Relación entre dimensiones antropométricas de tronco y valores de espirometría / Association between anthropometric dimensions of trunk and spirometry indices

Los objetivos del presente estudio fueron primero evaluar la asociación de dimensiones antropométricas de tórax y tronco con índices espirométricos, segundo, ajustar una ecuación de predicción con dimensiones antropométricas de tronco y tercero, comparar nuestro modelo predictivo con dos ecuaciones diagnósticas. Se evaluaron 59 estudiantes universitarios entre 20 y 40 años, de ambos sexos, sin hábito tabáquico. Las variables consideradas fueron: edad, sexo, peso, estatura, diámetro transverso de tórax, diámetro anteroposterior de tórax, perímetro de tórax, altura de tórax, altura de tronco, flujo espiratorio máximo (FEM), volumen espiratorio forzado en el primer segundo (VEF1) y capacidad vital forzada (CVF). Se utilizó el análisis de regresión múltiple para estimar los valores espirométricos en función de las variables demográficas y antropométricas. La CVF y el VEF1 tienen asociación lineal directa con el diámetro transverso de tórax, altura de tórax, perímetro de tórax y altura de tronco. Se ajustó una ecuación de regresión lineal múltiple que indicó que es posible estimar la CVF y el VEF11 en función de la altura de tronco y el perímetro de tórax para ambos sexos. Estas variables son capaces de explicar el 74 % de los valores de CVF y el 68 % de los valores de VEF1. Al comparar los valores obtenidos por nuestras ecuaciones predictivas con las ecuaciones de referencia nacional observamos que nuestros resultados son más cercanos a los de Quanjer et al. (2012) que a los de Knudson et al. (1983). La altura de tronco y el perímetro de tórax tienen asociación directa con el VEF1 y CVF y son buenos predictores del VEF1 y CVF en estudiantes universitarios. Nuestros valores estimados son más cercanos a las ecuaciones de Quanjer et al. (2012) en comparación a las estimaciones de Knudson (1983).

SUMMARY: The purposes of the present study were first to evaluate the association between anthropometric dimensions of the thorax and trunk with spirometric indices, second, to fit a prediction equation with anthropometric dimensions of the trunk, and third, to compare our predictive model with two diagnostic equations. Fifty-nine university students between 20 and 40 years old, of both sexes and non-smokers were recruited. Variables considered were age, sex, weight, height, chest transverse diameter, chest anteroposterior diameter, chest perimeter, chest height, trunk height, maximum expiratory flow (PEF), forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC). Multiple regression analysis was used to estimate spirometric values based on demographic and anthropometric variables. FVC and FEV1 have a direct linear association with chest transverse diameter, chest height, chest circumference, and trunk height. A multiple linear regression equation was fitted, indicating that it is possible to estimate FVC and FEV1 as a function of trunk height and chest girth for both sexes. These variables can explain 74% of the FVC values and 68% of the FEV1 values. Comparing the values obtained by our predictive equations with the national reference equations, we observe that our results are closer to those of Quanjer et al. (2012) than to those of Knudson et al. (1983). Trunk height and chest circumference have a direct association with FEV1 and FVC and are good predictors of FEV1 and FVC in university students. Our estimated values are closer to Quanjer et al. (2012) than Knudson et al. (1983) prediction equations.

Interacción cardiopulmonar en el paciente pediátrico crítico / Cardiopulmonary interactions in the critical pediatric patient

To optimize the management of critically ill patients, it is essential to understand the principles of cardiopulmonary interaction.The ultimate goal of the interaction between pulmonary and circulatory systems from a physiological point of view is to optimize the delivery of oxygen to tissues in order to meet metabolic demand, especially in situations where normal physiology is altered, as is the case of pediatric critically ill patients. Thus, during a critical illness, if any of these systems fails (together or separately), the end result is an inadequate delivery of O2 to tissues, which can lead to ischemia, progressive organ dysfunction, and if untreated, to death.In this review we will address key physiological concepts involved in cardiopulmonary interactions and how they are affected by the management we perform in the pediatric critically ill patients.

Para optimizar el manejo de los pacientes críticos, es fundamental comprender los principios de la interacción cardiopulmonar. El objetivo úultimo desde el punto de vista fisiológico de la interacción entre los sistemas circulatorio y pulmonar es optimizar la entrega de oxígeno a los tejidos y dar cuenta de la demanda metabólica especialmente en situaciones donde la fisiología normal se ve alterada, como es el caso de los pacientes pediátricos críticamente enfermos. Es así como durante una enfermedad crítica, si alguno de estos dos sistemas falla, (juntos o por separado), el resultado final es una inadecuada entrega de O2 tisular, que puede conducir a isquemia, disfunción orgánica progresiva, y si no se trata, hasta la muerte.En esta revisión intentaremos abordar de forma didáctica los principales conceptos fisiológicos involucrados en las interaccionescardiopulmonares y cómo estos se ven afectados frente a las intervenciones que realizamos en el manejo de los pacientes críticos.

