Pulmonary hypertension and pulmonary disorders in cystic fibrosis

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Association of pulmonary function and functional capacity with invasive mechanical ventilation time after coronary artery bypass grafting

Introdução: A cirurgia de revascularização do miocárdio (CRM) é realizada para diminuir os sintomas característicos da doença arterial coronariana (DAC) e após esse procedimento os pacientes necessitam de ventilação mecânica invasiva (VMI). Um tempo prolongado de VMI resulta no aumento de complicações pulmonares, mortalidade e prolonga o tempo de internação hospitalar. Objetivo: Verificar a associação entre a função pulmonar e a capacidade funcional pré-operatória com o tempo de VMI após CRM. Casuística e Métodos: Estudo de coorte prospectivo realizado entre 2011 e 2015 com inclusão de 40 indivíduos. Foram avaliadas a capacidade funcional e função pulmonar no pré-operatório da CRM, além do tempo de VMI no momento após o procedimento cirúrgico. Resultados: As variáveis da função pulmonar apresentaram correlação inversa com o tempo de VMI pós CRM, capacidade vital forçada (CVF) (r = -0,51; p = 0,001); o volume expiratório forçado no 1º segundo (VEF1) (r = -0,49; p = 0,001), o pico de fluxo expiratório (PFE) (r = -0,42; p = 0,008) e a capacidade vital inspiratória (CVin) (r = -0,51; p = 0,001). A mesma correlação não foi observada entre a capacidade funcional (r = -0,22; p = 0,166) e o tempo de VMI pós CRM. Conclusão: Os pacientes que apresentaram melhor função pulmonar no pré-operatório de CRM, necessitaram um menor tempo de VMI após essa cirurgia. O mesmo não foi observado em relação a capacidade funcional.Introduction: The coronary artery bypass grafting (CABG) is widely utilized to decrease the symptoms of coronary artery disease. After this surgery the patients will need mechanical ventilation. Prolonged mechanical ventilation results in higher rates of pulmonary complications and mortality, as well as higher hospital length of stay. Objective: To evaluate the association between pulmonary function, functional capacity, and the duration of invasive mechanical ventilation after CABG. Patients and Methods: The prospective cohort study was carried out during 2011 and 2015. In total, 40 patients undergoing CABG were evaluated for preoperative pulmonary function and functional capacity. Results: Preoperative pulmonary function was found to be inversely proportional to duration of invasive mechanical ventilation after CABG, forced vital capacity (FVC) (r = -0,5; p = 0,001), forced expiratory volume in 1 second (FEV1) (r = -0,49; p = 0,001), peak expiratory flow (PEF) (r = -0,42; p = 0,008), inspiratory vital capacity (IVC) (r = -0,51; p = 0,001). However, there was no correlation between functional capacity (r = -0,22; p = 0,166) and duration of invasive mechanical ventilation after CABG. Conclusion: The patients whose pulmonary function were significantly higher remained less time under ventilation than the patients with poorer pulmonary function. However, there was no relation between functional capacity and duration of invasive mechanical ventilation in these patients

Repeatability of the 6-min walk test in non-cystic fibrosis bronchiectasis

Non-cystic fbrosis bronchiectasis (NCFB) is a chronic lung disease characterized by progressive and irreversible changes of the bronchial tree. The evaluation of exercise capacity is essential to manage this disease. This study aims to determine the within-subject repeatability of two Six Minute Walk Test (6MWT) in adults with NCFB. NCFB. This cross-sectional observational study included 66 NCFB subjects above 18 years-old (mean of 55 ± 17 years old, 68% women). 73% of the participants presented moderate to severe clinical condition classifed by Bronchiectasis Severity Index. It showed that these participants walked 16.6 m less (95%CI 3.8 to 29.4; p< 0.01) in the second 6MWT when compared to the frst test, with a within-subject coefcient variation of 9.4% (95%CI 7.2–11.2%) and an intra-test reliability with a high intraclass correlation coefcient of 0.88 (95%CI 0.80–0.93). Bland–Altman plot showed an agreement regarding test repeatability, besides presented a large limit of agreement (− 85 to 116 m). Respiratory rate and systolic blood pressure were signifcantly higher before starting the second test. In conclusion, 6MWT seems to be reproducible in NCFB subjects and vital sign verifcation should be attentively checked to assess if the patient is fully recovered to perform a second test, as well as the disease severity score. Other studies on this matter should be conducted with a larger number of participants to confrm the fndings of the present study