Comparison of the physiological responses induced by different pediatric exercise field tests in children.

OBJECTIVE: This study aimed to compare the physiological responses induced by the modified shuttle walk test (MSWT), the 6-minute walk test (6MWT), and the pediatric Glittre activities of daily living test for children (TGlittre-P) in healthy children. METHOD: This was an analytical observational cross-sectional study. All subjects underwent an anthropometric evaluation, pulmonary function test, TGlittre-P, 6MWT, and MSWT using a portable gas analyzer. Each test was conducted on the same day, and a maximum period of 15 days was considered for completion of the 3 days of data collection. RESULTS: Overall, 24 subjects were included (mean age, 9.78 ± 1.27 years). The peak oxygen consumption (VO2peak ) during the MSWT (1409.94 ± 285.13 mL/kg/min) was significantly higher than that during the TGlittre-P (982.19 ± 205.95 mL/kg/min) and 6MWT (982.85 ± 257.09 mL/kg/min) (P < .001 for both). There was no difference in VO2peak  as well as most of the physiological variables between the 6MWT and TGlittre-P (P = .987). The MSWT VO2peak correlated with the 6MWT VO2peak (r = 0.67; P = .00) and the TGlittre-P VO2peak (r = 0.43; P = .04). The VO2peak values achieved in the 6MWT and TGlittre-P were also correlated (r = 0.68; P = .00). Unlike in the MSWT, in which the physiological measurements show an incremental response, the VO2 , heart rate, minute ventilation, and respiratory exchange ratio were stabilized in the TGlittre-P and 6MWT. CONCLUSION: The TGlittre-P and 6MWT showed similar physiological responses and required less metabolic, respiratory, and cardiovascular overload than the MSWT. The performance measures and VO2peak values obtained in the three tests were correlated.

Evaluation of respiratory dynamics by volumetric capnography during submaximal exercise protocol of six minutes on treadmill in cystic fibrosis patients / Avaliação da dinâmica respiratória por capnografia volumétrica durante o protocolo de exercício submáximo por seis minutos em esteira em pacientes com fibrose cística

Abstract Objectives: Volumetric capnography provides the standard CO2 elimination by the volume expired per respiratory cycle and is a measure to assess pulmonary involvement. Thus, the objective of this study was to evaluate the respiratory dynamics of healthy control subjects and those with cystic fibrosis in a submaximal exercise protocol for six minutes on the treadmill, using volumetric capnography parameters (slope 3 [Slp3], Slp3/tidal volume [Slp3/TV], and slope 2 [Slp2]). Methods: This was a cross-sectional study with 128 subjects (cystic fibrosis, 64 subjects; controls, 64 subjects]. Participants underwent volumetric capnography before, during, and after six minutes on the treadmill. Statistical analysis was performed using the Friedman, Mann-Whitney, and Kruskal-Wallis tests, considering age and sex. An alpha = 0.05 was considered. Results: Six minutes on the treadmill evaluation: in cystic fibrosis, volumetric capnography parameters were different before, during, and after six minutes on the treadmill; the same was observed for the controls, except for Slp2. Regarding age, an Slp3 difference was observed in cystic fibrosis patients regardless of age, at all moments, and in controls for age ≥ 12 years; a difference in Slp3/TV was observed in cystic fibrosis and controls, regardless of age; and an Slp2 difference in the cystic fibrosis, regardless of age. Regarding sex, Slp3 and Slp3/TV differences were observed in cystic fibrosis regardless of sex, and in controls in male participants; an Slp2 difference was observed in the cystic fibrosis and female participants. The analysis between groups (cystic fibrosis and controls) indicated that Slp3 and Slp3/TV has identified the CF, regardless of age and sex, while the Slp2 showed the CF considering age. Conclusions: Cystic fibrosis showed greater values of the parameters before, during, and after exercise, even when stratified by age and sex, which may indicate ventilation inhomogeneity in the peripheral pathways in the cystic fibrosis.