Which Fingers Should We Perform Two-Finger Chest Compression Technique with When Performing Cardiopulmonary Resuscitation on an Infant in Cardiac Arrest?

This study compared the effectiveness two-finger chest compression technique (TFCC) performed using the right vs. left hand and the index-middle vs. middle-ring fingers. Four different finger/hand combinations were tested randomly in 30 healthcare providers performing TFCC (Test 1: the right index-middle fingers; Test 2: the left index-middle fingers; Test 3: the right middle-ring fingers; Test 4: the left middle-ring fingers) using two cross-over trials. The "patient" was a 3-month-old-infant-sized manikin. Each experiment consisted of cardiopulmonary resuscitation (CPR) consisting of 2 minutes of 30:2 compression: ventilation performed by one rescuer on a manikin lying on the floor as if in cardiac arrest. Ventilations were performed using the mouth-to-mouth method. Compression and ventilation data were collected during the tests. The mean compression depth (MCD) was significantly greater in TFCC performed with the index-middle fingers than with the middle-ring fingers regardless of the hand (95% confidence intervals; right hand: 37.8-40.2 vs. 35.2-38.6 mm, P = 0.002; left hand: 36.9-39.2 vs. 35.5-38.1 mm, P = 0.003). A deeper MCD was achieved with the index-middle fingers of the right versus the left hand (P = 0.004). The ratio of sufficiently deep compressions showed the same patterns. There were no significant differences in the other data. The best performance of TFCC in simulated 30:2 compression: ventilation CPR performed by one rescuer on an infant in cardiac arrest lying on the floor was obtained using the index-middle fingers of the right hand. Clinical Trial Registry at the Clinical Research Information Service (KCT0001515).

Training a Chest Compression of 6-7 cm Depth for High Quality Cardiopulmonary Resuscitation in Hospital Setting: A Randomised Controlled Trial

PURPOSE: During cardiopulmonary resuscitation (CPR), chest compression (CC) depth is influenced by the surface on which the patient is placed. We hypothesized that training healthcare providers to perform a CC depth of 6-7 cm (instead of 5-6 cm) on a manikin placed on a mattress during CPR in the hospital might improve their proper CC depth. MATERIALS AND METHODS: This prospective randomised controlled study involved 66 premedical students without CPR training. The control group was trained to use a CC depth of 5-6 cm (G 5-6), while the experimental group was taught to use a CC depth of 6-7 cm (G 6-7) with a manikin on the floor. All participants performed CCs for 2 min on a manikin that was placed on a bed 1 hour and then again 4 weeks after the training without a feedback. The parameters of CC quality (depth, rate, % of accurate depth) were assessed and compared between the 2 groups. RESULTS: Four students were excluded due to loss to follow-up and recording errors, and data of 62 were analysed. CC depth and % of accurate depth were significantly higher among students in the G 6-7 than G 5-6 both 1 hour and 4 weeks after the training (p0.05). CONCLUSION: Training healthcare providers to perform a CC depth of 6-7 cm could improve quality CC depth when performing CCs on patients who are placed on a mattress during CPR in a hospital setting.

Reconstrução da parede torácica após a ressecção de extensos tumores / Reconstruction of chest wall after resection of large tumors

INTRODUÇÃO: Nos estágios finais da reconstrução torácica, consequente a exéreses tumorais, são necessários procedimentos complexos e implantes. O que requer cuidados multidisciplinares, com a participação dos cirurgiões torácicos, plástico, radiologista e fisioterapeuta. O objetivo foi descrever as opções de reconstrução torácica após ressecção de neoplasia, realizado no Hospital Sarah Brasília. MÉTODO: Estudo retrospectivo de reconstrução torácica em tempo único, após excisão de tumor, fisioterapia respiratória com ventilação não invasiva e exercícios. RESULTADOS: Entre 2007 a 2012 foram operados 10 pacientes, sete homens e três mulheres; idade 10 a 31 anos; oito apresentavam tumores torácicos metastáticos (osteosarcoma, sinoviosarcoma, Fibrosarcoma epitelioide esclerosante e Rabdomiosarcoma) e dois originários da parede torácica (fibromatose e condrosarcoma). Observou-se boa evolução no pós-operatório imediato, com extubação ao final da cirurgia, retirada do dreno torácico entre 5° e 8° PO. As complicações foram: atelectasia (10%), recorrência tumoral (10%), e óbito em 3 (30%) casos . CONCLUSÃO: Foi possível a reconstrução torácica em tempo único utilizando tela de polipropileno, polimetilmetacrilato e retalhos musculares, com recuperação precoce da função pulmonar e baixo índice de complicações imediatas.

