Brocoprovocación con solución salina hipertónica en niños asmáticos

OBJECTIVE: To verify if the bronchoprovocation test with 4.5% hypertonic saline solution allows to detect the gradient of response in asthmatic children and adolescents, according to asthma severity. METHODS: 75 asthmatic patients aged six to 18 years-old were evaluated in this cross-sectional study. They were classified according to asthma severity in: intermittent or mild persistent (IM) and moderate or severe persistent (MS). They were also classified according to sensitization to inhaled allergens in atopics: positive skin prick test to Dermatophagoides pteronyssinus, D. farinae and Blomia tropicalis; or non- atopic with negative skin prick tests. All patients underwent a bronchoprovocation test with 4.5% hypertonic saline solution. The result of the bronchoprovocation test was considerd positive if at least a reduction of 20% in the forced expiratory volume in one second (FEV1) was noted. RESULTS: 60 individuals were atopic. The bronchoprovocation test was positive more frequently in the MS group than in the IM one (93 versus 65%). Less time was needed for a 20% fall of FEV1 in the MG compared to the IL group [90 (30 - 330) versus 210 (30 - 690) seconds; p<0.05]. The percentage of FEV1 fall was higher in the MG group than in the IL one [26,4% (14 - 63) versus 20% (0 - 60); p<0.05]. CONCLUSIONS: The 4.5% hypertonic saline solution bronchoprovocation test is safe and easy to perform. It detects a gradient of response in asthmatic children and adolescents regarding asthma severity. Higher frequency of positive tests, shorter time for FEV1 fall, and higher percentage of FEV1 fall were observed in moderate and severe asthmatic patients.OBJETIVO: Verificar si la prueba de broncoprovocación, con solución salina hipertónica a 4,5%, permite detectar el gradiente de respuesta en niños y adolescentes con asma, según la gravedad de la enfermedad. MÉTODOS: Estudio transversal, compuesto por 75 pacientes asmáticos, con edades entre seis y 18 años. Los pacientes fueron clasificados por la gravedad (intermitente asociada a persistente liviana - IL - y persistente moderada asociada a grave - MG) y según la presencia de sensibilización a aeroalérgenos (pruebas cutáneas de hipersensibilidad inmediata a Dermatophagoides pteronyssinus, D. farinae y Blomita tropicalis) o no (atópicos versus no atópicos). Todos fueron sometidos a la prueba de broncoprovocación con solución salina hipertónica a 4,5%, considerándose el resultado positivo como la reducción del volumen espiratorio forzado en el primer segundo (VEF1) ≥20%. RESULTADOS: Sesenta individuos eran atópicos. La frecuencia de positividad de la prueba de broncoprovocación fue mayor en el Grupo MG que en el IL (93 versus 65%). El tiempo necesario para la reducción de 20% del VEF1 para el grupo de atópicos fue menor en el MG cuando comparado al IL, 90 (30 a 330) versus 210 (30 a 690) segundos, con p<0,05. El porcentaje de reducción del VEF1 fue más acentuada en el subgrupo MG que en el IL, 26,4 (14 a 63%) versus 20% (0 a 60%), p<0,05. CONCLUSIONES: La prueba de broncoprovocación con solución salina hipertónica a 4,5% es de fácil realización y segura, permitiendo detectar el gradiente de respuesta en niños y adolescentes con asma, según la gravedad de la enfermedad. La mayor frecuencia de positividad y la reducción más rápida del VEF1 fueron observadas en los pacientes con asma moderada o grave.OBJETIVO: Verificar se o teste de broncoprovocação, com solução salina hipertônica a 4,5%, permite detectar o gradiente de resposta em crianças e adolescentes com asma, segundo a gravidade da enfermidade. MÉTODOS: Estudo transversal composto por 75 pacientes asmáticos com idades entre seis e 18 anos. Os pacientes foram classificados pela gravidade (intermitente associada à persistente leve - IL, e persistente moderada associada à grave - MG) e segundo a presença de sensibilização a aeroalérgenos (testes cutâneos de hipersensibilidade imediata a Dermatophagoides pteronyssinus, D. farinae e Blomia tropicalis) ou não (atópicos versus não atópicos). Todos foram submetidos ao teste de broncoprovocação com solução salina hipertônica a 4,5%, considerando-se o resultado positivo se havia redução do volume expiratório forçado no primeiro segundo (VEF1) ≥20%. RESULTADOS: 60 indivíduos eram atópicos. A frequência de positividade do teste de broncoprovocação foi maior no Grupo MG do que no IL (93 versus 65%). O tempo necessário para a queda de 20% do VEF1 para o grupo de atópicos foi menor no MG quando comparado ao IL: 90 (30 - 330) versus 210 (30 - 690) segundos, com p<0,05. A porcentagem de queda do VEF1 foi mais acentuada no subgrupo MG do que no IL [26,4% (14 - 63) versus 20% (0 - 60), p<0,05]. CONCLUSÕES: O teste de broncoprovocação com solução salina hipertônica a 4,5% é de fácil realização e seguro, permitindo detectar gradiente de resposta em crianças e adolescentes com asma segundo a gravidade da mesma. A maior frequência de positividade e a queda mais rápida do VEF1 foram observadas nos pacientes com asma moderada ou grave.Centro Universitário de Ensino Superior de MaceióUniversidade Nove de JulhoUNIFESP Departamento de Pediatria da Escola Paulista de MedicinaUNIFESP, Depto. de Pediatria da Escola Paulista de MedicinaSciEL

