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Introducción. Los pacientes conectados a ventilación mecánica invasiva pueden presentar complicaciones respiratorias, donde la retención de secreciones es una de las más frecuentes. El drenaje y eliminación de las secreciones depende entre otras variables de los flujos respiratorios generados, donde una diferencia absoluta entre el flujo espiratorio máximo (FEM) y flujo inspiratorio máximo (FIM) menor a 17 Lâ¢min-1 o una relación FIM/FEM mayor a 0.9 favorecerían la retención de secreciones. Sin embargo, falta por determinar los flujos respiratorios resultantes y la proporción de pacientes con riesgo de retención de secreciones según estos parámetros. Objetivo. Determinar los flujos respiratorios durante la ventilación mecánica invasiva y la proporción de pacientes que se encuentra en riesgo de retención de secreciones. Métodos. Estudio descriptivo transversal desarrollado en la Unidad de Paciente Crítico Médico-Quirúrgico del "Hospital Clínico de la Red de Salud UC-CHRISTUS". Se incluyeron pacientes adultos intubados y conectados a ventilación mecánica, en quienes se determinó los flujos respiratorios resultantes y se estimó la diferencia absoluta FEM-FIM, la relación FIM/FEM y la proporción de pacientes con riesgo de retención de secreciones. Resultados. Se incluyeron 100 pacientes, 45% presentaba entre sus diagnósticos patología respiratoria. La mediana de la diferencia absoluta entre FEM y FIM fue de 6 Lâ¢min-1 (-5 - 14.5) y la mediana de la tasa FIM/FEM de 0.87 (0.7 - 1.13). Un 84% presentó una diferencia absoluta entre FEM y FIM menor a 17 Lâ¢min-1, mientras que el 46% presentó una relación FIM/FEM mayor a 0.9. Conclusión. Una alta proporción de pacientes conectados a ventilación mecánica presenta riesgo de retención de secreciones independiente de la presencia o ausencia de patología respiratoria. Se requieren futuras investigaciones para evaluar el impacto de este criterio sobre complicaciones respiratorias.
Background. Patients connected to invasive mechanical ventilation may develop respiratory complications, where retention of secretions is one of the most frequent. The drainage and elimination of the secretions depend on other variables of the respiratory flows generated, where an absolute difference between the peak expiratory flow (PEF) and peak inspiratory flow (PIF) less than 17 Lâ¢min-1 or a PIF/PEF ratio greater than 0.9 would favor secretion retention. However, it is necessary to determine the respiratory flows and the proportion of patients, with and without respiratory pathology, with a risk of secretions retention according to these parameters. Objective. Determine respiratory flows during connection to invasive mechanical ventilation and the proportion of patients with and without respiratory pathology at risk of secretions retention. Methods. A descriptive cross-sectional study was conducted in the Medical-Surgical Intensive Care Unit of the "Hospital Clínico de la Red de Salud UC-CHRISTUS". Intubated adult patients connected to mechanical ventilation were included, in whom the respiratory flows were assessed, and the absolute PEF-PIF difference, PIF/PEF ratio, and the proportion of patients with a risk of secretions retention were determined. Results. 100 patients were included, of which 45% presented among their diagnoses acute or chronic respiratory pathology. For the total number of patients, the median of the absolute difference between PEF and PIF was 6 Lâ¢min-1 (-5 - 14.5), and the median of the PIF/PEF ratio of 0.87 (0.7 - 1.13). Of the total of patients, 84% presented an absolute difference between PEF and PIF less than 17 L⢠min-1, while 46% presented a PIF/PEF ratio greater than 0.9. Conclusion. Considering the absolute difference between PEF-PIF and the PIF/PEF ratio, many patients present a risk of secretions retention. However, whether this is associated with severe respiratory complications in patients connected to invasive mechanical ventilation should be clarified in future research.
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Objective To investigate the effect of high altitude on peak expiratory flow (PEF) in elderly patients with heart failure and respiratory tract infection and its relationship with inflammatory response. Methods A total of 380 elderly patients over 60 years old with heart failure and respiratory tract infection admitted to our hospital from January 2020 to September 2022 were selected by cluster sampling method as research objects, including 190 long-term residents in high-altitude areas and 190 long-term residents in non-high-altitude areas.Information on current diseases, peak expiratory flow (PEF) levels, and inflammatory status (serum TNF) were collected- α， CRP, PCT and IL-6 levels) and other potential influencing factors; The relevant test indexes were collected at the time of enrollment (baseline) and at the time of discharge after treatment (the shortest hospital stay of 6 days and the longest hospital stay of 21 days); To compare the effects of long-term living at high altitude on PEF level and inflammatory state. The study used spss19 0 statistical software package for analysis. Results In this study, 380 elderly patients over 60 years old with heart failure and respiratory tract infection were enrolled, including 190 long-term residents in high-altitude areas (high-altitude group) and 190 long-term residents in non-high-altitude areas (control group). The mean age of patients in the high altitude group was (66.20±6.56) years old, the proportion of male patients was 53.16%, and the proportion of patients with heart failure duration less than 5 years was 70.00%. The average age of the control group was (66.93±6.77) years old, the proportion of male patients was 53.85%, and the proportion of patients with heart failure duration less than 5 years was 71.79%. The levels of PEF, FEV1 and FVC in 2 groups were higher than the baseline level at discharge (t=2.095, 7.139, 11.047, 14.594, 14.104, 12.250, all P<0.05). And the high altitude group was significantly lower than the control group (t=5.260, 6.912, 6.262, P<0.05). The baseline levels of TNF-α, CRP, PCT and IL-6 in the high altitude group were higher than those in the control group. After treatment, the levels of several inflammation-related factors decreased in both groups, but the high altitude group was still higher than the control group. The expression levels of inflammation-related factors (TNF-α, CRP, IL-6, PCT) in subjects at high altitude were negatively correlated with the levels of lung function related indicators (PEF, FEV1, FVC) (r=-0.453, -0.496, -0.379, -0.563, -0.467, -0.522, -0.497, -0.518, -0.419, -0.416, -0.438, -0.480), and the correlation coefficients were statistically significant (P<0.05). Conclusion High altitude living factors are associated with the decrease of PEF. At the same time, it indirectly aggravates the inflammatory state of patients, and it is more difficult for therapeutic intervention to control the inflammation to the ideal level within the same time, which is worthy of clinical attention.