Resumo Objetivos: A capnografia volumétrica fornece o padrão de eliminação do CO2, pelo volume expirado por ciclo respiratório e avalia o comprometimento pulmonar. O objetivo do estudo foi avaliar a dinâmica respiratória de indivíduos controles saudáveis e em indivíduos com fibrose cística, em um protocolo de exercício submáximo por seis minutos em esteira, por parâmetros da capnografia volumétrica [slope 3(Slp3), Slp3/volume corrente (Slp3/TV) e slope 2(Slp2)]. Métodos: Estudo de corte transversal com 128 indivíduos [(fibrose cística) 64 indivíduos; (controles) 64 indivíduos]. Os participantes realizaram capnografia volumétrica antes, durante e após seis minutos em esteira. Análise estatística realizada pelos testes de Friedman, Mann-Whitney e Kruskal-Wallis, considerado a idade e o sexo. Alpha = 0,05. Resultados: Avaliação de seis minutos em esteira: na fibrose cística, os parâmetros da capnografia volumétrica foram diferentes antes, durante e após seis minutos em esteira, o mesmo ocorreu nos controles, exceto para o Slp2. Considerando a idade: (Slp3) diferença na FC, independentemente da idade, em todos os momentos e nos controles apenas para ≥ 12 anos; (Slp3/TV) diferença para fibrose cística e controles independentemente da idade; (Slp2) diferença apenas para o grupo fibrose cística, independentemente da idade. Considerando o sexo: (Slp3 e Slp3/TV) diferença para fibrose cística, independentemente do sexo, e controles apenas no sexo masculino; (Slp2) diferença para fibrose cística e sexo feminino. Análise entre grupos (fibrose cística versus controles): Slp3 e Slp3/TV identificou a fibrose cística, independentemente da idade e sexo, enquanto o Slp2 evidenciou a fibrose cística considerando a idade. Conclusão: A fibrose cística apresentou maiores valores dos parâmetros antes, durante e após exercício, inclusive quando se considerou idade e sexo, podendo indicar não homogeneidade da distribuição da ventilação nas vias periféricas.

Evaluation of respiratory dynamics by volumetric capnography during submaximal exercise protocol of six minutes on treadmill in cystic fibrosis patients.

OBJECTIVES: Volumetric capnography provides the standard CO2 elimination by the volume expired per respiratory cycle and is a measure to assess pulmonary involvement. Thus, the objective of this study was to evaluate the respiratory dynamics of healthy control subjects and those with cystic fibrosis in a submaximal exercise protocol for six minutes on the treadmill, using volumetric capnography parameters (slope 3 [Slp3], Slp3/tidal volume [Slp3/TV], and slope 2 [Slp2]). METHODS: This was a cross-sectional study with 128 subjects (cystic fibrosis, 64 subjects; controls, 64 subjects]. Participants underwent volumetric capnography before, during, and after six minutes on the treadmill. Statistical analysis was performed using the Friedman, Mann-Whitney, and Kruskal-Wallis tests, considering age and sex. An alpha=0.05 was considered. RESULTS: Six minutes on the treadmill evaluation: in cystic fibrosis, volumetric capnography parameters were different before, during, and after six minutes on the treadmill; the same was observed for the controls, except for Slp2. Regarding age, an Slp3 difference was observed in cystic fibrosis patients regardless of age, at all moments, and in controls for age≥12 years; a difference in Slp3/TV was observed in cystic fibrosis and controls, regardless of age; and an Slp2 difference in the cystic fibrosis, regardless of age. Regarding sex, Slp3 and Slp3/TV differences were observed in cystic fibrosis regardless of sex, and in controls in male participants; an Slp2 difference was observed in the cystic fibrosis and female participants. The analysis between groups (cystic fibrosis and controls) indicated that Slp3 and Slp3/TV has identified the CF, regardless of age and sex, while the Slp2 showed the CF considering age. CONCLUSIONS: Cystic fibrosis showed greater values of the parameters before, during, and after exercise, even when stratified by age and sex, which may indicate ventilation inhomogeneity in the peripheral pathways in the cystic fibrosis.

Impulse oscillometry and obesity in children / Oscilometria de impulso e obesidade em crianças

Abstract Objective: To compare impulse oscillometry system parameters of normal-weight children with overweight and obese children. Method: All participants were submitted to the evaluation of lung function (spirometry and impulse oscillometry) following the American Thoracic Society standards. The evaluation of respiratory mechanics was performed using the Jaeger™ MasterScreen™ Impulse Oscillometry System (Erich Jaeger, Germany), three tests were recorded, with acquisition for at least 20 seconds. Results: The study included 81 children (30 in the control group, 21 in the overweight group, and 30 the in obesity group), matched for age and sex. Regarding spirometry data, obesity group showed higher numerical values in relation to the control group; however, there were no significant differences among the three groups. For impulse oscillometry parameters, there was a difference between control group and obesity group for respiratory impedance (p = 0.036), resistance at 5 hertz (p = 0.026), resonant frequency (p = 0.029), and reactance area (p = 0.014). For the parameters expressed in percentage of predicted, there were differences in resistance at 5 hertz, resonant frequency, and reactance area between control group and obesity group. Conclusions: Obese children showed increased oscillometry parameters values representative of airway obstruction, compared to normal-weight children. Changes in some oscillometry parameters can already be observed in overweight school-aged children.

