Playful strategy to improve the quality of spirometry and analysis of reference values in a group of schoolchildren from Asunción / Estrategia lúdica para mejorar la calidad de las espirometría y análisis de los valores de referencia en un grupo de escolares de Asunción

Introducción. Los niños requieren especial dedicación para lograr espirometrías de calidad. Objetivo. Este trabajo evalúa la frecuencia de maniobras aceptables en escolares, la utilidad de gestos de incentivo para optimizar la obtención de pruebas de alta calidad y realiza un análisis de ajuste a varias ecuaciones de referencia. Materiales y Métodos. Se realizaron maniobras espiratorias forzadas en un grupo de escolares de Asunción- Paraguay, escogiendo variables recomendadas para la interpretación en un espirómetro portátil, para evaluar la frecuencia de pruebas de calidad. Aquellos que no consiguieron estudios aceptables, fueron sometidos a un entrenamiento con silbato en rollo (juguete) para evaluar el desempeño ulterior. Los resultados de alta calidad fueron pareados a valores esperados determinados por diversas ecuaciones buscando evaluar el grado de adecuación. Resultados. De 113 escolares, el 58,4% pudo conseguir maniobras de grado A o B. Después del estímulo con el silbato en rollo, la frecuencia de estudios aceptables ascendió a 79,6%. Los parámetros de referencia con mejor ajuste fueron aquellos determinados por la Global Lung Initiative (GLI). Conclusión. Los incentivos lúdicos son una alternativa para optimizar la obtención de pruebas de espirometría en escolares, que con el uso de parámetros de GLI adecuarían el manejo clínico de ciertas enfermedades respiratorias.

Introduction. Children require special dedication to achieve high quality spirometry. Objective. This work evaluates the frequency of acceptable maneuvers in schoolchildren, the usefulness of incentive gestures to optimize the obtaining of high-quality tests, and performs an analysis of adjustments to several reference equations. Material and Methods. Forced expiratory maneuvers were performed in a group of schoolchildren from Asunción, Paraguay, choosing variables recommended for interpretation in a portable spirometer, to evaluate the frequency of high quality tests. Those who did not achieve acceptable studies were subjected to training with a roll whistle (toy) to evaluate their subsequent performance. The high-quality results were matched to expected values determined by various equations to evaluate adequacy. Results. Of 113 schoolchildren, 58,4% were able to achieve grade A or B maneuvers. After the stimulus with the roll whistle, the frequency of acceptable studies rose to 79,6%. The reference parameters with the best fit were those determined by the Global Lung Initiative (GLI). Conclusion. Playful incentives are an alternative to obtaining acceptable spirometry tests in schoolchildren, which, with the use of GLI parameters, would adjust the clinical management of certain respiratory diseases.

Single breath counting technique to assess pulmonary function: a systematic review and meta-analysis.

Pulmonary function is usually assessed by measuring Vital Capacity (VC) using equipment such as a spirometer or ventilometer, but these are not always available to the population, as they are relatively expensive tests, difficult to transport and require trained professionals. However, the single breath counting technique (SBCT) appears as a possible alternative to respiratory function tests, to help in the pathophysiological understanding of lung diseases. The objective is to verify the applicability of the SBCT as a parameter for evaluating VC. This is a systematic review registered in the International Prospective Register of Systematic Reviews (CRD42023383706) and used for PubMed®, Scientific Electronic Library Online, LILACS, EMBASE, and Web of Science databases of articles published until January 2023. Methodological quality regarding the risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 and National Institutes of Health tools. Eleven of a total of 574 studies were included, of these, nine showed a correlation between VC and SBCT (weak in healthy, moderate in neuromuscular and strong in hospitalized patients). One study of hospitalized patients accurately identified a count value of 21 for a VC of 20 ml kg-1(Sensitivity = 94% and Specificity = 77%), and another estimated a count lower than 41 for a VC below 80% of predicted in patients with neuromuscular dystrophy (Sensitivity = 89% and Specificity = 62%), and another showed good intra and inter-examiner reproducibility in young, adult, and elderly populations. A meta-analysis of three studies showed a moderate correlation in subjects with neuromuscular diseases (r= 0.62, 95% CI = 0.52-0.71,p< 0.01). A high risk of bias was identified regarding the justification of the sample size and blinding of the evaluators. SBCT has been presented as an alternative to assess VC in the absence of specific equipment. There is a clear relationship between SBCT and VC, especially in neuromuscular and hospitalized individuals. New validation studies conducted with greater control of potential bias risks are necessary.

Enfermedad de Pompe y compromiso respiratorio / Pompe Disease and Respiratory Impairment

Introducción: El compromiso respiratorio en la enfermedad de Pompe es una de sus manifestaciones más frecuentes, tiene un impacto negativo en la calidad de vida y facilita la aparición de múltiples complicaciones. Se puede presentar como parte evolutiva de la enfermedad o incluso ser el síntoma inicial de la patología. Contenidos: La presentación clínica del compromiso respiratorio en la enfermedad de Pompe se caracteriza por disnea, ortopnea, cefalea y tos, y sus cambios paraclínicos incluyen hipercapnia, policitemia, elevación del índice de apnea/hipopnea, así como disminución de la capacidad vital y de las presiones inspiratoria y espiratorias máximas. El compromiso respiratorio es causado principalmente por disfunción muscular (especialmente el diafragma) y alteración de la regulación del sistema nervioso central. Conclusiones: Es fundamental la valoración acuciosa inicial de los patrones respiratorios y por supuesto su seguimiento, el cual dependerá del tipo de progresión de la disfunción respiratoria (rápida o lenta) o del requerimiento específico para cada paciente (ventilación no invasiva o invasiva).

Introduction: Respiratory compromise in Pompe disease is one of the most frequent manifestations, which has a negative impact on quality of life and leads to multiple complications. This can occur as an evolutionary part of the disease, or even be the initial symptom of the pathology. Contents: Its clinical presentation is characterized by dyspnea, orthopnea, headache, and cough, and its paraclinical changes include hypercapnia, polycythemia, elevated apnea/hypopnea index, decreased vital capacity, and decreased maximum inspiratory and expiratory pressures. Respiratory compromise is caused mainly by muscular dysfunction (especially the diaphragm) and alteration of regulation of the central nervous system. Conclusions: An initial careful assessment of respiratory patterns is essential, and of course their follow-up, that will depend of the type of progression of respiratory dysfunction (rapid or slow) or the specific requirement for each patient (non-invasive or invasive ventilation).

