Cirugías por traumatismo torácico: caracterización y variables asociadas a mortalidad / Thoracic trauma surgery: indications, findings and mortality associated variables

Resumen Introducción: El traumatismo torácico (TT) es la causa de aproximadamente un cuarto de las muertes por traumatismos. Los pacientes tratados con cirugía por traumatismo torácico (CTT) presentan un amplio espectro de características y pronósticos. Objetivos: Describir características clínicas, indicaciones, temporalidad, morbilidad, mortalidad y las variables asociadas a mortalidad en pacientes con CTT. Materiales y Método: Estudio observacional de pacientes tratados con CTT, período enero-1981 a diciembre-2019. Revisión de protocolos prospectivos de TT y base de datos. Se realizó regresión logística para variables asociadas a mortalidad. Se utilizó SPSS25® con prueba chi-cuadrado para comparar clasificación, tipo de TT y su distribución temporal, considerando significativo p < 0,05. Resultados: En total 808 casos (18,2%) de 4.448 TT requirieron CTT. Fueron hombres 767 (94,9%) y la edad promedio fue 31,5 ± 13,8 años. El traumatismo fue penetrante y por arma blanca en la mayoría de los casos. Fueron politraumatizados 164 (20,3%). La cirugía fue urgente en 474 (58,7%), precoz en 41 (5,0%) y diferida en 293 (36,3%) casos. La mortalidad global fue de 6,7% y fue significativamente mayor en TT contusos, politraumatizados y en cirugía urgente. La mortalidad fue 9,7% en CTT urgente, 4,9% en precoz y 2,0% en diferida (p < 0,001). Se observaron variables independientes asociadas a mortalidad. Conclusión: En nuestra serie, las CTT se realizaron principalmente en hombres jóvenes con TT penetrantes. Correspondieron a un grupo heterogéneo en cuanto a las indicaciones, hallazgos y lesiones intratorácicas y/o asociadas. Múltiples variables demostraron influir significativamente en la mortalidad de los pacientes tratados con CTT.

Background: Thoracic Trauma (TT) is the cause of approximately a quarter of trauma deaths. The patients who undergo Thoracic Trauma Surgery (TTS) present a wide spectrum of characteristics and prognosis. Aim: To describe clinical characteristics, indications, temporality, morbidity, mortality and mortality associated variables in TTS patients. Materials and Method: Observational study of TT hospitalized patients, period January-1981 to December-2019. A review of operation notes and database was done. A logistic regression for mortality associated variables was made. To compare classification, type of TT and its temporal distribution, SPSS25® with chi-square test was used, considering significant p < 0.05. Results: A total of 808 (18.2%) of 4.448 TT patients required TTS, 767 (94.9%) were men with average age: 31.5 ± 13.8. The trauma was penetrating trauma due to a stab in most cases, 164 (20.3%) were polytraumatized. The surgery was urgent in 474 (58.7%), early in 41 (5.0%) and delayed in 293 (36.3%) cases. The global mortality was 6.7% and was significantly higher in the blunt TT, polytrauma, urgent and early surgery patients. Mortality in urgent TTS was 9.7%, early 4.9% and 2.0% in delayed (p < 0.001). Independent variables associated with mortality were observed. Conclusions: In our series, TTS were performed mainly in young men with penetrating TT. The group was heterogeneous regarding surgical indications, findings and intrathoracic or associated injuries. Multiple variables showed to influence significantly on mortality in patients who underwent TTS.

Fisiología respiratoria: contribución de la estructura de la vía aérea y el pulmón a la función del aparato respiratorio / Contribution of the airways and lung structure to the respiratory system function

Conocer la estructura del sistema respiratorio es fundamental para comprender cómo realiza sus funciones, desde la principal, el intercambio gaseoso, hasta otras funciones no respiratorias tales como el equilibrio ácido-base, fonación, defensa pulmonar, metabolismo pulmonar y procesamiento de materiales bioactivos. El objetivo de esta revisión es describir los conocimientos actuales de la anatomía del aparato respiratorio y mencionar sus funciones tanto respiratorias como no respiratorias.

Knowing the structure of the respiratory system is essential to understand how it performs its various functions, from the main, gas exchange, to its non-respiratory functions such as acid-base balance, phonation, lung defense, pulmonary metabolism, and the handling of bioactive materials. The main objective of this review is to describe the updated knowledge of the respiratory system's anatomy and to mention its various respiratory and non-respiratory functions.