Resumo Objetivo: Comparar parâmetros do Sistema de Oscilometria de Impulso de crianças com peso normal com crianças com sobrepeso e obesas. Método: Todos os participantes foram submetidos à avaliação de mecanismos respiratórios utilizando o Sistema de Oscilometria de Impulso Jaeger™ (MasterScreen™ IOS, Erich Jaeger, Alemanha) seguindo as normas da Sociedade Torácica Americana. Todos os participantes foram submetidos a testes de espirometria e oscilometria (três testes foram registrados, com coleta de dados por pelo menos 20 segundos). Resultados: O estudo incluiu 81 crianças (30 no grupo de controle, 21 no grupo sobrepeso e 30 no grupo obesidade), pareadas por idade e sexo. No que diz respeito a dados de espirometria, o grupo obesidade mostrou valores numéricos mais elevados; contudo, não houve diferenças significativas entre os três grupos. No que diz respeito a parâmetros do Sistema de Oscilometria de Impulso, houve diferença entre o grupo de controle e o grupo obesidade em Z5 (p = 0,036), resistência 5 hertz (p = 0,026), frequência de ressonância (p = 0,029) e área de reatância (p = 0,014). Nos parâmetros expressos em percentual previsto, houve diferenças em resistência 5 hertz, frequência de ressonância e área de reatância entre o grupo de controle e grupo obesidade. Conclusões: Crianças obesas mostraram parâmetros de oscilometria aumentados representativos de obstrução das vias aéreas em comparação a crianças com peso normal. As alterações em alguns parâmetros oscilométricos já podem ser observadas em crianças com sobrepeso em idade escolar.

Impulse oscillometry and obesity in children.

OBJECTIVE: To compare impulse oscillometry system parameters of normal-weight children with overweight and obese children. METHOD: All participants were submitted to the evaluation of lung function (spirometry and impulse oscillometry) following the American Thoracic Society standards. The evaluation of respiratory mechanics was performed using the Jaeger™ MasterScreen™ Impulse Oscillometry System (Erich Jaeger, Germany), three tests were recorded, with acquisition for at least 20seconds. RESULTS: The study included 81 children (30 in the control group, 21 in the overweight group, and 30 the in obesity group), matched for age and sex. Regarding spirometry data, obesity group showed higher numerical values in relation to the control group; however, there were no significant differences among the three groups. For impulse oscillometry parameters, there was a difference between control group and obesity group for respiratory impedance (p=0.036), resistance at 5hertz (p=0.026), resonant frequency (p=0.029), and reactance area (p=0.014). For the parameters expressed in percentage of predicted, there were differences in resistance at 5 hertz, resonant frequency, and reactance area between control group and obesity group. CONCLUSIONS: Obese children showed increased oscillometry parameters values representative of airway obstruction, compared to normal-weight children. Changes in some oscillometry parameters can already be observed in overweight school-aged children.

Predictive equations for maximal respiratory pressures of children aged 7-10.

BACKGROUND: Measurements of respiratory muscle strength are widely used for assessment in children; however, clearly defined predictive equations for the Brazilian pediatric population have yet to be established. OBJECTIVE: To determine the prediction equations for maximal respiratory pressures in healthy children. METHOD: Cross-sectional observational study with normal-weight students aged 7-10 years (n=399, 198 boys) with health attested by the (International Study of Asthma and Allergies in Childhood) questionnaire and medical history. Biometric data were evaluated (weight, height, and body mass index) as predictors. Spirometry and maximal expiratory pressure values were measured according to the recommendations of the American Thoracic Society. To verify data normality, the Shapiro-Wilk test was applied, and Pearson's test was used to verify the correlation between variables. The models were developed using simple linear regression and multivariate analyses. For all tests, the significance level was p<0.05. RESULTS: Boys showed higher values of maximal respiratory pressures than girls, both increasing with age. For boys, these values had moderate correlation with age, weight, and height and weak correlation with body mass index. For girls, maximum inspiratory pressure had a weak correlation with age and moderate correlation with biometric data. Maximum expiratory pressure had a moderate correlation with age and biometric measures. The best predictive models were found in boys: Log(MIP)=1.577+0.006×weight (kg) (R2aj=14.1%) and Log(MEP)=1.282+0.409×height (m) (R2aj=13.9%); and for girls: Log(MIP)=1.548+0.006×weight (kg) (R2aj=15.0%) and Log(MEP)=1.524+0.012×age (years)+0.005×weight (kg) (R2aj=21.6%). CONCLUSION: Prediction equations for maximal respiratory pressures were developed for boys and girls. The biometric measurements were shown to have a weak influence on the results.