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Objective:To investigate the clinical efficacy of caspofungin combined with voriconazole in the treatment of older adult patients with pulmonary fungal infection and its effects on pulmonary function and inflammatory factors.Methods:A total of 100 patients with pulmonary fungal infection admitted to Hangzhou Ninth People's Hospital from January 2016 to December 2020 were included in this study. They were randomly assigned to undergo treatment with either voriconazole (control group, n = 50) or caspofungin combined with voriconazole (observation group, n = 50) for 14 consecutive days. Clinical efficacy and changes in pulmonary function and inflammatory factors after treatment relative to before treatment were determined in each group. Results:Total response rate in the observation group was significantly higher than that in the control group [90.00% (45/50) vs. 74.00% (37/50), χ2 = 4.33, P < 0.05). After treatment, forced vital capacity, forced expiratory volume in 1 second, and maximum expiratory flow rate in the observation group were (2.31 ± 0.77) L, (79.30 ± 6.72)%, (86.14 ± 7.27)%, respectively, which were significantly higher than (1.78 ± 0.74) L, (73.22 ± 6.56)%, (78.16 ± 7.09)% in the control group ( t = 3.50, 4.57, 5.55, all P < 0.05). Tumor necrosis factor α, interleukin-6, and procalcitonin levels in the observation group were (8.32 ± 1.41) ng/L, (35.19 ± 3.40) μg/L, (1.94 ± 0.78) ng/L, respectively, which were significantly lower than (10.15 ± 1.58) ng/L, (46.09 ± 3.64) μg/L, (2.43 ± 0.84) ng/L in the control group ( t = 6.11, 15.43, 3.02, all P < 0.05). The incidence of adverse reactions in the observation group was 4.0% (2/50), which was significantly lower than 18.0% (9/50) in the control group ( χ2 = 5.00, P < 0.05). Conclusion:Caspofungin combined with voriconazole for the treatment of pulmonary fungal infection in older adult patients can effectively improve pulmonary function, inhibit the inflammatory response, and have no obvious adverse reactions with accurate clinical efficacy.
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Background : Asthma is a heterogenous disease defined by the history of respiratory symptoms (shortness of breath, wheezing, cough, and chest tightness) that vary over time and in intensity, along with variable expiratory airflow limitation. Despite an ever-increasing prevalence of asthma across all age groups, this condition remains poorly managed in India. Majority of the Indian patients remain undiagnosed or wrongly diagnosed in general clinical practice and even those who get diagnosed, remain poorly or inadequately treated1,2. Since the last published 2020 Indian Medical Association (IMA) recommendations on the management of asthma in primary care, noteworthy critical changes have been recommended in relation to the diagnosis/management of asthma in international guidelines. Hence, there was a need to update the existing IMA recommendations. For the same, an expert group meeting was organized with family physicians having clinical experience in managing patients with asthma along with chest physicians and pediatricians. Important updates related to asthma diagnosis and its management were discussed and the final recommendation decisions were derived from the joint group discussion. Some of the key points derived from the discussion are mentioned below in the executive summary. For a detailed version of the new recommendations please click on the url.
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Background: This study was done to compare the effect of stress on peak expiratory flow rate (PEFR) and body mass index (BMI) in medical and non-medical students. Aim and Objective: The aim of the study was to compare the effects of stress on PEFR and BMI in medical and non-medical students. Materials and Methods: In this study, stress, PEFR, and BMI comparison were made between 200 medical and non-medical students of S.N.M.C, Agra and Agra College, respectively, aged between 17 and 21 years. To estimate the prevalence of stress, we used perceived stress scale, PEFR was measured using Rossmax Portable Peak Flow Meter, which having a range of 60–800 l/min. BMI was calculated using formula, Quetelet Index. Cutoff for the subjects was taken as 25 as per the revised WHO standards. Results: In this study, moderate and high perceived level of stress was more common in medical students as compared to non-medical students and the result was found to be statistically significant (P < 0.0001). PEFR was 400 ± 102 in medical students and 420 ± 86.77 was in non-medical students. By applying unpaired t-test, significant changes were observed in PEFR among both groups (P < 0.05). BMI was 22.5 ± 3.12 in medical students and 22.6 ± 1.98 in non-medical students. By applying unpaired t-test, insignificant changes were observed in BMI among both groups (P ? 0.05). Conclusion: From the results obtained from our study, incidence of stress was greater in medical students and that of highly perceived grades. Significant changes were observed for PEFR and insignificant change was observed for BMI among both groups.