Relación entre dimensiones antropométricas de tronco y valores de espirometría / Association between anthropometric dimensions of trunk and spirometry indices

Los objetivos del presente estudio fueron primero evaluar la asociación de dimensiones antropométricas de tórax y tronco con índices espirométricos, segundo, ajustar una ecuación de predicción con dimensiones antropométricas de tronco y tercero, comparar nuestro modelo predictivo con dos ecuaciones diagnósticas. Se evaluaron 59 estudiantes universitarios entre 20 y 40 años, de ambos sexos, sin hábito tabáquico. Las variables consideradas fueron: edad, sexo, peso, estatura, diámetro transverso de tórax, diámetro anteroposterior de tórax, perímetro de tórax, altura de tórax, altura de tronco, flujo espiratorio máximo (FEM), volumen espiratorio forzado en el primer segundo (VEF1) y capacidad vital forzada (CVF). Se utilizó el análisis de regresión múltiple para estimar los valores espirométricos en función de las variables demográficas y antropométricas. La CVF y el VEF1 tienen asociación lineal directa con el diámetro transverso de tórax, altura de tórax, perímetro de tórax y altura de tronco. Se ajustó una ecuación de regresión lineal múltiple que indicó que es posible estimar la CVF y el VEF11 en función de la altura de tronco y el perímetro de tórax para ambos sexos. Estas variables son capaces de explicar el 74 % de los valores de CVF y el 68 % de los valores de VEF1. Al comparar los valores obtenidos por nuestras ecuaciones predictivas con las ecuaciones de referencia nacional observamos que nuestros resultados son más cercanos a los de Quanjer et al. (2012) que a los de Knudson et al. (1983). La altura de tronco y el perímetro de tórax tienen asociación directa con el VEF1 y CVF y son buenos predictores del VEF1 y CVF en estudiantes universitarios. Nuestros valores estimados son más cercanos a las ecuaciones de Quanjer et al. (2012) en comparación a las estimaciones de Knudson (1983).

SUMMARY: The purposes of the present study were first to evaluate the association between anthropometric dimensions of the thorax and trunk with spirometric indices, second, to fit a prediction equation with anthropometric dimensions of the trunk, and third, to compare our predictive model with two diagnostic equations. Fifty-nine university students between 20 and 40 years old, of both sexes and non-smokers were recruited. Variables considered were age, sex, weight, height, chest transverse diameter, chest anteroposterior diameter, chest perimeter, chest height, trunk height, maximum expiratory flow (PEF), forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC). Multiple regression analysis was used to estimate spirometric values based on demographic and anthropometric variables. FVC and FEV1 have a direct linear association with chest transverse diameter, chest height, chest circumference, and trunk height. A multiple linear regression equation was fitted, indicating that it is possible to estimate FVC and FEV1 as a function of trunk height and chest girth for both sexes. These variables can explain 74% of the FVC values and 68% of the FEV1 values. Comparing the values obtained by our predictive equations with the national reference equations, we observe that our results are closer to those of Quanjer et al. (2012) than to those of Knudson et al. (1983). Trunk height and chest circumference have a direct association with FEV1 and FVC and are good predictors of FEV1 and FVC in university students. Our estimated values are closer to Quanjer et al. (2012) than Knudson et al. (1983) prediction equations.

Functional physical training to improve the physical health of university students / Treinamento físico funcional para a saúde física de universitários / Entrenamiento físico funcional para la salud física de los estudiantes universitarios

ABSTRACT Introduction: Recently, the obesity rate in Chinese universities has increased substantially and the indicators of physical fitness have declined. The physical quality of college students is an alarming problem that cannot be ignored. The results of structured work could establish a basis for colleges and universities to formulate scientific functional physical training programs. Objective: Analyze the role of functional physical training in teaching physical education to male college students in colleges and universities. Methods: 116 male volunteer students from 4 colleges and universities were selected and divided into control and experimental groups. The groups received three physical education classes lasting 90 minutes for eight weeks. The experimental group received an additional 30 minutes of functional physical training. Both groups were tested for vital capacity, seated forward bending, standing long jump, 50-meter run, pull-up, and 1000-meter test. The tests were compared and statistica50-meteryzed. Results: After 1000-meters of training, the experimental group was superior to the control group on all measures except sitting forward flexion. The results showed significant changes (P<0.01). The restorative effect of the experimental group was significantly enhanced. There was no significant difference in body weight, BMI, 50-meter run, jump, vital capacity, pull-up, and other indicators before and after control training (P>0.05). Conclusion: The 8 weeks of functional physical training promoted a significant effect on improving the physical health of college students. Functional physical training should be appropriately reinforced in university physical education classes to improve students' physical fitness. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução: Recentemente, a taxa de obesidade nas universidades chinesas tem aumentado substancialmente e os indicadores de aptidão física têm diminuído. A qualidade física dos estudantes universitários é um problema alarmante que não pode ser ignorado. Os resultados de um trabalho estruturado poderiam estabelecer uma base para que faculdades e universidades possam formular programas científicos de treinamento físico funcional. Objetivo: Analisar o papel do treinamento físico funcional no ensino da educação física de estudantes universitários do sexo masculino em faculdades e universidades. Métodos: Foram selecionados 116 estudantes voluntários do sexo masculino em 4 faculdades e universidades, divididos em dois grupos: controle e experimental. Os grupos receberam três aulas de educação física com duração de 90 minutos durante oito semanas. O grupo experimental recebeu 30 minutos adicionais de treinamento físico funcional. Os dois grupos foram testados quanto à capacidade vital, flexão sentado para frente, salto em pé à distância, corrida de 50 metros, pull-up e teste de 1000 metros. Os testes foram comparados e analisados estatisticamente. Resultados: Após oito semanas de treinamento, o grupo experimental foi superior ao grupo de controle em todas as medidas, exceto a flexão sentado. Os resultados apresentaram alterações significativas (P<0,01). O efeito restaurador do grupo experimental foi significativamente aprimorado. Não houve diferença significativa no peso corporal, IMC, 50 metros de corrida, salto, capacidade vital, pull-up e outros indicadores antes e depois do treinamento controle (P>0,05). Conclusão: As 8 semanas de treinamento físico funcional promoveram um efeito significativo na melhoria da saúde física dos estudantes universitários. O treinamento físico funcional deve ser adequadamente reforçado nas aulas de educação física universitária para melhorar a aptidão física dos estudantes. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción: Recientemente, la tasa de obesidad en las universidades chinas ha aumentado considerablemente y los indicadores de aptitud física han disminuido. La calidad física de los estudiantes universitarios es un problema alarmante que no se puede ignorar. Los resultados de un trabajo estructurado podrían sentar las bases para que los colegios y universidades formulen programas científicos de entrenamiento físico funcional. Objetivo: Analizar el papel del entrenamiento físico funcional en la enseñanza de la educación física de los estudiantes universitarios varones en los colegios y universidades. Métodos: Se seleccionaron 116 estudiantes voluntarios varones de 4 colegios y universidades, divididos en dos grupos: control y experimental. Los grupos recibieron tres clases de educación física de 90 minutos durante ocho semanas. El grupo experimental recibió 30 minutos adicionales de entrenamiento físico funcional. Ambos grupos fueron sometidos a pruebas de capacidad vital, flexión hacia delante sentada, salto de longitud de pie, carrera de 50 metros, dominadas y prueba de 1000 metros. Las pruebas se compararon y se analizaron estadísticamente. Resultados: Tras ocho semanas de entrenamiento, el grupo experimental fue superior al grupo de control en todas las medidas, excepto en la flexión hacia delante en posición sentada. Los resultados mostraron cambios significativos (P<0,01). El efecto restaurador del grupo experimental fue significativamente mayor. No hubo diferencias significativas en el peso corporal, el IMC, la carrera de 50 metros, el salto, la capacidad vital, la dominada y otros indicadores antes y después del entrenamiento de control (P>0,05). Conclusión: Las 8 semanas de entrenamiento físico funcional promovieron un efecto significativo en la mejora de la salud física de los estudiantes universitarios. El entrenamiento físico funcional debe reforzarse adecuadamente en las clases de educación física de la universidad para mejorar la aptitud física de los estudiantes. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Deep learning for analysis of changes in vital capacity and blood markers after swimming matches based on blended learning / Aprendizado profundo para análise das alterações da capacidade vital e marcadores sanguíneos após jogos de natação baseados no aprendizado combinado / Aprendizaje profundo para el análisis de los cambios en la capacidad vital y los marcadores sanguíneos después de los partidos de natación basados en el aprendizaje combinado

