperature and under constant pressure. The same measurements were taken in the fusion of the first 22cm of a 9.0mm endotracheal tube with 10.0mm diameter, and with the end part in 12cm of a 6.0mm endotracheal tube with 7.0mm diameter. Results The fusion of the first 22cm of an endotracheal tube of 10.0mm diameter with the terminal part in 12cm of an endotracheal tube of 6.0mm diameter, preserving the total length of 34cm, generated average flow and airway resistance similar to that of a conventional 7.5mm endotracheal tube. Conclusion This simulation study demonstrates that a single-sized endotracheal tube may facilitate endotracheal intubation without causing increased airway resistance.

RESUMO Objetivo Simular diferentes diâmetros de tubos endotraqueais e verificar os aspectos fluidinâmicos, considerando medições de fluxo e resistência. Métodos Foi utilizado um software de fluidinâmica para calcular o fluxo médio e a resistência das vias aéreas nos tubos endotraqueais com diâmetro de 6,0, 7,0, 7,5, 8,0, 9,0 e 10,0mm, em temperatura corporal normal e pressão constante. As mesmas medidas foram realizadas na fusão dos primeiros 22cm de um tubo endotraqueal de 9,0 e 10,0mm de diâmetro, com a parte terminal em 12cm de um tubo endotraqueal de 6,0 e 7,0mm de diâmetro. Resultados A fusão dos primeiros 22cm de um tubo endotraqueal de diâmetro 10,0 mm com a parte terminal em 12cm de um tubo endotraqueal de 6,0mm de diâmetro, preservando o comprimento total de 34cm, gerou fluxo médio e resistência de vias aéreas semelhantes aos de um tubo endotraqueal convencional de 7,5mm. Conclusão Um tubo endotraqueal de tamanho único pode facilitar a intubação endotraqueal, sem causar aumento de resistência na via aérea.

Insuflador-exsuflador mecânico versus manobra PEEP-ZEEP em pacientes em ventilação mecânica prolongada / Mechanical insufflator-exsufflator versus PEEP-ZEEP maneuver in patients on prolonged mechanical ventilation

Introdução: A presença da via aérea artificial, associada com a imobilidade no leito, resulta em um déficit na desobstrução das vias aéreas em pacientes sob ventilação mecânica (VM). Tal condição contribui para o desenvolvimento de quadros de hipoxemia e/ou infecções respiratórias, aumentando o trabalho respiratório e também as falhas de extubação. Objetivo: Comparar os efeitos da utilização do insuflador-exsuflador mecânico e da manobra PEEP-ZEEP em relação à mecânica respiratória em pacientes ventilados mecanicamente por tempo prolongado. Métodos: Ensaio clínico randomizado cruzado, incluindo pacientes em ventilação mecânica por mais de 10 dias. Os pacientes foram randomizados para receber a aplicação do insuflador-exsuflador mecânico e da manobra PEEP-ZEEP. Foram mensuradas complacência pulmonar, estática e dinâmica, e resistência pulmonar antes e após a aplicação de cada técnica. Resultados: Foram incluídos 22 pacientes. Na análise intragrupos observa-se aumento significativo na complacência dinâmica e complacência estática após a aplicação de ambas as técnicas. A resistência pulmonar variou significativamente apenas após a aplicação do insuflador-exsuflador mecânico. Não foram observadas diferenças significativas na análise intergrupos. Conclusão: O insuflador-exsuflador mecânico e a manobra de PEEP-ZEEP demonstraram ter efeito positivo tanto sobre a complacência estática quanto a dinâmica. Entretanto, a resistência pulmonar aumentou após a aplicação do insuflador-exsuflador mecânico. (AU)

Introduction: The presence of the artificial airway associated with immobility in the bed results in a deficit in the clearance of the airways in patients under mechanical ventilation (MV). This condition contributes to the development of hypoxemia and/or respiratory infections, increasing respiratory work and also extubation failures. Objective: To compare the effects of the use of mechanical insufflation-exsufflation and PEEP-ZEEP maneuver in relation to respiratory mechanics in patients on prolonged mechanical ventilation. Methods: Randomized cross-over trial, including patients on mechanical ventilation for more than 10 days. The patients were randomized to receive the application of mechanical insufflator-exsuflator and PEEP-ZEEP maneuver. Pulmonary compliance, static and dynamic, and pulmonary resistance were measured before and after the application of each technique. Results: 22 patients were included. In the intragroup analysis we observed a significant increase in the dynamic compliance and static compliance after the application of both techniques. Pulmonary resistance varied significantly only after application of the mechanical insufflation-exsufflation. No significant differences were observed in the inter-group analysis. Conclusion: The mechanical insufflator-exsuflator and the PEEP-ZEEP maneuver were shown to have a positive effect on both static and dynamic complacency. However, pulmonary resistance increased after the application of the mechanical insufflation-exsufflation.(AU)