Effects of non-invasive ventilation and posture on chest wall volumes and motion in patients with amyotrophic lateral sclerosis: a case series

ABSTRACT Background The effects of non-invasive ventilation (NIV) on the breathing pattern and thoracoabdominal motion of patients with amyotrophic lateral sclerosis (ALS) are unknown. Objectives 1) To analyze the influence of NIV on chest wall volumes and motion assessed by optoelectronic plethysmography in ALS patients and 2) to compare these parameters in the supine and sitting positions to those of healthy individuals (without NIV). Method Nine ALS patients were evaluated in the supine position using NIV. In addition, the ALS patients and nine healthy individuals were evaluated in both sitting and supine positions. Statistical analysis was performed using the paired Student t-test or Wilcoxon test and the Student t-test for independent samples or Mann-Whitney U test. Results Chest wall volume increased significantly with NIV, mean volume=0.43 (SD=0.16)L versus 0.57 (SD=0.19)L (p=0.04). No significant changes were observed for the pulmonary rib cage, abdominal rib cage, or abdominal contribution. The index of the shortening velocity of the diaphragmatic muscle, mean=0.15 (SD=0.05)L/s versus 0.21 (SD=0.05)L/s (p<0.01), and abdominal muscles, mean=0.09 (SD=0.02)L/s versus 0.14 (SD=0.06)L/s (p<0.01), increased during NIV. Comparisons between the supine and sitting positions showed similar changes in chest wall motion in both groups. However, the ALS patients presented a significantly lower contribution of the abdomen in the supine position compared with the controls, mean=56 (SD=13) versus 69 (SD=10) (p=0.02). Conclusions NIV improved chest wall volumes without changing the contribution of the chest wall compartment in ALS patients. In the supine position, ALS patients had a lower contribution of the abdomen, which may indicate early diaphragmatic dysfunction.

O tórax e o envelhecimento: manifestações radiológicas / The chest and aging: radiological findings

Nos idosos (convencionalmente definidos como indivíduos com idade > de 60 anos), é muitas vezes difícil estabelecer o que é normal devido a inúmeras modificações anatômicas e fisiológicas que ocorrem durante o processo de envelhecimento. Como resultado, o principal problema consiste em diferenciar o ponto em que o envelhecimento é normal daquele no qual a doença começa. Os achados radiológicos do tórax de pessoas idosas sadias são comumente limítrofes. Revisamos sistematicamente a literatura médica sobre o assunto, abrangendo o período entre 1950 e 2011, incluindo artigos em português, inglês, francês, italiano e espanhol. A busca foi feita através das bases de dados PubMed, LILACS e SciELO, utilizando os seguintes termos: age, aging, lung, thorax, chest, X-ray, radiography, pulmonary, computed tomography e suas traduções correspondentes, em combinações variadas. Os critérios de inclusão foram artigos originais e de revisão de achados radiológicos no tórax relacionados ao envelhecimento. Em linhas gerais, o envelhecimento resulta em modificações fisiológicas que devem ser reconhecidas de forma a não serem erroneamente interpretadas como patologias.

In the elderly (conventionally defined as individuals > 60 years of age), it is often difficult to establish what normality is, because of the numerous anatomical and physiological modifications that occur during the aging process. As a result, the greatest challenge is to differentiate between the normal aging process and the onset of disease. Healthy elderly people commonly present borderline findings on chest imaging. We systematically reviewed the medical literature on the subject, covering the period between 1950 and 2011, including articles in Portuguese, English, French, Italian, and Spanish. We searched the PubMed, LILACS, and SciELO databases, using the search terms "age", "aging", "lung", "thorax", "chest", "X-ray", "radiography", "pulmonary", and "computed tomography"-as well as their corresponding translations-in various combinations. We included only original or review articles on aging-related chest imaging findings. In broad terms, aging results in physiological modifications that must be recognized so as not to be erroneously interpreted as pathological.

Breathing pattern and thoracoabdominal motion during exercise in chronic obstructive pulmonary disease

Subjects with chronic obstructive pulmonary disease (COPD) present breathing pattern and thoracoabdominal motion abnormalities that may contribute to exercise limitation. Twenty-two men with stable COPD (FEV1 = 42.6 ± 13.5 percent predicted; age 68 ± 8 years; mean ± SD) on usual medication and with at least 5 years of diagnosis were evaluated at rest and during an incremental cycle exercise test (10 watts/2 min). Changes in respiratory frequency, tidal volume, rib cage and abdominal motion contribution to tidal volume and the phase angle that measures the asynchrony were analyzed by inductive respiratory plethysmography at rest and during three levels of exercise (30-50, 70-80, and 100 percent maximal work load). Repeated measures ANOVA followed by pre-planned contrasts and Bonferroni corrections were used for analyses. As expected, the greater the exercise intensity the higher the tidal volume and respiratory frequency. Abdominal motion contributed to the tidal volume increase (rest: 49.82 ± 11.19 percent vs exercise: 64.15 ± 9.7 percent, 63.41 ± 10 percent, and 65.56 ± 10.2 percent, respectively, P < 0.001) as well as the asynchrony [phase angle: 11.95 ± 7.24° at rest vs 22.2 ± 15° (P = 0.002), 22.6 ± 9° (P < 0.001), and 22.7 ± 8° (P < 0.001), respectively, at the three levels of exercise]. In conclusion, the increase in ventilation during exercise in COPD patients was associated with the major motion of the abdominal compartment and with an increase in the asynchrony independent of exercise intensity. It suggests that cycling exercise is an effective way of enhancing ventilation in COPD patients.

