Psychometric Properties of the Barthel Index Used at Intensive Care Unit Discharge.

BACKGROUND: The Barthel Index, originally developed and validated to assess activities of daily living in patients with neuromuscular disorders, is commonly used in research and clinical practice involving critically ill patients. OBJECTIVES: To evaluate the internal consistency, reliability, measurement error, and construct validity of the Barthel Index used at intensive care unit discharge. METHODS: In this observational study, 2 physiotherapists measured the physical functioning of 122 patients at intensive care unit discharge, using the Barthel Index and other measurement instruments. RESULTS: The patients had a median (IQR) age of 56 (47-66) years, and 62 patients (51%) were male. The primary reason for intensive care unit admission was sepsis (28 patients [23%]), and 83 patients (68%) were receiving mechanical ventilation. The Cronbach α value indicating internal consistency was 0.81. For interrater reliability, the intraclass correlation coefficient for the total score was 0.98 (95% CI, 0.97-0.98; P < .001) and the κ statistic for the individual items was 0.54 to 0.94. The standard error of measurement was 7.22, the smallest detectable change was 20.01, and the 95% limits of agreement were -10.3 and 11.8. The Barthel Index showed moderate to high correlations with the other physical functioning measurement instruments (ρ = 0.57 to 0.88; P < .001 for all). CONCLUSION: The Barthel Index is a reliable and valid instrument for assessing physical functioning at intensive care unit discharge.

Early Rehabilitation Index: tradução, adaptação transcultural para o português do Brasil e Early Rehabilitation Barthel Index: validação para o uso na unidade de terapia intensiva / Early Rehabilitation Index: translation and cross-cultural adaptation to Brazilian Portuguese; and Early Rehabilitation Barthel Index: validation for use in the intensive care unit

RESUMO Objetivo: Traduzir, adaptar transculturalmente para o português do Brasil o instrumento Early Rehabilitation Index e validar para uso na unidade de terapia intensiva o instrumento Early Rehabilitation Barthel Index, para avaliação do estado funcional. Métodos: Foram executadas as seguintes etapas: preparação, tradução, reconciliação, tradução reversa, revisão, harmonização, pré-teste e avaliação psicométrica. Após esse processo inicial, a versão em português foi aplicada por dois avaliadores em pacientes que permaneciam pelo menos 48 horas internados na unidade de terapia intensiva. Verificou-se a confiabilidade da escala por meio da consistência interna, da confiabilidade entre avaliadores e do efeito piso e teto. Para a validade de constructo, correlacionou-se o Early Rehabilitation Barthel Index com instrumentos que usualmente são utilizados para avaliação do estado funcional na unidade de terapia intensiva. Resultados: Participaram 122 pacientes com mediana de idade de 56 [46,8 - 66] anos. O Early Rehabilitation Barthel Index teve confiabilidade adequada com coeficiente alfa de Cronbach de 0,65. A confiabilidade entre avaliadores foi excelente, com coeficiente de correlação intraclasse de 0,94 (IC95% 0,92 - 0,96) e moderado a excelente com índice de concordância de kappa de 0,54 a 1,0. Os efeitos piso e teto foram mínimos. Observou-se a validade do Early Rehabilitation Barthel Index por meio das correlações com o escore total do Perme Escore (rô = 0,72), da Escala de Estado Funcional em UTI (rô = 0,77), do Physical Function in Intensive Care Test-score (rô = 0,69), do Medical Research Council sum score (rô = 0,58), além das dinamometrias de preensão palmar (rô = 0,58) e manual de coxa (rô = 0,55), todos com p < 0,001. Conclusão: A versão adaptada do Early Rehabilitation Index para o português brasileiro e na sua totalidade, Early Rehabilitation Barthel Index é confiável e válida para avaliação do estado funcional dos pacientes na alta da unidade de terapia intensiva.