INTRODUCTION: Complex procedures and implants are required in the final stages of chest wall reconstruction after tumor excision. This process requires multidisciplinary care with participation from thoracic and plastic surgeons, a radiologist, and a physical therapist. The goal of this study was to describe the options for chest wall reconstruction after neoplasm resection at Hospital Sarah Brasilia. METHOD: A retrospective study of one-time chest wall reconstruction after tumor excision, respiratory physical therapy with noninvasive ventilation, and exercises was conducted. RESULTS: Between 2007 and 2012, 10 patients underwent surgery (seven men, three women; age range: 10-31 years); eight patients had metastatic thoracic tumors (e.g., osteosarcoma, synovial sarcoma, sclerosing epithelioid fibrosarcoma, and rhabdomyosarcoma) and two had tumors originating from the chest wall (fibromatosis and chondrosarcoma). The outcomes were good after the immediate postoperative period, with extubation occurring at the end of surgery and chest tube removal between the fifth and eighth postoperative day. Three cases (30%) involved complications of atelectasis (10%), tumor recurrence (10%), or death. CONCLUSION: One-time chest wall reconstruction using polypropylene mesh, polymethylmethacrylate, and muscle flaps was possible and was associated with early recovery of pulmonary function and a low rate of immediate complications.

Establishment of a 3D finite element model of human thoracic cage and biomechanical analysis / 法医学杂志

OBJECTIVE@#To establish a 3D finite element model of the complete human thoracic cage, and to perform a biomechanical analysis.@*METHODS@#The multislice computed tomography (MSCT) images of human thorax were obtained and used to develop a 3D reconstruction and a finite element model of the thoracic cage by finite element modeling software. The right hypochondrium area of the model was simulated to sustain the frontal impacts by a blunt impactor with velocities of 4, 6 and 8 m/s, and the distribution of stress and strain after the impact of the model was analyzed.@*RESULTS@#A highly anatomically simulated finite element model of human thoracic cage was successfully developed with a fine element mean quality which was above 0.7. The biomechanical analysis showed that the thoracic cage revealed both local bending and overall deformation after the impact. Stress and strain arose from the initial impact area of the ribs, and then spread along the ribs to both sides, at last concentrated in the posterior side of the ribs and near the sternum. Impacts with velocities of 6 m/s and 8 m/s were predicted to cause rib fractures when the strain of the ribs were beyond the threshold values.@*CONCLUSION@#The finite element modeling software is capable of establishing a highly simulated 3D finite element model of human thoracic cage. And the established model could be applicable to analyze stress and strain distribution of the thoracic cage under forces and to provide a new method for the forensic identification of chest injury.

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.

The effect of different supermarket checkout workstations on trunk kinematics of checkout operators / O efeito de diferentes modelos de checkout na cinemática de operadores de supermercado

OBJECTIVES: This study analyzed the effect of a standard and a modified checkout workstation during a simulated task on trunk postures of a supermarket checkout operator. METHODS: Eight participants performed a task involving grasping, scanning and depositing products, while 3D images of the trunk were collected. RESULTS: A number of kinematic changes were observed in trunk posture. A greater anterior flexion (3.0±1.2º) and lateral bending during grasping (7.1±1.4º) were found in the standard checkout workstation when compared to the modified model (p<0.05). Other variables did not show significant differences (p>0.05). DISCUSSION: The modified checkout workstation provided less lateral bending of the trunk to grasp products (8.1º ± 2.8; p<0.05), which was considered an advantage with respect to the standard model. Changes in the sagittal and transversal planes were not observed (p>0.05), irrespective of the checkout workstations (p>0.05). The modified checkout workstation successfully reduced risk of injury in some aspects, particularly the problems associated with lateral bending of the trunk. Other studies are required to test whether such potential benefits are obtained on a daily basis. CONCLUSIONS: Supermarket checkout operators may be at high risk of occupational injury due to different workstation demands. Modifications to checkout workstation design are an attractive possibility to reduce postural stress and fatigue in checkout operators. Longitudinal studies are required to test whether changes observed in the present study are sustained in the long term.

