Dayane Montemezzo

Influence of 4 interfaces in the assessment of maximal respiratory pressures.

BACKGROUND: The measurement of maximal respiratory pressure (MRP) is a procedure widely used in clinical practice to evaluate respiratory muscle strength through the maximal inspiratory pressure (PImax) and maximal expiratory pressure (PEmax). Its clinical applications include diagnostic procedures and evaluating responses to interventions. However, there is great variability in the equipment and measurement procedures. Understanding the impacts of the characteristics of different interfaces can augment the repeatability of this method and help to establish widely applicable predictive equations. The aim of this study was to evaluate the influence of 4 different interfaces on a subjects capacity to generate MRP and the impact of these interfaces on the repeatability of these measurements. METHODS: Fifty healthy subjects (mean ± SD age 26.36 ± 4.89 y) with normal spirometry were evaluated. MRP was measured by a digital manometer connected to 4 interfaces using different combinations of mouthpieces and tubes. The following variables were analyzed: maximum mean pressure, peak pressure, plateau pressure, and plateau variation. Analysis of variance for repeated measures or a Friedman test was used to compare the 4 interfaces, with P < .008 after Bonferroni adjustment considered significant. RESULTS: There was no significant difference between the 4 interfaces with respect to maximum mean pressure, peak pressure, plateau pressure, or plateau variation for PImax (P ≥ .49) or PEmax (P ≥ .11), nor did the number of tests performed to fulfill the criteria of repeatability for PImax (P = .69) or PEmax (P = .47) differ among the 4 interfaces. CONCLUSIONS: PImax and PEmax values seem not to be influenced by the different interfaces studied, suggesting that patient comfort and availability of interfaces can be considered.

Predictive equations for respiratory muscle strength according to international and Brazilian guidelines

Background: The maximum static respiratory pressures, namely the maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP), reflect the strength of the respiratory muscles. These measures are simple, non-invasive, and have established diagnostic and prognostic value. This study is the first to examine the maximum respiratory pressures within the Brazilian population according to the recommendations proposed by the American Thoracic Society and European Respiratory Society (ATS/ERS) and the Brazilian Thoracic Association (SBPT). Objective: To establish reference equations, mean values, and lower limits of normality for MIP and MEP for each age group and sex, as recommended by the ATS/ERS and SBPT. Method: We recruited 134 Brazilians living in Belo Horizonte, MG, Brazil, aged 20-89 years, with a normal pulmonary function test and a body mass index within the normal range. We used a digital manometer that operationalized the variable maximum average pressure (MIP/MEP). At least five tests were performed for both MIP and MEP to take into account a possible learning effect. Results: We evaluated 74 women and 60 men. The equations were as follows: MIP=63.27-0.55 (age)+17.96 (gender)+0.58 (weight), r2 of 34% and MEP= - 61.41+2.29 (age) - 0.03(age2)+33.72 (gender)+1.40 (waist), r2 of 49%. Conclusion: In clinical practice, these equations could be used to calculate the predicted values of MIP and MEP for the Brazilian population.

Pressões respiratórias máximas: equipamentos e procedimentos usados por fisioterapeutas brasileiros

A mensuracao das pressoes respiratorias maximas - metodo de avaliacao das condicoes de forca dos musculos respiratorios - e um teste voluntario e esforco-dependente, com aplicacoes clinicas de ordem diagnostica e terapeutica. Ha uma grande variedade de equipamentos e interfaces para sua execucao, o que acarreta uma relativa ausencia de padronizacao. O objetivo deste estudo foi identificar os diferentes equipamentos, procedimentos e forma de interpretar a mensuracao das pressoes respiratorias maximas entre fisioterapeutas brasileiros. Dezenove fisioterapeutas respiratorios, de 13 diferentes instituicoes, situadas em tres regioes do pais, responderam a um questionario sobre esses aspectos. Os resultados mostram que prevaleceu o uso de manovacuometro analogico (60%), com tubo de silicone (60%) e interface do tipo bocal tubular (53,4%), contendo orificio de fuga de 1 a 2 mm de diâmetro (86,6%), associado ao uso de clipe nasal (100%). Na mensuracao, foi observado um numero minimo de tres testes aceitaveis e reprodutiveis (80%) e, para a analise dos valores encontrados, todos usam valores de referencia ou equacoes preditivas. Os dados sugerem que existe uma relativa uniformidade em relacao a mensuracao das pressoes respiratorias maximas entre fisioterapeutas brasileiros.