ABSTRACT Objective: To translate and cross-culturally adapt the Early Rehabilitation Index to Brazilian Portuguese and validate the Early Rehabilitation Barthel Index for use in the intensive care unit to assess functional status. Methods: The following steps were performed: preparation, translation, reconciliation, back-translation, revision, harmonization, pretesting, and psychometric evaluation. After this initial process, the Portuguese version was applied by two evaluators to patients hospitalized in the intensive care unit for at least 48 hours. The reliability of the scale was assessed by internal consistency, interrater reliability, and floor and ceiling effects. To measure construct validity, the Early Rehabilitation Barthel Index was correlated with instruments typically used to assess functional status in the intensive care unit. Results: A total of 122 patients with a median age of 56 (46.8 - 66) years participated in the study. The Early Rehabilitation Barthel Index had adequate reliability, with a Cronbach's alpha coefficient of 0.65. The interrater reliability was excellent, with an intraclass correlation coefficient of 0.94 (95%CI 0.92 - 0.96), and agreement was moderate to excellent, with a kappa agreement index of 0.54 to 1.0. The floor and ceiling effects were minimal. The validity of the Early Rehabilitation Barthel Index was observed through its correlations with the total Perme score (rho = 0.72), the Functional Status Score for the ICU (rho = 0.77), the Physical Function in the Intensive Care Test score (rho = 0.69), and the Medical Research Council sum score (rho = 0.58), in addition to handgrip strength (rho = 0.58) and knee extensor strength measured by hand-held dynamometry (rho = 0.55), all with p < 0.001. Conclusion: The adapted versions of the Early Rehabilitation Index for Brazilian Portuguese and, in its entirety, the Early Rehabilitation Barthel Index are reliable and valid for assessing the functional status of patients at discharge from the intensive care unit.

Emergence of Alveolar Consolidations in Serial Lung Ultrasound and Diagnosis of Ventilator-Associated Pneumonia.

BACKGROUND: Lung ultrasound (LUS) has been reported as a promising diagnostic tool for ventilator-associated pneumonia (VAP), but patients with previous lung parenchyma commitment have been not studied. PURPOSE: To evaluate whether the emergence of sonographic consolidations, rather than their presence, can improve the VAP diagnosis in a sample including patients with previous lung parenchyma diseases. METHODS: Patients who completed 48 hours of mechanical ventilation were prospectively studied with daily LUS examinations. We checked the emergence of different consolidation types on the eve and on the day of a clinical suspicion of VAP. We elaborated an algorithm considering, sequentially, the emergence of (1) subpleural consolidations in anterior lung regions on the eve of suspicion; (2) lobar/sublobar consolidation in anterior lung regions on the day of suspicion; (3) lobar/sublobar consolidation with dynamic air bronchograms on the day of suspicion; and (4) any other lobar/sublobar consolidation on the day of suspicion in association with a positive Gram smear of endotracheal aspirate. RESULTS: Of the 188 included patients, 60 were suspected and 33 confirmed VAP. The presence of sonographic consolidations at the clinical suspicion had no diagnostic value for VAP. The emergence of subpleural consolidations in anterior lung regions on the eve of suspicion had specificity of 95% (95% confidence interval [CI], 79%-99%). The emergence of lobar/sublobar consolidations in anterior lung regions on the day of suspicion had specificity of 100% (95% CI, 87%-100%). The emergence of lobar/sublobar consolidations with dynamic air bronchograms on the day of suspicion had specificity of 96% (95% CI, 81%-99%). Finally, the proposed algorithm had sensitivity of 63% (95% CI, 46%-77%) and specificity of 85% (95% CI, 67%-94%) for VAP. CONCLUSIONS: The presence of sonographic consolidations was not accurate for VAP when patients with previous lung parenchyma commitment were included. However, serial LUS examinations detected the emergence of specific signs of VAP.

