Camila Isabel Santos Schivinski

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

BACKGROUNDnThere 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.nnnOBJECTIVEnTo 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.nnnMETHODnnnnSEARCH STRATEGYnWe searched the Physiotherapy Evidence Database PEDro, Scientific Electronic Library Online SciELO, MEDLINE, and Cochrane Central Register of Controlled Trials.nnnSELECTION CRITERIAnWe 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.nnnDATA COLLECTION AND ANALYSISnThe 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.nnnRESULTSnSix 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.nnnCONCLUSIONnBreathing 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.

Cirurgia cardíaca pediátrica: o que esperar da intervenção fisioterapêutica?

This study aims to gather and present scientific evidence on the role of a physiotherapist in the pre, peri and postoperative of pediatric cardiac surgery. This professional is able to prevent, minimize or reverse possible respiratory dysfunction and motor sequelae resulting from these interventions. Studies discuss the involvement of respiratory system, specifically the clearance of bronchial secretions and ventilatory adequacy, as a result of surgical procedure. Scientific evidences suggest the effectiveness of physiotherapy in reducing indices of: pneumonia, atelectasis, hospitalization, sequelae deleterious and length of bed restriction, beyond clinical improvement. These data confirm positive contribution of physiotherapeutic intervention in these surgeries.This study aims to gather and present scientific evidence on the role of a physiotherapist in the pre, peri and postoperative of pediatric cardiac surgery. This professional is able to prevent, minimize or reverse possible respiratory dysfunction and motor sequelae resulting from these interventions. Studies discuss the involvement of respiratory system, specifically the clearance of bronchial secretions and ventilatory adequacy, as a result of surgical procedure. Scientific evidences suggest the effectiveness of physiotherapy in reducing indices of: pneumonia, atelectasis, hospitalization, sequelae deleterious and length of bed restriction, beyond clinical improvement. These data confirm positive contribution of physiotherapeutic intervention in these surgeries.

Influência da alteração postural da coluna torácica em parâmetros cardiorrespiratórios de crianças e adolescentes com fibrose cística

OBJECTIVES: To assess the impact of increased thoracic kyphosis on pulmonary function and functional capacity in children and adolescents with cystic fibrosis (CF) and to verify the influence of disease severity, age and nutritional status on this deformity. METHOD: This was a cross-sectional, analytical study conducted at a university hospital. It included CF patients with confirmed diagnosis and without pulmonary exacerbation. The sample was submitted to postural assessment, spirometry (FEV1, FVC and FEV1/FVC) and 6-minute walk test distance (6-MWT distance). Data were analyzed using the Mann Whitney test, Spearman correlation and logistic regression. RESULTS: Forty-two patients were enrolled, 61.9% presented increase of thoracic kyphosis. There was no difference in values of FEV1, FVC, FEV1/FVC and 6-MWT distance between the groups with or without thoracic kyphosis (p = 0.407; p = 0.756; p = 0.415; p = 0.294). In the group without alteration, patients with more disease severity had a mean FEV1 of 74.1±21.9% and FVC of 79.8±18.7% while in those of lesser severity higher values were found (95.6±12.2% and 97.6±13.2%, respectively) (p = 0.027 and p = 0.027). The presence of kyphosis was correlated with age (p = 0.048) but not with severity (p = 0.151) and body mass index (p = 0.088). CONCLUSIONS: There was a high prevalence of increased thoracic kyphosis in children and adolescents with CF. The deformity did not affect pulmonary function and functional capacity and there was no relationship with disease severity. Regardless of posture, worsening of disease severity determined worsening of pulmonary function.OBJECTIVESnTo assess the impact of increased thoracic kyphosis on pulmonary function and functional capacity in children and adolescents with cystic fibrosis (CF) and to verify the influence of disease severity, age and nutritional status on this deformity.nnnMETHODnThis was a cross-sectional, analytical study conducted at a university hospital. It included CF patients with confirmed diagnosis and without pulmonary exacerbation. The sample was submitted to postural assessment, spirometry (FEV1, FVC and FEV1/FVC) and 6-minute walk test distance (6-MWT distance). Data were analyzed using the Mann Whitney test, Spearman correlation and logistic regression.nnnRESULTSnForty-two patients were enrolled, 61.9% presented increase of thoracic kyphosis. There was no difference in values of FEV1, FVC, FEV1/FVC and 6-MWT distance between the groups with or without thoracic kyphosis (p = 0.407; p = 0.756; p = 0.415; p = 0.294). In the group without alteration, patients with more disease severity had a mean FEV1 of 74.1±21.9% and FVC of 79.8±18.7% while in those of lesser severity higher values were found (95.6±12.2% and 97.6±13.2%, respectively) (p = 0.027 and p = 0.027). The presence of kyphosis was correlated with age (p = 0.048) but not with severity (p = 0.151) and body mass index (p = 0.088).nnnCONCLUSIONSnThere was a high prevalence of increased thoracic kyphosis in children and adolescents with CF. The deformity did not affect pulmonary function and functional capacity and there was no relationship with disease severity. Regardless of posture, worsening of disease severity determined worsening of pulmonary function.

