Bilevel positive airway pressure in two moments after bariatric surgery

SUMMARY OBJECTIVE To investigate the use of Bilevel Positive Airway Pressure (BiPAP) in morbidly obese individuals in two moments following bariatric surgery (Roux-en-Y gastric bypass): post-anesthetic recovery (PAR) and first postoperative day (1PO). DESIGN Randomized and blinded clinical trial. METHODS We studied 40 morbidly obese individuals aged between 25 and 55 years who underwent pulmonary function test and chest X-ray preoperatively, and on the day of discharge (2nd day after surgery). They were randomly allocated into two groups: PAR-G (BiPAP in PAR for one hour), and 1PO-G (BIPAP for one hour on the 1PO). RESULTS In the PAR-G and 1PO-G, respectively there were significant reductions in slow vital capacity (SVC) (p=0.0007 vs. p<0.0001), inspiratory reserve volume (IRV) (p=0.0016 vs. p=0.0026), and forced vital capacity (FVC) (p=0.0013 vs. p<0.0001) and expiratory reserve volume (ERV) was maintained only for the PAR-G (p=0.4446 vs. p=0.0191). Comparing the groups, the SVC (p=0.0027) and FVC (p=0.0028) showed a significant difference between the treatments, while the PAR-G showed smaller declines in these capacities. The prevalence of atelectasis was 10% for the PAR-G and 30% for the 1PO-G (p=0.0027). CONCLUSION Thus, the use of BiPAP in PAR can promote restoration of ERV and contribute to the reduction of atelectasis.

RESUMO OBJETIVO Investigar o uso da pressão positiva em dois níveis nas vias aéreas (BiPAP) em obesos mórbidos em dois momentos após a cirurgia bariátrica (bypass gástrico em Y-de-Roux): recuperação pós-anestésica (RPA) e primeiro dia de pós-operatório (1PO). DESENHO Ensaio clínico randomizado e cego. MÉTODO Foram estudados 40 obesos mórbidos, com idade entre 25 e 55 anos, submetidos à prova de função pulmonar e radiografia de tórax no pré-operatório e no dia da alta (segundo dia de pós-operatório). Eles foram alocados aleatoriamente em dois grupos: G-RPA (BiPAP na RPA por uma hora) e G-1PO (BiPAP por uma hora no 1PO). RESULTADOS No G-RPA e G-1PO, respectivamente, houve reduções significativas na capacidade vital lenta (CVL) (p=0,0007 vs p<0,0001), volume de reserva inspiratório (VRI) (p=0,0016 vs p=0,0026) e capacidade vital forçada (CVF) (p=0,0013 vs p<0,0001). O volume de reserva expiratório (VRE) foi mantido apenas para o G-RPA (p=0,4446 vs p=0,0191). Comparando os grupos, a CVL (p=0,0027) e a CVF (p=0,0028) apresentaram diferenças significativas entre os tratamentos e o G-RPA apresentou menores declínios nessas capacidades. A prevalência de atelectasia foi de 10% para o G-RPA e 30% para o 1PO-G (p=0,0027). CONCLUSÃO O uso de BiPAP na RPA pode promover uma restauração do VRE e contribuir para a redução de atelectasias.

Impacto da técnica de expiração lenta e prolongada na mecânica respiratória de lactentes sibilantes / Impact of the prolonged slow expiratory maneuver on respiratory mechanics in wheezing infants