Capacidade de exercício e função pulmonar de escolares com história de displasia broncopulmonar: revisão sistemática / Exercise capacity and pulmonary function of school age children with a history of bronchopulmonary dysplasia: a systematic review

A displasia broncopulmonar (DBP) é uma doença respiratória crônica decorrente da necessidade de oxigênio e/ou ventilação mecânica no período neonatal. A lesão pulmonar decorrente da DBP pode levar a alterações na função pulmonar, com limitação do fluxo e aumento da resistência das vias aéreas, que perduram durante a infância e adolescência. Objetivo: realizar uma revisão sistemática de estudos que avaliaram a função pulmonar e a capacidade de exercício de escolares com DBP. Método: realizadas buscas sistematizadas em três bases de dados eletrônicas SciELO, PEDro e MEDLINE viaOvid, sendo selecionados artigos publicados até janeiro de 2014 que avaliaram tanto a função pulmonar como a capacidade de exercício em escolares com DBP. Resultados: através das estratégias de busca foram encontrados 376 títulos relacionados ao tema. Após análise dos critérios de inclusão, apenas cinco trabalhos foram selecionados para compor amostra final. Conclusões: crianças com história de DBP apresentam variável obstrução ao fluxo aéreo em idade escolar e podem atingir menores valores de consumo máximo de oxigênio, volume minuto e volume corrente durante o exercicio. Ainda assim, a função pulmonar parece não influenciar a capacidade de exercício nesta população...

Bronchopulmonary dysplasia (BPD) is a chronic respiratory disease accused by the need of oxygen and/ or mechanical ventilation in the neonatal period. The resulting lung injury of BPD may lead to changes in lung function, with flow limitation and increased airway resistance, which may persist throughout childhood and adolescence to adulthood. Objective: conduct a systematic review studies that evaluated lung function and exercise capacity in school-age children with BPD. Method: we performed systematic searches of three electronic databases Scielo, PEDro and MEDLINE Ovid, being selected articles published up to january 2014. That assessed pulmonary function and exercise capacity in school-age children with bronchopulmonary dysplasia. Results: through the search strategies 376 titles related to the topic were found, after analysis of the inclusion criteria, only five were selected to compose the final sample. Conclusion: children with a history of BPD have variable airflow obstruction at school age and can reach lower maximal values of oxygen, minute volume and tidal volume during exercise. Still, there is no influence lung function on exercise capacity in this population...

Sistema de oscilometria de impulso em pediatria: revisão de literatura / Impulse Oscillometry System in pediatrics: review

A oscilometria de impulso (IOS) é considerado um método de avaliação da mecânica respiratória, e por ser não invasivo, vem sendo crescentemente indicado na assistência e investigação do paciente pediátrico. Estudos tem tido como interesse a determinação de valores de referência e a verificação da relação do IOS com outros métodos de avaliação respiratória. Objetivo: apresentar uma atualização da literatura quanto ao sistema, critérios técnicos e interpretação de dados, bem como, a relação do sistema com outros métodos de avaliação respiratória e sua aplicabilidade clínica. Método: revisão bibliográfica com consulta nas bases de dados MEDLINE/PubMed e Ebsco, utilizando as palavras-chaves:“impulse oscillometry”, “reference values” e “child”. Considerou-se todo material com informações sobre o equipamento, suas indicações e aplicação como instrumento de avaliação em diferentes situações clínicas. Resultados: foram identificados 45 documentos, sendo 41 ensaios clínicos e 4 revisões, complementados com 20 trabalhos: 1 guideline, 1 manual sobre o equipamento e 18 artigos referentes ao tema. Esse material foi caracterizado por abordar o equipamento, seus parâmetros de avaliação, técnica de execução e posicionamento do paciente durante o exame, critérios de aceitabilidade e reprodutibilidade e interpretação dos dados obtidos. São várias as publicações dessa ferramenta na avaliação da mecânica respiratória de disfunções como asma e fibrose cística e geração de valores de referência em crianças saudáveis. Conclusão: o IOS é um recurso relativamente novo, cuja indicação em pediatria tem sido crescente, mas que ainda carece investigações, tanto técnicas quanto clínicas...