ABSTRACT Introduction Nowadays, more people are concerned with physical exercise and swimming competitions, as a major sporting event, have become a focus of attention. Such competitions require special attention to their athletes and the use of computational algorithms assists in this task. Objective To design and validate an algorithm to evaluate changes in vital capacity and blood markers of athletes after swimming matches based on combined learning. Methods The data integration algorithm was used to analyze changes in vital capacity and blood acid after combined learning swimming competition, followed by the construction of an information system model to calculate and process this algorithm. Results Comparative experiments show that the neural network algorithm can reduce the calculation time from the original initial time. In the latest tests carried out in about 10 seconds, this has greatly reduced the total calculation time. Conclusion According to the model requirements of the designed algorithm, practical help has been demonstrated by building a computational model. The algorithm can be optimized and selected according to the calculation model according to the reality of the application. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução Atualmente, mais pessoas preocupam-se com o exercício físico e as competições de natação, como evento esportivo de destaque, tornou-se foco de atenção. Tais competições exigem atenção especial aos seus atletas e o uso de algoritmos computacionais auxiliam nessa tarefa. Objetivo Projetar e validar um algoritmo para avaliação das alterações da capacidade vital e marcadores sanguíneos dos atletas após os jogos de natação baseados no aprendizado combinado. Métodos O algoritmo de integração de dados foi usado para analisar as mudanças de capacidade vital e ácido sanguíneo após competição de natação de aprendizado combinado, seguido à construção de um modelo de sistema de informação para calcular e processar esse algoritmo. Resultados Experiências comparativas mostram que o algoritmo de rede neural pode reduzir o tempo de cálculo a partir do tempo inicial original. Nos últimos testes levados à cabo em cerca de 10 segundos, isto reduziu muito o tempo total de cálculo. Conclusão De acordo com os requisitos do modelo do algoritmo projetado, foi demonstrada a ajuda prática pela construção de um modelo computacional. O algoritmo pode ser otimizado e selecionado de acordo com o modelo de cálculo, segundo a realidade da aplicação. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción Hoy en día, cada vez más personas se preocupan por el ejercicio físico y las competiciones de natación, como evento deportivo destacado, se han convertido en un foco de atención. Estas competiciones requieren una atención especial para sus atletas y el uso de algoritmos computacionales ayuda en esta tarea. Objetivo Diseñar y validar un algoritmo para evaluar los cambios en la capacidad vital y los marcadores sanguíneos de los atletas después de los partidos de natación basado en el aprendizaje combinado. Métodos Se utilizó el algoritmo de integración de datos para analizar los cambios de la capacidad vital y la acidez de la sangre tras la competición de natación de aprendizaje combinado, seguido de la construcción de un modelo de sistema de información para calcular y procesar este algoritmo. Resultados Los experimentos comparativos muestran que el algoritmo de la red neuronal puede reducir el tiempo de cálculo con respecto al tiempo inicial. En las últimas pruebas realizadas en unos 10 segundos, esto redujo en gran medida el tiempo total de cálculo. Conclusión De acuerdo con los requisitos del modelo del algoritmo diseñado, se ha demostrado la ayuda práctica mediante la construcción de un modelo computacional. El algoritmo puede optimizarse y seleccionarse según el modelo de cálculo en función de la realidad de la aplicación. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Mediator Effect of Cardiorespiratory Fitness on the Association between Physical Activity and Lung Function in Adults: Cross-Sectional Results from the Epimov Study.

We investigated whether cardiorespiratory fitness (CRF) mediates the association between moderate-to-vigorous physical activity (MVPA) and lung function in asymptomatic adults. We examined the cross-sectional results of 1362 adults aged 18-80 years from the Epidemiology and Human Movement Study. Participants were submitted to spirometry to obtain forced vital capacity (FVC) and forced expiratory volume in 1s (FEV1). Additionally, we used cardiopulmonary exercise testing to obtain peak oxygen uptake (V˙O2) as a measure of CRF. Participants used a triaxial accelerometer for 4-7 days to obtain MVPA. Mediation analyses were performed considering the CRF as a mediator, MVPA as an independent variable, and FVC and FEV1 as dependent variables with adjustment for age, sex, and cardiovascular risk score. We aimed to investigate the total (path c) and direct (paths a, b, c') effects through the regression coefficients. We also examined the indirect effect, which was obtained from the product of the coefficients (path ab). Our sample was composed mainly of overweight and middle-aged women. MVPA was positively related to CRF (path a), as well as CRF and lung function (path b). MVPA also presented a significant positive total effect (path c) in the lung function. However, this relationship became non-significant when CRF was included in the model for both FVC and FEV1 (path c'). We did not observe a direct effect of MVPA on the lung function. In contrast, the indirect effect was significant (path ab). Lastly, CRF mediated 60% of the total effect of MVPA on FVC and 61.9% on FEV1. CRF mediates the relationship between lung function and MVPA in asymptomatic adults. Therefore, our results reinforce the need to include CRF assessment in practice clinical routine and suggest that strategies focusing on CRF might be more promising to prevent respiratory diseases in adults.

Fat mass to fat-free mass ratio and its associations with clinical characteristics in asthma.

