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2.
Rev. méd. Chile ; 147(10): 1291-1302, oct. 2019. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1058596

RESUMO

Background: Women with obstructive sleep apnea-hypopnea syndrome (OSAS) are less likely to be assessed or to receive an appropriate diagnosis, and they may have poorer quality of life and survival rates. Aim: To assess gender-specific clinical differences in adult patients with OSAS. Material and Methods: A standardized clinical questionnaire and four sleep questionnaires (Berlin, Epworth Sleepiness Scale, STOP and STOP-Bang) were administered and anthropometric data were measured. Patients underwent an overnight in-laboratory polysomnography to confirm the diagnosis of OSAS. Receiver operating characteristic curves, sensitivity and specificity of clinical manifestations and sleep questionnaires were calculated. Results: Of 1,464 screened patients, 509 were female, 58.6% had moderate to severe OSAS. Clinical variables associated with OSAS risk in women were age, insomnia, nocturia, hypertension and cervical circumference. Paired by age and respiratory events, the snoring frequency was similar in both genders, although witnessed apneas and high cervical circumference and waist/hip ratio were more common in males. Morning headaches, insomnia, excessive daytime sleepiness, depression, anxiety and poor quality of sleep were more common in women. Women were older than men, more obese (although with an obesity pattern less centrally distributed) and referred hypertension, diabetes, depression and hypothyroidism with higher frequency. Sleep questionnaires performance were similar in both sexes. Conclusions: It is likely that women with OSAS may partially be underdiagnosed due to circumstances related to a different OSAS clinical expression.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Inquéritos e Questionários/normas , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia , Qualidade de Vida , Índice de Gravidade de Doença , Comorbidade , Chile/epidemiologia , Fatores Sexuais , Antropometria , Prevalência , Estudos Prospectivos , Fatores de Risco , Sensibilidade e Especificidade , Distribuição por Sexo , Distribuição por Idade , Estatísticas não Paramétricas
3.
Rev. méd. Chile ; 147(8): 983-992, ago. 2019. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1058633

RESUMO

Background: C-reactive protein (CRP) is used to monitor patients' response during treatment of infectious diseases. Morbidity and mortality associated with community-acquired pneumonia (CAP) is high, particularly in hospitalized patients. Better risk prediction during hospitalization could improve management and ultimately reduce mortality rates. Aim: To evaluate CRP measured at admission and the third day of hospitalization as a predictor for adverse events in CAP. Material and Methods: A prospective cohort study of adult patients hospitalized with CAP at an academic hospital. Major adverse outcomes were admission to ICU, mechanical ventilation, prolonged hospital length of stay, hospital complications and 30-day mortality. Predictive associations between CRP (as absolute levels and relative decline at third day) and adverse events were analyzed. Results: Eight hundred and twenty-three patients were assessed, 19% were admitted to ICU and 10.6% required mechanical ventilation. The average hospital stay was 8.8 ± 8.2 days, 42% had nosocomial complications and 8.1% died within 30 days. Ninety eight percent of patients had elevated serum CRP on admission to the hospital (18.1 ± 14.1 mg/dL). C-reactive protein measured at admission was associated with the risk of bacterial pneumonia, bacteremic pneumonia, septic shock and use of mechanical ventilation. Lack of CRP decline within three days of hospitalization was associated with high risk of complications, septic shock, mechanical ventilation and prolonged hospital stay. Conclusions: CRP responses at third day of hospital admission was a valuable predictor of adverse events in hospitalized CAP adult patients.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Pneumonia/sangue , Proteína C-Reativa/análise , Infecções Comunitárias Adquiridas/sangue , Imunocompetência , Pneumonia/imunologia , Pneumonia/mortalidade , Prognóstico , Choque Séptico/mortalidade , Choque Séptico/sangue , Fatores de Tempo , Biomarcadores/sangue , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Infecções Comunitárias Adquiridas/imunologia , Infecções Comunitárias Adquiridas/mortalidade , Área Sob a Curva
4.
Rev. méd. Chile ; 146(12): 1371-1383, dic. 2018. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-991346