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Background: Throughout the human life span, airway behavior and the clinical manifestations of airway disease show gender differences which are related to other factors such as biological and sociocultural factors. Similar studies have been conducted in various parts of India and showed wide variations even within the state with similar socioeconomic and cultural factors. Even physical activity too has influenced pulmonary function tests (PFT). The most of the studies on PFT were carried out in the Southern part of Karnataka and no previous studies on this topic were done in Bidar. Aim and Objectives: The aim of the study was to study the gender differences in peak expiratory flow rate (PEFR) and timed vital capacity among medical students of BRIMS, Bidar. Materials and Methods: After obtaining ethical clearance from institute, the study was conducted on healthy 18� years aged 200 males and 200 female undergraduate medical students in Department of Physiology, BRIMS, Bidar. After recording basic physical characteristics, lung parameters that are forced vital capacity (FVC), forced expiratory volume in the 1st s (FEV1), FEV3, and PEFR were recorded using Micro Quark, a PC-based spirometer, connected through serial port (RS232). Statistical analysis was done using independent sample t-test with the help of SPSS 25 version. P < 0.05 was considered the level of significance. Results: Results revealed that there was statistically significant decrease in the mean values of FVC(L), FEV1(L), FEV3(L), and PEFR (L/min) in female subjects compared to male subjects (P < 0.01). Even there was statistical significant decrease in FEV1/FVC ratio in female subjects compared to male subjects (P < 0.05). Conclusion: Our study concluded that the values of FVC, FEV1, FEV3, FEV1/FVC, and PEFR were observed to be higher in male undergraduate subjects when compared with female subjects of BRIMS, Bidar.
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Background: Pulmonary function parameters can be altered with the change in body position. Therefore, physiological basis behind such consequent influence is essential to be understood. Pulmonary function tests are generally conducted in the erect sitting posture as it is more feasible and comfortable. However, bedridden patients are unable to do so and only few studies are found on recumbent postures. Thus, to comfort such patients in breathing, need arises to meet this requisite investigation to conclude the best recumbent body posture. Aim and Objectives: To compare and assess forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC ratio, forced expiratory flow of during 25�% expiration (FEF25�%, and peak expiratory flow rate (PEF) in the Supine, Crook-lying and Fowler抯 position. Materials and Methods: The present research was carried out on 128 healthy adults to measure FVC, FEV1, FEV1/FVC ratio, FEF25�% and PEF using a computer-based spirometer in the Supine, Crook-lying and Fowler抯 position. One-way Analysis of Variance with Tukey HSD post-hoc test was utilized between each body postures by evaluation of their mean values. Results: This study consisted of 128 subjects (males 57, females 71) with mean age of 21.62 � 1.75 years, mean weight 59.71 � 9.97 kg, mean height 164.68 � 9.30 cm and Body mass index 21.91 � 2.38 kg/m2. Fowler抯 posture showed significantly (P < 0.05) higher value in all spirometric parameters as compared to other two postures. Outcome of the study showed all spirometric parameters value- greater in the Fowler抯 posture than that of Supine or Crook-lying posture. Conclusion: The implication of this research is that it will meet the need of selection of the most suitable substitute posture for better pulmonary functioning in bedridden people.
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Background: Normal ageing and increasing body mass index (BMI) are related to decline in lung functions in adults in both genders. Females are more likely than age and height-matched males to show smaller lung size and diffusion surface, lower maximal expiratory flow rate, and reduced airway diameter. Lung mechanics and respiratory muscle strength, thoracic compliance, airway resistance, and elastic recoil of the lungs determine the pulmonary function tests (PFTs), and these tests are known to differ with age, sex, socio-economic status, cultural factors, and geographical region of the subject and are related to weight, height and BMI of the individuals. Aim and Objectives: The present study is planned to assess the peak expiratory flow rate (PEFR) and other PFTs and to evaluate the effect of age, gender and BMI on these lung functions. Materials and Methods: This study consists of 200 healthy individuals of age group 18–60 years. A sample was stratified into 5 age groups, and on the basis of BMI, the subjects were categorized as underweight, normal, overweight, and obese. Anthropometric measurements were recorded using standard procedures. PEFR was recorded using Wright’s peak-flow meter and forced vital capacity (FVC), Forced Expiratory Volume in 1 s (FEV1), FEV1/FVC, FEF25–75%, FEF2–1.2, slow vital capacity (SVC), and maximum voluntary ventilation (MVV) were analyzed using Expirograph (Helios 401, RMS, India). Chi-square test was used for analysis of categorical variables. For comparison of two groups, unpaired t-test was used and to assess the relation between the variables, Pearson’s co-relation was used. One way ANOVA was used to compare the difference between the means of more than two groups and Tukey post hoc analysis was done for multiple comparisons. Results: There was highly significant difference in the mean values of PEFR and other PFTs (P < 0.000) among the 5 age groups and a significant difference between younger and older age groups. PEFR, FVC, FEV1, FEV1/FVC, FEF25–75%, FEF0.2–1.2, SVC, and MVV were negatively correlated with age (r = ?0.514, ?0.535, ?0.568, ?0.255, ?0.566, ?0.516, ?0.304, ?0.523, respectively). Females showed reduced mean values of PEFR, FVC, FEV1, FEF25–75%, FEF0.2–1.2, SVC, MVV when compared to males (P < 0.000), and the differences in the mean values were significantly high. Highly significant difference was seen in the mean values of PEFR and other PFTs among the categories of BMI (P < 0.000). The mean values of FVC, FEV1, FEV1/FVC, FEF25–75%, FEF0.2–1.2, MVV were lower among underweight compared to their mean values among individuals with normal BMI. There was negative correlation between PEFR, FVC, FEV1, FEF25–75%, FEF0.2–1.2, SVC, MVV, and BMI (r = ?0.327, ?0.254, ?0.238, ?0.269, ?0.254, ?0.236, ?0.195, respectively). Conclusions: PFTs aid in the prompt and accurate diagnosis of respiratory disorders, such as asthma, chronic obstructive pulmonary disease allowing for efficient management by encompassing a thorough understanding of the disease and exercise respiratory training regimens even in otherwise healthy individuals. The present study showed that PEFR and other PFTs decrease with advancing age and BMI and females showed reduced lung functions compared to males.