BACKGROUND: Fat mass to fat-free mass ratio (FM/FFM) assesses the combined effect of the balance between fat mass and fat-free mass. AIMS: to evaluate the associations beetween FM/FFM and clinical outcomes in asthma and to compare clinical characteristics between individuals with higher and lower FM/FFM. METHODS: 128 participants with asthma underwent anthropometric, spirometry and bioelectrical impedance assessments. Physical activity in daily life (PADL) was assessed by the Actigraph for 7 days. Daily dose of inhaled medication, steps of pharmacological treatment, Asthma Control Questionnaire, Asthma Quality of Life Questionnaire and Hospital Anxiety and Depression Scale were also assessed. Participants were classified into two groups according to the 50th percentile of reference values for FM/FFM. RESULTS: Individuals with higher FM/FFM (n=75) used higher daily doses of inhaled corticosteroids, had worse lung function and fewer steps/day when compared to those with lower FM/FFM (n=53) (P≤0.021). Associations were found between absolute values of FM/FFM with lung function (FEV1 and FVC [liters]): R2=0.207 and 0.364;P<0.0001), and between the categories of lower or higher FM/FFM with steps of medication treatment (Cramer's V=0.218;P=0.016) and level of PADL (Cramer's V=0.236;P=0.009). The highest FM/FFM was a determining factor of physical inactivity (OR: 3.21;95%CI:1.17-8.78) and highest steps of pharmacological treatment (OR: 8.89;95%CI:1.23-64.08). CONCLUSION: Higher FM/FFM is significantly associated with worse clinical characteristics in individuals with asthma, such as higher doses of inhaled corticosteroids, worse lung function and fewer steps/day. Moreover, higher FM/FFM is a determining factor of physical inactivity and the highest steps of pharmacological treatment for asthma.

Effects of respiratory physiotherapy in patients with amyotrophic lateral sclerosis: protocol for a systematic review of randomised controlled trials.

INTRODUCTION: Respiratory muscle weakness and ventilatory failure are common complications in patients with amyotrophic lateral sclerosis (ALS) and may lead to death. Respiratory physiotherapy may improve lung function in this population. This study aims to investigate the effects of respiratory physiotherapy on lung function, cough efficacy and functional status of patients with ALS. METHODS AND ANALYSIS: A protocol was published on the International prospective register of systematic reviews (PROSPERO). The research will cover randomised controlled trials, with no language or publication date restriction, available in the following databases: MEDLINE/PubMed, EMBASE, Cochrane Library, Web of Science and Physiotherapy Evidence Database. The research question will be answered using a search strategy adapted for each database. Searches in databases will be conducted from January 2021 to December 2022. Two authors using the Cochrane risk of bias tool for randomised trials V.2 and Grading of Recommendations, Assessment, Development and Evaluations, respectively, will assess risk of bias and quality of evidence independently. According to the results obtained, data will be reported as a meta-analysis or a narrative report. ETHICS AND DISSEMINATION: No previous ethical approval is required for this publication since data used are already published. Results of this review will be disclosed via peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER: CRD42021251842.

Slow Vital Capacity: Differences Between the Expiratory Vital Capacity and the Inspiratory Vital Capacity

ABSTRACT Introduction: The vital capacity (VC) can be determined by means of the expiratory vital capacity (EVC) or the inspiratory vital capacity (IVC). Obtaining the highest VC volume is essential for the correct interpretation of lung function tests. Objectives: To determine the differences between the EVC and the IVC (EVC-IVC) according to the ventilatory pattern; to characterize the FEV1/EVC and FEV1/IVC ratios when an obstruction of the airways is detected; to study the effects of the EVC or IVC on the detec tion of air trapping or lung hyperinflation. Materials and Methods: Cross-sectional study. The sample included 388 individuals divided in 3 groups: healthy, airway obstruc tion, and restrictive lung disease. In order to detect the airway obstruction, we studied the FEV1/EVC and FEV1/IVC ratios. The presence of air trapping or lung hyperinflation was determined by means of a lung volume test. The differences between the EVC and the IVC (EVC-IVC) according to the ventilatory pattern were grouped into classes. Results: In the normal group, there was an EVC-IVC difference of ≥ 200 ml in 34.8% of the individuals; in the airway obstruction group, 28.4%, and in the restrictive lung disease group, 22.4%. The FEV1/EVC ratio detected airway obstruction in 44.8% of the individuals, and the FEV1/IVC ratio in 39.4%. In patients with airway obstruction, the EVC maneuver determined the presence of air trapping in 21.6% of subjects and lung hyperinflation in 9.5%. The IVC maneuver showed 18.2% and 10.8%, respectively. Conclusions: The EVC and IVC should not be used as interchangeable maneuvers, considering the volume differences obtained with each one of them. Their results influenced the interpretation of lung function.

Recomendaciones para el manejo respiratorio de los pacientes con atrofia muscular espinal / Recommendations for respiratory management of patients with spinal muscular atrophia / Recomendações para a manipulação respiratória de pacientes com atrofia muscular espinhal

Resumen: La atrofia muscular espinal (AME) es una enfermedad del asta anterior de la médula espinal, genéticamente determinada y causada por síntesis insuficiente de la proteína de supervivencia de la motoneurona. La debilidad muscular lleva a una disminución progresiva de la capacidad vital y de flujos medibles durante la tos. La intensidad y precocidad de la expresión motora se vincula con los grados de afectación de los grupos musculares respiratorios, determinando la meseta en la capacidad vital y progresión a la insuficiencia ventilatoria, como también el compromiso de los músculos inervados bulbares. Las formas clínicas más severas de AME, en especial aquellas con presentaciones más tempranas y respiración paradojal, tienen capacidades vitales y flujos pico tosidos menores. La evaluación secuencial de estos parámetros es esencial para el pronóstico funcional y vital de estos pacientes. La subclasificación de AME tipo 1 y 2 se relaciona con momentos deseables para la realización de cuidados respiratorios no invasivos en la infancia temprana y en la edad escolar, que mejoran la sobrevida y calidad de vida. Este documento sintetiza dichas recomendaciones con especial referencia a intervenciones guiadas por etapas que incluyan apilamiento de aire (air stacking), protocolos de tos asistida y soporte ventilatorio no invasivo con alta intensidad de presiones de soporte, incluso en aquellos pacientes con pérdida de la autonomía respiratoria, minimizando el riesgo de traqueotomía. La no consideración de estas recomendaciones en la valoración regular de los pacientes resta la oferta de tratamientos oportunos.

