Antônio Adolfo Mattos de Castro

Daily activities are sufficient to induce dynamic pulmonary hyperinflation and dyspnea in chronic obstructive pulmonary disease patients.

OBJECTIVE: The aim of this study was to measure dynamic lung hyperinflation and its influence on dyspnea perception in moderate and severe chronic obstructive pulmonary disease patients after performing activities of daily living. METHODS: We measured inspiratory capacity, sensation of dyspnea, peripheral oxygen saturation, heart rate and respiratory rate in 19 chronic obstructive pulmonary disease patients. These measurements were taken at rest and after performing activities of daily living (e.g., going up and down a set of stairs, going up and down a ramp and sweeping and mopping a room). RESULT: The inspiratory capacity of patients at rest was significantly decreased compared to the capacity of patients after performing activities. The change in inspiratory capacity was -0.67 L after going up and down a ramp, -0.46 L after sweeping and mopping a room, and -0.55 L after climbing up and down a set of stairs. Dyspnea perception increased significantly between rest, sweeping and mopping, and going up and down a set of stairs. Dyspnea perception correlated positively with inspiratory capacity variation (r = 0.85) and respiratory rate (r = 0.37) and negatively with peripheral oxygen saturation (r = -0.28). CONCLUSION: Chronic obstructive pulmonary disease patients exhibited reductions in inspiratory capacity and increases in dyspnea perception during commonly performed activities of daily living, which may limit physical performance in these patients.

Modulation of operational lung volumes with the use of salbutamol in COPD patients accomplishing upper limbs exercise tests

INTRODUCTION Pulmonary dynamic hyperinflation (DH) is an important factor limiting the physical capacity of patients with COPD. Inhaled bronchodilator should be able to reduce DH. OBJECTIVE To measure DH in COPD patients during upper limbs exercise tests with previous use of bronchodilator or placebo, and to evaluate the respiratory pattern to justify the dynamics of hyperinflation. METHODS Inspiratory capacity (IC) of 16 patients with COPD (age: 63+/- 13 years; FEV(1) of 1.5+/-0.7 L-41+/-11% predicted) was measured before and after an incremental arm exercise test (diagonal technique) with randomly and double-blinded inhaled placebo or salbutamol. RESULTS Rest IC increased from 2.32+/-0.44 L to 2.54+/-0.39 L after inhalation of 400 mcg of salbutamol (p=0.0012). There was a decrease in the IC after a maximal incremental arm exercise test, 222+/-158 ml (p=0.001) with placebo use, but no change was seen after the salbutamol use: 104+/-205 ml (p=0.41); 62% of the patients presented a 10% or more reduction in the IC after the exercise with placebo. There was a correlation between DH and lower FEV(1)/FVC (p=0.0067), FEV(1) predicted (p=0.0091) and IC% predicted (p=0.043) and higher VO(2)ml/Kg/min % predicted (p=0.05). Minute ventilation and respiratory rate were higher during the exercise with placebo (p=0.002) whereas VE/MVV ratio was lower in the exercise after salbutamol (p>0.05). CONCLUSION We conclude that the use of bronchodilator increases the IC of patient with COPD and may help not to increase the DH during a maximal exercise with the arms.

Oxygen and Ventilatory Output during Several Activities of Daily Living Performed by COPD Patients Stratified According to Disease Severity

Objectives To measure the oxygen and ventilatory output across all COPD stages performing 18 common ADL and identify the activities that present the highest metabolic and ventilatory output as well as to compare the energy expenditure within each disease severity. Materials and Methods Metabolic (VO2 and VCO2), ventilatory (f and VE), cardiovascular (HR) and dyspnea (Borg score) variables were assessed in one hundred COPD patients during the completion of eighteen ADL grouped into four activities domains: rest, personal care, labor activities and efforts. Results The activities with the highest proportional metabolic and ventilatory output (VO2/VO2max and VE/MVV) were walking with 2.5 Kg in each hand and walking with 5.0 Kg in one hand. Very severe patients presented the highest metabolic, ventilatory output and dyspnea than mild patients (p<0.05). Conclusions COPD patients present an increased proportion of energy expenditure while performing activities of daily living. The activities that developed the highest metabolic and ventilatory output are the ones associated to upper and lower limbs movements combined. Very severe patients present the highest proportional estimated metabolic and ventilatory output and dyspnea. Activities of daily living are mainly limited by COPD’s reduced ventilatory reserve.

Asincronía e hiperinsuflación en pacientes con enfermedad pulmonar obstructiva crónica durante 2 tipos de ejercicio de las extremidades superiores

INTRODUCTION Occurrence of dynamic hyperinflation during upper-limbs exercises in chronic obstructive pulmonary disease (COPD) patients it is not well established. We hypothesized that dynamic hyperinflation and thoracoabdominal asynchrony occurs in COPD patients accomplishing arms exercises. We assessed the occurrence and association of dynamic hyperinflation and thoracoabdominal asynchrony in COPD patients during the accomplishment of two arm exercises. PATIENTS AND METHODS This was a prospective study with 25 COPD patients. A maximal and a sub-maximal upper limbs exercise test with 50% load were performed with the diagonal technique and the arm cycle ergometer technique. Respiratory pattern, thoracoabdominal configuration and dynamic hyperinflation were assessed in the exercise tests. RESULTS Thirty per cent and 60% of patients hyperinflated at the end of the sub-maximum exercise tests with the diagonal and cycle ergometer techniques, respectively. Thoracoabdominal asynchrony occurred in 80% and 100% of patients who hyperinflated with the diagonal and cycle ergometer techniques, respectively. For both exercises we found enhancement of pulmonary ventilation, dyspnea, central respiratory drive and shortening of expiratory time (P<.05). Upper-limbs exercises with the diagonal technique presented less number of patients with these alterations. CONCLUSIONS Dynamic pulmonary hyperinflation and thoracoabdominal asynchrony association occurred in both upper-limbs exercises; however, the diagonal technique developed less dynamic hyperinflation and thoracoabdominal asynchrony in COPD patients than the arm cycle ergometer.