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Introdução: a verificação da limitação ao fluxo aéreo ocasionado pelo tabagismo, por meio da mensuração do pico de fluxo expiratório, é uma medida viável para estudos populacionais que permite a sinalização precoce ou prevenção da instalação da doença pulmonar obstrutiva crônica. Objetivo: avaliar o grau de limitação ao fluxo expiratório em tabagistas em diferentes níveis de atividade física. Metodologia: trata-se de um estudo transversal. Foram selecionados 68 fumantes ativos por mais de um ano, acima de 18 anos, de ambos os sexos. O pico de fluxo expiratório foi obtido por meio do medidor portátil do modelo Mini-WrightTM e o nível de atividade física foi avaliado pelo International Physical Activity Questionnaire 8.0. As variáveis estudadas foram descritas pela amplitude de variação das médias, desvios padrão, máximo, mínimo e coeficiente de variação, sendo estabelecido o nível de significância de 5% através do teste Qui-quadrado. Resultados: o percentual de redução dos valores do pico de fluxo expiratório, previsto em relação ao obtido, chegou a uma redução média de 56,87% em maiores de 60 anos e 53,19% em tabagistas com um tempo de prática maior de 30 anos. Houve aumento considerável do percentual médio de redução do pico de fluxo expiratório nos grupos de tabagistas insuficientemente ativos e sedentários. Conclusão: os resultados sugerem que a limitação ao fluxo expiratório foi mais acentuada em tabagistas do sexo feminino, acima de 60 anos, com tempo superior a 30 anos de prática do tabagismo e com baixo nível de atividade física. Os tabagistas considerados muito ativos apresentaram menor nível de limitação ao fluxo expiratório.
Introduction: the verification of airflow limitation caused by smoking, through the Peak Expiratory Flow is a viable measure for population studies that allows the early signaling or prevention of the onset of Chronic Obstructive Pulmonary Disease. Objective: assess the degree of expiratory flow limitation in smokers at different levels of physical activity. Methods: this is a cross-sectional study. 68 active smokers for more than one year, over 18 years, of both sexes were selected. Peak expiratory flow was obtained using a portable Mini-WrightTM model and the level of physical activity was assessed using the International Physical Activity Questionnaire 8.0. The variables studied were described by the range of variation of the means, standard deviations, maximum, minimum and coefficient of variation, with a significance level of 5% being established using the Chi-square test. Results: the percentage of reduction in the values of peak expiratory flow, predicted in relation to that obtained, reached a mean reduction of 56.87% in people over 60 years of age and 53.19% in smokers with more than 30 years of practice. There was a considerable increase in the mean percentage of reduction in peak expiratory flow in the groups of insufficiently active and sedentary smokers. Conclusion: results suggest that expiratory flow limitation was more accentuated in female smokers, over 60 years of age, with more than 30 years of smoking practice and with a low level of physical activity. Smokers considered very active had a lower level of limitation of expiratory flow.
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Humans , Male , Female , Adult , Aged , Tobacco Use Disorder , Exercise , Peak Expiratory Flow Rate , Cross-Sectional StudiesABSTRACT
INTRODUÇÃO: O pico de fluxo expiratório (PFE) é comumente usado para monitorar a progressão de doenças respiratórias, pois fornece boas informações sobre o estado das vias aéreas. Uma boa quantidade de pesquisas está sendo feita em todo o mundo para estabelecer uma equação de previsão local. A força-tarefa conjunta da Sociedade Torácica Americana e da Sociedade Respiratória Europeia promoveu pesquisas a esse respeito. Na Índia, os dados derivados da população caucasiana ainda são usados para o PFE. OBJETIVO: Estudar a relação dos parâmetros do PFE e os dados antropométricos como idade, altura, peso, índice de massa corporal (IMC), área de superfície corporal (ASC) e estabelecer uma equação de regressão para jovens adultos indianos. MÉTODOS: PFE foi feito em 1000 sujeitos de 15-25 anos da região metropolitana de Mumbai. O coeficiente de correlação de Pearson foi usado para entender a relação dos parâmetros antropométricos e PFE. A análise de regressão multivariada foi feita para estabelecer uma equação de predição. (Alfa 5%) RESULTADOS: Idade e todos os parâmetros antropométricos foram correlacionados com PFE. O pico de fluxo expiratório médio da população masculina foi de 515 ml / seg, enquanto a feminina foi de 399 ml / seg. Para o PFE, a maior correlação foi observada com a ASC seguida de altura, peso e idade, enquanto o IMC apresentou o menor coeficiente de correlação. TPFE teve a melhor significância com a idade, ASC, altura e IMC. Teve menos significado com o peso. No sexo feminino, a TPFE teve a melhor significância com altura, peso, IMC e idade. CONCLUSÃO: Existem diferenças de gênero na TPFE. Portanto, equações específicas de gênero são necessárias para a estimativa da TPFE
INTRODUCTION: Peak expiratory flow rate (PEFR) is commonly used to monitor the progression of respiratory diseases as it gives good information about the status of airways. A good amount of research is going across the world to establish a local prediction equation. The joint task force of the American thoracic society and European Respiratory Society has promoted research in this regard. In India, data derived from the Caucasian population are still used for PEFR. OBJECTIVE: To verify the relationship between PEF levels and the variables age, sex, anthropometric and body surface area, and establish the regression equation for young Indian adults. METHODS: A cross-sectional observational study was conducted in 15-25 years aged 1000 subjects from the Metropolitan region of Mumbai. Pearson's correlation coefficient was used to understand the relation of anthropometric parameters and PEFR. Multivariate regression analysis was done for establishing a prediction equation (Alpha 5%). RESULTS: Age and all anthropometric parameters were correlated with PEFR. The mean PEFR of the male population was 515 ml/sec, whereas, for females, it was 399 ml/sec, for PEFR highest correlation was observed with BSA (.696) followed by weight (.667), height (.630), age (.504) whereas BMI shown lowest correlation coefficient (.445). PEFR had the best significance with age, BSA, Height, and BMI. It had less significance with weight. In females, PEFR had the best significance with Height, weight, BMI, and Age. CONCLUSION: Gender-wise differences exist in PEFR. Hence gender-specific equations are needed for the estimation of PEFR.