OBJETIVOS: Analisar o efeito de um modelo padrão e de um modificado de checkout durante uma tarefa simulada de um operador de caixa de supermercado. MÉTODOS: Oito participantes desempenharam uma tarefa envolvendo apanhar, ler e depositar produtos, enquanto imagens 3D do tronco foram coletadas. RESULTADOS: Um número de mudanças cinemáticas foram observadas na postura do tronco. Uma maior flexão anterior (3.0±1.2º) e uma inclinação lateral durante o apanhar (7.1±1.4º) foram encontradas no checkout padrão quando comparadas ao modelo modificado (p<0.05). Outras variáveis não apresentaram mudanças significativas (p>0.05). DISCUSSÃO: O checkout modificado causou menor inclinação lateral do tronco para apanhar produtos (8.1º ± 2.8; p<0.05), o que foi considerado como uma vantagem em relação ao modelo padrão. Mudanças nos planos sagital transverso não foram observadas (p>0.05), independente do modelo do checkout (p>0.05). O modelo modificado se mostrou eficaz paras prover reduções de risco de lesão em alguns aspectos. Especificamente, problemas associados com as inclinações laterais do tronco podem ser reduzidos quando o checkout modificado é empregado. Outros estudos são necessários para testar se tais benefícios potenciais são obtidos em uso de base diária. CONCLUSÕES: Operadores de supermercado podem ter elevado risco de lesões ocupacionais devido a diferenças nas demandas de suas estações de trabalho. Modificações no design do checkout são uma possibilidade atrativa para reduzir o estresse postural ocupacional e a fadiga em operadores de checkout. Requerem-se estudos longitudinais para testar se as mudanças encontradas no presente estudo são sustentadas em longos períodos de uso.

Respiratory mechanics and morphometric changes during anesthesia with ketamine in normal rats

Ketamine is believed to reduce airway and pulmonary tissue resistance. The aim of the present study was to determine the effects of ketamine on the resistive, elastic and viscoelastic/inhomogeneous mechanical properties of the respiratory system, lungs and chest wall, and to relate the mechanical data to findings from histological lung analysis in normal animals. Fifteen adult male Wistar rats were assigned randomly to two groups: control (N = 7) and ketamine (N = 8). All animals were sedated (diazepam, 5 mg, ip) and anesthetized with pentobarbital sodium (20 mg/kg, ip) or ketamine (30 mg/kg, ip). The rats were paralyzed and ventilated mechanically. Ketamine increased lung viscoelastic/inhomogeneous pressure (26 percent) compared to the control group. Dynamic and static elastances were similar in both groups, but the difference was greater in the ketamine than in the control group. Lung morphometry demonstrated dilation of alveolar ducts and increased areas of alveolar collapse in the ketamine group. In conclusion, ketamine did not act at the airway level but acted at the lung periphery increasing mechanical inhomogeneities possibly resulting from dilation of distal airways and alveolar collapse

Evaluación de cateteres centrales y tubos endotraqueales en la unidad de cuidado intensivo con radigrafía de tórax portátil / Evaluation of central catheter and endo-tracheal tubes in the unit of intensive care with portable x-ray of thorax

Se realiza una revisión de los parámetros que definen la correcta ubicación de los diferentes tipos de catéteres centrales y de tubos endotraqueales, en los pacientes hospitalizados en la unidad de cuidado intensivo (UCI), mediante la evaluación con radiografía de tórax portátil, y se mencionan las complicaciones asociadas al monitoreo y soporte vital

Ventana pleurocutanea: tratamiento alternativo del empiema pleural

Presenta sobre la el tratamiento del torax, su anatomia fisiopatologia, empiema pleural, cuadro clinico tratamiento alternativo y resultado

Electrostatic potentials generated on the chest by wearing different types of fabrics

The electrostatic potentials [EP] generated on the surface of the upper part of the human body by different types of fabrics are studied. 40 healthy volunteers were divided into 5 equal groups. In the control group, the upper half of the body was bare during the test periods. Each of the other 4 groups dressed shirts of different fabrics: 100 percent polyester, 100 percent cotton, 50/50 percent polyester/cotton and 100 percent wool. EP were measured one hour after dressing the shirt. EP could not be detected from cotton or wool shirts, or from controls. Polyethylene shirts recorded the highest EP followed by the polyester/cotton mix. The EP generated during the day were higher than at night probably due to the higher temperature prevailing during the day. The polyester-containing shirts may have injurious effect on the chest. Friction between polyester shirt and the skin generates electric charges, and the skin is positively charged. A series of induced EP is generated in the intrathoracic organs. Opposite sign charges on the opposing surfaces of lung and heart create an "electrostatic field" across them, which may cause respiratory and cardiac derangement