Summary: Spinal Muscular Atrophy (SMA) is a disease of the anterior horn of the spinal cord, genetically determined, and caused by deficiency of survival motor neuron (SMN) protein. Muscle weakness leads to a progressive decrease in vital capacity and to diminished cough flows. Respiratory morbidity and mortality are a function of respiratory and bulbar-innervated muscle impairment. It can be measured by the sequential evaluation of vital capacity to determine the life time maximum (plateau) and its subsequent rate of decline, progressing to ventilatory failure. Bulbar-innervated muscle impairment can also be monitored and measured by spirometry. The more severe clinical forms of SMA, especially those with earlier onsets and paradoxical breathing, have lower vital capacities and cough peak flows. The sequential assessment of these parameters is key for the vital and functional prognosis of these patients. SMA sub-classification types 1 and 2 of SMA involve appropriate times for non-invasive respiratory interventions in early childhood and school age and improve afterlife and quality of life. This document summarizes these recommendations, as a function of SMA type, with special reference to interventions that include air stacking, manually and mechanically assisted coughing protocols and noninvasive ventilatory support techniques, even for patients who have no ventilator-free breathing ability to minimize or eliminate the need to resort to tracheotomy. Failure to properly evaluate these patients regularly reduces their survival and chances to avoid invasive airway tubes.

Resumo: A Atrofia Muscular Espinhal (SMA) é uma doença do corno anterior da medula espinhal, geneticamente determinada e causada pela síntese insuficiente da proteína de sobrevivência dos neurônios motores. A fraqueza muscular leva a uma diminuição progressiva da capacidade vital e fluxos mensuráveis durante a tosse. A intensidade e a precocidade da expressão motora estão relacionadas aos graus de envolvimento dos grupos musculares respiratórios, determinando o platô da capacidade vital e a progressão para insuficiência ventilatória, bem como o envolvimento dos músculos inervados do bulbar. As formas clínicas mais graves de SMA, especialmente aquelas com apresentações anteriores e respiração paradoxal, têm capacidades vitais mais baixas e fluxos de tosse mais baixos. A avaliação sequencial desses parâmetros é essencial para o prognóstico funcional e vital desses pacientes. A subclassificação de SMA tipo 1 e 2 está relacionada aos momentos desejáveis para cuidados respiratórios não invasivos na primeira infância e idade escolar, que melhoram a sobrevida e a qualidade de vida. Este documento resume essas recomendações com referência especial às intervenções guiadas por etapas que incluem empilhamento de ar, protocolos de tosse assistida e suporte ventilatório não invasivo com suporte pressórico de alta intensidade, mesmo em pacientes com perda de autonomia respiratória, minimizando o risco de traqueostomia. A não consideração dessas recomendações na avaliação regular dos pacientes reduz a oferta de tratamentos oportunos.

Evaluación de la función respiratoria en pacientes con patologías neuromusculares / Evaluation of Respiratory Function in Patients with Neuromuscular Diseases

Introducción: La Enfermedades Neuromusculares se caracterizan por la pérdida progresiva de la fuerza muscular, la morbi-mortalidad aumenta con la exageración de la debilidad muscular determinando mayor riesgo de complicaciones respiratorias. Es de suma importancia evaluar e interpretar adecuadamente la función pulmonar y ventilatoria para poder realizar intervenciones que pueda prevenir dichas complicaciones. Objetivos: El objetivo del estudio fue reportar el estado funcional respiratorio de un grupo de pacientes con ENM en control ambulatorio y relacionar estos hallazgos con umbrales clínicamente relevantes de complicaciones respiratorias, reforzando intervenciones basadas en opiniones de expertos. Materiales y métodos: Se realizó un estudio Descriptivo-Observacional de corte transversal, donde fueron evaluados en forma ambulatoria, de marzo del 2017 a agosto del 2018, 30 niños y adolescentes con enfermedades neuromusculares. Resultados: El 46% del total de pacientes presenta capacidad tusígena no funcional con alto riesgo de complicaciones. No obstante, sólo el 10% del total de pacientes fueron aptos para realizar adecuadamente estudios de espirometría. Durante las pruebas espirométricas, sólo el 50% de los pacientes logró mantener 6 segundos la espiración. Conclusión: Si bien la espirometría es la principal prueba de función pulmonar y una alta proporción de pacientes presentó alteraciones en su morfología, su realización en estados avanzados de enfermedad fue poco factible. Para detectar umbrales de complicaciones respiratorias graves, la medición del flujo generado durante la tos resultó mejor. Conclusión: Si bien la espirometría es la principal prueba de función pulmonar y una alta proporción de pacientes presentó alteraciones en su morfología, su realización en estados avanzados de enfermedad fue poco factible. Para detectar umbrales de complicaciones respiratorias graves, la medición del flujo generado durante la tos resultó mejor.

Introduction: Neuromuscular Diseases are characterized by the progressive loss of muscle mass, morbidity and mortality increases with the progress of muscle weakness due to the increased risk of respiratory complications, so it is very important to properly evaluate and interpret the measurements of lung functions and ventilation to be able to carry out a specific treatment that can reduce respiratory complications. Objectives: The purpose of this work is to present the results of the measurements of flows, volumes, respiratory capacities and spirometric patterns in outpatients with neuromuscular diseases and to verify their usefulness to detect vital risks. Materials and methods: A cross-sectional Descriptive-Observational study was carried out, where 30 children and adolescents with neuromuscular diseases were evaluated on an outpatient basis, from March 2017 to August 2018. Results: 46% of all patients presented a non-functional cough with a high risk of complications and only 10% of all patients were eligible for spirometry studies. During the spirometric tests, 50% of the patients managed to maintain expiration for 6 seconds. In 70% of the patients, abnormalities in the Flow-Volume curve could be detected. Conclusion: Although spirometry is the main pulmonary function test, its usefulness and efficacy in neuromuscular diseases depends on the findings of specific alterations in the morphology of the flow-volume curve, which in many cases are not possible to distinguish.

Phase Angle Evaluation of Lung Disease Patients and Its Relationship with Nutritional and Functional Parameters.

BACKGROUND: This study aimed to determine the value of phase angle (PhA) in patients with chronic obstructive pulmonary disease (COPD) and pulmonary hypertension (PH) and its association with nutritional and functional parameters. METHODS: A cross-sectional study of 77 patients under follow-up at the pulmonary outpatient clinic of a public hospital. Anthropometric measurements and functional assessments of physical and pulmonary capacity were performed, and a regular physical activity questionnaire was administered. RESULTS: The sample consisted of 38 patients with COPD (mean age, 63.8 ± 9.9 years; 68.4% female) and 39 patients with PH (mean age, 46.6 ± 14.4 years; 79.5% female). There was no difference in anthropometric measurements between patients with COPD and PH. Patients with COPD had mild to moderate limitations of pulmonary function, while patients with PH had only mild limitations (p < 0.01). Although the median distance covered in the 6-minute walk test (6MWT) was different between the COPD and PH groups (p < 0.05), it was considered adequate for these populations. Mean PhA was within the range considered adequate in patients with COPD (6.3°±1°) and PH (6.2°±0.8°) (p > 0.05). In the statistical analyses, although the correlations were weak, adequate PhA correlated with fat free mass index, 6MWT, disease staging, forced vital capacity, and forced expiratory volume in the first second. CONCLUSION: The anthropometric profile of both patient groups was very similar, and PhA values were within the expected range. Despite weak correlations, PhA is a clinical component to be followed and investigated in patients with lung disease.