Evaluation of prone position associated with CPAP in newborn preterm

The aim of this study was to evaluate clinical variables in new born preterm infants (NBPT) in the prone position (PP) associated with CPAP. A cross sectional study in NBPT with CPAP at the intensive care unit was done. Variables: heart rate (HR), respiratory rates (RR), SpO2, respiratory distress quantify by Silverman and Andersen (BSA) bulletin (which the higher level means worst respiratory distress) were assessed. The protocol was conducted in five phases. In phase I, HR, RR, SpO2, and BSA were evaluated in supine position. In phases II, III, IV and V the same variables were evaluated as phase I, at 5, 15, 30 and 60 min, respectively, after phase I. Following the phase I, the RNPT was positioned at the PP. We performed repeated analysis of variance to compare all the variables studied in five phases, and used the Bonferroni test for post hoc analysis. Statistical significance was considered when pO objetivo deste estudo foi avaliar os benefícios nas variáveis clínicas do decúbito ventral (DV) associado a pressão positiva contínua nas vias aéreas (CPAP), em recém-nascido pré-termo (RNPT). Foi feito um estudo transversal em RNPT com utilização do CPAP internados na unidade de terapia intensiva (UTI). As frequências cardíaca (FC) e respiratória (FR), SpO2, quantificação do desconforto respiratório pelo boletim de Silverman e Andersen (BSA: quanto maior o valor, pior o desconforto respiratório) foram avaliados em cinco fases. Na fase I foram avaliadas a FC, FR, SpO2 e BSA em decúbito supino. Nas fases II, III, IV e V foram coletadas as mesmas variáveis da fase I após 5, 15, 30 e 60 min, respectivamente. O RNPT foi posicionado em DV logo após a fase I. Foi realizada análise de variância repetida para comparação entre todas as variáveis estudadas nas cinco fases, e utilizado-se teste de Bonferroni para análise post hoc. Foi considerada significância estatística quando

Variable positive end-expiratory pressure can maintain oxygenation in experimental acute respiratory distress syndrome induced by oleic acid in dogs

