Comparación de los diferentes niveles de la presión espiratoria positiva en los volúmenes de la pared torácica en niños saludables y pacientes con fibrosis

ABSTRACT Positive Expiratory Pressure (PEP) improves lung function, however, PEP-induced changes are not fully established. The aim of this study was to assess the acute effects of different PEP levels on chest wall volumes and the breathing pattern in children with Cystic Fibrosis (CF). Anthropometric data, lung function values, and respiratory muscle strength were collected. Chest wall volumes were assessed by Optoelectronic plethysmography at rest and during the use of different PEP levels (10 and 20 cm H2O), randomly chosen. Eight subjects with CF (5M, 11.5±3.2 years, 32±9.5 kilograms) and seven control subjects (4M, 10.7±1.5 years, 38.2±7.8 kilograms) were recruited. The CF group showed significantly lower FEF values 25-75% (CF: 1.8±0.8 vs. CG: 2.3±0.6) and FEV1/FVC ratio (CF: 0.8±0.1 vs. CG: 1±0.1) compared with the control group (p<0.05). Different PEP levels increased the usual volume in chest wall and its compartments in both groups; however, this volume was significantly higher in the control group compared with the CF group during PEP20 (CW: 0.77±0.25 L vs. 0.44±0.16 L; RCp: 0.3±0.13 L vs. 0.18±0.1 L; RCa: 0.21±0.1 L vs. 0.12±0.1 L; AB: 0.25±0.1 L vs. 0.15±0.1 L; p<0.05 for all variables). Minute ventilation was significantly higher during PEP compared with breathing at rest in both groups (p<0.005). End-expiratory volume was also higher during PEP compared with breathing at rest for chest wall and pulmonary rib cage in both groups (p<0.05). Different PEP levels may increase chest wall volumes in CF patients

Comparison of different levels of positive expiratory pressure on chest wall volumes in healthy children and patients with fibrosis

La Presión Espiratoria Positiva (PEP) mejora la función pulmonar, mientras tanto, los cambios inducidos por la PEP no están totalmente establecidos. El objetivo del estudio fue evaluar los efectos agudos de distintas intensidades de PEP en los volúmenes de la pared torácica (PT) y patrón respiratorio en niños con Fibrosis Cística (FC). Datos antropométricos, función pulmonar y fuerza de la musculatura respiratoria. Los volúmenes de la PT fueron evaluados a través de la Pletismografía Optoelectrónica (POE) en reposo y durante el uso de distintas intensidades de PEP (10 y 20 cm H2O). Fueron reclutados 8 sujetos con FC (5H; 11,5 ± 3,2 años; 32 ± 9,5 kg) y 7 sujetos (4H; 10,7 ± 1,5 años; 38,2 ± 7,8 kg). Grupo FC mostró valores significativamente menores para FEF 25-75% (FC: 1,8 ± 0,8 vs. GC: 2,3 ± 0,6) y relación VEF1/CVF (FC: 0,8 ± 0,1 vs. GC: 1 ± 0,1) comparado al grupo control (p>;0,05). Distintas intensidades de PEP conllevaron a un incremento del volumen corriente de la PT y sus compartimentos en ambos los grupos, mientras tanto, este volumen incrementó de manera significativa en el grupo control cuando comparado al grupo FC durante PEP20 (CW: 0,77 ± 0,25 L vs. 0,44 ± 0,16 L; RCp: 0,3 ± 0,13 L vs. 0,18 ± 0,1 L; RCa: 0,21 ± 0,1 L vs. 0,12 ± 0,1 L; AB: 0,25 ± 0,1 L vs. 0,15 ± 0,1 L; p>;0,05 para todas las variables). La ventilación minuto incrementó de manera significativa durante la PEP en comparación a la respiración en reposo para ambos grupos (p>;0,005). El volumen espiratorio final también fue más grande durante la PEP en comparación a la respiración en reposo para PT y la caja torácica pulmonar en ambos los grupos (p>;0,05). Las distintas intensidades de PEP pueden inducir incrementos en los volúmenes de la pared torácica en pacientes con FC.Positive Expiratory Pressure (PEP) improves lung function, however, PEP-induced changes are not fully established. The aim of this study was to assess the acute effects of different PEP levels on chest wall volumes and the breathing pattern in children with Cystic Fibrosis (CF). Anthropometric data, lung function values, and respiratory muscle strength were collected. Chest wall volumes were assessed by Optoelectronic plethysmography at rest and during the use of different PEP levels (10 and 20 cm H2O), randomly chosen. Eight subjects with CF (5M, 11.5±3.2 years, 32±9.5 kilograms) and seven control subjects (4M, 10.7±1.5 years, 38.2±7.8 kilograms) were recruited. The CF group showed significantly lower FEF values 25-75% (CF: 1.8±0.8 vs. CG: 2.3±0.6) and FEV1/FVC ratio (CF: 0.8±0.1 vs. CG: 1±0.1) compared with the control group (pPressão Expiratória Positiva (PEwP) melhora a função pulmonar, entretanto, as mudanças induzidas pela PEP não estão totalmente estabelecidas. O objetivo do estudo foi avaliar os efeitos agudos de diferentes intensidades de PEP nos volumes da parede torácica (PT) e padrão respiratório em crianças com Fibrose Cística (FC). Dados antropométricos, função pulmonar e força da musculatura respiratória. Os volumes da PT foram avaliados através da Pletismografia Optoeletrônica (POE) em repouso e durante o uso de diferentes intensidades de PEP (10 e 20 cm H2O). Foram recrutados 8 sujeitos com FC (5H; 11,5 ± 3,2 anos; 32 ± 9,5 kg) e 7 sujeitos (4H; 10,7 ± 1,5 anos; 38,2 ± 7,8 kg). Grupo FC mostrou valores significativamente menores para FEF 25-75% (FC: 1,8 ± 0,8 vs. GC: 2,3 ± 0,6) e relação VEF1/CVF (FC: 0,8 ± 0,1 vs. GC: 1 ± 0,1) comparado ao grupo controle (p>;0,05). Diferentes intensidades de PEP levaram a um aumento do volume corrente da PT e seus compartimentos em ambos os grupos, entretanto, este volume aumentou de forma significativa no grupo controle quando comparado ao grupo FC durante PEP20 (CW: 0,77 ± 0,25 L vs. 0,44 ± 0,16 L; RCp: 0,3 ± 0,13 L vs. 0,18 ± 0,1 L; RCa: 0,21 ± 0,1 L vs. 0,12 ± 0,1 L; AB: 0,25 ± 0,1 L vs. 0,15 ± 0,1 L; p>;0,05 para todas as variáveis). A ventilação minuto aumentou de forma significativa durante a PEP em comparação a respiração em repouso para ambos os grupos (p>;0,005). Volume expiratório final também foi maior durante a PEP em comparação a respiração em repouso para PT e caixa torácica pulmonar em ambos os grupos (p>;0,05). Diferentes intensidades de PEP podem induzir aumentos nos volumes da parede torácica em pacientes com FC