Subject(s)
Peak Expiratory Flow Rate , Asthma , Young AdultABSTRACT
RESUMO Objetivo: Relatar a independência funcional e o grau de comprometimento pulmonar em pacientes adultos 3 meses após a alta da unidade de terapia intensiva. Métodos: Este foi um estudo de coorte retrospectiva conduzido em uma unidade de terapia intensiva multiprofissional para pacientes adultos em um único centro. Incluíram-se pacientes admitidos à unidade de terapia intensiva entre janeiro de 2012 e dezembro de 2013 que, 3 meses mais tarde, foram submetidos à espirometria e responderam ao questionário Medida de Independência Funcional. Resultados: Os pacientes foram divididos em grupos segundo sua classificação de independência funcional e espirometria. O estudo incluiu 197 pacientes, que foram divididos entre os grupos maior dependência (n = 4), menor dependência (n = 12) e independente (n = 181). Na comparação dos três grupos com relação à classificação pela Medida de Independência Funcional, pacientes com maior dependência tinham escores Acute Physiology and Chronic Health Evaluation II e Sequential Organ Failure Assessment mais altos quando da admissão à unidade de terapia intensiva, idade mais avançada, mais dias sob ventilação mecânica e tempo mais longo de permanência na unidade de terapia intensiva e no hospital. A maioria dos pacientes apresentava comprometimento pulmonar, sendo o padrão obstrutivo o mais frequentemente observado. Na comparação da independência funcional com a função pulmonar, observou-se que, quanto pior a condição funcional, pior a função pulmonar, observando-se diferenças significantes em relação ao pico de fluxo expiratório (p = 0,030). Conclusão: Em sua maioria, os pacientes que retornaram ao ambulatório 3 meses após a alta tinham boa condição funcional, porém apresentavam comprometimento pulmonar relacionado com o grau de dependência funcional.
ABSTRACT Objective: To relate functional independence to the degree of pulmonary impairment in adult patients 3 months after discharge from the intensive care unit. Methods: This was a retrospective cohort study conducted in one adult intensive care unit and a multi-professional post-intensive care unit outpatient clinic of a single center. Patients admitted to the intensive care unit from January 2012 to December 2013 who underwent (3 months later) spirometry and answered the Functional Independence Measure Questionnaire were included. Results: Patients were divided into groups according to the classification of functional independence and spirometry. The study included 197 patients who were divided into greater dependence (n = 4), lower dependence (n = 12) and independent (n = 181) groups. Comparing the three groups, regarding the classification of the Functional Independence Measure, patients with greater dependence had higher Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment values at intensive care unit admission with more advanced age, more days on mechanical ventilation, and longer stay in the intensive care unit and hospital. The majority of patients presented with pulmonary impairment, which was the obstructive pattern observed most frequently. When comparing functional independence with pulmonary function, it was observed that the lower the functional status, the worse the pulmonary function, with a significant difference being observed in peak expiratory flow (p = 0.030). Conclusion: The majority of patients who returned to the outpatient clinic 3 months after discharge had good functional status but did present with pulmonary impairment, which is related to the degree of functional dependence.
Subject(s)
Humans , Adult , Functional Status , Intensive Care Units , Spirometry , Retrospective Studies , APACHEABSTRACT
Objective:To evaluate the clinical efficacy of kidney-invigorating and asthma-relieving granules in treating kidney deficiency type of bronchial asthma patients in persistent.Methods:A total of 100 patients with bronchial asthma admitted to Shanghai Municipal Hospital of TCM from March 2020 to August 2020 were selected as the research subjects. The patients were divided into control group and treatment group by random and double blind method, 50 in each group. Both groups were treated by routine basic treatment. The control group was treated with Kidney-invigorating and asthma-relieving Placebo, while the observation group was treated with kidney-invigorating and asthma-relieving granules. All the treatment lasted for 6 weeks. The TCM syndromes scores, Asthma Control Test (ACT) scores, Peak expiratory flow/predicted value (PEF%) and eosinophil in peripheral blood before and after treatment were observed.Results:A total of 91 patients completed the clinical study. There were 45 patients in the control group and 46 in the treatment group. The total effective rate in the treatment group was 93.5% (43/46), while that in the control group was 77.8% (35/45), and the difference was statistically significant ( χ2=4.579, P=0.032). After the treatment, the scores of integral efficacy on syndromes in Chinese medicine, ACT and PEF% in the treatment group were significantly higher than those in the control group ( t values were 2.802, 3.420 and 8.938, respectively, all Ps<0.01). The eosinophil in peripheral blood of patients in the treatment group was significantly lower than that of the control group ( t=3.481, P=0.001). Conclusion:On the basis of conventional treatment of western medicine, kidney-invigorating and asthma-relieving granules can relieve the clinical symptoms of asthma, improve the control level of asthma, enhance the level of PEF, reduce airway inflammation.