Maximum phonation time in the pulmonary function assessment / Tempo máximo de fonação para avaliação da função pulmonar

ABSTRACT Purpose: to evaluate the reliability of the maximum phonation time (MPT) and Vital Capacity intra and inter-examiner, by means of the single-breath counting test (CT) and the sustained /a/ phoneme, and the slow vital capacity (SVC). Methods: a reliability study carried out in three groups of healthy individuals, each group with 30 volunteers, allocated according to age. SVC was measured using a spirometer, while the MPT was assessed by the phoneme /a/ and CT. The data were analyzed using SPSS version 20.0. Initially, descriptive statistics were used and for data reliability, the intraclass correlation coefficient (ICC). Results: the Intraclass Correlation Coefficients (ICC) were considered excellent, with significant results above 0.92 for SVC and greater than 0.79 for CT and phoneme /a/. Regarding the inter-examiner evaluation, the ICCs were also significant for both SVC with values greater than 0.96, and for CT and the phoneme /a/ with values greater than 0.85. The error inherent in the technique was assessed using the standard error of the measurement for intra and inter-examiner analyses with values ranging from 1.79 to 3.29 for phoneme /a/, 3.20 to 6.58 for CT and 65, 05 to 206.73 for SVCml. Conclusion: phonation techniques with the phoneme /a/ and CT, as well as SVC, have an excellent reliability, due to intra and inter-examiner agreement measures.

RESUMO Objetivo: avaliar a concordância do tempo máximo de fonação (TMF) com a Capacidade Vital, intra e interexaminador, por meio da técnica de contagem numérica em uma única respiração (TC) e do fonema /a/ sustentado e da capacidade vital lenta (CVL). Métodos: trata-se de um estudo de concordância realizado em três grupos de indivíduos saudáveis, cada grupo com 30 voluntários, alocados de acordo a idade. A CVL foi mensurada por meio do espirômetro, enquanto o TMF foi avaliado pela emissão do fonema/a/ e da TC. Os dados foram analisados pelo programa SPSS versão 20.0. Inicialmente utilizou-se estatística descritiva e para concordância dos dados foi utilizado o coeficiente de correlação intraclasse (CCI). Resultados: os Coeficientes de Correlação Intraclasse (CCI) intraexaminadores foram considerados excelentes, com resultados significantes acima de 0,92 para a CVL e maiores que 0.79 para a TC e fonema/a/. Em relação à avaliação interexaminadores, os CCIs também foram significantes tanto para a CVL com valores maiores que 0,96 quanto para a TC e o fonema/a/ com valores maiores que 0,85. O erro inerente a técnica foi avaliada por meio do erro padrão da medida para as analises intra e interexaminadores com valores que variaram de 1,79 a 3,29 para fonema/a/, 3,20 a 6,58 para TC e 65,05 a 206,73 para CVLml. Conclusão: as técnicas de fonação com o fonema /a/ e TC, assim como a CVL, demonstraram uma excelente concordância intra e interexaminadores.

Avaliação da função pulmonar em pacientes hospitalizados no pósoperatório de cirurgia cardíaca / Evaluation of pulmonary function in patients hospitalized in postoperative cardiac surgery

Introdução: a disfunção pulmonar no pós-operatório de cirurgia cardíaca continua sendo uma das mais importantes causas demorbidade, sendo que o comprometimento da função pulmonar, nessa circunstância, é frequente e contribui, significativamente, para o aumento do tempo de permanência hospitalar. O objetivo deste estudo foi avaliar o comportamento da função pulmonar em pacientes adultos hospitalizados, submetidos à cirurgia cardíaca por esternotomia mediana, no momento a alta da unidade tratamento intensivo, comparado ao quarto dia após a alta dessa unidade. Metodologia: o estudo foi realizado em uma unidade de pós-operatório de cirurgia cardiovascular, após aprovação do Comitê de Ética em Pesquisa. O Termo de Consentimento Livre Esclarecido foi obtido em todos os casos. Incluíram-se pacientes maiores de 18 anos, submetidos à cirurgia cardíaca eletiva. A função pulmonar foi realizada na alta da unidade de tratamento intensivo e, posteriormente, repetida no quarto dia. A função pulmonar foi mensurada pela capacidade vital forçada, pico de fluxo expiratório, além de variáveis do exame físico, como frequência respiratória e ausculta pulmonar. Resultados: 94 pacientes foram submetidos à cirurgia cardíaca eletiva via esternotomia mediana. A média (desvio padrão) de idade foi 50,64 (16,53) anos, com predomínio do sexo masculino (52,1%). A mediana (Q1-Q3) do tempo de permanência na unidade de tratamento intensivo foi de 2,00 dias (2,00-3,00), ao passo que a mediana (Q1-Q3) do tempo de permanência hospitalar foi de 6,00 dias (5,00-8,00). A mediana (Q1-Q3) da capacidade vital forçada e do fluxo respiratório, obtida pela espirometria no pós-operatório, no momento da alta, foi significativamente menor quando comparada ao quarto dia após alta da unidade de tratamento intensivo (p< 0,01). O tempo de permanência na unidade, assim como o tempo de permanência hospitalar não impactou na evolução das variáveis de função pulmonar. Conclusão: a função pulmonar é potencialmente reduzida no período inicial após a cirurgia cardíaca, com evolução gradual, e de recuperação lenta, no curso da recuperação cirúrgica. A manutenção desses valores reduzidos a níveis não críticos por um período prolongado no pós-operatório parece não afetar o desempenho dos pacientes, no que tange a capacidade de respirar profundamente e na efetividade de tosse.