Comparação entre as técnicas de vibrocompressão e de aumento do fluxo expiratório em pacientes traqueostomizados

Chest physical therapy plays a key role in respiratory complications due to bronchial hypersecretion. Techniques such as thoracic vibrocompression and expiratory flow enhancement (EFE) are some of the ones used to assure airway clearance. This study aimed at assessing the effects of EFE and vibrocompression on airway-secretion removal and its repercussions on hemodynamic and respiratory parameters of tracheostomised patients. Twenty patients of both sexes aged 18 to 73 with diagnosed pulmonary hypersecretion and/or mucus retention were assessed as to hemodynamic and respiratory parameters before and after application of these techniques. After vibrocompression a significant decrease (p<0.05) was noticed in diastolic and mean blood pressure (BP), respectively from 82.2±13.4 to 77.4±13.3 mmHg and from 104.3±18.2 to 90.9±9.07 mmHg; also, mean BP decreased from 103.5±13.2 to 94.1±9.0 mmHg (p<0.05) with the use of EFE. No difference could be found (p=0.60) between the airway-secretion amounts obtained after both techniques. Tracheostomised patients hence presented BP reduction after the application of both vibrocompression and EFE techniques, but the use of either technique made no difference as to the amount of removed secretion.A fisioterapia respiratoria tem papel fundamental nos casos de complicacoes pelo excesso de secrecao broncopulmonar. Manobras de remocao de secrecao bronquica como a vibrocompressao e o aumento do fluxo expiratorio (AFE) garantem a perviabilidade das vias aereas. O objetivo deste trabalho foi avaliar o efeito das manobras de AFE e vibrocompressao para remocao de secrecao e suas repercussoes hemodinâmicas e ventilatorias em pacientes traqueostomizados. Participaram 20 pacientes (com 18 a 73 anos) de ambos os sexos com diagnostico fisioterapeutico de hipersecrecao e/ou retencao de muco bronquico, submetidos a aplicacao dessas tecnicas e a remocao de secrecao, que foram avaliados antes e depois da intervencao quanto a parâmetros hemodinâmicos e respiratorios. Com a aplicacao da tecnica de vibrocompressao foi verificada queda significativa (p<0,05) nas pressoes arteriais (PA) diastolica e media de 82,2±13,4 para 77,4±13,3 mmHg e de 104,3±18,2 para 90,9±9,07 mmHg, respectivamente; o mesmo ocorreu com a PA media (p<0,05) apos a aplicacao da tecnica de AFE, de 103,5±13,2 para 94,1±9,0 mmHg. Nao houve diferenca entre as tecnicas aplicadas quanto ao volume de secrecao removida (p=0,60). Pacientes traqueostomizados apresentaram pois reducao da pressao arterial apos 30 minutos da aplicacao das tecnicas fisioterapeuticas, mas nao houve diferenca entre as tecnicas utilizadas quanto ao volume de secrecao removida.

Evaluación de la musculatura respiratoria en la predicción del resultado de la extubación de pacientes con ictus

BACKGROUND Patients with cerebral infarction often present impaired consciousness and unsatisfactory extubation. We aimed to assess the respiratory mechanics components that might be associated with the success of extubation in stroke patients. METHODS Twenty consecutive patients with stroke who needed mechanical ventilation support were enrolled. The maximal inspiratory pressure, gastric and the esophageal pressure (Pdi/Pdimax), minute volume, respiratory rate, static compliance, airway resistance, rapid and superficial respiration index (RSRI), inspiratory time/total respiratory cycle (Ti/Ttot), and PaO(2)/FiO(2) were measured. RESULTS The group who presented success to the extubation process presented 12.5±2.2=days in mechanical ventilation and the group who failed presented 13.1±2=days. The mean Ti/Ttot and Pdi/Pdimax for the failure group was 0.4±0.08 (0.36-0.44) and 0.5±0.7 (0.43-0.56), respectively. The Ti/Ttot ratio was 0.37±0.05 (0.34-0.41; p=0.0008) and the Pdi/Pdimax was 0.25±0.05 for the success group (0.21-0.28; p<0.0001). A correlation was found between Pdi/Pdimax ratio and the RSRI (r=0.55; p=0.009) and PaO(2)/FiO(2) (r=-0.59; p=0.005). Patients who presented a high RSRI (OR, 3.66; p=0.004) and Pdi (OR, 7.3; p=0.002), and low PaO(2)/FIO(2) (OR, 4.09; p=0.007), Pdi/Pdimax (OR, 4.12; p=0.002) and RAW (OR, 3.0; p=0.02) developed mechanical ventilation extubation failure. CONCLUSION Muscular fatigue index is an important predicting variable to the extubation process in prolonged mechanical ventilation of stroke patients.