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Abstract Introduction: Obesity, characterized by the accumulation of excess body fat, can alter respiratory mechanics and compromise functional capacity. Given its increasing prevalence and the significant morbidity associated with the condition, it is important to investigate techniques that enable rapid, easy measurement of lung function and the possible correlation between obesity and functional capacity. Objective: To assess lung function and functional capacity in obese adults and determine whether there is a correlation between reduced peak expiratory flow and impaired functional capacity. Methods: 30 participants, distributed into two groups: obese (36 ± 13 years) and normal weight (31 ± 9 years) were evaluated based on anthropometric measurements, the six-minute walk test (6MWT) and peak expiratory flow (PEF). Results: The obese individuals showed reduced PEF (382 ± 99 vs. 497 ± 104 L/min, p < 0.01), walked shorter distances in the 6MWT (453 ± 37 vs. 617 ± 50 m, p < 0.01), had higher blood pressure and perceived exertion (p < 0.05) when compared to normal weight participants. Additionally, there was a positive significant association between expiratory flow and distance walked in the 6MWT (r = 0.635 and p < 0.001). Conclusion: Obese individuals exhibited lower PEF and walked shorter distances in the 6MWT, indicating a positive correlation between these two variables. In light of this outcome, the assessment methods used could contribute to improving analysis of respiratory and functional status in this population and aid in exercise prescription.
Resumo Introdução: A obesidade, caracterizada por acúmulo excessivo de tecido adiposo no organismo, pode alterar a mecânica ventilatória, trazendo prejuízos funcionais. Considerando a prevalência crescente da obesidade, bem como a grande morbidade associada a esta condição, torna-se relevante investigar técnicas de mensuração rápidas e fáceis da função ventilatória e a possível correlação com a capacidade funcional. Objetivo: Avaliar a função ventilatória e a capacidade funcional em adultos obesos e determinar se pico de fluxo expiratório reduzido está correlacionado com prejuízo da capacidade funcional. Métodos: 30 participantes, distribuídos em dois grupos: obeso (36 ± 13 anos) e eutrófico (31 ± 9 anos) foram avaliados por meio de medidas antropométricas, do teste de caminhada de seis minutos (TC6´) e da avaliação do pico de fluxo expiratório (PFE). Resultados: Os indivíduos obesos apresentaram reduzido PFE (382 ± 99 vs. 497 ± 104 L/min, p < 0,01) e percorreram menor distância no TC6´ (453 ± 37 vs. 617 ± 50 m, p < 0,01) com maior pressão arterial e percepção de esforço (p < 0,05) quando comparados aos eutróficos. Além disso, foi encontrada correlação positiva e significativa entre fluxo expiratório e distância percorrida (r = 0,635 e p < 0,001). Conclusão: Os indivíduos obesos tiveram menor PFE e menor distância percorrida no TC6´, constatada correlação positiva entre essas duas variáveis. Diante de tal desfecho, a inclusão dos métodos avaliativos utilizados podem contribuir para melhor análise da condição respiratória e funcional dessa população e auxiliar na prescrição de exercícios.
Subject(s)
Humans , Peak Expiratory Flow Rate , Walk Test , Obesity , Functional Residual Capacity , MorbidityABSTRACT
Background: Expiration is a passive process with active muscle contraction being used more during forceful activities such as coughing or sneezing. The abdominal muscles are major muscles of diaphragm. So it improves the efficiency of expiration. In obese individuals there is deposition of fat around the rib cage and the chest wall. Studies have shown that there is a decrease in the functional residual capacity and expiratory reserve volume in obese individuals. The expiratory flow limitation is important determinant of breathlessness in obese individuals. Abdominal and thoracic fat have direct effects on downward movement of diaphragm and chest wall. Abdominal muscles are powerful expiratory muscles whose actions help to force the diaphragm back to its resting position. Aim: This present study was done to determine the effect of abdominal muscle exercises on peak expiratory flow rate in obese individuals. Methods: In this experimental study 30 obese subjects with decreased peak expiratory flow rate who fulfilled the inclusion and exclusion criteria having a Body mass index of more than 30kg/cm2 were selected for abdominal muscle exercise program for 4 weeks, 2 sets of each exercise, thrice a week for 10 repetitions for each set. The pre and post peak expiratory flow rate were measured by peak expiratory flow meter. Statistical analysis was done using one sample t and Wilcoxon test. Results: There was a significant increase in post peak expiratory flow rate compared to pre peak expiratory flow rate. Conclusion: This study showed that there is significant effect of abdominal muscle exercises on peak expiratory flow rate in obese individuals.