Early Rehabilitation Index: translation and cross-cultural adaptation to Brazilian Portuguese; and Early Rehabilitation Barthel Index: validation for use in the intensive care unit. / Early Rehabilitation Index: tradução, adaptação transcultural para o português do Brasil e Early Rehabilitation Barthel Index: validação para o uso na unidade de terapia intensiva.

OBJECTIVE: To translate and cross-culturally adapt the Early Rehabilitation Index to Brazilian Portuguese and validate the Early Rehabilitation Barthel Index for use in the intensive care unit to assess functional status. METHODS: The following steps were performed: preparation, translation, reconciliation, back-translation, revision, harmonization, pretesting, and psychometric evaluation. After this initial process, the Portuguese version was applied by two evaluators to patients hospitalized in the intensive care unit for at least 48 hours. The reliability of the scale was assessed by internal consistency, interrater reliability, and floor and ceiling effects. To measure construct validity, the Early Rehabilitation Barthel Index was correlated with instruments typically used to assess functional status in the intensive care unit. RESULTS: A total of 122 patients with a median age of 56 (46.8 - 66) years participated in the study. The Early Rehabilitation Barthel Index had adequate reliability, with a Cronbach's alpha coefficient of 0.65. The interrater reliability was excellent, with an intraclass correlation coefficient of 0.94 (95%CI 0.92 - 0.96), and agreement was moderate to excellent, with a kappa agreement index of 0.54 to 1.0. The floor and ceiling effects were minimal. The validity of the Early Rehabilitation Barthel Index was observed through its correlations with the total Perme score (rho = 0.72), the Functional Status Score for the ICU (rho = 0.77), the Physical Function in the Intensive Care Test score (rho = 0.69), and the Medical Research Council sum score (rho = 0.58), in addition to handgrip strength (rho = 0.58) and knee extensor strength measured by hand-held dynamometry (rho = 0.55), all with p < 0.001. CONCLUSION: The adapted versions of the Early Rehabilitation Index for Brazilian Portuguese and, in its entirety, the Early Rehabilitation Barthel Index are reliable and valid for assessing the functional status of patients at discharge from the intensive care unit.

OBJETIVO: Traduzir, adaptar transculturalmente para o português do Brasil o instrumento Early Rehabilitation Index e validar para uso na unidade de terapia intensiva o instrumento Early Rehabilitation Barthel Index, para avaliação do estado funcional. MÉTODOS: Foram executadas as seguintes etapas: preparação, tradução, reconciliação, tradução reversa, revisão, harmonização, pré-teste e avaliação psicométrica. Após esse processo inicial, a versão em português foi aplicada por dois avaliadores em pacientes que permaneciam pelo menos 48 horas internados na unidade de terapia intensiva. Verificou-se a confiabilidade da escala por meio da consistência interna, da confiabilidade entre avaliadores e do efeito piso e teto. Para a validade de constructo, correlacionou-se o Early Rehabilitation Barthel Index com instrumentos que usualmente são utilizados para avaliação do estado funcional na unidade de terapia intensiva. RESULTADOS: Participaram 122 pacientes com mediana de idade de 56 [46,8 - 66] anos. O Early Rehabilitation Barthel Index teve confiabilidade adequada com coeficiente alfa de Cronbach de 0,65. A confiabilidade entre avaliadores foi excelente, com coeficiente de correlação intraclasse de 0,94 (IC95% 0,92 - 0,96) e moderado a excelente com índice de concordância de kappa de 0,54 a 1,0. Os efeitos piso e teto foram mínimos. Observou-se a validade do Early Rehabilitation Barthel Index por meio das correlações com o escore total do Perme Escore (rô = 0,72), da Escala de Estado Funcional em UTI (rô = 0,77), do Physical Function in Intensive Care Test-score (rô = 0,69), do Medical Research Council sum score (rô = 0,58), além das dinamometrias de preensão palmar (rô = 0,58) e manual de coxa (rô = 0,55), todos com p < 0,001. CONCLUSÃO: A versão adaptada do Early Rehabilitation Index para o português brasileiro e na sua totalidade, Early Rehabilitation Barthel Index é confiável e válida para avaliação do estado funcional dos pacientes na alta da unidade de terapia intensiva.