RESUMO

Background: Molecular biological techniques allow the identification of more pathogens associated with community-acquired pneumonia (CAP). Aim: To compare clinical and laboratory parameters of patients with CAP caused by different groups of pathogens. Material and Methods: In a prospective study, immunocompetent adult patients hospitalized with CAP were tested for the presence of a broad range of possible respiratory pathogens using bacterial cultures, polymerase chain reaction, urinary antigen testing and serology. Results: Pathogens were detected in 367 of 935 patients with CAP (39.2%). Streptococcus pneumoniae (10.7%) and influenza virus (6%) were the most frequently identified bacterial and viral pathogens, respectively. Pneumococcal pneumonia predominated in older adults, with multiple comorbidities, with elevation of inflammatory parameters and hypoxemia, like other bacterial pneumonias. Viral pneumonia predominated in elderly patients with multiple comorbidities, with a shorter hospital length of stay and lower mortality. Pneumonia associated with atypical microorganisms predominated in young adults, smokers, with subacute clinical evolution. Their hospital stays and lethality was similar to other bacterial pneumonias. Viral and classical bacterial pneumonias predominated in high risk pneumonia severity index categories. Although several variables were associated with the detection of a pathogen group, substantial overlap avoided the identification of reliable clinical predictors to distinguish etiologies. Conclusions: The clinical and radiographic characteristics were similar in pulmonary infections caused by classical bacteria, respiratory viruses and atypical microorganisms. Therefore, microbial testing for common respiratory pathogens is still necessary to optimize treatment.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Pneumonia Viral/virologia , Pneumonia Bacteriana/microbiologia , Imunocompetência , Pneumonia Viral/diagnóstico , Fatores Socioeconômicos , Índice de Gravidade de Doença , Estudos Prospectivos , Fatores de Risco , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/virologia , Pneumonia Bacteriana/diagnóstico , Tempo de Internação
5.
Rev. méd. Chile ; 146(10): 1123-1134, dic. 2018. tab
Artigo em Espanhol | LILACS | ID: biblio-978747

RESUMO

Background: Simple but accurate tools should be used to identify patients with obstructive sleep apnea syndrome (OSAS), aiming at an early detection and prevention of serious consequences. Aim: To assess the predictive value of four sleep questionnaires (Berlin, Epworth Sleepiness Scale [ESS], STOP, and STOP-Bang) in the screening of patients with OSAS. Material and Methods: The four sleep questionnaires were administered to 1,050 snorers aged 56 ± 15 years (68% males) assessed at a sleep clinic. An overnight unattended respiratory polygraphy was performed to all patients to confirm the diagnosis of OSAS. The sensitivity, specificity, positive and negative predictive values of the four questionnaires were calculated. Results: Eighty four percent of participants had OSAS. The clinical variables associated with OSAS risk were age, male gender, hypertension, overweight, cervical circumference, waist/hip ratio, history of snoring, witnessed apneas and nycturia. Eighty-three, 86, 92 and 46 % of cases were classified as having a high risk for OSAS, according to the Berlin, STOP and STOP-Bang questionnaires and ESS, respectively. STOP and STOP-Bang questionnaires had the highest sensitivity to predict OSAS (88 and 95%, respectively) while the Flemons Index had the highest specificity (82%). Conclusions: Sleep questionnaires were able to identify patients with a high risk for OSAS but without accurately excluding those at low risk.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Inquéritos e Questionários/normas , Apneia Obstrutiva do Sono/diagnóstico , Valores de Referência , Ronco/diagnóstico , Índice de Gravidade de Doença , Estudos Prospectivos , Reprodutibilidade dos Testes , Fatores de Risco , Sensibilidade e Especificidade , Polissonografia/métodos , Estatísticas não Paramétricas , Apneia Obstrutiva do Sono/etiologia
6.
Rev. méd. Chile ; 145(6): 694-702, June 2017. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-902533