Noninvasive assessment of respiratory muscle strength and activity in Myotonic dystrophy

To evaluate sensitivity/specificity of the maximum relaxation rate (MRR) of inspiratory muscles, amplitude of electromyographic activity of the sternocleidomastoid (SCM), scalene (SCA), parasternal (2ndIS) and rectus abdominis (RA) muscles; lung function and respiratory muscle strength in subjects with Myotonic dystrophy type 1 (DM1) compared with healthy subjects

Confiabilidade do teste da caminhada de seis minutos em pacientes com miastenia gravis generalizada

The purpose of this study was to assess the reliability of the six minutes walking test (6MWT) as a functional capacity test for patients with generalized myasthenia gravis (MG). Eleven patients with generalized MG (5 men, six women), aged 55±9 years, were first assessed as to pulmonary function and then submitted to three 6MWT in different days. Heart rate and oxygen saturation were measured (by means of portable oxymeter) during, and dyspnea (by the Borg scale) and distance walked were measured after, each test. At the three tests distances walked were 498 m, 517 m and 520 m (respectively 99%, 103%, and 104% of predicted values). Mean heart rate, oxygen saturation, and dyspnea values showed constant behaviour through the three tests. A high relative reliability was found between the tests, with interclass coefficient correlation over 0.90 (6MWT1-6MWT2, 0.960; 6MWT1-6MWT3, 0.945; and 6MWT2-6MWT3, 0.970); absolute reliability of 4%, 3.5% and 4.8%, as well as good repeatability of 11%, 9.8% and 13.4% were found for respectively the first, second, and third tests. Upper and lower agreement limits, as well as bias mean values by the Bland-Altman test show clinically acceptability. It may hence be said that the 6MWT proved safe, reliable and reproducible, and may be used for exercise tolerance assessment and follow up of patients with generalized myasthenia gravis.Este estudo objetivou determinar a confiabilidade do teste da caminhada de seis minutos (TC6M) como um teste de capacidade funcional em pacientes com miastenia gravis generalizada (MG). Foram selecionados 11 pacientes com MG - 5 homens, 6 mulheres - com idade de 55±9 anos, avaliados inicialmente quanto à função fulmonar, que se submeteram a três TC6M em dias diferentes. Durante e/ou após cada teste foram medidas freqüência cardíaca e saturação de oxigênio (por oxímetro portátil), sensação de dispnéia (pela escala de Borg) e distância percorrida. Nos três testes as distâncias percorridas foram 498 m, 517 m e 520 m (respectivamente 99%, 103% e 104% do valor predito). Em média, a freqüência cardíaca, dispnéia e saturação de oxigênio mostraram comportamento constante nos três testes. Foram encontradas alta confiabilidade relativa, com coeficiente de correlação interclasse maior que 0,90 entre os testes (TC6M1-TC6M2, 0,960; TC6M1-TC6M3, 0,945; e TC6M2-TC6M3, 0,970) e confiabilidade absoluta de 4%, 3,5% e 4,8%, com reprodutibilidade de 11%, 9,8% e 13,4%, respectivamente para o primeiro, segundo e terceiro testes. Os limites superiores e inferiores de concordância e o valor médio das médias das diferenças (bias) calculados pelo teste de Bland-Altman mostraram-se clinicamente aceitáveis. Conclui-se que o TC6M se mostrou seguro, confiável e reprodutível, podendo ser aplicado para avaliação e seguimento da tolerância ao exercício em pacientes com MG generalizada