The Brazilian Portuguese-language version of the Manchester Respiratory Activities of Daily Living questionnaire: construct validity, reliability, and measurement error.

OBJECTIVE: To test the construct validity, reliability, and measurement error of the Brazilian Portuguese-language version of the Manchester Respiratory Activities of Daily Living (MRADL) questionnaire in patients with COPD. METHODS: We evaluated 50 patients with COPD, among whom 30 were men, the mean age was 64 ± 8 years, and the median FEV1 as a percentage of the predicted value (FEV1%predicted) was 38.4% (interquartile range, 29.1-57.4%). Pulmonary function and limitations in activities of daily living (ADLs) were assessed by spirometry and by face-to-face application of the MRADL, respectively. For the construct validity analysis, we tested the hypothesis that the total MRADL score would show moderate correlations with spirometric parameters. We analyzed inter-rater reliability, test-retest reliability, inter-rater measurement error, and test-retest measurement error. RESULTS: The total MRADL score showed moderate correlations with the FEV1/FVC ratio, FEV1 in liters, FEV1%predicted, and FVC%predicted, all of the correlations being statistically significant (r = 0.34, r = 0.31, r = 0.42, and r = 0.38, respectively; p < 0.05 for all). For the reliability and measurement error of the total MRADL score, we obtained the following inter-rater and test-retest values, respectively: two-way mixed-effects model intraclass correlation coefficient for single measures, 0.92 (95% CI: 0.87-0.96) and 0.89 (95% CI: 0.81-0.93); agreement standard error of measurement, 1.03 and 0.97; smallest detectable change at the individual level, 2.86 and 2.69; smallest detectable change at the group level, 0.40 and 0.38; and limits of agreement, -2.24 to 1.96 and -2.65 to 2.69. CONCLUSIONS: In patients with COPD in Brazil, this version of the MRADL shows satisfactory construct validity, satisfactory inter-rater/test-retest reliability, and indeterminate inter-rater/test-retest measurement error.

The Brazilian Portuguese-language version of the Manchester Respiratory Activities of Daily Living questionnaire: construct validity, reliability, and measurement error / Versão em português do Brasil do questionário Manchester Respiratory Activities of Daily Living: validade de construto, confiabilidade e erro de medida

ABSTRACT Objective: To test the construct validity, reliability, and measurement error of the Brazilian Portuguese-language version of the Manchester Respiratory Activities of Daily Living (MRADL) questionnaire in patients with COPD. Methods: We evaluated 50 patients with COPD, among whom 30 were men, the mean age was 64 ± 8 years, and the median FEV1 as a percentage of the predicted value (FEV1%predicted) was 38.4% (interquartile range, 29.1-57.4%). Pulmonary function and limitations in activities of daily living (ADLs) were assessed by spirometry and by face-to-face application of the MRADL, respectively. For the construct validity analysis, we tested the hypothesis that the total MRADL score would show moderate correlations with spirometric parameters. We analyzed inter-rater reliability, test-retest reliability, inter-rater measurement error, and test-retest measurement error. Results: The total MRADL score showed moderate correlations with the FEV1/FVC ratio, FEV1 in liters, FEV1%predicted, and FVC%predicted, all of the correlations being statistically significant (r = 0.34, r = 0.31, r = 0.42, and r = 0.38, respectively; p < 0.05 for all). For the reliability and measurement error of the total MRADL score, we obtained the following inter-rater and test-retest values, respectively: two-way mixed-effects model intraclass correlation coefficient for single measures, 0.92 (95% CI: 0.87-0.96) and 0.89 (95% CI: 0.81-0.93); agreement standard error of measurement, 1.03 and 0.97; smallest detectable change at the individual level, 2.86 and 2.69; smallest detectable change at the group level, 0.40 and 0.38; and limits of agreement, −2.24 to 1.96 and −2.65 to 2.69. Conclusions: In patients with COPD in Brazil, this version of the MRADL shows satisfactory construct validity, satisfactory inter-rater/test-retest reliability, and indeterminate inter-rater/test-retest measurement error.