Dynamic changes of lung function in mice with pulmonary fibrosis / 医学研究生学报

Objective　Pulmonary function testing is a commonly used indicator for clinical evaluation of the degree of pulmonary fibrosis in patients. This paper aims to investigate the dynamic changes of lung function in mice with pulmonary fibrosis and to establish a range of reference values for lung function parameters in normal Kunming mice.　Methods　Twenty-eight SPF Kunming mice were randomly divided into normal control group (n=14) and model group (n=14). After anesthesia with 10% chloral hydrate, the normal control group only underwent tracheal puncture. The model group received intratracheal puncture and injection of bleomycin (BLM) (5 mg/kg body weight), and the lung function indicators of all mice were detected in the same order on the 1st, 2nd, 3rd and 4th weekends after modeling: Ti, Te, PIF, PEF, TV, EV, RT, MV, f, Penh and EF50.　Results　After intratracheal BLM injection, mice in the model group showed decreased hair softness and smoothness, hair loss and decreased activity after the 2nd week. Compared with the control group, Ti, Te and RT values in the model group significantly increased at week 4 (P<0.05), while the values of PEF, RT, MV, f and EF50 decreased significantly at the same week (P<0.05). Compared with the model group at week 1, the differences in Ti, Te, RT and f values at week 2, 3 and 4 were statistically significant (P<0.05); the differences in MV and EF50 values at week 3 and 4 were statistically significant (P<0.05); while the PIF values only showed differences at week 4 (P<0.001). Compared with the Penh values in the control group at week 2, 3 and 4 (0.553±0.189, 0.662±0.164, 0.712±0.189), the differences of the model group (0.820±0.205, 0.936±0.188, 1.053±0.236) showed statistical significance (P<0.001). Compared with the model group at week 1, the differences of Penh values in the model group only showed statistical significance at week 3 and 4 (P<0.05). Through four-week lung function test, various parameters were obtained, among which the normal range of the main index Penh value was 0.27-0.88.　Conclusion　The lung function detected by the non-invasive whole body plethysmography system was stable and reliable with good effects; the lung function in mice with the BLM-induced pulmonary fibrosis continued to decrease within four weeks. Penh, which reflects airway resistance, can be used for overall screening of the lung function among the test mice after two weeks of modeling.

Effects of propofol, desflurane, and sevoflurane on respiratory functions following endoscopic endonasal transsphenoidal pituitary surgery: a prospective randomized study / 대한마취과학회지

BACKGROUND: General anesthesia with intravenous or inhalation anesthetics reduces respiratory functions. We investigated the effects of propofol, desflurane, and sevoflurane on postoperative respiratory function tests.METHODS: This single-center randomized controlled study was performed in a university hospital from October 2015 to February 2017. Ninety patients scheduled for endoscopic endonasal transsphenoidal pituitary surgery were randomly categorized into either of these three groups: propofol (n = 30, the Group TIVA), desflurane (n = 30, the Group D) or sevoflurane (n = 30, the Group S). We analyzed the patients before, after, and 24 h following surgery, to identify the following parameters: forced expiratory volume in 1 second (FEV₁) %, forced vital capacity (FVC) %, FEV₁/FVC, and arterial blood gases (ABG). Furthermore, we also recorded the intraoperative dynamic lung compliance and airway resistance values.RESULTS: We did not find any significant differences in FEV₁ values (primary outcome) among the groups (P = 0.336). There was a remarkable reduction in the FEV₁ and FVC values in all groups postoperatively relative to the baseline (P < 0.001). The FVC, FEV₁/FVC, ABG analysis, compliance, and airway resistance were similar among the groups. Intraoperative dynamic compliance values were lower at the 1st and 2nd hours than those immediately after intubation (P < 0.001).CONCLUSIONS: We demonstrated that propofol, desflurane, and sevoflurane reduced FEV₁ and FVC values postoperatively, without any significant differences among the drugs.