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.

Teste de caminhada de seis minutos em pediatria: relação entre desempenho e parâmetros antropométricos

Abstract Introduction : Anthropometric differences may influence the performance in the 6-minute walk test. Objective : To analyze publications concerning the 6MWT performed in children and adolescents and to identify the in fluence of anthropometric parameters on test performance. Materials and methods : research in the electronic databases Medline and Scielo using to the keywords: six-minute walk test, children, adolescents, anthropometric measures/ variables, growth and exercise tolerance, in the search of studies involving 6MWT in children and adolescents, that present correlation between anthropometric data and test variables. It was identified 45 studies related to the search and after examination of the titles, abstracts and full articles, it were included 13 compatible studies with the proposed theme. Results : the selected material approach the 6MWT and your application in different situa-tions: analysis of reproducibility, correlation with maximal cardiopulmonary exercise testing, indications in dif-ferents diseases, reference values in healthy, effect parameter of prevention/rehabilitation program. Many studies relate the covered distance in 6MWT with age and sex, as well as with anthropometric variables, showing frequent correlation with height, beyond the age, weight and body mass index. Other data such as length and strength of lower limbs, percentage of fat mass/lean and respiratory muscle strength, related to changes in the period of ju-venile development, also seem to influence the test performance.

Assessment of respiratory muscle strength in children according to the classification of body mass index

OBJECTIVE: To assess and compare the respiratory muscle strength among eutrophic, overweight and obese school children, as well as to identify anthropometric and respiratory variables related to the results. METHODS: Cross-sectional survey with healthy schoolchildren aged 7-9 years old, divided into three groups: Normal weight, Overweight and Obese. The International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was applied. The body mass index (BMI) was evaluated, as well as the forced expiratory volume in one second (FEV1) with a portable digital device. The maximal inspiratory and expiratory pressures (MIP and MEP) were measured by a digital manometer. Comparisons between the groups were made by Kruskal-Wallis test. Spearmans correlation coefficient was used to analyze the correlations among the variables. RESULTS: MIP of eutrophic school children was higher than MIP found in overweight (p=0.043) and obese (p=0.013) children. MIP was correlated with BMI percentile and weight classification (r=-0.214 and r=-0.256) and MEP was correlated with height (r=0.328). Both pressures showed strong correlation with each other in all analyses (r≥0.773), and less correlation with FEV1 (MIP - r=0.362 and MEP - r=0.494). FEV1 correlated with MEP in all groups (r: 0.429 - 0.569) and with MIP in Obese Group (r=0.565). Age was correlated with FEV1 (r=0.578), MIP (r=0.281) and MEP (r=0.328). CONCLUSIONS: Overweight and obese children showed lower MIP values, compared to eutrophic ones. The findings point to the influence of anthropometric variables on respiratory muscle strength in children.OBJETIVO: Avaliar e comparar a forca muscular respiratoria de escolares eutroficos, com sobrepeso e obesos, bem como identificar variaveis antropometricas e respiratorias que se relacionem com os resultados.METODOS: Estudo transversal com escolares higidos de sete a nove anos, divididos em tres grupos: Eutroficos, Sobrepeso e Obesos. Aplicou-se o questionario do International Study of Asthma and Allergies in Childhood(ISAAC) e avaliaram-se o indice de massa corporea (IMC), o volume expiratorio forcado no primeiro segundo (VEF1), por meio de um leitor digital portatil, e as pressoes inspiratorias e expiratorias maximas (PIMax e PEMax), medidas por manovacuometria digital. Compararam-se os grupos pelo teste de Kruskal-Wallis. Aplicou-se o coeficiente de correlacao de Spearman para analisar correlacoes entre as variaveis.RESULTADOS: A PIMax de escolares eutroficos foi maior que a dos portadores de sobrepeso (p=0,043) e a dos obesos (p=0,013). A PIMax correlacionou-se com o percentil e a classificacao do IMC (r=-0,214 e r=-0,256) e a PEMax, com a estatura (r=0,328). Ambas as pressoes mostraram forte correlacao entre si em todas as analises (r≥0,773) e fraca correlacao com VEF1(PIMax - r=0,362 e PEMax - r=0,494). O VEF1 correlacionou-se com a PEMax nos tres grupos (r=0,429-0,569) e com a PIMax no Grupo Obeso (r=0,565). A idade apresentou relacao com as variaveis VEF1 (r=0,578), PIMax (r=0,281) e PEMax (r=0,328).CONCLUSOES: Escolares obesos e com sobrepeso apresentaram valores inferiores de PIMax em comparacao aos eutroficos. Os achados apontam para a influencia de variaveis antropometricas na forca muscular respiratoria em criancas.