RESUMO

Background: Community-acquired pneumonia (CAP) causes significant morbidity and mortality in adults. Aim: To compare the accuracy of four validated rules for predicting adverse outcomes in patients hospitalized with CAP. Patients and Methods: We compared the pneumonia severity index (PSI), British Thoracic Society score (CURB-65), SMART-COP and severe CAP score (SCAP) in 659 immunocompetent adult patients aged 18 to 101 years, 52% male, hospitalized with CAP. Major adverse outcomes were: admission to ICU, need for mechanical ventilation (MV), in-hospital complications and 30-day mortality. Mean hospital length of stay (LOS) was also evaluated. The predictive indexes were compared based on sensitivity, specificity, and area under the curve of the receiver operating characteristic curve. Results: Of the studied patients, 77% had comorbidities, 23% were admitted to the intensive care unit and 12% needed mechanical ventilation. The rate of all adverse outcomes and hospital LOS increased directly with increasing PSI, CURB-65, SMART-COP and SCAP scores. The sensitivity, specificity and area under the curve of the prognostic indexes to predict adverse events were: Admission to ICU (PSI: 0.48, 0.84 and 0.73; SMART-COP: 0.97, 0.23 and 0.75; SCAP: 0.57, 0.81 and 0.76); use of MV (PSI: 0.44, 0.84 and 0.75; SMART-COP: 0.96, 0.35 and 0.84; SCAP: 0.53, 0.87 and 0.78); 30-days mortality (PSI: 0.45, 0.97 and 0.83; SMART-COP: 0.94, 0.29 and 0.77; SCAP: 0.53, 0.95 and 0.81). CURB-65 had a lower discriminatory power compared to the other indices. Conclusions: PSI score and SCAP were more accurate and specific and SMART-COP was more sensitive to predict the risk of death. SMART-COP was more sensitive and SCAP was more specific in predicting the use of mechanical ventilation.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Pneumonia/imunologia , Hospedeiro Imunocomprometido/imunologia , Hospitalização/estatística & dados numéricos , Pneumonia/mortalidade , Prognóstico , Respiração Artificial/estatística & dados numéricos , Índice de Gravidade de Doença , Valor Preditivo dos Testes , Estudos Prospectivos , Infecções Comunitárias Adquiridas/imunologia , Infecções Comunitárias Adquiridas/mortalidade , Unidades de Terapia Intensiva/estatística & dados numéricos
7.
Rev. méd. Chile ; 144(12): 1513-1522, dic. 2016. graf, tab
Artigo em Espanhol | LILACS | ID: biblio-845481

RESUMO

Background: Community-acquired pneumonia (CAP) is a relevant worldwide cause of morbidity and mortality in adult population, however its etiology is often not identified and therapy is empirical. Aim: To assess the etiology of CAP in immunocompetent adult hospitalized patients using conventional and molecular diagnostic methods. Material and Methods: We prospectively studied 240 adult patients who were hospitalized for CAP to identify the microbial etiology. Sputum and blood cultures were obtained as well as serology testing for Mycoplasma pneumoniae and Chlamydophila pneumoniae, urinary antigen testing for Legionella pneumophila and Streptococcus pneumoniae, and a nasopharyngeal swab for the detection of sixteen respiratory viruses by reverse transcriptase polymerase chain reaction (RT-PCR). Results: In 100 patients (41.7%) a single respiratory pathogen was identified. In 17 (7.1%) cases, a mixed bacterial and viral infection was detected and no pathogen was identified in 123 cases (51%). The most commonly identified pathogens identified were: influenza virus (15.4%), parainfluenza virus (10.8%), rhinovirus (5%), Streptococcus pneumoniae (5%), respiratory syncytial virus (2.9%) and Mycoplasma pneumoniae (2.5%). Infectious agent detection by RT-PCR provided greater sensitivity than conventional techniques. Viral respiratory infections were more prevalent in older patients with comorbidities and high risk patients, according to the Fine index at hospital admission. The clinical severity and outcome were independent of the etiological agents detected. Conclusions: The use of molecular diagnostic techniques expanded the detection of respiratory viruses in immunocompetent adults hospitalized with CAP.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Pneumonia Viral/virologia , Vírus Sinciciais Respiratórios/genética , Imunocompetência , Pneumonia Viral/microbiologia , Vírus Sinciciais Respiratórios/classificação , Estações do Ano , Índice de Gravidade de Doença , Estudos Prospectivos , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/virologia , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Coinfecção
8.
Rev. méd. Chile ; 144(11): 1382-1390, nov. 2016. tab
Artigo em Espanhol | LILACS | ID: biblio-845459