Usefulness of Measuring Airway Length with Cephalometry in Pediatric Subjects with Obstructive Sleep Apnea

Influencia de la obesidad sobre la resistencia y conductancia específica de la vía aérea en niños escolares / The impact of obesity on specific airway resistance and conductance among schoolchildren

Introducción. La obesidad infantojuvenil es un problema epidemiológico en los países en vías de desarrollo. Su prevalencia entre los niños en edad preescolar y escolar supera el 30%. Esta se asocia a una amplia variedad de complicaciones de salud, entre ellas, una acelerada pérdida de la función pulmonar, que provoca cambios en la fisiología y mecánica ventilatoria. El objetivo de este estudio fue estudiar la asociación entre obesidad y aumento de la resistencia específica de las vías aéreas (specific resistance airway; sRaw, por sus siglas en inglés) en una muestra infantojuvenil obesa de la comuna de Talca. Material y método. En una muestra de 36 sujetos con un promedio de edad de 9,38 ± 1,99 años, dividida en dos grupos, peso normal y obesos, se midieron los pliegues tricipital, subescapular, abdominal y volúmenes pulmonares. Para el análisis estadístico, se determinó la normalidad de los datos y, posteriormente, se utilizaron los test t de Student o U de Mann-Whitney y Pearson o Spearman según correspondiera. Se consideró un nivel de significancia estadística de p < 0,05. Resultados. Al comparar sujetos de peso normal con obesos, se observó un aumento significativo de la sRaw y una disminución significativa de la conductancia específica de la vía aérea en sujetos obesos. Además, se observó una correlación buena y significativa entre sRaw y porcentaje de grasa. Conclusiones. Los sujetos obesos mostraron un aumento de la sRaw y disminución de la conductancia específica de la vía aérea.

Introduction. Child and adolescent obesity is an epidemiological problem in developing countries. Its prevalence among preschoolers and schoolchildren is over 30%. It has been associated with a wide range of health complications, including rapid loss of lung function leading to changes in physiology and ventilatory mechanics. The objective of this study was to analyze the association between obesity and the increase in specific airway resistance (sRaw) in a sample of obese children and adolescents from the district of Talca. Material and method. In a sample of 36 subjects with an average age of 9.38 ± 1.99 years, divided into 2 groups (normal weight and obese), the tricipital, subscapular, and abdominal skinfolds and lung volumes were measured. For the statistical analysis, data normality was determined and then the Student's t test or the Mann-Whitney U test and Pearson's or Spearman's correlations were used, as applicable. A value of p < 0.05 was considered statistically significant. Results. When comparing normal weight and obese subjects, a significant increase in sRaw and a significant reduction in specific airway conductance (sGaw) were observed in obese subjects. In addition, an adequate and significant correlation was observed between sRaw and fat percentage. Conclusions. Obese subjects showed an increased sRaw and a reduced sGaw.

Clinical value of pulsed pulmonary function test in the diagnosis of chronic obstructive pulmonary disease / 中国基层医药

Objective To investigate the clinical value of pulsed pulmonary function in the diagnosis of chronic obstructive pulmonary disease (COPD).Methods 32 patients with chronic obstructive pulmonary disease admitted to Haiyang People's Hospital from March 2016 to March 2017 were selected as observation group .Another 32 cases without COPD were selected as control group .All the patients received pulsed pulmonary function test .The relevant indicators of oscillation technology and pulmonary function test indicators were compared between the two groups.Results The resonance frequency , total respiratory impedance , central airway resistance and peripheral airway resistance in the observation group were (16.9 ±1.5)kPa · L-1· s-1,(0.46 ±0.03)kPa· L-1· s-1, (0.56 ±0.05)kPa · L-1· s-1 and (0.15 ±0.03)kPa · L-1· s-1,which were significantly higher than those in the control group [(9.5 ±0.3)kPa· L-1· s-1,(0.26 ±0.01)kPa · L-1· s-1,(0.24 ±0.01)kPa· L-1· s-1, (0.02 ±0.01)kPao· L-1· s-1] (t=30.595,40.000,39.691 and 26.000,all P<0.05).The FEV1％ in the observation group was (41.5 ±1.9)％,which was lower than (81.1 ±2.0)％ in the control group(t=47.229,P<0.05).The FEV1/FVC level in the observation group was (49.5 ±3.3),which was lower than (81.9 ±2.6) in the control group(t=21.678,P<0.05).Conclusion The results of pulsed pulmonary function are synchronous and consistent with routine pulmonary function test ,especially for elderly ,pediatric and critically ill patients .