Introduction: pulmonary dysfunction in the postoperative period of cardiac surgery continues to be one of the most important causes of morbidity, and the involvement of pulmonary function in this circumstance is frequent and contributes significantly to an increase in the length of hospital stay. Objective: the objective of this study was to evaluate the pulmonary function behavior in hospitalized adult patients submitted to cardiac surgery by median sternotomy at the time of discharge from the intensive care unit, compared to the fourth day after discharge from this unit. Metodology: the study was performed in a postoperative unit of cardiovascular surgery, after approval of the Research Ethics Committee. The Informed Consent Form was obtained in all cases. Patients older than 18 years who underwent elective cardiac surgery were included. Pulmonary function was performed on discharge from the intensive care unit and then repeated on the fourth day. Pulmonary function was measured by forced vital capacity, peak expiratory flow, besides variables of physical examination, such as respiratory rate and pulmonary auscultation. Results: a number of 94 patients underwent elective cardiac surgery via median sternotomy. Mean (standard deviation) of age was 50.64 (16.53) years, with a predominance of males (52.1%). Median (Q1-Q3) of the time spent in the intensive care unit was 2.00 days (2.00-3.00), while the median (Q1-Q3) of the length of hospital stay was 6.00 days (5.00-8.00). Median (Q1-Q3) of forced vital capacity and respiratory flow, obtained by spirometry in the postoperative period at discharge, was significantly lower when compared to the fourth day after discharge from the intensive care unit (p <0.01 ). The length of stay in the unit, as well as the length of hospital stay, did not affect the evolution of pulmonary function variables. Conclusion: pulmonary function is potentially reduced in the initial period after cardiac surgery, with gradual evolution, and slowness in the course of surgical recovery. Maintaining these reduced values at uncritical levels for a prolonged postoperative period does not appear to affect patients' performance with regard to their ability to breathe deeply and in cough effectiveness.

Intensidade de Exercício durante o Teste de Caminhada de 6 Minutos em Pacientes com Doença Arterial Periférica / Exercise Intensity during 6-Minute Walk Test in Patients with Peripheral Artery Disease

Resumo Fundamento a caminhada não supervisionada em solo tem sido indicada para pacientes com doença arterial periférica (DAP) sintomática. No entanto, a magnitude do esforço exigido por essa atividade e as características dos pacientes que a praticam com mais intensidade não estão claras. Objetivos determinar se a caminhada em solo excede o limiar ventilatório (LV), um reconhecido marcador de intensidade de exercício, em pacientes com DAP sintomática. Métodos Foram recrutados 70 pacientes (61,4% do sexo masculino e com idade entre 40 e 85 anos) com DAP sintomática. Os pacientes realizaram um teste ergométrico em esteira para definir o LV. Em seguida, foram submetidos ao teste de caminhada de 6 minutos para determinar o alcance do LV durante deambulação no solo. Realizou-se regressão logística múltipla para identificar preditores de LV durante o teste de caminhada de 6 minutos, e o valor de p<0,05 foi considerado significativo para todas as análises. Resultados Ao todo, 60% dos pacientes atingiram o LV durante o teste de caminhada de 6 minutos. Mulheres (OR = 0,18 e IC95% = 0,05 a 0,64) e pacientes com mais aptidão cardiorrespiratória (OR = 0,56 e IC 95% = 0,40 a 0,77) tiveram menor probabilidade de chegar ao LV durante a caminhada em solo em comparação a homens e pacientes com menos aptidão cardiorrespiratória, respectivamente. Conclusão Mais da metade dos pacientes com DAP sintomática alcançou o LV durante o teste de caminhada de 6 minutos. Mulheres e pacientes com mais aptidão cardiorrespiratória têm menos probabilidade de chegar ao LV durante o teste de caminhada de 6 minutos, o que indica que a caminhada no solo pode ser mais intensa para esse grupo. Isso deve ser considerado ao se prescreverem exercícios de caminhada em solo para esses pacientes. (Arq Bras Cardiol. 2020; 114(3):486-492)

Abstract Background Non-supervised ground walking has been recommended for patients with symptomatic peripheral artery disease (PAD). However, the magnitude of the effort required by this activity and the characteristics of patients whose ground walking is more intense are unclear. Objectives To determine whether ground walking exceeds the ventilatory threshold (VT), a recognized marker of exercise intensity, in patients with symptomatic PAD. Methods Seventy patients (61.4% male and aged 40 to 85 years old) with symptomatic PAD were recruited. Patients performed a graded treadmill test for VT determination. Then, they were submitted to a 6-minute walk test so the achievement of VT during ground ambulation could be identified. Multiple logistic regression was conducted to identify predictors of VT achievement during the 6-minute walk test. The significance level was set at p < 0.05 for all analyses. Results Sixty percent of patients achieved VT during the 6-minute walk test. Women (OR = 0.18 and 95%CI = 0.05 to 0.64) and patients with higher cardiorespiratory fitness (OR = 0.56 and 95%CI = 0.40 to 0.77) were less likely to achieve VT during ground walking compared to men and patients with lower cardiorespiratory fitness, respectively. Conclusion More than half of patients with symptomatic PAD achieved VT during the 6-minute walk test. Women and patients with higher cardiorespiratory fitness are less likely to achieve VT during the 6-minute walk test, which indicates that ground walking may be more intense for this group. This should be considered when prescribing ground walking exercise for these patients. (Arq Bras Cardiol. 2020; 114(3):486-492)

Clinical and functional correlations of the difference between slow vital capacity and FVC / Correlação clínica e funcional da diferença entre capacidade vital lenta e CVF

ABSTRACT Objective: To evaluate the relationship that the difference between slow vital capacity (SVC) and FVC (ΔSVC-FVC) has with demographic, clinical, and pulmonary function data. Methods: This was an analytical cross-sectional study in which participants completed a respiratory health questionnaire, as well as undergoing spirometry and plethysmography. The sample was divided into two groups: ΔSVC-FVC ≥ 200 mL and ΔSVC-FVC < 200 mL. The intergroup correlations were analyzed, and binomial logistic regression analysis was performed. Results: The sample comprised 187 individuals. In the sample as a whole, the mean ΔSVC-FVC was 0.17 ± 0.14 L, and 61 individuals (32.62%) had a ΔSVC-FVC ≥ 200 mL. The use of an SVC maneuver reduced the prevalence of nonspecific lung disease and of normal spirometry results by revealing obstructive lung disease (OLD). In the final logistic regression model (adjusted for weight and body mass index > 30 kg/m2), OLD and findings of air trapping (high functional residual capacity and a low inspiratory capacity/TLC ratio) were predictors of a ΔSVC-FVC ≥ 200 mL. The chance of a bronchodilator response was found to be greater in the ΔSVC-FVC ≥ 200 mL group: for FEV1 (OR = 4.38; 95% CI: 1.45-13.26); and for FVC (OR = 3.83; 95% CI: 1.26-11.71). Conclusions: The use of an SVC maneuver appears to decrease the prevalence of nonspecific lung disease and of normal spirometry results. Individuals with a ΔSVC-FVC ≥ 200 mL, which is probably the result of OLD and air trapping, are apparently more likely to respond to bronchodilator administration.