Impulse oscillometry (IOS) is considered a method of evaluation of respiratory mechanics, and being non-invasive, has been increasingly mentioned in the care and research of pediatric patients. Studies have considered the interest of determining reference values and check the IOS relationship with other methods of respiratory assessment. Objective: to present an update of the literature regarding the system, technical criteria and interpretation of data, as well as the relationship of the system with other methods of respiratory assessment and its clinical applicability. Method: literature review with consultation in the databases MEDLINE / PubMed and Ebsco, using the keywords: “impulse oscillometry”, “reference values” and “child”. It was considered all material with information about the equipment, their indications and application as an evaluation tool in different clinical situations. Results: 45 documents were identified, (41 trials and 4 reviews), supplemented with 20 papers (1 guideline, 1 manual on equipment and 18 articles on the subject). This material was characterized by approaching the equipment, its parameters evaluation, performance technique and positioning of the patient during the examination, criteria for acceptability and reproducibility, and interpretation of the data obtained. There are several publications of this tool in the evaluation of respiratory mechanics disorders such as asthma and cystic fibrosis, and making on reference values in healthy children. Conclusion: IOS is a relatively new feature, whose indicationin pediatrics has been increasing, but still required investigations, both technical and clinical investigations...

Percepção de esforço e dispneia em pediatria: revisão das escalas de avaliação / Perceived exertion and dyspnea in pediatrics: a review of rating scales

Modelo do estudo: revisão bibliográfica. Objetivo: revisar e apresentar diferentes escalas utilizadas para avaliação da percepção de esforço e dispneia em crianças e adolescentes. Metodologia: revisão bibliográfica com consulta nas bases de dados: Medline/PubMed e SPORTDiscus (EBSCO), sem restrição de data, realizada no período de fevereiro a maio de 2013. Foram utilizados os descritores: child, perceived exertion, dyspnea, scale. Consideradas publicações que validaram e utilizaram escalas de percepção de esforço e/ou dispneia específicas para crianças e adolescentes. Resultados: foram encontrados 154 estudos, dos quais 12 foram incluídos nessa revisão. Identificou-se um total de 15 escalas validadas na língua inglesa e 1 em português, sendo que a maioria delas utiliza como base a escala de Borg. Cada uma possui particularidades, considerando o tipo de exercício e atividade que será desempenhada, a situação clinica a ser avaliada e idade da criança. Sua adequada aplicação pode retratar informações confiáveis e viabilizar a participação ativa desse grupo etário durante diferentes atividades, auxiliando na área assistencial e cientifica. Conclusões: não há nenhuma escala considerada padrão ouro até o momento. Todas são elaboradas com Figuras, descritores verbais e numéricos, para facilitar a compreensão das crianças e permitir que as mesmas tenham entendimento das próprias sensações de dispneia e de esforço.

Design of the study: literature review. Objective: to review and present different scales used to evaluate the perceived exertion and dyspnea in children and adolescents. Methodology: a literature review to researching in the electronic databases: Medline / PubMed and SPORTDiscus (EBSCO), no date restrictionin the period of February to May 2013. Used the following keywords: child, Perceived exertion, dyspnea, scale. Publications that used and validated perceived exertion and / or dyspnea scales specific to children and adolescents were considered. Results: 154 studies were found, of which 12 were included in this review. Were identified a total of 15 validated scales in English and one in Portuguese, with the majority of them to build on the Borg scale. Each has its own peculiarities, considering the type of exercise and activity to be performed, the clinical situation to be assessed and the child’s age. Its proper application can portray reliable information and facilitate the active participation of this age group during different activities, assisting in the care and science. Conclusions: there is no scale considered the gold standard so far. All scales are elaborated with figures, verbal and numerical descriptors, to facilitate understanding of the children and allow them to have their own understanding of dyspnea and effort.