Espirometría forzada versus oscilometría de impulso / Forced spirometry versus impulse oscillometry

Impulse oscillometry (IOS) is an emerging tool in the study of pulmonary function in respiratory diseases. In this review we compare its usefulness with that of forced spirometry in children. Although these techniques measure different mechanical properties of the respiratory system, -the first, resistance, and the second, flow- they are, undoubtedly, complementary tests.. This review includes a brief description of some comparative studies since 1973, year of the first publication about children; then, with the advent of technology, its application in the mid-80s and 90s made it possible to include reference values in order to establish functional diagnoses. IOS measures airway, pulmonary and thoracic resistance, which is a primary function of the mechanics of ventilation, whereas spirometry measures the flow, which is a secondary function. This principle allows us to understand why IOS indices are more sensitive than those of spirometry

La Oscilometría de Impulso (IOS) es una herramienta emergente en el estudio de la función pulmonar y en esta revisión se compara su utilidad con la espirometría forzada en niños. Aunque ambas técnicas miden diferentes propiedades mecánicas del sistema respiratorio, resistencias la primera y flujos la segunda, tienen un carácter complementario incuestionable. Esta revisión describe brevemente algunos trabajos comparativos a partir de 1973, fecha de la primera publicación en niños y luego con el advenimiento tecnológico, su aplicación a mediados de los 80 y 90 permite incluir valores de referencia para poder establecer diagnósticos funcionales. La IOS se caracteriza por medir resistencia de la vía aérea y toracopulmonar y que desde el punto de vista de la mecánica respiratoria ésta es una función primaria versus los flujos, medidos por espirometría, que son una función secundaria, este principio es el que permite entender porque sus índices son más sensibles que los de la espirometría

Changes of airway resistance before and after Bronchial Diulation Test in patients with senile Asthma / 实用医学杂志

Objective To investigate the changes of airway resistance before and after Bronchial Diulation Test in patients with senile asthma and the effect of age on the degree of airway resistance. Methods A total of 29 (> 60 years)senile asthma patients and 21 younger( 60 years)and the group of healthy control(age < 60 years ). Each index of the airway resistance has a very good correlation with FEV1%,with the highest degree of relation is X5%. Conclusion The airway resistance of senile asthmatic patients was significantly improved after diuslation test and these indexes IOS would be valuable in evaluating the changes of airway resistance of senile asthma.

Therapeutic effects of histone deacetylase inhibitor givinostat on air inflammation and high airway resistance in a murine asthma model / 中华内科杂志

Objective To investigate the therapeutic effects of givinostat , a histone deacetylase inhibitor (HDACI), on the development of chronic asthma with airway inflammation , airway remodeling and airway hyperresponsiveness ( AHR) .Methods BALB/C mice were randomly divided into control group , asthma group, dexamethasone group and givinostat group (n=12 per group).AHR was assessed.Total cell numbers and differential counts , interleukin-4 ( IL-4 ) , interleukin-5 ( IL-5 ) and interferon-γ( IFNγ) levels in the bronchoalveolar lavage fluid ( BALF) were measured in the above 4 groups.The pathology of lung tissue was evaluated .Immunohistochemical ( IHC) staining and Western blot were used to detect αsmooth muscle actin(α-SMA) and transforming growth factor-β1(TGFβ1).Results Compared with the asthma only group, givinostat treatment relieved airway resistance (2.96 ±1.01 vs 6.50 ±0.79,P0.05] was enhanced in BALF.Inflammatory cell infiltration around the airway was reduced , with decreased inflammatory cell score [(1.60 ±0.69) points vs (3.40 ±0.68) points, P <0.01] and inflammatory cell number (111.65 ±31.41 vs 601.25 ±186.85, P<0.01).The goblet cell metaplasia [(26.36 ±2.33)%vs (57.21 ±11.56)%] and collagen deposition area [(52.77 ±7.58)μm2/μm vs (111.81 ±12.40)μm2/μm] were obviously reduced (P<0.01).The expressions of α-SMA and TGFβ1 in the lung tissue were both significantly decreased ( P<0.01 ) .Conclusion Givinostat treatment can reduce airway inflammation , airway remodeling and airway hyperresponsiveness in chronic asthma .Its effect is comparable to that of glucocorticoid hormone treatment .