RESUMO

Background: Identifying risk factors for lung cancer in the population could improve the cost-effectiveness of early detection programs using thoracic computed tomography (CT). Aim: To examine the risk factors of lung cancer in a cohort of adult smokers. Patients and Methods: An annual clinical and respiratory functional assessment, chest computed tomography for three years and clinical follow up for five years was carried out in 270 patients aged 65 ± 9 years, 55% males, active or former smokers of 10 or more pack-years. Results: Thirty seven percent of patients were active smokers, consuming 37 ± 26 packs/year, 85% had comorbidities, especially chronic obstructive pulmonary disease (COPD) (66%), hypertension (48%), diabetes (22%) and dyslipidemia (42%). Thirteen percent of patients had family history of lung cancer. Twenty-one cases of lung cancer were detected in the five years follow up, especially squamous cell carcinoma and adenocarcinoma. In the univariate analysis, the main risk factors for lung cancer identified were an age older than 60 years, history of COPD, family history of lung cancer, active smoking, tobacco consumption more than 30 pack/year and lung hyperinflation. In multivariate analysis, the three independent risk factors for lung cancer were a family history of lung cancer, active smoking and the number of packs per year of tobacco consumption. Conclusions: The identification of risk groups probably will improve the performance of programs for early detection of lung cancer.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/etiologia , Adenocarcinoma/etiologia , Fumar/efeitos adversos , Neoplasias Pulmonares/etiologia , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/epidemiologia , Adenocarcinoma/diagnóstico , Adenocarcinoma/epidemiologia , Fumar/epidemiologia , Tomografia Computadorizada por Raios X , Comorbidade , Chile/epidemiologia , Estudos Prospectivos , Fatores de Risco , Seguimentos , Medição de Risco , Doença Pulmonar Obstrutiva Crônica/etiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Diabetes Mellitus/etiologia , Diabetes Mellitus/epidemiologia , Dislipidemias/etiologia , Dislipidemias/epidemiologia , Detecção Precoce de Câncer , Hipertensão/etiologia , Hipertensão/epidemiologia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/epidemiologia
9.
Rev. chil. enferm. respir ; 18(3): 151-160, sept. 2002. tab, graf
Artigo em Espanhol | LILACS | ID: lil-323300

RESUMO

El ejercicio físico es un elemento básico en la rehabilitación en pacientes con EPOC. Sin embargo, los resultados son variables, lo que puede deberse a las diferentes estrategias de entrenamiento utilizadas. En 22 pacientes con EPOC avanzada (VEF, 35,6 ñ 15,7 por ciento: edad 63 ñ 15 años; x ñ DS) Evaluamos su adaptación a un esquema de entrenamiento (E) en bicicleta ergométrica que consistió en aplicar inicialmente una carga inicial de 30 por ciento de la máxima previamente determinada (CM) y aumentarla en 15 a 20 por ciento en las sesiones siguientes cuando el paciente era capaz de mantenerla por 45 minutos, hasta alcanzar la meta de 75 por ciento de la CM. La intensidad del E se midió en watts calculando el área bajo la curva de la relación entre las cargas aplicadas y el número de sesiones de entrenamiento. El efecto del E se evaluó a través de los cambios en la carga y el VO2 máximos, la duración de un ejercicio submáximo, la frecuencia cardíaca, (FC), disnea, fatiga de las extremidades inferiores y lactato sanguíneo para una misma carga y tiempo de ejercicio. La CM de E fue 61 ñ 23 por ciento (x ñ DS) del máximo. Seis pacientes no fueron capaces de alcanzar la carga establecida como meta. En los restantes ésta se alcanzó en un número variable de sesiones (12 ñ 7). La intensidad del entrenamiento fue de 952 ñ 325 watt. El E produjo un aumento de la CM (p<0,02) y del tiempo de ejercicio (p<0,0001) y una disminución significativa de la FC, disnea, fatigabilidad y lactato sanguíneo. La duración del ejercicio se correlacionó con la reducción de la disnea (r= -0,448; p<0,05) y la intensidad del entrenamiento con la disminución de la fatiga (r= -0,5176; p = 0,014) y también del lactato sanguíneo (r= -0,488; p = 0,021). Los resultados demuestran que aún cuando la adaptación al esquema de entrenamiento fue variable de acuerdo a la capacidad individual y no pudo ser aplicada a todos los pacientes, la mayoría de ellos obtuvo efectos beneficiosos