RESUMO Objetivo: Avaliar a relação da diferença entre a capacidade vital lenta (CVL) e CVF (ΔCVL-CVF) com dados demográficos, clínicos e de função pulmonar. Métodos: Estudo analítico, transversal, no qual os participantes responderam a um questionário de saúde respiratória e foram submetidos a espirometria e pletismografia. A amostra foi dividida em dois grupos: ΔCVL-CVF ≥ 200 mL e ΔCVL-CVF < 200 mL. Foram realizadas análises de correlações entre os grupos e de regressão logística binominal. Resultados: Foram selecionados 187 indivíduos. Na amostra total, a média da ΔCVL-CVF foi de 0,17 ± 0,14 L. Na amostra, 61 indivíduos (32,62%) apresentaram ΔCVL-CVF ≥ 200 mL. O uso da manobra expiratória lenta reduziu a prevalência de distúrbio ventilatório inespecífico e resultados espirométricos normais, ao revelar distúrbio ventilatório obstrutivo (DVO). DVO e achados de aprisionamento aéreo (capacidade residual funcional elevada e capacidade inspiratória/CPT reduzida) foram preditores de ΔCVL-CVF ≥ 200 mL no modelo final da regressão logística (ajustada para peso e índice de massa corpórea > 30 kg/m2). Foi observada maior chance de resposta ao broncodilatador no grupo ΔCVL-CVF ≥ 200 mL: VEF1 (OR = 4,38; IC95%: 1,45-13,26) e CVF (OR = 3,83; IC95%: 1,26-11,71). Conclusões: O uso da manobra expiratória lenta diminuiu a prevalência de distúrbio ventilatório inespecífico e de resultados espirométricos normais, podendo a ΔCVL-CVF ≥ 200 mL ser resultado de DVO e aprisionamento aéreo, tendo maior chance de resposta ao broncodilatador.

¿Cómo realizar el seguimiento de los pacientes con fibrosis pulmonar idiopática? / How to monitor patients with idiopathic pulmonary fibrosis?

La fibrosis pulmonar idiopática (FPI) se ha clasificado en enfermedad leve o temprana-moderada-severa o Avanzada, sin puntos de corte en parámetros clínicos, funcionales o imagenológicos. No existe aún consenso en cual es el principal parámetro que se debe medir. Si bien las variables funcionales como la capacidad vital forzada (CVF), capacidad de difusión de monóxido de carbono (DLCO) y test de caminata de 6 minutos se han utilizado de forma rutinaria en la practica clínica y en los principales estudios clínicos de tratamiento muchas veces no son representativos de la evolución clínica. Por lo anterior se han desarrollado, índices o puntajes compuestos como la escala GAP (Gender-Age-Physiology) que podrían ser útiles en el seguimiento de los pacientes.

Idiopathic pulmonary fibrosis (IPF) has been classified as mild or early - moderate - severe or advanced disease, with no cut-off points in clinical, functional or imaging parameters. There is no consensus yet on which is the main parameter to be measured although the functional variables such as forced vital capacity (FVC), carbon monoxide diffusion capacity (DLCO) and 6-minute walk test, have been routinely used in clinical practice and in the main clinical studies of treatment, are often not representative of the clinical evolution. Therefore, composite indices or scores such as the GAP (Gender-Age-Physiology) scale have been developed that could be useful in the follow-up of patients.

Impacto do fast track em cirurgia cardíaca de adultos: desfechos clínicos e hospitalares / Impact of fast-track management on adult cardiac surgery: clinical and hospital outcomes

RESUMO Objetivo: Comparar o impacto de duas estratégias de fast track quanto ao momento de extubação e retirada da ventilação mecânica invasiva de adultos no pós-operatório cardíaco em desfechos clínicos e hospitalares. Métodos: Estudo de coorte retrospectivo com pacientes submetidos à cirurgia cardíaca. Os pacientes foram classificados de acordo com o tempo de extubação em Grupo Controle (extubados após 6 horas de admissão na unidade de terapia intensiva, com tempo máximo de ventilação mecânica de 18 horas), Grupo 1 (extubados em sala de operação após término da cirurgia) e Grupo 2 (extubados em até 6 horas pós-admissão na unidade de terapia intensiva). Os desfechos primários analisados foram: capacidade vital no primeiro dia de pós-operatório, tempo de internamento hospitalar e na unidade de terapia intensiva. Os desfechos secundários foram reintubação, pneumonia adquirida no hospital, sepse e óbito. Resultados: Para os 223 pacientes avaliados, a capacidade vital foi menor nos Grupos 1 e 2 comparados ao Controle (p = 0,000 e p = 0,046, respectivamente). Os dias de internamento em unidade de terapia intensiva foram significativamente menores nos Grupos 1 e 2 quando comparados ao Controle (p = 0,009 e p = 0,000, respectivamente), já os dias de internamento hospitalar foram menores no Grupo 1 quando comparado ao Controle (p = 0,014). Houve associação entre a extubação na sala de operação (Grupo 1) com reintubação (p = 0,025) e complicações pós-cirúrgicas (p=0,038). Conclusão: Pacientes submetidos ao fast track com extubação em até 6 horas apresentaram menor tempo de internamento em unidade de terapia intensiva sem aumentar complicações pós-cirúrgicas e óbito. Pacientes extubados em sala de operação tiveram menor tempo de internamento hospitalar e em unidade de terapia intensiva, mas apresentaram aumento na frequência de reintubação e complicações pós-cirúrgicas.

ABSTRACT Objective: To compare the impact of two fast-track strategies regarding the extubation time and removal of invasive mechanical ventilation in adults after cardiac surgery on clinical and hospital outcomes. Methods: This was a retrospective cohort study with patients undergoing cardiac surgery. Patients were classified according to the extubation time as the Control Group (extubated 6 hours after admission to the intensive care unit, with a maximum mechanical ventilation time of 18 hours), Group 1 (extubated in the operating room after surgery) and Group 2 (extubated within 6 hours after admission to the intensive care unit). The primary outcomes analyzed were vital capacity on the first postoperative day, length of hospital stay, and length of stay in the intensive care unit. The secondary outcomes were reintubation, hospital-acquired pneumonia, sepsis, and death. Results: For the 223 patients evaluated, the vital capacity was lower in Groups 1 and 2 compared to the Control (p = 0.000 and p = 0.046, respectively). The length of stay in the intensive care unit was significantly lower in Groups 1 and 2 compared to the Control (p = 0.009 and p = 0.000, respectively), whereas the length of hospital stay was lower in Group 1 compared to the Control (p = 0.014). There was an association between extubation in the operating room (Group 1) with reintubation (p = 0.025) and postoperative complications (p = 0.038). Conclusion: Patients undergoing fast-track management with extubation within 6 hours had shorter stays in the intensive care unit without increasing postoperative complications and death. Patients extubated in the operating room had a shorter hospital stay and a shorter stay in the intensive care unit but showed an increase in the frequency of reintubation and postoperative complications.