Profile of children undergoing congenital heart surgery and analysis of their respiratory complications

OBJETIVO: Describir las caracteristicas demograficas y clinicas de ninos sometidos a la cirugia de correccion de cardiopatia congenita (CC) en un hospital universitario, comparando pacientes con y sin complicaciones respiratorias en el post-operatorio. METODOS: Estudio retrospectivo, realizado por medio de consulta de prontuarios de ninos sometidos a la cirugia correctiva de CC, en el Hospital de Clinicas de la Universidad Estadual de Campinas (Unicamp), en el periodo de noviembre de 2006 a septiembre de 2007. Se analizaron datos relativos a la edad, sexo, peso, comorbidades y tipo de CC de los ninos incluidos en el estudio, comparando pacientes con y sin complicaciones respiratorias en el post-operatorio. Se utilizaron el test de Mann-Whitney y el exacto de Fisher, considerandose significante p<0,05. RESULTADOS: Se analizaron 55 (95%) prontuarios disponibles de ninos sometidos a la cirugia cardiaca con mediana de edad de 37,5 meses, siendo el 49% muchachos. Presencia de tres o mas CC fue verificada en el 29,1% de los pacientes y el 53% de los casos presentaban comorbidades. Respecto a las complicaciones respiratorias en el post-operatorio, el 31% de los pacientes evolucionaron con atelectasia/derrame pleural y el 5,5% laringitis/pneumomediastino/lesion pulmonar. Otros tipos de complicaciones fueron identificadas en el 24% de los pacientes. La sobrevida fue del 89% y ninos con complicaciones respiratorias en el post-operatorio fueron sometidos a mayor tiempo de ventilacion mecanica y permanencia hospitalaria (p<0,001). CONCLUSIONES: El conocimiento de la relacion entre complicaciones respiratorias y mayor tiempo de ventilacion mecanica y hospitalizacion refuerzan la necesidad de prevenir tales complicaciones para reduccion de los costos hospitalarios.

Perfil das crianças submetidas à correção de cardiopatia congênita e análise das complicações respiratórias

OBJETIVO: Describir las caracteristicas demograficas y clinicas de ninos sometidos a la cirugia de correccion de cardiopatia congenita (CC) en un hospital universitario, comparando pacientes con y sin complicaciones respiratorias en el post-operatorio. METODOS: Estudio retrospectivo, realizado por medio de consulta de prontuarios de ninos sometidos a la cirugia correctiva de CC, en el Hospital de Clinicas de la Universidad Estadual de Campinas (Unicamp), en el periodo de noviembre de 2006 a septiembre de 2007. Se analizaron datos relativos a la edad, sexo, peso, comorbidades y tipo de CC de los ninos incluidos en el estudio, comparando pacientes con y sin complicaciones respiratorias en el post-operatorio. Se utilizaron el test de Mann-Whitney y el exacto de Fisher, considerandose significante p<0,05. RESULTADOS: Se analizaron 55 (95%) prontuarios disponibles de ninos sometidos a la cirugia cardiaca con mediana de edad de 37,5 meses, siendo el 49% muchachos. Presencia de tres o mas CC fue verificada en el 29,1% de los pacientes y el 53% de los casos presentaban comorbidades. Respecto a las complicaciones respiratorias en el post-operatorio, el 31% de los pacientes evolucionaron con atelectasia/derrame pleural y el 5,5% laringitis/pneumomediastino/lesion pulmonar. Otros tipos de complicaciones fueron identificadas en el 24% de los pacientes. La sobrevida fue del 89% y ninos con complicaciones respiratorias en el post-operatorio fueron sometidos a mayor tiempo de ventilacion mecanica y permanencia hospitalaria (p<0,001). CONCLUSIONES: El conocimiento de la relacion entre complicaciones respiratorias y mayor tiempo de ventilacion mecanica y hospitalizacion refuerzan la necesidad de prevenir tales complicaciones para reduccion de los costos hospitalarios.