Assuntos
Humanos , Adolescente , Adulto , Pessoa de Meia-Idade , Exercício Físico , Teste de Esforço , Pneumopatias Obstrutivas/terapia , Ácido Láctico/sangue , Protocolos Clínicos , Dispneia , Tolerância ao Exercício , Fadiga , Frequência Cardíaca/fisiologia , Pneumopatias Obstrutivas/reabilitação , Esforço Físico
11.
Rev. méd. Chile ; 130(7): 787-791, jul. 2002. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-323254

RESUMO

Vibrio vulnificus is a lactose positive Gram negative rod that lives in warm seas and can infect wounds and produce sepsis. Its infection is acquired after eating oysters or other filtering marine organisms. We report a 53 years old diabetic male who started with fever after a voyage to Central America. He was admitted febrile, hipotense, dehydrated and polypneic. Painful erythematous lesions and lumps were observed in his upper and lower limbs. After 72 hours of evolution, the lesions became violaceous, with crepitating vesicles full of hemorrhagic exudate. He developed a renal failure and a disseminated intravascular coagulation. Blood cultures demonstrated the presence of Vibrio vulnificus and the patient died 68 hours after admission


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Vibrioses , Choque Séptico/microbiologia , Coagulação Intravascular Disseminada/microbiologia , Hepatite Alcoólica/complicações
12.
Rev. méd. Chile ; 129(10): 1171-1178, oct. 2001. tab, graf
Artigo em Espanhol | LILACS | ID: lil-301909

RESUMO

Background: Exercise tolerance in patients with COPD is highly variable and poorly related to airways obstruction assessed by FEV1. These patients develop dynamic hyperinflation (DH) during an incremental exercise test which can be evaluated through a reduction in inspiratory capacity (IC). Aim: to evaluate: a) if the six minute walking test (6 MWD) induce DH reducing IC, b) if the reduction in IC is related to tidal expiratory flow limitation at rest (FL). Subjects and methods: Thirty eight stable COPD patients (28 FL and ten non FL during resting breathing, determined by the negative pressure technique). Inspiratory capacity was measured before and immediately after the 6 MWD test. Dyspnea, SpO2 and heart rate were measured before and after the test. Results: Inspiratory capacity was lower in FL patients as compared to patients without FL (p <0,005). Although no differences were found between groups in 6 MWD, dyspnea and HR, a significant reduction in IC after the walking test was observed only in FL patients (p <0,0001). In addition, SpO2 fell significantly (p <0,0001) after walking in the same group. Conclusions: Our results demonstrate that a moderate exercise such as the walking test induces DH and hypoxemia in patients with COPD and FL and stresses the importance of assessing DH by measuring IC in these patients


Assuntos
Humanos , Masculino , Feminino , Teste de Esforço , Pneumopatias Obstrutivas/diagnóstico , Testes de Função Respiratória/métodos , Espirometria , Caminhada
13.
Rev. méd. Chile ; 129(4): 359-66, abr. 2001. tab, graf
Artigo em Espanhol | LILACS | ID: lil-286997

RESUMO

Background: Health related quality of life (QoL) is severely impaired in COPD patients as a consequence of dyspnea and limited exercise tolerance, which lead to physical deconditioning and muscle atrophy resulting in weakness and fatigue. Psychosocial factors such as depression and anxiety also contribute to this impairment. Aim: To evaluate: a) the impact of COPD on quality of life, and b) the effect of 10 weeks of exercise training on exercise performance and on QoL. Patients and methods: The Spanish version of the Chronic Respiratory Questionnaire (CRQ) was applied to 55 COPD patients (FEV1 37 ñ 13 percent pred) for the assessment of QoL and in 30 of them submitted to exercise training for 10 weeks. Exercise performance was evaluated by measuring: six-minute walking distance, maximal workload (Wmax), maximal O2 consumption (VO2max) as well as endurance time, blood lactic acid, dyspnea and leg fatigue during a submaximal exercise. Trained patients were evaluated before and after training. Results : COPD patients showed a reduction (mean ñ SD) in the four domains of the CRQ: dyspnea (3.1 ñ 0.9); fatigue (4.3 ñ 1.3); mastery (4.65 ñ 1.3), emotional function (4.1 ñ 0.97), and in Wmax and VO2max (52 ñ 16 Watt and 970 ñ 301 ml/min). No significant relationship between the impairment in exercise tolerance and in QoL was observed. Exercise training significantly improved the four domains of QoL (p < 0.0001), Wmax (p < 0.05), VO2max (p < 0.02) and endurance time (p < 0.001). Isotime exercise measurements of dyspnea, leg fatigue and lactic acid decreased after training (p < 0.001, each). No significant relation between changes in QoL and changes in exercise performance were observed. Conclusions: Our results demonstrate that QoL is seriously impaired in patients with COPD and confirm: (a) the lack of relationship of QoL to the usually measured physiological parameters, and (b) the beneficial effect of exercise training on QoL through the reduction of symptoms. These findings stresses the need of measuring quality of life in our patients if we want to evaluate the impact of therapeutic procedures on well-being from the patients' perspective


