Application of positive airway pressure in restoring pulmonary function and thoracic mobility in the postoperative period of bariatric surgery: a randomized clinical trial / Aplicação de pressão positiva nas vias aéreas na restauração da função pulmonar e da mobilidade torácica no pós-operatório de cirurgia bariátrica: um ensaio clínico randomizado

Objective: To evaluate whether the application of bilevel positive airway pressure in the postoperative period of bariatric surgery might be more effective in restoring lung volume and capacity and thoracic mobility than the separate application of expiratory and inspiratory positive pressure. Method: Sixty morbidly obese adult subjects who were hospitalized for bariatric surgery and met the predefined inclusion criteria were evaluated. The pulmonary function and thoracic mobility were preoperatively assessed by spirometry and cirtometry and reevaluated on the 1st postoperative day. After preoperative evaluation, the subjects were randomized and allocated into groups: EPAP Group (n=20), IPPB Group (n=20) and BIPAP Group (n=20), then received the corresponding intervention: positive expiratory pressure (EPAP), inspiratory positive pressure breathing (IPPB) or bilevel inspiratory positive airway pressure (BIPAP), in 6 sets of 15 breaths or 30 minutes twice a day in the immediate postoperative period and on the 1st postoperative day, in addition to conventional physical therapy. Results: There was a significant postoperative reduction in spirometric variables (p<0.05), regardless of the technique used, with no significant difference among the techniques (p>0.05). Thoracic mobility was preserved only in group BIPAP (p>0.05), but no significant difference was found in the comparison among groups (p>0.05). Conclusion: The application of positive pressure does not seem to be effective in restoring lung function after bariatric surgery, but the use of bilevel positive pressure can preserve thoracic mobility, although this technique was not superior to the other techniques. .

Objetivo: Avaliar se a aplicação de dois níveis de pressão positiva nas vias aéreas no pós-operatório de cirurgia bariátrica pode ser mais efetiva do que quando aplicadas pressões positivas expiratória e inspiratória separadamente na restauração dos volumes e capacidades pulmonares e na mobilidade torácica. Método: Foram avaliadas 60 voluntárias adultas, obesas mórbidas, internadas para realização da cirurgia bariátrica. Afunção pulmonar e a mobilidade torácica foram avaliadas por meio da espirometria e da cirtometria no pré-operatório e reavaliadas no primeiro pós-operatório. Após a avaliação pré-operatória, as voluntárias foram randomizadas e alocadas nos grupos G EPAP (n=20), G RPPI (n=20) e G BIPAP (n=20) e então receberam a intervenção proposta, pressão positiva expiratória nas vias aéreas (EPAP), respiração por pressão positiva inspiratória (RPPI) ou pressão positiva binível nas vias aéreas (BIPAP), em sessões de seis séries de 15 respirações ou de 30 minutos, duas vezes ao dia no pós-operatório imediato e no primeiro pós-operatório, além do tratamento fisioterapêutico convencional. Resultados: Houve redução significativa das variáveis espirométricas no pós-operatório (p<0,05), independente do recurso utilizado, não havendo diferença significativa entre as técnicas (p>0,05), e preservação da mobilidade torácica somente nas voluntárias do grupo BIPAP (p>0,05), porém sem diferença nas comparações entre os grupos (p>0,05). Conclusão: A aplicação de pressão positiva parece não ser efetiva na restauração da função ...

Family socioeconomic status and the provision of motor affordances in the home

BACKGROUND: Socioeconomic status (SES) and stimulation provided in the home environment are influential factors in aspects of child well-being including motor development. Little is known regarding the influence of SES on specific aspects of the home environment. OBJECTIVE: To evaluate the availability of affordances in the home to promote infant motor development and family SES. METHOD : The sample consisted of 300 families with infants aged 3 to 18 months. SES was assessed according to family socioeconomic class, income and parental level of education. To evaluate motor affordances found at home, the Affordances in the Home Environment for Motor Development-Infant Scale (AHEMD-IS) was used. The AHEMD-IS was designed to assess dimensions of the home environment including Physical Space (outside and inside space), Daily Activities and Play Materials (fine-motor and gross-motor toys). RESULTS: SES indicators significantly influenced the availability of Physical Space and Play Materials. The Physical Space dimension was influenced by family economic class and income. The Play Materials dimension was influenced by all SES indicators. Daily Activities were not influenced by any of the SES indicators. Daily activities and play material were influenced by the infant's age. CONCLUSIONS: This study suggests that SES indicators are influential with regard to the provision of motor affordances in the home environment for infants. However, daily activities, which represent an aspect of the environment that is highly dependent on parental generation of situations that are conducive to motor skill development, are independent of family SES. .