Padrão respiratório e movimento toracoabdominal em indivíduos saudáveis: influência da idade e do sexo / Breathing pattern and thoracoabdominal motion in healthy individuals: influence of age and sex

OBJETIVO: Descrever o padrão respiratório e o movimento toracoabdominal de indivíduos saudáveis considerando a idade e o sexo. MÉTODOS: Foram estudados 104 indivíduos com idades entre 20-39, 40-59 e 60-80 anos, 41 homens e 63 mulheres, com índice de massa corporal e valores espirométricos normais. A pletismografia respiratória por indutância foi utilizada para mensurar, durante o repouso e em decúbito dorsal, as seguintes variáveis: volume corrente (Vc), frequência respiratória (f), ventilação minuto (VE), razão entre o tempo inspiratório e o tempo total do ciclo respiratório (Ti/Ttot) e fluxo inspiratório médio (Vc/Ti), deslocamento da caixa torácica ( por centoCT), relação de fase inspiratória (PhRIB), relação de fase expiratória (PhREB) e ângulo de fase (AngFase). As comparações entre as faixas etárias foram realizadas por meio da ANOVA one-way ou Kruskal-Wallis H, comparações entre os sexos foram realizadas por meio dos testes t de Student para amostras independentes ou Mann-Withney U, de acordo com a distribuição dos dados, considerando significativo p<0,05. RESULTADOS: Na comparação entre os sexos, mulheres apresentaram valores significativamente menores em relação aos homens nas variáveis Vc, VE e Ti/Ttot nas faixas etárias de 20 a 39 e de 60 a 80 anos, sem nenhuma diferença na faixa etária de 40 a 59 anos. Na comparação entre as faixas etárias, indivíduos com 60 a 80 anos apresentaram PhRIB e AngFase significativamente maiores em relação aos adultos entre 20 e 39 anos, sem diferenças significativas nas variáveis do padrão respiratório. CONCLUSÃO: Os dados encontrados sugerem influência do sexo sobre o padrão respiratório e da idade sobre o movimento toracoabdominal.

OBJECTIVE: To describe the breathing pattern and thoracoabdominal motion of healthy individuals, taking age and sex into consideration. METHODS: The study included 104 individuals aged 20 to 39, 40 to 59, and 60 to 80 years (41 males and 63 females), with normal body mass index and spirometric values. Participants were evaluated at rest in the supine position, by means of respiratory inductive plethysmography. The following variables were measured: tidal volume (Vt), respiratory frequency (f), minute ventilation (VE), inspiratory duty cycle (Ti/Ttot), mean inspiratory flow (Vt/Ti), rib cage motion ( percentRC), inspiratory phase relation (PhRIB), expiratory phase relation (PhREB), and phase angle (PhaseAng). Comparisons between the age groups were performed using one-way ANOVA or Kruskal-Wallis H, while comparisons between the sexes were performed using Student's t test or the Mann-Whitney U test, depending on the data distribution; p<0.05 was taken to be significant. RESULTS: Comparison between the sexes showed that, in the age groups 20 to 39 and 60 to 80 years, women presented significantly lower values for Vt, VE, and Ti/Ttot than men, and there was no significant difference in the age group 40 to 59 years. Comparisons between the age groups showed that participants aged 60 to 80 presented significantly greater PhRIB and PhaseAng than participants aged 20 to 39 years, without significant differences in the breathing pattern. CONCLUSION: The data suggest that breathing pattern is influenced by sex whereas thoracoabdominal motion is influenced by age.

Interaction between intra-abdominal pressure and positive-end expiratory pressure

OBJECTIVE: The aim of this study was to quantify the interaction between increased intra-abdominal pressure and Positive-End Expiratory Pressure. METHODS: In 30 mechanically ventilated ICU patients with a fixed tidal volume, respiratory system plateau and abdominal pressure were measured at a Positive-End Expiratory Pressure level of zero and 10 cm H2O. The measurements were repeated after placing a 5 kg weight on the patients' belly. RESULTS: After the addition of 5 kg to the patients' belly at zero Positive-End Expiratory Pressure, both intra-abdominal pressure (p<0.001) and plateau pressures (p=0.005) increased significantly. Increasing the Positive-End Expiratory Pressure levels from zero to 10 cm H2O without weight on the belly did not result in any increase in intra-abdominal pressure (p=0.165). However, plateau pressures increased significantly (p< 0.001). Increasing Positive-End Expiratory Pressure from zero to 10 cm H2O and adding 5 kg to the belly increased intra-abdominal pressure from 8.7 to 16.8 (p<0.001) and plateau pressure from 18.26 to 27.2 (p<0.001). Maintaining Positive-End Expiratory Pressure at 10 cm H2O and placing 5 kg on the belly increased intra-abdominal pressure from 12.3 +/- 1.7 to 16.8 +/- 1.7 (p<0.001) but did not increase plateau pressure (26.6+/-1.2 to 27.2 +/-1.1 -p=0.83). CONCLUSIONS: The addition of a 5kg weight onto the abdomen significantly increased both IAP and the airway plateau pressure, confirming that intra-abdominal hypertension elevates the plateau pressure. However, plateau pressure alone cannot be considered a good indicator for the detection of elevated intra-abdominal pressure in patients under mechanical ventilation using PEEP. In these patients, the intra-abdominal pressure must also be measured.