Assuntos
Humanos , Masculino , Feminino , Qualidade de Vida , Terapia por Exercício , Pneumopatias Obstrutivas/reabilitação , Inquéritos e Questionários , Dispneia/epidemiologia , Testes de Função Respiratória
14.
Rev. méd. Chile ; 129(2): 133-9, feb. 2001. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-284978

RESUMO

Background: Patients with chronic heart failure have a lower inspiratory muscle strength and fatigue endurance. Aim: To assess the effects of selective training of respiratory muscles in patients with heart failure. Patients and methods : Twenty patients with stable chronic heart failure, aged 58.3 ñ 3 years with an ejection fraction of 28 ñ 9 percent, were subjected to respiratory muscle training with threshold valves. The load was fixed in 30 percent of maximal inspiratory pressure (PImax) in 11 and in 10 percent of PImax in nine. Two sessions of 15 minutes, 6 days per week, during 6 weeks were done. Degree of dyspnea (Mahler score), maximal oxygen uptake, distance walked in 6 minutes, respiratory muscle function and left ventricular ejection fraction were measured before and after training. Results: Both training loads were associated to an improvement in dyspnea (+2.7 ñ 1.8 and +2.8 ñ 1.8 score points with 30 percent Plmax and 10 percent PImax respectively), maximal oxygen uptake (from 19 ñ 3 to 21.6 ñ 5 and from 16 ñ 5 to 18.6 ñ 7 ml/kg/min with 30 percent PImax and 10 percent PImax respectively, p< 0.05), PImax (from 78 ñ 22 to 99 ñ 22 and from 72 ñ 34 to 82.3 cm H20 with 30 percent Plmax and 10 percent PImax respectively), sustained PImax (from 63 ñ 18 to 90 ñ 22 and from 58 ñ 3 to 69 ñ 3 cm H20 with 30 percent PImax and 10 percent PImax respectively), and maximal sustained load (from 120 ñ 67 to 195 ñ 47 and from 139 ñ 120 to 192 ñ 154 g with 30 percent PImax and 10 percent PImax respectively). The distance walked in 6 min only increased in subjects trained at 30 percent PImax (from 451 ñ 78 to 486 ñ 68 m). Conclusions: Selective training of respiratory muscles results in a functional improvement of patients with chronic heart failure


Assuntos
Humanos , Feminino , Masculino , Exercícios Respiratórios , Insuficiência Cardíaca/terapia , Testes de Função Respiratória/métodos
15.
Rev. méd. Chile ; 127(6): 647-54, jun. 1999. tab, graf
Artigo em Espanhol | LILACS | ID: lil-245305

RESUMO

Background: The benefits of non-invasive mechanical ventilation (NIMV) in hypercapnic patients with severe stable COPD remain controversial mainly due to their unknown mechanisms. Aim: To assess the clinical and physiological benefits of a 3 weeks period of intermittent NIMV and their underlying mechanisms in COPD patients. Patients and methods: Twelve patients (10 male) prospectively recruited (age 65 ñ 3 years, FEV1 27 ñ 2 percent predicted, PaO2 46 ñ 2 mmHg, PaCO2 55 ñ 2 mmHg) were submitted to NIMV using a commercially available system (BiPAP) 3 h a day, 5 days a week for 3 weeks. Arterial blood gases, 6 min walking distance, dyspnea (MahlerÕs scale), breathing pattern, PIMax, ventilatory drive (P0,1) and the impedance of the respiratory system (P0,1/VT/TI) were measured before and after NIMV. Results: A significant improvement in PaO2, PaCO2, PIMax, dyspnea and exercise capacity was observed in addition to a trend for VT to increase and for respiratory rate (RR) to decrease. The impedance of the respiratory system showed a significant reduction. Ventilatory drive, normalized for PaCO2 levels, did not change. Improvement in PaCO2 was related to an increase in VT, whereas a significant association between the reduction in RR and the fall in respiratory system impedance was also found. Conclusions: Our study supports previous data demonstrating that NIMV improves clinical and physiologic parameters in advanced stable COPD and suggest that the underlying mechanism is a reduction in the inspiratory load. A randomized clinical trial is needed to confirm that this mechanism is operative