Lung volumes and airway resistance in patients with a possible restrictive pattern on spirometry / Volumes pulmonares e resistência das vias aéreas em pacientes com possível padrão restritivo à espirometria

ABSTRACT Objective: Many patients with proportional reductions in FVC and FEV1 on spirometry show no reduction in TLC. The aim of this study was to evaluate the role that measuring lung volumes and airway resistance plays in the correct classification of patients with a possible restrictive pattern on spirometry. Methods: This was a prospective study involving adults with reduced FVC and FEV1, as well as an FEV1/FV(C) ratio within the predicted range. Restrictive lung disease (RLD) was characterized by TLC below the 5th percentile, as determined by plethysmography. Obstructive lung disease (OLD) was characterized by high specific airway resistance, significant changes in post-bronchodilator FEV1, or an FEF25-75% < 50% of predicted, together with a high RV/TLC ratio. Nonspecific lung disease (NLD) was characterized by TLC within the predicted range and no obstruction. Combined lung disease (CLD) was characterized by reduced TLC and findings indicative of airflow obstruction. Clinical diagnoses were based on clinical suspicion, a respiratory questionnaire, and the review of tests of interest. Results: We included 300 patients in the study, of whom 108 (36%) were diagnosed with RLD. In addition, 120 (40%) and 72 (24%) were diagnosed with OLD/CLD and NLD, respectively. Among the latter, 24 (33%) were clinically diagnosed with OLD. In this sample, 151 patients (50.3%) were obese, and obesity was associated with all patterns of lung disease. Conclusions: Measuring lung volumes and airway resistance is often necessary in order to provide an appropriate characterization of the pattern of lung disease in patients presenting with a spirometry pattern suggestive of restriction. Airflow obstruction is common in such cases.

RESUMO Objetivo: Muitos pacientes com redução proporcional de CVF e VEF1 na espirometria não têm CPT reduzida. O objetivo deste estudo foi avaliar o papel da medida dos volumes pulmonares e da resistência das vias aéreas para a classificação correta de pacientes com possível restrição à espirometria. Métodos: Estudo prospectivo de adultos com CVF e VEF1 reduzidos e relação VEF1/CV(F) na faixa prevista. Distúrbio ventilatório restritivo (DVR) foi definido por CPT < 5º percentil por pletismografia. Distúrbio ventilatório obstrutivo (DVO) foi caracterizado por resistência específica de vias aéreas elevada, resposta significativa do VEF1 pós-broncodilatador e/ou um FEF25-75% < 50% do previsto associado a uma relação VR/CPT elevada. Distúrbio ventilatório inespecífico (DVI) foi caracterizado por CPT na faixa prevista e ausência de obstrução. Distúrbio ventilatório combinado (DVC) foi caracterizado por CPT reduzida e achados indicativos de obstrução ao fluxo aéreo. Os diagnósticos clínicos foram baseados em suspeita clínica, um questionário respiratório e revisão de exames de interesse. Resultados: Foram incluídos 300 pacientes no estudo, dos quais 108 (36%) tiveram diagnóstico de DVR, enquanto 120 (40%) foram diagnosticados com DVO ou DVC e 72 (24%) com DVI. Destes últimos, 24 (33%) tinham diagnóstico clínico de DVO. Nesta amostra, 151 pacientes (50,3%) eram obesos, e isso se associou com todos os padrões de distúrbios funcionais. Conclusões: Medidas dos volumes pulmonares e da resistência das vias aéreas são frequentemente necessárias para a caracterização adequada do tipo de distúrbio funcional em casos com possível restrição à espirometria. A obstrução ao fluxo aéreo é comum nesses casos.

Orofacial-cervical alterations in individuals with upper airway resistance syndrome / Alteração cérvico-orofacial em indivíduos com síndrome da resistência de via aérea superior