Veress needle insertion in the left hypochondrium in creation of the pneumoperitoneum / Punção no hipocôndrio esquerdo com agulha de Veress para a criação do pneumoperitônio

PURPOSE: To test the efficacy of the puncture in the left hypochondrium as an alternative method. METHODS: Sixty-two patients randomly distributed into two groups were studied: Group LH, puncture in the left hypochondrium (n=30), and Group ML, puncture in the abdominal midline (n=32). The following were assessed: needle positioning tests, number of failed attempts at needle insertion, and time needed for creation of pneumoperitoneum. Gas flow, volume and intraperitoneal pressure were recorded at every 20 seconds, until a 12 mmHg pressure was reached inside the peritoneal cavity. RESULTS: A similar number of positive results for the needle positioning tests were observed in both groups. Two failed attempts to reach the peritoneal cavity were observed in Group ML and one in Group LH. The time necessary for the creation of pneumoperitoneum was on average 3 minutes and 46 seconds for Group LH, and 4 minutes and 2 seconds for Group ML. Average gas flow, volume and pressure were equivalent for both groups. CONCLUSION: Puncture in the left hypochondrium was as effective as puncture in the abdominal midline for the creation of pneumoperitoneum.

OBJETIVO: Avaliar a eficácia e segurança da punção alternativa no hipocôndrio esquerdo. MÉTODOS: Sessenta e dois pacientes distribuídos aleatoriamente em dois grupos foram estudados prospectivamente: grupo HE, punção no hipocôndrio esquerdo (n=30) e grupo LM, punção na linha média do abdome (n=32). Foram avaliados os testes de posicionamento da agulha, o número de tentativas frustradas e a duração da instalação do pneumoperitônio. Os fluxos correntes, as pressões intraperitoneais e os volumes injetados foram registrados a cada 20 segundos, até 12 mmHg. RESULTADOS: O número de resultados positivos aos testes de posicionamento da agulha foi semelhante em ambos os grupos. Ocorreram duas tentativas infrutíferas de punção no grupo LM e uma no grupo HE. O tempo necessário para o estabelecimento do pneumoperitônio foi, em média, 3 minutos e 46 segundos para o Grupo HE e 4 minutos e 2 segundos para o grupo LM. As médias dos fluxos, das pressões e dos volumes foram respectivamente equivalentes entre os grupos.. CONCLUSÃO: A punção no HE foi tão eficaz no estabelecimento do pneumoperitônio quanto a punção na LM do abdome.

Monitoreo de la presión intraabdominal (PIA) en el paciente quirúrgico grave / Monitoring of intraabdominal pressure (IAP) in the severe surgical patient

Se realizó un estudio prospectivo-investigativo sobre el valor de la medición de la presión intraabdominal (PIA) en nuestro medio para determinar su valor como diagnóstico y pronóstico en los pacientes quirúrgicos admitidos en la Unidad de Terapia Intensiva del Hospital Universitario Clinicoquirúrgico Gustavo Aldereguía Lima, del 1ro. de marzo al 31 de diciembre de 1998 (n:80). A la totalidad de los casos se le realizó medición y aplicó encuesta para determinar valores al ingreso y a las 6, 12, 24 y 48 horas y cierre de su evolución, así como la presencia de complicaciones y aparición de signos clínicos. Se aplicó método de significación estadística de la t de student y análisis de riesgo absoluto y relativo con media y desviación estándar. Se determinó que la PIA tiene un alto valor predictivo en la aparición de complicaciones de pacientes quirúrgicos, y su aumento estableció un pronóstico desfavorable en cuanto a complicaciones y riesgo de muerte, su elevación antecede a la aparición de signos clínicos como fiebre, taquicardia o taquipnea y el valor de su lectura se incrementa en la medida en que transcurre el tiempo de evolución(AU)

A prospective and investigative study was made to determine the diagnostic and prognostic value in our environment of the measurement of intraabdominal pressure (IAP) in surgical patients admitted in the Intensive Care Unit of the "Gustavo Aldereguia Lima" Clinical and Surgical Teaching Hospital from March 1st to December 3lst, 1998 (n:80). All the cases were measured and surveyed in order to determine values on admission and at 6, 12, 24, and 48 hours and at the end of their evolution. The complications and the appearance of clinical signs were also determined. The t of student method of statistical significance and the analysis of relative and absolute risk with mean and standard deviation were applied. It was observed that IAP has a high predictive value in the appearance of surgical patients and that its increase produced an unfavorable prognosis regarding complications and death risk. Its rise preceeds the appearance of clinical signs such as fever, tachycardia, or tachypnea and the value of its reading increases as the time of evolution goes by(AU)