Impulse oscillometry, spirometry, and passive smoking in healthy children and adolescents

OBJECTIVEnTo identify changes in the forced and quiet breathing parameters of lung function in healthy children and adolescents exposed to passive smoking (PS).nnnMETHODnComparative cross-sectional study. Healthy schoolchildren aged 6 to 14 years. We collected anthropometric data, lung function parameters using spirometry (forced breathing), and quiet breathing parameters using impulse oscillometry. The sample was divided into two groups according to exposure to PS: passive smoking group (PSG) and non-passive smoking group (NPSG). For the statistical analysis, the Shapiro-Wilk test was used to verify data normality and the T-test or Mann-Whitney test to compare spirometric and oscillometric parameters between groups (p≤0.05).nnnMAIN FINDINGSnThe study included 78 children and adolescents, with 14 boys and 25 girls in each group. There were differences in the mean values for peak expiratory flow (p=0.01). There were no significant differences between the groups in values for z-score and lower limit of normal. The PSG had higher mean absolute values for reactance area (X5=0.05) and significant percentage of predicted values for the following impulse oscillometry parameters: central airway resistance (R20%, p=0.03) and for the indicators of presence of airway obstruction (Fres%, p=0.01; X5%=0.01% and AX%, p=0.01).nnnCONCLUSIONnChildren and adolescents exposed to PS had lower values for the spirometric variables and higher values for the oscillometric variables, indicating changes in forced and quiet parameters of lung function compared to the NPSG.

Manual vibrocompression and nasotracheal suctioning in post-operative period of infants with heart deffects

OBJETIVO: Verificar a repercussao da vibrocompressao manual e da aspiracao nasotraqueal sobre os parâmetros cardiorrespiratorios de frequencia cardiaca (fc) e respiratoria (fr), saturacao periferica de oxigenio (SpO2), dor e desconforto respiratorio, em lactentes no pos-operatorio de cirurgias cardiacas. METODOS: Estudo controlado e randomizado, com as avaliacoes realizadas pela mesma fisioterapeuta, em dois momentos: antes e apos o procedimento. Dividiu-se o total de lactentes, por sorteio simples, em dois grupos: Intervencao (GI), com vibrocompressao manual toracica, aspiracao nasotraqueal e repouso; e Controle (GC), com 30 minutos de repouso. Avaliaram-se os dados cardiorrespiratorios (SpO2; fc; fr), aplicando-se as escalas: Neonatal Infant Pain Scale (NIPS), para analisar a dor, e Boletim de Silvermann-Andersen (BSA), para verificar o desconforto respiratorio. Os dados foram tratados por meio de analise de variância (ANOVA) para medidas repetidas, sendo significante p<0,05. RESULTADOS: Avaliaram-se 20 lactentes cardiopatas, dez em cada grupo (sete acianoticos e tres cianoticos), com idades de zero a 12 meses. Para analisar a interacao entre o grupo e o tempo, observou-se diferenca significativa na variacao da SpO2 (p=0,016), sem alteracao nas demais variaveis. Ja o comportamento dos parâmetros nos tempos apresentou diferenca significativa apenas na variacao da fr (p=0,001). Quanto a avaliacao do efeito no grupo, nao houve diferenca estatistica em nenhum dos dados (SpO2 - p=0,77; fc - p=0,14; fr - p=0,17; NIPS - p=0,49 e BSA - p=0,51). CONCLUSOES: A vibrocompressao manual e a aspiracao nasotraqueal aplicadas em lactentes no pos-operatorio de cirurgias cardiacas nao prejudicaram a SpO2 e a fr, alem de nao desencadearem dor e desconforto respiratorio. [Registro Brasileiro de Ensaios Clinicos (ReBEC): REQ: 1467].OBJECTIVE: To evaluate the impact of manual vibrocompression and nasotracheal suctioning on heart (hr) and respiratory (rr) rates, peripheral oxygen saturation (SpO2), pain and respiratory distress in infants in the postoperative period of a cardiac surgery. METHODS: Randomized controlled trial, in which the assessments were performed by the same physiotherapist in two moments: before and after the procedure. The infants were randomly divided into two groups: Intervention (IG), with manual chest vibrocompression, nasotracheal suctioning and resting; and Control CG), with 30 minutes of rest. Cardiorespiratory data (SpO2; hr; rr) were monitored and the following scales were used: Neonatal Infant Pain Scale (NIPS), for pain evaluation, and Bulletin of Silverman-Andersen (BSA), for respiratory distress assessment. The data were verified by analysis of variance (ANOVA) for repeated measures, being significant p<0.05. RESULTS: 20 infants with heart disease, ten in each group (seven acyanotic and three cyanotic) were enrolled, with ages ranging from zero to 12 months. In the analysis of the interaction between group and time, there was a significant difference in the variation of SpO2 (p=0.016), without changes in the other variables. Considering the main effect on time, only rr showed a significant difference (p=0.001). As for the group main effect, there were no statistical differences (SpO2 - p=0.77, hr - p=0.14, rr - p=0.17, NIPS - p=0.49 and BSA - p=0.51 ). CONCLUSIONS: The manual vibrocompression and the nasotracheal suctioning applied to infants in postoperative of cardiac surgery did not altered SpO2 and rr, and did not trigger pain and respiratory distress. [Brazilian Registry of Clinical Trials (ReBEC): REQ: 1467].