RESUMO Objetivo: Testar a validade de construto, a confiabilidade e o erro de medida da versão em português do Brasil do questionário Manchester Respiratory Activities of Daily Living (MRADL) em pacientes com DPOC. Métodos: Avaliamos 50 pacientes com DPOC, 30 dos quais eram homens. A média de idade foi de 64 ± 8 anos, e a mediana do VEF1 em porcentagem do previsto (VEF1%previsto) foi de 38,4% (intervalo interquartil: 29,1-57,4%). A função pulmonar e limitações experimentadas durante a realização de atividades cotidianas foram avaliadas por meio de espirometria e da aplicação presencial do MRADL, respectivamente. Para a análise de validade de construto, testamos a hipótese de que haveria correlações moderadas entre a pontuação total no MRADL e parâmetros espirométricos. Analisamos a confiabilidade e o erro de medida entre avaliadores e entre teste e reteste. Resultados: Houve correlações moderadas e estatisticamente significativas entre a pontuação total no MRADL e VEF1/CVF, VEF1 em litros, VEF1%previsto e CVF%previsto (r = 0,34, r = 0,31, r = 0,42 e r = 0,38, respectivamente; p < 0,05 para todas). No tocante à confiabilidade e ao erro de medida para a pontuação total no MRADL entre avaliadores e entre teste e reteste, respectivamente, foram obtidos os seguintes valores: coeficiente de correlação intraclasse de duas vias e efeitos mistos para medidas únicas = 0,92 (IC95%: 0,87-0,96) e 0,89 (IC95%: 0,81-0,93); erro-padrão de medida do tipo concordância = 1,03 e 0,97; mínima mudança detectável no indivíduo = 2,86 e 2,69; mínima mudança detectável no grupo = 0,40 e 0,38; limites de concordância = −2,24 a 1,96 e −2,65 a 2,69. Conclusões: Em pacientes com DPOC, a versão brasileira do MRADL apresenta validade de construto satisfatória, confiabilidade interavaliadores/teste-reteste satisfatória e erro de medida interavaliadores/teste-reteste indeterminado.

Análise do estado funcional de pacientes crí­ticos internados em unidade de terapia intensiva / Functional status analysis of critically ill patients in the intensive care unit

O comprometimento fí­sico funcional é um aspecto significativo em pacientes crí­ticos e para que seja possí­vel intervir de forma precoce, torna-se importante analisar o estado funcional destes indiví­duos. Este é um estudo longitudinal e prospectivo, do qual participaram 40 indiví­duos internados na UTI do HU/UFSC em Ventilação Mecânica (VM) por pelo menos 48h. Na inclusão ao estudo (AV1) foram coletados dados referentes ao estado funcional e fragilidade prévios; na segunda etapa (AV2) - avaliação da força muscular e do estado funcional; e na alta clí­nica (AV3) ­ reavaliação da força muscular, estado funcional e check list dos marcos funcionais. De forma geral, os pacientes apresentaram prejuí­zo significativo na funcionalidade no despertar, com Índice de Barthel médio de 3,33 ± 6 e Escore Perme de 8,18 ± 3,99 e também na alta da UTI, com Índice de Barthel médio de 12,7 ± 13,99 e Escore Perme de 13,68 ± 6. O estado funcional e a fragilidade prévios se relacionaram com os desfechos clí­nicos (p = 0,022 e p = 0.019, respectivamente). O estado funcional no despertar teve correlação com o desfecho funcional (p < 0,001). A força muscular periférica se alterou juntamente com o estado funcional tanto no despertar (p = 0,005 e p < 0,001) quanto na alta da UTI (p = 0,002). Sendo assim, pode-se dizer que o estado funcional dos pacientes reduziu significativamente durante a internação na UTI, comparada há um mês antes da admissão, e manteve-se baixa após a alta dessa unidade. Verificou-se ainda que o estado funcional e a fragilidade prévios se relacionam com o desfecho clí­nico e que o estado funcional no despertar se relaciona com o desfecho funcional. A força muscular periférica também se alterou juntamente com o estado funcional. (AU)