Acute effects of three pulmonary reexpansion modalities on thoracoabdominal motion of healthy subjects: Randomized crossover study

Background Chest physiotherapy can be an alternative to increase lung volumes through pulmonary expansion therapies, but there is still inconsistency in the literature in order to determine which device can promote a greater volume increase at the expense of a better ventilatory pattern. Therefore, the aim of this study was to evaluate and compare the chest wall kinematics of healthy subjects submitted to the use of three different devices for pulmonary reexpansion. Methods Chest wall compartmental and operational volumes, breathing pattern and thoracoabdominal asynchrony were evaluated in 12 healthy individuals through optoelectronic plethysmography during quiet breathing, pulmonary reexpansion and recovery. Three different devices (volume-oriented incentive spirometer–IS-v; positive expiratory pressure–PEP; and incentive spirometer volume and pressure oriented–IS-vp) were administered in a random order with at least 48h between the devices. Results A greater volume variation in the chest wall and its compartments was observed when the IS-vp was used in comparison with the other devices (p<0.05). Furthermore, the IS-vp mobilizes a greater amount of volume accompanied by greater synchronism between the compartments when compared to IS-v (p <0.05). Conclusion The IS-vp may be able to increase total and compartmental chest wall volumes, as well as improve synchrony among compartments when compared to IS-v and PEP devices, thus constituting an important tool for treating patients with restrictive ventilatory pattern

Agricultural fertilizers applied as nutrient solution in Cattleya labiata Lindl

Fertilization through nutrient solution is commonly used in commercial production of potted flowers, being employed soluble NPK formulations. However, most commercial formulations available in the market have high costs and the use of agricultural fertilizers can be an economically viable alternative. The objective of this study was to evaluate the effectiveness of agricultural fertilizers applied as nutrient solutions, in replacement of commercial formulations, on initial growth of Cattleya labiata. C. labiata seedlings in vitro propagated were grown in a greenhouse with controlled temperature, 27 ± 2° C, and retaining 50% brightness. Polypropylene pots were used with 0.415 L capacity, containing a mixture of pine bark and charcoal (1:1, v:v) as substrate. Altogether were used 4 treatments: without fertilization (control); Peters® - NPK 20 20 20 (3.0 g L -1 ); NPK - urea (1.3 g L -1 ), superphosphate (3.3 g L -1 ) and potassium chloride (1.0 g L -1 ); NK - urea (1.3 g L -1 ) and potassium chloride (1.0 g L -1 ). The nutrient solutions were applied 50 ml per pot every two weeks, according to the treatments. Were evaluated phytometric characteristics, pH and electrical conductivity of the substrate beyond the levels and accumulation of macronutrients. The experimental design was completely randomized with 12 replications, being considered each pot with two plants as an experimental unit. The parameters were submitted to ANOVA and Tukey’s test at 5% probability. Regarding phytometric parameters no significant differences were observed between the treatments that received fertilization, which are superior to the control in height and dry mass of shoots. The more accumulated nutrients were K>Ca>N, in the treatments that received fertilization. The use of urea, superphosphate and potassium chloride, applied in nutrient solution, have potential to replace the commercial formulations in the initial growth of native orchid Cattleya labiata

Air Stacking: A Detailed Look Into Physiological Acute Effects on Cough Peak Flow and Chest Wall Volumes of Healthy Subjects

Air stacking (AS) is a lung insufflation method that requires the use of a manual insufflator to provide air volumes higher than inspiratory capacity. Neuromuscular patients benefit the most from the maneuver; however, the acute effects of AS in healthy subjects are still unclear

Non-invasive assessment of fatigue and recovery of inspiratory rib cage muscles during endurance test in healthy individuals

Introduction Fatigue is defined as loss of capacity to develop muscle force and/or velocity that is reversible at rest. We assessed non-invasively the fatigue and recovery of inspiratory rib cage muscles during two respiratory endurance tests in healthy individuals. Methods The sniff nasal inspiratory pressure (SNIP) was assessed before and after two respiratory endurance tests: normocapnic hyperpnea (NH) and inspiratory pressure threshold loading (IPTL). Contractile (maximum rate of pressure development and time to peak pressure) and relaxation parameters (maximum relaxation rate [MRR], time constant of pressure decay [τ], and half relaxation time) obtained from sniff curves and shortening velocity and mechanical power estimated using optoelectronic plethysmography were analyzed during SNIP maneuvers. Respiratory muscle activity (electromyography) and tissue oxygenation (near-infrared spectroscopy—NIRS) were obtained during endurance tests and SNIP maneuvers. Fatigue development of inspiratory rib cage muscles was assessed according to the slope of decay of median frequency. Results Peak pressure during SNIP decreased after both protocols (p Conclusion Fatigue development behaved differently between protocols and relaxation properties (MRR and τ), shortening velocity, and mechanical power changed only in the IPTL