OBJETIVO: Avaliar as alterações da mecânica respiratória e do volume corrente (VC) em lactentes sibilantes em ventilação espontânea após a realização da técnica de expiração lenta e prolongada (ELPr). MÉTODOS: Foram incluídos no estudo lactentes com história de sibilância recorrente e sem exacerbações nos 15 dias anteriores. Para a avaliação da função pulmonar, os lactentes foram sedados e posicionados em decúbito dorsal com máscara facial acoplada a um pneumotacógrafo. As variáveis da respiração corrente - VC e FR - e da mecânica respiratória - complacência do sistema respiratório (Csr), resistência (Rsr) e constante de tempo (psr) - foram mensuradas antes e após a realização de três sequências consecutivas de ELPr. RESULTADOS: Foram avaliados 18 lactentes, com média de idade de 32 ± 11 semanas. Houve um aumento significante no VC após ELPr (79,3 ± 15,6 mL vs. 85,7 ± 17,2 mL; p = 0,009), assim como uma redução na FR (40,6 ± 6,9 ciclos/min vs. 38,8 ± 0,9 ciclos/min; p = 0,042). Entretanto, não houve alterações significantes nos valores da mecânica respiratória (Csr: 11,0 ± 3,1 mL/cmH2O vs. 11,3 ± 2,7 mL/cmH2O; Rsr: 29,9 ± 6,2 cmH2O • mL-1 • s-1 vs. 30,8 ± 7,1 cmH2O • mL-1 • s-1; e psr: 0,32 ± 0,11 s vs. 0,34 ± 0,12 s; p > 0,05 para todos). CONCLUSÕES: Essa técnica de fisioterapia respiratória é capaz de induzir alterações significativas no VC e na FR de lactentes com sibilância recorrente, mesmo na ausência de exacerbações. A manutenção das variáveis da mecânica respiratória indica que a técnica é segura para ser aplicada nesse grupo de pacientes. Estudos com lactentes sintomáticos são necessários para quantificar os efeitos funcionais da técnica.

OBJECTIVE: To evaluate changes in respiratory mechanics and tidal volume (V T) in wheezing infants in spontaneous ventilation after performing the technique known as the prolonged, slow expiratory (PSE) maneuver. METHODS: We included infants with a history of recurrent wheezing and who had had no exacerbations in the previous 15 days. For the assessment of the pulmonary function, the infants were sedated and placed in the supine position, and a face mask was used and connected to a pneumotachograph. The variables of tidal breathing (V T and RR) as well as those of respiratory mechanics-respiratory system compliance (Crs), respiratory system resistance (Rrs), and the respiratory system time constant (prs)-were measured before and after three consecutive PSE maneuvers. RESULTS: We evaluated 18 infants. The mean age was 32 ± 11 weeks. After PSE, there was a significant increase in V T (79.3 ± 15.6 mL vs. 85.7 ± 17.2 mL; p = 0.009) and a significant decrease in RR (40.6 ± 6.9 breaths/min vs. 38.8 ± 0,9 breaths/min; p = 0.042). However, no significant differences were found in the variables of respiratory mechanics (Crs: 11.0 ± 3.1 mL/cmH2O vs. 11.3 ± 2.7 mL/cmH2O; Rrs: 29.9 ± 6.2 cmH2O • mL-1 • s-1 vs. 30.8 ± 7.1 cmH2O • mL-1 • s-1; and prs: 0.32 ± 0.11 s vs. 0.34 ±0.12 s; p > 0.05 for all). CONCLUSIONS: This respiratory therapy technique is able to induce significant changes in V T and RR in infants with recurrent wheezing, even in the absence of exacerbations. The fact that the variables related to respiratory mechanics remained unchanged indicates that the technique is safe to apply in this group of patients. Studies involving symptomatic infants are needed in order to quantify the functional effects of the technique.

Ioga versus atividade aeróbia: efeitos sobre provas espirométricas e pressão inspiratória máxima / Yoga versus aerobic activity: effects on spirometry results and maximal inspiratory pressure

OBJETIVO: Esclarecer se, em indivíduos saudáveis, a prática de ioga pode modificar a pressão inspiratória máxima e os índices espirométricos quando comparada com a prática de ginástica aeróbia. MÉTODOS: Ensaio clínico controlado. Foram alocados consecutivamente 31 voluntários hígidos, formando-se dois grupos: um que praticou ginástica aeróbia (n = 15) e outro que praticou ioga (n = 16). Os indivíduos do primeiro grupo serviram como controles e praticaram ginástica aeróbia em duas sessões semanais com duração de 45 a 60 minutos por três meses. Os indivíduos do segundo grupo praticaram posturas selecionadas de ioga em duas sessões semanais com a mesma duração, também por três meses. Capacidade vital forçada, volume expiratório forçado no primeiro segundo e pressão inspiratória máxima foram medidos antes e ao final dos três meses de treinamento. RESULTADOS: Os índices espirométricos não apresentaram alterações significativas. As práticas de ioga ou ginástica aeróbia resultaram em pequenos aumentos da pressão inspiratória máxima, não significativos estatisticamente. Contudo, o delta absoluto da pressão inspiratória máxima (final menos inicial) do grupo que praticou ioga demonstrou uma variação positiva significativa para ambos os sexos em relação ao grupo controle: sexo masculino 19,5 cm H2O versus 2,8 cm H2O (p = 0,05), e sexo feminino 20 cm H(2)0 versus 3,9 cm H2O (p = 0,01), respectivamente. CONCLUSÃO: A pressão inspiratória máxima de indivíduos que praticaram ioga ou ginástica aeróbia não aumentou de maneira estatisticamente significativa após três meses de treinamento. Entretanto, a variação absoluta da pressão inspiratória máxima foi maior entre os praticantes de ioga.