Functional physical impairment is a significant aspect in critically ill patients and in order to be able to intervene at an early stage, it is important to analyze the functional status of these individuals. This is a longitudinal and prospective study, in which participated 40 patients hospitalized at ICU of the HU/UFSC in mechanical ventilation for at least 48 hours. At inclusion in the study (AV1) data was collected regarding the previous functional status and frailty, at second stage (AV2) - evaluation of muscle strength and functional status and clinical discharge (AV3) ­ revaluation of muscle strength, functional status and a check list of functional milestones. In general, the patients presented significant impairment of functionality at awakening, with a Barthel Index mean of 3.33 ± 6 and Perme Score of 8.18 ± 3.99, and at ICU discharge, with a Barthel Index with mean of 12.7 ± 13.99 and a Perme Score of 13.68 ± 6. The previous functional and frailty status was related to the clinical outcome (p = 0.022 and p=0.019, respectively). The functional status at awakening had a correlation with the functional outcome (p<0.001). The peripheral muscle strength modifies with functional status in both the awakening (p=0,005 e p<0,001) and discharge of the ICU (p=0,002). Therefore, the functional status of patients has significantly reduced during ICU stay, compared with the status one month prior, and remains low after discharge. It was also find that the functional status and previous frailty relate with the clinical outcome and that the functional status at awakening correlated to functional outcome. The peripheral muscle strength also modifies with functional status. (AU)

Functional capacity measurement: reference equations for the Glittre Activities of Daily Living test / Avaliação da capacidade funcional: equações de referência para o teste Glittre Activities of Daily Living

ABSTRACT Objective: To develop reference equations for the Glittre Activities of Daily Living test (Glittre ADL-test) on the basis of anthropometric and demographic variables in apparently healthy individuals. A secondary objective was to determine the reliability of the equations in a sample of COPD patients. Methods: This was a cross-sectional study including 190 apparently healthy individuals (95 males; median age, 54.5 years [range, 42-65]; median FEV1 = 97% [range, 91-105.2]; and median FVC = 96% [range, 88.5-102]) recruited from the general community and 74 COPD patients (55 males; mean age, 65 ± 8 years; body mass index [BMI] = 25.9 ± 4.7 kg/m2; FEV1 = 36.1 ± 14.1%; and FVC = 62.7 ± 16.1%) recruited from a pulmonary rehabilitation center. Results: The mean time to complete the Glittre ADL-test was 2.84 ± 0.45 min. In the stepwise multiple linear regression analysis, age and height were selected as Glittre ADL-test performance predictors, explaining 32.1% (p < 0.01) of the total variance. Equation 1 was as follows: Glittre ADL-testpredicted = 3.049 + (0.015 × ageyears) + (−0.006 × heightcm). Equation 2 included age and BMI and explained 32.3% of the variance in the test, the equation being as follows: Glittre ADL-testpredicted = 1.558 + (0.018 × BMI) + (0.016 × ageyears). Conclusions: The reference equations for the time to complete the Glittre ADL-test were based on age, BMI, and height as independent variables and can be useful for predicting the performance of adult individuals. The predicted values appear to be reliable when applied to COPD patients.