ABSTRACT INTRODUCTION: Studies that assess the upper airways in sleep-related breathing disorders have been performed only in patients with obstructive sleep apnea syndrome who seek medical attention. Therefore, in addition to the need for population studies, there are no data on the orofacial-cervical physical examination in subjects with upper airway resistance syndrome. OBJECTIVES: To compare the orofacial-cervical examination between volunteers with upper airway resistance syndrome and without sleep-related breathing disorders. METHODS: Through questionnaires, physical measurements, polysomnography, and otorhinolaryngological evaluation, this study compared the orofacial-cervical physical examination, through a systematic analysis of the facial skeleton, mouth, throat, and nose, between volunteers with upper airway resistance syndrome and volunteers without sleep-related breathing disorders in a representative sample of the adult population of the city of São Paulo. RESULTS: There were 1042 volunteers evaluated; 49 subjects (5%) were excluded as they did not undergo otorhinolaryngological evaluation, 381 (36%) had apnea-hypopnea index > 5 events/hour, and 131 (13%) had oxyhemoglobin saturation < 90%. Among the remaining 481 subjects (46%), 30 (3%) met the criteria for the upper airway resistance syndrome definition and 53 (5%) met the control group criteria. At the clinical evaluation of nasal symptoms, the upper airway resistance syndrome group had more oropharyngeal dryness (17% vs. 29.6%; p = 0.025) and septal deviation grades 1-3 (49.1% vs. 57.7%; p = 0.025) when compared to controls. In the logistic regression model, it was found that individuals from the upper airway resistance syndrome group had 15.6-fold higher chance of having nose alterations, 11.2-fold higher chance of being hypertensive, and 7.6-fold higher chance of complaining of oropharyngeal dryness when compared to the control group. CONCLUSION: Systematic evaluation of the facial skeleton, mouth, throat, and nose, between volunteers with upper airway resistance syndrome and volunteers without sleep-related breathing disorders, showed that the presence of upper airway resistance syndrome is mainly associated with nasal alterations and oropharyngeal dryness, in addition to the risk of hypertension, regardless of gender and obesity.

Resumo Introdução: Estudos que avaliam a via aérea superior (VAS) nos distúrbios respiratórios relacionados ao sono (DRRS) foram realizadas somente em pacientes com Síndrome da apneia obstrutiva do sono (SAOS) que procuram o atendimento médico. Portanto, além da necessidade de estudos populacionais, não há dados sobre o exame físico cérvico-orofacial em indivíduos com Síndrome de Resistência das Vias Aéreas Superiores (SRVAS). Objetivos: Comparar o exame cérvico orofacial entre voluntário com SRVAS e sem DRRS. Método: Através de questionários, medidas físicas, polissonografia e avaliação otorrino-laringológica comparou-se o exame físico cérvico orofacial, através de uma análise sistemática do esqueleto facial, boca, faringe e nariz, entre voluntários com SRVAS e voluntários sem DRRS em uma amostra representativa da população adulta da cidade de São Paulo. Resultados: Avaliamos 1042 voluntários. Foram excluídos: 49 indivíduos (5%) que não realizaram avaliação otorrinolaringológica; 381 (36%) apresentaram índice de apneia e hipopnéia (IAH) > 5 eventos/hora e 131 (13%) apresentaram saturação da oxihemoglobina < 90%. Entre os 481 voluntários restantes (46%), 30 (3%) preenchiam os critérios estabelecidos para a definição de SRVAS e 53 (5%) que preenchiam os critérios do grupo controle. Na avaliação clínica dos sintomas nasais, o grupo SRVAS apresentou mais ressecamento orofaríngeo (17% vs. 29,6%; p = 0,025), desvio septal grau 1 a 3 (49,1% vs. 57,7%; p = 0,025), comparado ao controle. No modelo de regressão logística observamos que indivíduos do grupo SRVAS apresentaram uma razão de chance 15,6 vezes maior de apresentarem nariz alterado; 11,2 vezes maior de serem hipertensos e 7,6 vezes maior de se queixarem de ressecamento orofaríngeo quando comparados ao grupo controle. Conclusão: A avaliação sistemática do esqueleto facial, boca, faringe e nariz, entre voluntários com SRVAS e voluntários sem DRRS, mostrou que a presença de SRVAS está principalmente associada à alterações nasais e ressecamento orofaríngeo, além do risco de hipertensão arterial, independentemente do gênero e obesidade.

Does the different amount of short-acting bronchodilator drugs have different effects on small airway response in bronchodilator test?

