Impact of Early Mobilization Added to Respiratory Physiotherapy Postextubation on Weaning Success

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Near-normal aerobic capacity in long-term survivors after lung transplantation.

The clinical course of lung transplantation (LT) is diverse: some patients present chronic lung allograft dysfunction (CLAD) and progressive decline in pulmonary function, but others maintain normal spirometric values and active lives. OBJECTIVES: The aim of this study was to elucidate whether long-term LT survivors with normal spirometry achieve normal exercise capacity, and to identify predictive factors of exercise capacity. METHODS: This was a cross-sectional multicentre study, where bilateral LT recipients who survived at least 10 years after LT, with normal spirometry, no diagnosis of CLAD and modified Medical Research Council dyspnoea degree ≤2 underwent cardiopulmonary exercise testing (CPET). RESULTS: 28 LT recipients were included with a mean±sd age of 48.7±13.6 years. Oxygen uptake (V' O2 ) had a mean±sd value of 21.49±6.68 mL·kg-1·min-1 (75.24±15.6%) and the anaerobic threshold was reached at 48.6±10.1% of the V' O2max predicted. The mean±sd heart rate reserve at peak exercise was 17.56±13.6%. The oxygen pulse increased during exercise and was within normal values at 90.5±19.4%. The respiratory exchange ratio exceeded 1.19 at maximum exercise. The median (25-75th percentile) EuroQol-5D score was 1 (0.95-1), indicating a good quality of life. The median (25-75th percentile) International Physical Activity Questionnaire score was 5497 (4007-9832) MET-min·week-1 with 89% of patients reporting more than 1500 MET-min·week-1. In the multivariate regression models, age, sex and diffusing capacity of the lung for carbon monoxide remained significantly associated with V' O2max (mL·kg-1·min-1); haemoglobin and forced expiratory volume in 1 s were significantly associated with maximum work rate (watts), after adjusting for confounders. CONCLUSION: We report for the first time near-normal peak V' O2 values during CPET and normal exercise capacity in long-term LT recipients without CLAD.

Sympathetic contributions to habituation and recovery of the cardiac defense response.

The cardiac defense response (CDR) to intense auditory stimulation is characterized by two acceleration-deceleration heart rate (HR) components. This study investigated contributions of sympathetic cardiac control to habituation and recovery of the CDR. Fifty-six healthy subjects were presented with noise stimuli eliciting the CDR. Three stimuli were presented with short and long (2.5 min and 12.5 min) inter-trial intervals (ITIs). The pre-ejection period was recorded as an index of sympathetic cardiac control, in addition to HR. Repeated stimulation at short ITI was associated with marked habituation of the HR and sympathetic responses; both responses exhibited a degree of recovery with long ITI. Regarding the time course, the first acceleration-deceleration was accompanied by a decline and subsequent increase in sympathetic cardiac control. During the second acceleration-deceleration, the parameters exhibited parallel courses. These results suggest that the sympathetic contribution to the habituation and recovery is limited to the second HR component.

Mathematical detection of aortic valve opening (B point) in impedance cardiography: A comparison of three popular algorithms.

The preejection period (PEP) is an index of left ventricle contractility widely used in psychophysiological research. Its computation requires detecting the moment when the aortic valve opens, which coincides with the B point in the first derivative of impedance cardiogram (ICG). Although this operation has been traditionally made via visual inspection, several algorithms based on derivative calculations have been developed to enable an automatic performance of the task. However, despite their popularity, data about their empirical validation are not always available. The present study analyzes the performance in the estimation of the aortic valve opening of three popular algorithms, by comparing their performance with the visual detection of the B point made by two independent scorers. Algorithm 1 is based on the first derivative of the ICG, Algorithm 2 on the second derivative, and Algorithm 3 on the third derivative. Algorithm 3 showed the highest accuracy rate (78.77%), followed by Algorithm 1 (24.57%) and Algorithm 2 (13.82%). In the automatic computation of PEP, Algorithm 2 resulted in significantly more missed cycles (48.57%) than Algorithm 1 (6.3%) and Algorithm 3 (3.5%). Algorithm 2 also estimated a significantly lower average PEP (70 ms), compared with the values obtained by Algorithm 1 (119 ms) and Algorithm 3 (113 ms). Our findings indicate that the algorithm based on the third derivative of the ICG performs significantly better. Nevertheless, a visual inspection of the signal proves indispensable, and this article provides a novel visual guide to facilitate the manual detection of the B point.