Comparison of Isokinetic Strength of Knee and Pulmonary Function between Collegians and Hockey Players in College

OBJECTIVE: The purpose of this study was to examine the strength of the knee and pulmonary function comparing collegians and hockey players in college. METHOD: KINdegreeCOM isokinetic dynamometer and medigraph were used to evaluate strength of the right lower extremity and pulmonary function to 30 male students comprising 15 hockey players and 15 collegians with no significant difference in age, weight, and height between the two groups. All subjects used their right lower limb as dominant limb. RESULTS: 1) The significant differences between collegians and hockey players were found in the peak torque at 60o/sec,180o/sec. 2) The siginficant differences between collegians and hockey players were found in forced vital capacity, forced expiratory volume in one second and expiratory reserve volume on the pulmonary function. 3) The significant correlation between isokinetic strength and pulmonary function were found in peak torque. CONCLUSION: It is turned out that hockey players in college have much better isokinetic strength and pulmonary function than collegians, so it is suggested this result have to be considered in selecting hockey players and exercise prescription.

An easy method of spirometry.

Recording of forced expiration from tidal inspiratory level-referred to as Forced Expiratory Capacity (FEC) is a simple and more convenient technique than the conventional forced vital capacity (FVC) manouvre. From FEC tracing, volume expelled in one second (FEC1) and its percentage (FEC1%) can be measured. Such spirometric recording obtained from tidal breathing to Residual Volume (RV) may be referred to as Spirometric Recording at low lung volume. Asthmatics as well as old subjects find this manouvre easier to perform than the conventional FVC technique. FEC recording becomes a simple, reliable and sensitive test for evaluation of early airway obstruction in asymptomatic smokers and therefore may be utilised in clinical and epidemiologic surveys.

Lung function tests in Rajasthani subjects.

Various lung volumes and ventilatory tests (TV, ERV, IC, MV, MVV, VC, FEV1, MMFER and PEFR) were determined and BR, DI and AVI (Air velocity Index) calculated in 241 Rajasthani subjects of either sex ranging from 17 to 40 years of age. Most of the values (Mean +/- SEM) are higher in males than in females, and also higher in the younger age groups (17 to 27 years) than in the older age groups (28 to 40 years) for the same sex.

Pulmonary Function Studies on Normal Korean Adults / 대한마취과학회지

Since pulmonary function testing was first described by Hutchinson in 1846, this technic has been developed by many physiologists and applied to clinical fields for eviluation of cardiopulmonary status in order to improve diagnosis and treatment of cardiopulmonary diseases. The normal values of the lung volumes and capacities, maximal midexpiratory flow, maximal breathing capacity and forced expiratory volume and time in 120 (male-60, female-60) normal Korean adults by using a Gaensler-Collins bronchospirometer are presented. The results were as follows: 1. The vital capacity of the normal Korean adult was 4191+/-451ml. for males and 2685+/-375 ml. for females. 2. The ratio of inspiratory capacity to vital capacity for males was 66+/- 9% and for females 70+/- 7%, but that of expiratory reserve volume to vital capacity for males was 34+/-9% and for females was 30+/-7%. The ratio of inspiratory capacity to vital capacity of normal Korean adults is slightly lower than that of whites, while that of expiratory reserve volume to vital capacity of normal Korean adults is slightly higher than that of whites. 3. The maximal breathing capacity of males was 95+/- 171/min. and that of females 61+/-141/min. 4. The maxima mid-expiratory flow for males was 266+/- 711/min. and for females 176+/- 421 /min. The maximal mid-expiratory time of males was 0. 497+/- 0.145 second and that of females 0. 479+/- 0. 128 second.