PURPOSE: It is recommended to use 200 (2 puffs) or 400 (4 puffs) µg of salbutamol in the bronchodilator response (BDR) test. We aimed to compare the difference between these 2 doses with regard to small airway dysfunction. METHODS: One hundred sixteen subjects who visited the hospital for diagnosis or follow-up of asthma were consecutively enrolled between June 1 and November 31, 2013. The subjects were randomly assigned to the BDR test at the 2 doses (200 or 400 µg of salbutamol), with physicians blinded to the group each subject was assigned to and undertook the BDR test using the spirometry and impulse oscillometry system (IOS). RESULTS: A total of 116 subjects participated in this study; the mean age was 7.8±3.6 years. The number of participants who were assigned to 2 and 4 puffs groups was 59 and 57, respectively. The mean age was older in the 4 puffs group than in the 2 puffs group (P=0.008). There were no significant difference in spirometric and oscillometric parameters between the 2 and 4 puffs groups. However, in subgroup analysis of asthmatic patients on maintenance therapy (n=21), there was a significant difference in relative changes in Rrs5 between the 2 and 4 puffs groups (16.4%±9.6% vs. 28.7%±8.8%, P=0.035). The forced expiratory volume of 1 second showed a significant correlation with resistance in the 2 puffs group and with reactance in the 4 puffs group. CONCLUSION: There was a significant relationship between the amounts of bronchodilators administered and the small airway dysfunction in children with asthma on maintenance therapy. Further research is warranted to delineate changes in spirometric and IOS measures in accordance with the different amounts of bronchodilators administered.

Upper airway dimensions and sleep efficiency – three‑dimensional imaging analysis and assessment of the nasopharyngeal appliance.

Background: Reduction of upper airway (UA) dimensions during sleep is contemplated to cause reduced sleep efficiency (SE) but a definitive association is not affirmed. Efficacy of nasopharyngeal appliance (NPA) in management of UA resistance syndrome (UARS) has not been compared with mandibular repositioning splint (MRS). This study intended to assess relation of UA dimensions to SE and effectiveness of NPA. Materials and Methods: Research had two phases: Case–control study to determine association between UA and SE; randomized control trial (with independent concurrent trial groups and double‑blind design) to analyze treatment outcome with NPA. Subjects were categorized to three groups of 20 in each: A control group of healthy subjects (Group A); two “Randomly Assigned” sample groups of subjects with reduced SE (Groups B and C). Preliminary questionnaire for sleep analysis, Final data collection sheet (first and second case sheets) were recorded, cephalometric variables analyzed, and diagnostic overnight polysomnography was done to match and confirm selection criteria. Three‑dimensional computed tomography was done to analyze airway dimensions before and after appliance placement. ANOVA and post‑hoc tests were used for statistical analysis of results. Conclusions: Reduced UA dimension during sleep is associated with reduced SE; NPA gives better improvement for UARS than MRS.

Effect of 1,25-dihydroxyvitamin D3 on mast cells tryptase in asthmatic guinea pigs

Objective: To explore the effect of 1,25-dihydroxyvitamin D3 on the mast cell tryptase (MCT) in asthmatic guinea pigs. Methods: A total of 60 male or female healthy guinea pigs were randomly divided into control group (group A), asthmatic group (group B), and 1,25-dihydroxyvitamin D3 group (group C), with 20 cases in each group. To establish asthmatic guinea pig models, 1mL peanut oil was filled into stomach in the morning in group A and group B, and 1mL peanut oil with 1,25-dihydroxyvitamin D3 was filled into stomach in group C. Airway resistance (Re) of asthmatic guinea pigs was detected, and the bronchoalveolar lavage fluid (BALF) cells were counted. Lung tissue with HE and MCT immunohistochemical staining were used to observe the pathological changes in lung tissue and the distribution of MCT. Results: After injection of different concentration of acetylcholine chloride, the Re in group B and group C were increased significantly compared with group A (P<0.05); compared with group B, the Re in group C were decreased significantly (t=-5.385,-5.761,-6.184,-13.574, P<0.05); the total number of BALF cells and eosinophils were increased significantly in group B and C (t=19.618, 9.598, 10.854, 5.388, P<0.05); compared with group B, the total number of BALF cells and eosinophils in group C was decreased significantly (t=-5.555,-5.392, P<0.05); the number of tryptase positive cells in group B was increased significantly than that in group A (t=21.312, P<0.05), and in addition to the alveolar septum and submucosa, the cells were also distributed around blood vessels and outside the cells; the number of tryptase positive cells in group C was decreased significantly compared with group B, and the difference was statistically significant (t=5.043, P<0.05). Conclusions: After the asthmatic guinea pigs are treated with 1,25-dihydroxyvitamin D3, their BALF, Re, infiltration degree of inflammatory cells in the trachea and lung tissue and airway inflammatory reaction are reduced significantly. 1,25-dihydroxyvitamin D3 has a certain inhibiting effect on the activation of mast cells and the release of MCT granules.