Respuesta: Evaluación respiratoria en personas con lesión medular / Reply: Respiratory assesment in people with spinal cord injury

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Validación española del cuestionario International Spinal Cord Injury Pulmonary Function Basic Data Set para valorar la repercusión de la lesión medular en el sistema respiratorio / Spanish validation of the International Spinal Cord Injury Pulmonary Function Basic Data Set questionnaire for the study of the repercussion of spinal cord injury in the respiratory system

Introducción y objetivo: La disfunción del sistema respiratorio y las complicaciones respiratorias en la lesión medular repercuten en la morbimortalidad. El objetivo de este trabajo fue: 1) traducir y validar al español el cuestionario de consenso internacional: International Spinal Cord Injury Pulmonary Function Basic Data Set, y 2) determinar la influencia de la lesión medular crónica en el sistema respiratorio, en términos de funcionalismo respiratorio. Material y método: Traducción y validación al español del cuestionario de consenso internacional de la función pulmonar para la lesión medular. Se realizó un estudio de fiabilidad del cuestionario y un estudio descriptivo transversal para determinar el estado del sistema respiratorio en los lesionados medulares. Resultados: El 91,9% no presentaban ninguna enfermedad respiratoria antes de la lesión medular. El 54,8% tenían historia tabáquica. El 27,4% presentaron complicaciones respiratorias. Los resultados de pruebas de función respiratoria fueron FVC 67%, FEV1 72% y PEF 70%. En cuanto a la fiabilidad y concordancia, fue del 98%. Conclusión: El cuestionario de consenso internacional sobre la función pulmonar en su versión española es una herramienta útil para el estudio de la afectación respiratoria en la lesión medular (AU)

Introduction and objective: The dysfunction of the respiratory system and the breathing complications in persons with injured spinal cord has an effect on the morbidity and the mortality of the disease. The objectives were: 1) to translate to Spanish and validate the questionnaire of international consensus: International Spinal Cord Injury Pulmonary Function Basic Data Set, and 2) to determine the influence of chronic spinal cord injury in the respiratory system in terms of respiratory functionalism. Materials and method: Translation to Spanish and validation of the questionnaire of international consensus intended for the study of the pulmonary function in spinal cord injury disease. We tested the reliability of that questionnaire. We conducted a descriptive transversal study to determine the degree of involvement of the respiratory system in spinal cord injury. Results: A percentage of 91.9 did not have any respiratory pathology before spinal cord injury and 54.8% of patients smoked. A percentage of 27.4 of patients presented breathing complications one year after the injury. Results of the respiratory function tests were: FVC 67%, FEV1 72% and PEF 70%. Concordance and reliability were 98%. Conclusion: The Spanish version of the questionnaire of international consensus about the pulmonary function is a useful tool for the study of the respiratory involvement in spinal cord injury (AU)

[Spanish validation of the International Spinal Cord Injury Pulmonary Function Basic Data Set questionnaire for the study of the repercussion of spinal cord injury in the respiratory system]. / Validación española del cuestionario International Spinal Cord Injury Pulmonary Function Basic Data Set para valorar la repercusión de la lesión medular en el sistema respiratorio.

INTRODUCTION AND OBJECTIVE: The dysfunction of the respiratory system and the breathing complications in persons with injured spinal cord has an effect on the morbidity and the mortality of the disease. The objectives were: 1) to translate to Spanish and validate the questionnaire of international consensus: International Spinal Cord Injury Pulmonary Function Basic Data Set, and 2) to determine the influence of chronic spinal cord injury in the respiratory system in terms of respiratory functionalism. MATERIALS AND METHOD: Translation to Spanish and validation of the questionnaire of international consensus intended for the study of the pulmonary function in spinal cord injury disease. We tested the reliability of that questionnaire. We conducted a descriptive transversal study to determine the degree of involvement of the respiratory system in spinal cord injury. RESULTS: A percentage of 91.9 did not have any respiratory pathology before spinal cord injury and 54.8% of patients smoked. A percentage of 27.4 of patients presented breathing complications one year after the injury. Results of the respiratory function tests were: FVC 67%, FEV1 72% and PEF 70%. Concordance and reliability were 98%. CONCLUSION: The Spanish version of the questionnaire of international consensus about the pulmonary function is a useful tool for the study of the respiratory involvement in spinal cord injury.