Impacto de fatores externos sobre a mecânica respiratória avaliada por um modelo fotogramétrico específico: biofotogrametria / Assessing the impact that external factors have on respiratory mechanics assessed using a specific photogrammetric model

Este é um relato sobre a adaptação metodológica da técnica fotogramétrica, utilizada em outras especialidades, para análise do movimento respiratório. A biofotogrametria e o modelo denominado biofotogrametria para análise da mecânica respiratória (BAMER), foram testados em uma condição fisiopatológica previamente descrita: a presença de hiperinsuflação dinâmica após exercício com uso de pressão expiratória final positiva. O modelo BAMER identificou um aumento da área tóraco-abdominal após exercício com uso de pressão expiratória final positiva, resultado este comparável aos obtidos por sistemas mais robustos em cinemática respiratória. A pesquisa em biofotogrametria possui valor relevante para muitas áreas, posto que agrega dados quantitativos, sendo particularmente relevante na pediatria, onde o monitoramento é escasso.

This is a report on a methodological adaptation of the photogrammetric technique, which is used in other medical specialties, for use in analyzing respiratory movements. Photogrammetry and a model of photogrammetry designated biofotogrametria para análise da mecânica respiratória (BAMER, photogrammetric analysis of respiratory mechanics) were tested under previously described pathophysiological conditions: post-exercise dynamic hyperinflation using positive end-expiratory pressure. The BAMER model identified an increase in the thoraco-abdominal area following exercise using positive end-expiratory pressure. These results are comparable to those obtained with more robust systems of respiratory kinematics. The use of photogrammetry has value in many areas, since it produces quantitative data, being particularly relevant in pediatrics, in which monitoring resources are scarce.

Efeito de um programa de alongamento muscular pelo método de Reeducação Postural Global sobre a força muscular respiratória e a mobilidade toracoabdominal de homens jovens sedentários / Effect of a muscle stretching program using the Global Postural Reeducation method on respiratory muscle strength and thoracoabdominal mobility of sedentary young males

OBJETIVO: Avaliar o efeito do alongamento da cadeia muscular respiratória, pelo método de Reeducação Postural Global (RPG), sobre a força muscular respiratória e a mobilidade toracoabdominal de homens jovens sedentários. MÉTODOS: Estudo randomizado, realizado com 20 voluntários sedentários, idade 22,65 ± 2,5 anos, divididos em dois grupos de 10: grupo controle, que não participou do alongamento, e grupo submetido à intervenção pelo método de RPG. O protocolo foi constituído por um programa de alongamento da cadeia muscular respiratória na postura 'rã no chão com os braços abertos' realizado com a regularidade de duas vezes por semana, durante 8 semanas, totalizando 16 sessões. Os dois grupos foram submetidos à avaliação da medida da pressão inspiratória máxima, pressão expiratória máxima e cirtometria toracoabdominal, antes e após o período de intervenção. RESULTADOS: Os valores das pressões respiratórias máximas e da cirtometria do grupo controle antes e após o período de intervenção não apresentaram alterações significativas (p > 0,05). No grupo RPG, os valores de todas as variáveis apresentaram diferenças estatisticamente significativas após o protocolo de intervenção (p < 0,05). CONCLUSÕES: O protocolo de alongamento da cadeia muscular respiratória proposto pelo método de RPG mostrou ser eficiente para promover o aumento das pressões respiratórias máximas e das medidas da cirtometria toracoabdominal, sugerindo que pode ser utilizado como um recurso fisioterapêutico para o desenvolvimento da força muscular respiratória e da mobilidade toracoabdominal.

OBJECTIVE: To evaluate the effect that respiratory muscle stretching using the global postural reeducation (GPR) method has on respiratory muscle strength, thoracic expansion and abdominal mobility in sedentary young males. METHODS: This was a randomized study involving 20 sedentary volunteers, aged 22.7 ± 2.5 years, divided into two groups of 10: a control group, composed of subjects not performing any exercises, and a group of subjects submitted to the GPR method. The protocol consisted of a program to stretch the respiratory muscles with participants in the 'open-arm, open hip joint angle' position, which was regularly performed twice a week for 8 weeks, totaling 16 sessions. The two groups were submitted to measurements of maximal inspiratory pressure, maximal expiratory pressure, thoracic expansion and abdominal mobility, prior to and after the intervention period. RESULTS: The initial and final values for maximal respiratory pressures, thoracic expansion and abdominal mobility for the control group showed no significant differences (p > 0.05). However, for the GPR group, all values increased after the intervention (p < 0.05). CONCLUSIONS: Respiratory muscle stretching using the GPR method was efficient in promoting an increase in maximal respiratory pressures, thoracic expansion and abdominal mobility, suggesting that it could be used as a physiotherapy resource to develop respiratory muscle strength, thoracic expansion and abdominal mobility.