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Background: The aim of the study was assessment of post-operative outcomes of rectus sheath block and comparison ofoutcomes between rectus sheath block and sub cutaneous bupivacaine.Materials and Methods: This study enrolled 58 patients who were scheduled to undergo laparotomy. Group I – 30 patientsreceived rectus sheath block using bupivacaine by placing catheters in between the muscle and posterior rectus sheath.Group II – 28 patients received bupivacaine infiltration by placing catheters in the subcutaneous plane. Visual analog scale(VAS) score, peak expiratory flow rate (PEFR), rescue analgesia, and complications were noted and follow-up of thesepatients was done.Results: Both the groups were comparable, hemoglobin concentration and anesthesiologists grades (statisticallyinsignificant). The majority of the patients from rectus sheath block group had VAS scores <5 comparing to subcutaneousinfiltration group which was statistically very significant (P ≤ 0.001). There was a statistically significant improvement ofpost-operative PEFR values in Group I as compared to Group II (P < 0.001). In Group I, 20 patients showed VAS scoreof 1 (no pain) at rest as compared only four patients in Group II. Rate of infection was more common in group receivingsubcutaneous infiltration.Conclusion: The patients from rectus sheath block group showed a statistically significant decrease in post-operative painin terms of VAS scores compared to that of subcutaneous bupivacaine infiltration group. There was statistically significantdecreased use of opioids as rescue analgesic in the rectus sheath group compared to that of the subcutaneous bupivacaineinfiltration group.
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Introdução: a disfunção pulmonar no pós-operatório de cirurgia cardíaca continua sendo uma das mais importantes causas demorbidade, sendo que o comprometimento da função pulmonar, nessa circunstância, é frequente e contribui, significativamente, para o aumento do tempo de permanência hospitalar. O objetivo deste estudo foi avaliar o comportamento da função pulmonar em pacientes adultos hospitalizados, submetidos à cirurgia cardíaca por esternotomia mediana, no momento a alta da unidade tratamento intensivo, comparado ao quarto dia após a alta dessa unidade. Metodologia: o estudo foi realizado em uma unidade de pós-operatório de cirurgia cardiovascular, após aprovação do Comitê de Ética em Pesquisa. O Termo de Consentimento Livre Esclarecido foi obtido em todos os casos. Incluíram-se pacientes maiores de 18 anos, submetidos à cirurgia cardíaca eletiva. A função pulmonar foi realizada na alta da unidade de tratamento intensivo e, posteriormente, repetida no quarto dia. A função pulmonar foi mensurada pela capacidade vital forçada, pico de fluxo expiratório, além de variáveis do exame físico, como frequência respiratória e ausculta pulmonar. Resultados: 94 pacientes foram submetidos à cirurgia cardíaca eletiva via esternotomia mediana. A média (desvio padrão) de idade foi 50,64 (16,53) anos, com predomínio do sexo masculino (52,1%). A mediana (Q1-Q3) do tempo de permanência na unidade de tratamento intensivo foi de 2,00 dias (2,00-3,00), ao passo que a mediana (Q1-Q3) do tempo de permanência hospitalar foi de 6,00 dias (5,00-8,00). A mediana (Q1-Q3) da capacidade vital forçada e do fluxo respiratório, obtida pela espirometria no pós-operatório, no momento da alta, foi significativamente menor quando comparada ao quarto dia após alta da unidade de tratamento intensivo (p< 0,01). O tempo de permanência na unidade, assim como o tempo de permanência hospitalar não impactou na evolução das variáveis de função pulmonar. Conclusão: a função pulmonar é potencialmente reduzida no período inicial após a cirurgia cardíaca, com evolução gradual, e de recuperação lenta, no curso da recuperação cirúrgica. A manutenção desses valores reduzidos a níveis não críticos por um período prolongado no pós-operatório parece não afetar o desempenho dos pacientes, no que tange a capacidade de respirar profundamente e na efetividade de tosse.
Introduction: pulmonary dysfunction in the postoperative period of cardiac surgery continues to be one of the most important causes of morbidity, and the involvement of pulmonary function in this circumstance is frequent and contributes significantly to an increase in the length of hospital stay. Objective: the objective of this study was to evaluate the pulmonary function behavior in hospitalized adult patients submitted to cardiac surgery by median sternotomy at the time of discharge from the intensive care unit, compared to the fourth day after discharge from this unit. Metodology: the study was performed in a postoperative unit of cardiovascular surgery, after approval of the Research Ethics Committee. The Informed Consent Form was obtained in all cases. Patients older than 18 years who underwent elective cardiac surgery were included. Pulmonary function was performed on discharge from the intensive care unit and then repeated on the fourth day. Pulmonary function was measured by forced vital capacity, peak expiratory flow, besides variables of physical examination, such as respiratory rate and pulmonary auscultation. Results: a number of 94 patients underwent elective cardiac surgery via median sternotomy. Mean (standard deviation) of age was 50.64 (16.53) years, with a predominance of males (52.1%). Median (Q1-Q3) of the time spent in the intensive care unit was 2.00 days (2.00-3.00), while the median (Q1-Q3) of the length of hospital stay was 6.00 days (5.00-8.00). Median (Q1-Q3) of forced vital capacity and respiratory flow, obtained by spirometry in the postoperative period at discharge, was significantly lower when compared to the fourth day after discharge from the intensive care unit (p <0.01 ). The length of stay in the unit, as well as the length of hospital stay, did not affect the evolution of pulmonary function variables. Conclusion: pulmonary function is potentially reduced in the initial period after cardiac surgery, with gradual evolution, and slowness in the course of surgical recovery. Maintaining these reduced values at uncritical levels for a prolonged postoperative period does not appear to affect patients' performance with regard to their ability to breathe deeply and in cough effectiveness.