The use of positive end-expiratory pressure (PEEP) or lung recruitment maneuvers (RM) to improve oxygenation in acute respiratory distress syndrome (ARDS) is used but it may reduce cardiac output (CO). Intermittent PEEP may avoid these complications. Our objective was to determine if variable PEEP compared with constant PEEP is capable of maintaining arterial oxygenation and minimizing hemodynamic alterations with or without RM. Eighteen dogs with ARDS induced by oleic acid were randomized into three equal groups: group 1, low variable PEEP; group 2, high variable PEEP, and group 3, RM + high variable PEEP. All groups were submitted to constant PEEP, followed by variable PEEP (PEEP was increased from 5 to 10 cmH2O in group 1, and from 5 to 18 cmH2O in the other two groups). PaO2 was higher in group 3 (356.2 ± 65.4 mmHg) than in group 1 (92.7 ± 29.7 mmHg) and group 2 (228.5 ± 72.4 mmHg), P 0.05. Variable PEEP is able to maintain PaO2 when performed in combination with RM in dogs with ARDS. After RM, CO was reduced and there was no relevant difference between the variable and constant PEEP periods.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de MedicinaCentro Universitário São CamiloUniversidade de São Paulo Faculdade de Medicina Laboratório de Investigação Médica (LIM 12)UNIFESP, EPM, Depto. de MedicinaSciEL

Relationship between gait speed and physical function in patients with symptomatic peripheral artery disease

OBJECTIVE: The aim of the study was to analyze the relationship between gait speed and measurements of physical function in patients with symptomatic peripheral artery disease (PAD). METHODS: One hundred sixty-nine patients (age 66.6±9.4 years) with symptomatic PAD were recruited. Usual and fast gait speeds were assessed with a 4-meter walk test. Objective (balance, sit-to-stand, handrip strength, and six-minute walk test) and subjective (WIQ – Walking Impairment Questionnaire and WELCH – Walking Estimated-Limitation Calculated by History) measurements of physical function were obtained. Crude and adjusted linear regression analyses were used to confirm significant associations. RESULTS: Usual and fast gait speeds were significantly correlated with all objective and subjective physical function variables examined (ro0.55, po0.05). In the multivariate model, usual gait speed was associated with six-minute walking distance (b=0.001, po0.001), sit-to-stand test score (b=-0.005, p=0.012), and WIQ stairs score (b=0.002, p=0.006) adjusted by age, ankle brachial index, body mass index, and gender. Fast gait speed was associated with six-minute walking distance (b=0.002, po0.001), WIQ stairs score (b=0.003, p=0.010), and WELCH total score (b=0.004, p=0.026) adjusted by age, ankle brachial index, body mass index, and gender. CONCLUSION: Usual and fast gait speeds assessed with the 4-meter test were moderately associated with objective and subjective measurements of physical function in symptomatic PAD patients

Relationship between gait speed and physical function in patients with symptomatic peripheral artery disease

OBJECTIVE: The aim of the study was to analyze the relationship between gait speed and measurements of physical function in patients with symptomatic peripheral artery disease (PAD). METHODS: One hundred sixty-nine patients (age 66.6±9.4 years) with symptomatic PAD were recruited. Usual and fast gait speeds were assessed with a 4-meter walk test. Objective (balance, sit-to-stand, handrip strength, and six-minute walk test) and subjective (WIQ – Walking Impairment Questionnaire and WELCH – Walking Estimated-Limitation Calculated by History) measurements of physical function were obtained. Crude and adjusted linear regression analyses were used to confirm significant associations. RESULTS: Usual and fast gait speeds were significantly correlated with all objective and subjective physical function variables examined (ro0.55, po0.05). In the multivariate model, usual gait speed was associated with six-minute walking distance (b=0.001, po0.001), sit-to-stand test score (b=-0.005, p=0.012), and WIQ stairs score (b=0.002, p=0.006) adjusted by age, ankle brachial index, body mass index, and gender. Fast gait speed was associated with six-minute walking distance (b=0.002, po0.001), WIQ stairs score (b=0.003, p=0.010), and WELCH total score (b=0.004, p=0.026) adjusted by age, ankle brachial index, body mass index, and gender. CONCLUSION: Usual and fast gait speeds assessed with the 4-meter test were moderately associated with objective and subjective measurements of physical function in symptomatic PAD patients