RESUMO Objetivo: Elaborar equações de referência para o teste Glittre Activities of Daily Living (Glittre ADL) com base em variáveis antropométricas e demográficas em indivíduos aparentemente saudáveis. O objetivo secundário foi determinar a confiabilidade das equações em uma amostra composta por pacientes com DPOC. Métodos: Estudo transversal com 190 indivíduos aparentemente saudáveis [95 homens; mediana de idade: 54,5 anos (variação: 42-65); mediana de VEF1 = 97% (variação: 91-105,2); mediana de CVF = 96% (variação: 88,5-102)] recrutados na comunidade geral e 74 pacientes com DPOC [55 homens; média de idade: 65 ± 8 anos; índice de massa corporal (IMC) = 25,9 ± 4,7 kg/m2; VEF1 = 36,1 ± 14,1%; CVF = 62,7 ± 16,1%] recrutados em um centro de reabilitação pulmonar. Resultados: A média do tempo necessário para completar o teste Glittre ADL foi de 2,84 ± 0,45 min. Na análise de regressão linear múltipla passo a passo (stepwise), a idade e a estatura foram selecionadas como preditores do desempenho no teste Glittre ADL, explicando 32,1% (p < 0,01) da variância total. A equação 1 foi a seguinte: Glittre ADLprevisto = 3,049 + (0,015 × idadeanos) + (−0,006 × alturacm). A equação 2 incluiu idade e IMC e explicou 32,3% da variância do teste: Glittre ADLprevisto = 1,558 + (0,018 × IMC) + (0,016 × idadeanos). Conclusões: As equações de referência para o tempo necessário para completar o teste Glittre ADL basearam-se na idade, IMC e estatura como variáveis independentes e podem ser úteis para prever o desempenho de indivíduos adultos. Os valores previstos são aparentemente confiáveis quando aplicados em pacientes com DPOC.

Functional capacity measurement: reference equations for the Glittre Activities of Daily Living test.

OBJECTIVE: To develop reference equations for the Glittre Activities of Daily Living test (Glittre ADL-test) on the basis of anthropometric and demographic variables in apparently healthy individuals. A secondary objective was to determine the reliability of the equations in a sample of COPD patients. METHODS: This was a cross-sectional study including 190 apparently healthy individuals (95 males; median age, 54.5 years [range, 42-65]; median FEV1 = 97% [range, 91-105.2]; and median FVC = 96% [range, 88.5-102]) recruited from the general community and 74 COPD patients (55 males; mean age, 65 ± 8 years; body mass index [BMI] = 25.9 ± 4.7 kg/m2; FEV1 = 36.1 ± 14.1%; and FVC = 62.7 ± 16.1%) recruited from a pulmonary rehabilitation center. RESULTS: The mean time to complete the Glittre ADL-test was 2.84 ± 0.45 min. In the stepwise multiple linear regression analysis, age and height were selected as Glittre ADL-test performance predictors, explaining 32.1% (p < 0.01) of the total variance. Equation 1 was as follows: Glittre ADL-testpredicted = 3.049 + (0.015 × ageyears) + (-0.006 × heightcm). Equation 2 included age and BMI and explained 32.3% of the variance in the test, the equation being as follows: Glittre ADL-testpredicted = 1.558 + (0.018 × BMI) + (0.016 × ageyears). CONCLUSIONS: The reference equations for the time to complete the Glittre ADL-test were based on age, BMI, and height as independent variables and can be useful for predicting the performance of adult individuals. The predicted values appear to be reliable when applied to COPD patients.

Chest ultrasonography for the emergency diagnosis of traumatic pneumothorax and haemothorax: A systematic review and meta-analysis.