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Pneumopatias Obstrutivas/terapia , Respiração Artificial/métodos , Espirometria , Estudos Prospectivos , Dispneia , Gasometria , Testes de Função Respiratória
17.
Rev. méd. Chile ; 125(9): 1019-25, sept. 1997. tab, graf
Artigo em Espanhol | LILACS | ID: lil-208917

RESUMO

We retrospectively analyzed the mortality of 443 patients older than 65 years old, admitted to an intensive care unit between 1993 and 1994. The mortality was compared with that of 334 younger patients admitted in the same period. Severity of disease was determined using admission APACHE II score. Older patients had a higher admission APACHE score than younger subjects (18.4+- and 14.5+-8.7 respectively, p 0.01). Mortality during the intensive care unit stay was similar in older and younger patients (18.5 and 14.4 per cent, respectively). Hospital mortality was also similar (22.4 and 25.9 per cent respectively). Older patients had a higher frequency of chronic diseases and degree of functional impairment. Mortality rates for different diseases were also similar in older and younger patients. Older age was not associated with a higher mortality during intensive care unit stay. Prognosis is determined by the admission severity score and the number of concomitant chronic diseases


Assuntos
Humanos , Masculino , Feminino , Idoso , /estatística & dados numéricos , Taxa de Sobrevida/tendências , Unidades de Terapia Intensiva/estatística & dados numéricos , Saúde do Idoso , Admissão do Paciente/tendências
18.
Rev. méd. Chile ; 125(8): 934-8, ago. 1997.
Artigo em Espanhol | LILACS | ID: lil-207134

RESUMO

Recent reports have described a pathogenic role of nitric oxide in several reapiratory disease. It is specially useful in the adult respiratory distress syndrome, where it acts as a selective vasodilator and improves gas exchange, decreasing pulmonary shunting. Although it has a proven bronchodilator effect, its therapeutic role in diseases such as asthma and crhonic limitation of airway flow is not well defined. This article review the metabolism, mechanisms of action, potential uses and adverse effects of nitric oxide in respiratory disease


Assuntos
Humanos , Doenças Respiratórias/terapia , Óxido Nítrico/uso terapêutico , Asma/terapia , Broncodilatadores/farmacocinética , Pneumopatias Obstrutivas/terapia , Óxido Nítrico/efeitos adversos , Óxido Nítrico/fisiologia , Óxido Nítrico/metabolismo , Síndrome do Desconforto Respiratório/terapia
20.
Rev. méd. Chile ; 125(3): 305-10, mar. 1997. tab
Artigo em Espanhol | LILACS | ID: lil-194832

RESUMO

The charts of all patients admitted to an intensive care unit of a University Hospital, during 1 year, were reviewed. The diagnosis that caused the admission was considered the main disease. Severity at the moment of admission was assesses using the Apache asore. A total of 777 patients were admitted during the study period. Twenty had to be excluded due to lack of reliable data. Four hundred thirty two (57 percent) were over 65 years old. Cardiovascular diseases were the main cause of admission in young and old patients. Mortality was 14,8 percent of patients over 65 years old and 18.7 percent in younger patients. Main causes of death were cardiac arrest, cardiogenic shock, sepsis and cerebrovascular disease. No differences in causes of death were observed between young and old patients. Patients older than 65 years old admitted to intensive care units are very similar to the younger counterparts in their prognosis and causes of admission


Assuntos
Humanos , Masculino , Feminino , Idoso , Unidades de Terapia Intensiva/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Índice de Gravidade de Doença , Doenças Respiratórias/epidemiologia , Doenças Cardiovasculares/epidemiologia , Causas de Morte/tendências , Gastroenteropatias/epidemiologia , Idoso Fragilizado/estatística & dados numéricos
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