Assessment of the reproducibility of the indirect ultrasound method of measuring diaphragm mobility.

The aim of this study was to assess the reproducibility of the ultrasound (US) measurement of craniocaudal displacement of the left branch of the portal vein as an indirect method of measuring right hemidiaphragm mobility in healthy young adults. Forty-one healthy participants were selected, ranging from 20 to 30 years of age. The US tests were conducted and interpreted by two observers (A and B) on two separate occasions (Test 1 and Test 2). Intra-observer and interobserver reproducibility and repeatability of US measurements were determined by the intraclass correlation coefficient (ICC[2,1] ) using a 95% confidence interval (CI). Interobserver reproducibility assessment showed 'high correlation' for Test 1 and Test 2 (ICC[2,1]  = 0·83, 95% CI = 0·70-0·91, and ICC[2,1]  = 0·79, 95% CI = 0·61-0·89, respectively). Intra-observer reproducibility assessment showed 'moderate correlation' for observer A (ICC[2,1]  = 0·69, 95% CI = 0·45-0·84) and for observer B (ICC[2,1]  = 0·65, 95% CI = 0·39-0·81). Repeatability assessment showed 'high correlation' for all tests performed (ICC[2,1]  = 0·86, 0·80, 0·74, 0·79, P<0·001). In conclusion, US measurement of craniocaudal displacement of the left branch of the portal vein is a reproducible method of measuring right hemidiaphragm mobility in healthy young adults.

Fisioterapia respiratória no neonato estável em UTIN: comparação entre técnicas / Respiratory therapy on stable newborn in NICU: comparison between techniques

Introdução: Recém-nascidos (RN) apresentam peculiaridades anatômicas e fisiológicas que os predispõem a complicações pulmonares, algumas delas associadas a quadros álgicos. A aplicação de técnicas de fisioterapia respiratória (TFR) é parte da terapêutica dos RN sob cuidados intensivos, mas pouco se sabe sobre sua repercussão na dor dessa população. Objetivo: Avaliar e comparar a intensidade da dor e parâmetros cardiorrespiratórios de RN em unidade de terapia intensiva neonatal (UTIN) submetidos a duas diferentes TFR. Métodos: Ensaio clínico randomizado e cego realizado com RN caracterizados quanto a dados gestacionais e antropométricos, condições de internação e sinais de desconforto respiratório (BSA). Randomicamente foram alocados nos grupos: G1 -fisioterapia convencional e G2 - reequilíbrio toracoabdominal. Os neonatos receberam apenas um atendimento e foram avaliados em três momentos (antes - T1; imediatamente após um dos procedimentos - T2; e depois de 15 minutos do término - T3). Foram considerados parâmetros cardiorrespiratórios (saturação de oxigênio, frequências cardíaca e respiratória) e três escalas específicas para avaliação da dor (NIPS, NFCS e PIPP). Para análise dos dados se aplicaram os testes Quiquadrado, Wilcoxon e Mann Whitney, sendo significativos valores de p<0,05. Resultados: Participaram 14 RN, 64,3% femininos e 57,1% pré-termo/muito baixo peso, média de idade gestacional 31,71±3,31semanas, idade 10,43 ± 6,22 dias e peso 1.695,71 ± 540,46 g, sem diferença significativa entre os grupos. Verificou-se queda estatisticamente significativa da frequência cardíaca nos dois grupos (G1: T1xT3 = 147,14x138,71 / p=0,042; G2: T1xT2 = 151,43x139 / p=0,018 e T1xT3 = 151,43x145,57 / p=0,046) e não foi identificada presença de dor. Conclusões: As técnicas de fisioterapia respiratória (TFR) aplicadas reduziram a frequência cardíaca dos RN e não desencadearam dor, nem instabilidade clínica...