Subject(s)
Humans , Male , Female , Adult , Respiratory Function Tests , Thoracic Surgery , Peak Expiratory Flow Rate , Vital CapacityABSTRACT
Background: Asthma is chronic inflammatory disorder associated with variable airflow obstruction and bronchial hyper responsiveness with different phenotypes. The objective of this study was to study the knowledge, attitude and practices among parents of Asthmatic children.Methods: It was a prospective observational study, conducted at Fortis Hospital Jaipur, from April 2016 to March 2018. All Asthmatic children fulfilling inclusion were included, 120 children were studied. A detailed interview of all the children/parents was conducted by pre-validated KAP questionnaire. Subjects were labelled as Bronchial Asthma in children above 5 years of age on the basis of symptoms and measurement of Peak Expiratory Flow (PEF) both baseline and post bronchodilator by PEF meter and in children less than 5 years of age by clinical symptoms, family history and response to bronchodilator according to GINA guidelines. Statistical analysis was done by one-way ANOVA test and Chi-square test.Results: In this study 26.4% parents were ignorant about etiology, 32% believed it to be allergy and 39.62% believed it to be hereditary. 1.9% had misconception of contagious. 68% parents know that their child have asthma while 32% parents did not know. Majority (52.1%) attributed it to cold air and rainy season followed by Dust mite and pollution in (42%).Conclusions: Knowledge about Asthma has improved over last few decades but still needs replenishment. Knowledge gap between recommended and actual practices, lack of adherence to aerosol therapy and fear of medication side-effects still persists. Parental education is important part of management of Asthma.
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Background: The Peak Expiratory Flow Rate (PEFR) is useful to screen and monitor the severity of asthma in children. Many studies have documented that age, height and weight are some of the main factors that affect the PEFR. Thus, the present study was done to find the PEFR values among the school children and to find the factors that influences the PEFR values in our geographical area.Methods: It was a cross sectional study conducted in school children belong the rural area of Kancheepuram district, Tamil Nadu, India. A total of 378 students of both the gender at the age group of 5-10 years were selected for the study. The PEFR was measured by making the participant seated comfortably. One peak flow meter was used for 25 children and mouthpiece was changed for each student.Results: The PEFR value among and male and female participants was analyzed statistically (Table 2). The mean value of male and female study population was 169.53'37.38 and 146.24'33.01 respectively. The difference in the mean values were statistically significant (p=0.001) and found to be high in male participants. The Pearson correlation r between PEFR with height is 0.463, thus showing a positive correlation with the p?0.001 which is statistically significant. The Pearson correlation r between PEFR and chest circumference is 0.335 thus indicating a positive correlation between PEFR and chest circumference.Conclusions: From the present study, the normal values of PEFR has been deduced for the healthy school children in our geographical area. Further, it was found that the height and chest circumference are influencing factors for PEFR. Further regression equation has been derived that can help us to find the approximate PEFR values with the help of height and chest circumference of the children.
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Background: Asthma is a heterogeneous disease characterized by cough, wheeze and shortness of breath that vary in intensity and time with variable expiratory airflow limitation, associated with chronic airway inflammation. Aim of the study was to assess the usefulness of Peak Expiratory Flow Rate [PEFR] and oxygen saturation in determining severity of acute asthma, to measure objective change in PEFR and oxygen saturation following bronchodilator therapy and the role of chest X-rays in acute asthma.Methods: A prospective study of 50 children above 5 years with acute asthma who presented to the emergency department in a tertiary care hospital were included. PEFR and oxygen saturation before and after bronchodilator therapy was measured. Indication for chest X-rays, its clinical correlation and change in standard treatment of acute asthma based on X-ray reports was noted.Results: The mean PEFR and PEFR % of expected was lower in severe asthma when compared to moderate asthma and was statistically significant (p<0.001). The % of expected PEFR before salbutamol therapy was 48.78'14.36, which improved significantly to 67.13'14.22 after treatment (p<0.001). Oxygen saturation before and after salbutamol therapy was 94.96 ' 4.11 and 96.96'2.87 respectively with the change being significant (p value <0.001). Chest X-rays were performed in 12 (24%) children as per standard guidelines, of which 1(9%) was abnormal showing right basal consolidation. Chest X-ray correlated with clinical findings in 1 child and the findings on chest X-ray altered the ongoing treatment by addition of antibiotic.Conclusions: PEFR and oxygen saturation is useful in the emergency department to objectively assess the severity of acute asthma and the response to initial bronchodilator therapy. Chest X-rays are not routinely indicated in the standard treatment of acute asthma.
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Introduction: Factors such as age, sex, body surface area,Body mass index (BMI), posture, physical activity, ethnicityetc which can influence Peak Expiratory Flow Rate (PEFR)as well as vital capacity. This study was aimed to find theinfluence of gender and anthropometric parameters on PEFRand vital capacity.Material and methods: Healthy medical students (17-23years) were enrolled in the study. PEFR was recorded usingMini Wight’s flow meter and vital capacity was assessed usinga wet spirometer. The data were analyzed statistically.Results: The study included 90 students (59 females and 31males). The study found that males had a significantly higherPEFR and vital capacity compared to females (p=0.0001).A statistically insignificant trend of negative correlation wasnoted between BMI with PEFR (r = -0.02, p= 0.84) or withvital capacity (r = -0.004, p = 0.97) in females. A significantdifference was found between the observed and predictedvalue for vital capacity in both males and females.Conclusion: Significantly higher PEFR and vital capacityin males could be due to the high stature, muscle build anddecreased body fat. This study noted a significant differencebetween males and females for the observed and predictedvalue for vital capacity which could be due to the use ofinadequate prediction equations for this population. Furtherstudies are needed to derive a better prediction equation tocorrelate predicted one with the actual vital capacity.