OBJECTIVE: To assess the accuracy of the chest ultrasonography for the emergency diagnosis of traumatic pneumothorax and haemothorax in adults. STUDY DESIGN: Systematic review and meta-analysis. METHODS: PubMed, EMBASE, Scopus, Web of Science and LILACS (up to 2016) were systematically searched for prospective studies on the diagnostic accuracy of ultrasonography for pneumothorax and haemothorax in adult trauma patients. The references of other systematic reviews and the included studies were checked for further articles. The characteristics and results of the studies were extracted using a standardised form, and their methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). Primary analysis was performed considering each hemithorax as an independent unit, while secondary analysis considered each patient. The global diagnostic accuracy of the chest ultrasonography was estimated using the Rutter-Gatsonis hierarchical summary ROC method. Moreover, Reitsma's bivariate model was used to estimate the sensitivity, specificity, positive likelihood ratio (LR + ) and negative likelihood ratio (LR-) of each sonographic sign. This review was previously registered (PROSPERO CRD42016048085). RESULTS: Nineteen studies were included in the review, 17 assessing pneumothorax and 5 assessing haemothorax. The reference standard was always chest tomography, alone or in parallel with chest radiography and observation of the chest tube. The overall methodological quality of the studies was low. The diagnostic accuracy of chest ultrasonography had an area under the curve (AUC) of 0.979 for pneumothorax (Fig). The absence of lung sliding and comet-tail artefacts was the most reported sonographic sign of pneumothorax, with a sensitivity of 0.81 (95% confidence interval [95%CI], 0.71-0.88), specificity of 0.98 (95%CI, 0.97-0.99), LR+ of 67.9 (95%CI, 26.3-148) and LR- of 0.18 (95%CI, 0.11-0.29). An echo-poor or anechoic area in the pleural space was the only sonographic sign for haemothorax, with a sensitivity of 0.60 (95%CI, 0.31-0.86), specificity of 0.98 (95%CI, 0.94-0.99), LR+ of 37.5 (95%CI, 5.26-207.5), LR- of 0.40 (95%CI, 0.17-0.72) and AUC of 0.953. CONCLUSION: Notwithstanding the limitations of the included studies, this systematic review and meta-analysis suggested that chest ultrasonography is an accurate tool for the diagnostic assessment of traumatic pneumothorax and haemothorax in adults.

Accuracy and Applications of Lung Ultrasound to Diagnose Ventilator-Associated Pneumonia: A Systematic Review.

BACKGROUND: Lung ultrasound (LUS) is an accurate tool to diagnose community-acquired pneumonia. However, it is not yet an established tool to diagnose ventilator-associated pneumonia (VAP). PURPOSE: To assess the evidence about LUS in the diagnosis of VAP, we conducted a systematic review of the literature. METHODS: We searched PubMed, Embase, Scopus, Web of Science, and LILACS. Two researchers independently selected the studies that met the inclusion criteria. Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was used to assess the quality of the studies. In a qualitative synthesis, 3 questions guided the review: Q1. What are the sonographic signs of VAP? Q2. How can LUS be combined with others tests or signs of VAP? Q3. What is the role of LUS in VAP screening? MAIN RESULTS: Three studies (n = 377 patients) with different designs were included. In terms of Q1, the 3 studies assessed the accuracy of sonographic consolidations. In patients suspected for VAP, lobar or hemilobar consolidation alone was not sufficient to diagnose VAP but seems useful to exclude it. The most useful signs were small subpleural consolidations (sensitivity: 81%; specificity: 41%) and dynamic air bronchograms (sensitivity: 44%; specificity: 81%). Two studies were assessed for Q2, when the 2 signs above were included in a clinical score (Ventilator-associated Pneumonia Lung Ultrasound Score associated with quantitative culture of endotracheal aspirate-VPLUS-EAquant), the accuracy was amplified (sensitivity: 48% and specificity: 97% for score ≥4; sensitivity: 78% and specificity: 77% for score ≥3 points). Finally, regarding Q3, no studies have assessed the use of LUS in screening of VAP. CONCLUSION: Small subpleural consolidations and dynamic air bronchograms were the most useful sonographic signs to diagnose VAP in suspected patients. Clinical scores including LUS had better diagnosis accuracy than LUS alone. There are no data on LUS for VAP screening.