Fisioterapia respiratória em lactentes sibilantes / Respiratory physiotherapy in wheezing infants

Nos primeiros anos de vida a sibilância é um achado clínico muito comum na faixa etária pediátrica, entretanto, os efeitos das técnicas de fisioterapia respiratória (TFR) são controversos nesses pacientes. Objetivo: Verificar os efeitos das TFR sobre parâmetros cardiorrespiratórios de lactentes sibilantes. Métodos: Ensaio clínico controlado randomizado incluiu lactentes com quadro de sibilância. No grupo intervenção (GI) protocolou-se TFR por 20 minutos (higiene nasal, desobstrução rinofaríngea retrógrada, aumento do fluxo expiratório lento, vibração mecânica e tosse assistida) e controle (GC): sem TFR, apenas contato manual torácico. Antes e após os procedimentos verificou-se: frequência respiratória (FR) e cardíaca (FC), saturação periférica de oxigênio (SpO2), escore de Wood(EW) e comportamento do lactente. Na estatística aplicou-se o teste de Wilcoxon (á=0,05). Resultados: Participaram 59 lactentes, 20 no GI com média de idade de 14,7 meses e 39 bebês no GC, com média de idade de 13,4 anos. No GI houve diminuição da FC e da SpO2 após as TFR, sem significância estatística e aumento da FR no limite da significância. EW permaneceu inalterado. O GC não apresentou nenhuma alteração. Conclusão: Lactentes submetidos às TFR propostas não apresentaram alteração imediata significativa em parâmetros cardiorrespiratórios...

Breathing exercises in upper abdominal surgery: a systematic review and meta-analysis.

BACKGROUND: There is currently no consensus on the indication and benefits of breathing exercises for the prevention of postoperative pulmonary complications PPCs and for the recovery of pulmonary mechanics. OBJECTIVE: To undertake a systematic review of randomized and quasi-randomized studies that assessed the effects of breathing exercises on the recovery of pulmonary function and prevention of PCCs after upper abdominal surgery UAS. SEARCH STRATEGY: We searched the Physiotherapy Evidence Database PEDro, Scientific Electronic Library Online SciELO, MEDLINE, and Cochrane Central Register of Controlled Trials. SELECTION CRITERIA: We included randomized controlled trials and quasi-randomized controlled trials on pre- and postoperative UAS patients, in which the primary intervention was breathing exercises without the use of incentive inspirometers. DATA COLLECTION AND ANALYSIS: The methodological quality of the studies was rated according to the PEDro scale. Data on maximal respiratory pressures MIP and MEP, spirometry, diaphragm mobility, and postoperative complications were extracted and analyzed. Data were pooled in fixed-effect meta-analysis whenever possible. RESULTS: Six studies were used for analysis. Two meta-analyses including 66 participants each showed that, on the first day post-operative, the breathing exercises were likely to have induced MEP and MIP improvement treatment effects of 11.44 mmH2O (95%CI 0.88 to 22) and 11.78 mmH2O (95%CI 2.47 to 21.09), respectively. CONCLUSION: Breathing exercises are likely to have a beneficial effect on respiratory muscle strength in patients submitted to UAS, however the lack of good quality studies hinders a clear conclusion on the subject.

Breathing exercises in upper abdominal surgery: a systematic review and meta-analysis / Exercícios respiratórios em cirurgia abdominal alta: revisão sistemática e metanálise

BACKGROUND: There is currently no consensus on the indication and benefits of breathing exercises for the prevention of postoperative pulmonary complications PPCs and for the recovery of pulmonary mechanics. OBJECTIVE: To undertake a systematic review of randomized and quasi-randomized studies that assessed the effects of breathing exercises on the recovery of pulmonary function and prevention of PCCs after upper abdominal surgery UAS. METHOD: Search Strategy: We searched the Physiotherapy Evidence Database PEDro, Scientific Electronic Library Online SciELO, MEDLINE, and Cochrane Central Register of Controlled Trials. Selection Criteria: We included randomized controlled trials and quasi-randomized controlled trials on pre- and postoperative UAS patients, in which the primary intervention was breathing exercises without the use of incentive inspirometers. Data Collection and Analysis: The methodological quality of the studies was rated according to the PEDro scale. Data on maximal respiratory pressures MIP and MEP, spirometry, diaphragm mobility, and postoperative complications were extracted and analyzed. Data were pooled in fixed-effect meta-analysis whenever possible. RESULTS: Six studies were used for analysis. Two meta-analyses including 66 participants each showed that, on the first day post-operative, the breathing exercises were likely to have induced MEP and MIP improvement treatment effects of 11.44 mmH2O (95%CI 0.88 to 22) and 11.78 mmH2O (95%CI 2.47 to 21.09), respectively. CONCLUSION: Breathing exercises are likely to have a beneficial effect on respiratory muscle strength in patients submitted to UAS, however the lack of good quality studies hinders a clear conclusion on the subject.

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