Comparison of three protocols for measuring the maximal respiratory pressures

Introduction To avoid the selection of submaximal efforts during the assessment of maximal inspiratory and expiratory pressures (MIP and MEP), some reproducibility criteria have been suggested. Criteria that stand out are those proposed by the American Thoracic Society (ATS) and European Respiratory Society (ERS) and by the Brazilian Thoracic Association (BTA). However, no studies were found that compared these criteria or assessed the combination of both protocols. Objectives To assess the pressure values selected and the number of maneuvers required to achieve maximum performance using the reproducibility criteria proposed by the ATS/ERS, the BTA and the present study. Materials and method 113 healthy subjects (43.04 ± 16.94 years) from both genders were assessed according to the criteria proposed by the ATS/ERS, BTA and the present study. Descriptive statistics were used for analysis, followed by ANOVA for repeated measures and post hoc LSD or by Friedman test and post hoc Wilcoxon, according to the data distribution. Results The criterion proposed by the present study resulted in a significantly higher number of maneuvers (MIP and MEP – median and 25%-75% interquartile range: 5[5-6], 4[3-5] and 3[3-4] for the present study criterion, BTA and ATS/ERS, respectively; p < 0.01) and higher pressure values (MIP – mean and 95% confidence interval: 103[91.43-103.72], 100[97.19-108.83] and 97.6[94.06-105.95]; MEP: median and 25%-75% interquartile range: 124.2[101.4-165.9], 123.3[95.4-153.8] and 118.4[95.5-152.7]; p < 0.05). Conclusion The proposed criterion resulted in the selection of pressure values closer to the individual’s maximal capacity. This new criterion should be considered in future studies concerning MIP and MEP measurements.

Shuttle walking test como instrumento de avaliação da capacidade funcional: uma revisão da literatura

Introduction: The Shuttle walking test (SWT) was originally developed for individuals with chronic obstructive pulmonary disease (COPD). It is also been used to evaluate the functional capacity in other health conditions. Objective: To do a review about the use of the Shuttle walking test to assess the functional capacity. Materials and Methods: A literature review was performed in Medline, Lilacs and Scielo considering the keywords: Shuttle walking test, validity, reproducibility, reliability, sensibility, minimum clinically significance difference and prognostic. Results: Thirty seven articles mentioned the SWT as a variable of interest. Besides COPD it was used to evaluate patients with heart failure, coronary arterial disease, heart transplantation, peripheral arterial obstructive disease, cystic fibrosis, idiopathic pulmonary fibrosis and patients with pacemakers. Conclusions: The SWT is valid, reliable and safe to assess cardiorespiratory fitness and functional capacity in different health conditions. It is usable on clinical practice to evaluate responses to treatments and also for prognostic.

Could peak oxygen uptake be estimated from proposed equations based on the six-minute walk test in chronic heart failure subjects?

Highlights • Measured and estimated VO2peak in CHF patients showed a moderate association.• With the exception of equation 1, all equations underestimated VO2peak by up to 51%.• The agreement evaluated using Bland–Altman was not consistent.

Using the Human Activity Profile to Assess Functional Performance in Heart Failure.

PURPOSE: To investigate (1) the validity of using the Human Activity Profile (HAP) in patients with heart failure (HF) to estimate functional capacity; (2) the association between the HAP and 6-Minute Walk Test (6MWT) distance; and (3) the ability of the HAP to differentiate between New York Heart Association (NYHA) functional classes. METHODS: In a cross-sectional study, we evaluated 62 clinically stable patients with HF (mean age, 47.98 years; NYHA class I-III). Variables included maximal functional capacity as measured by peak oxygen uptake ( O2) using a cardiopulmonary exercise test (CPET), peak O2 as estimated by the HAP, and exercise capacity as measured by the 6MWT. RESULTS: The difference between the measured (CPET) and estimated (HAP) peak O2 against the average values showed a bias of 2.18 mL/kg/min (P = .007). No agreement was seen between these measures when applying the Bland-Altman method. Peak O2 in the HAP showed a moderate association with the 6MWT distance (r = 0.62; P < .0001). Peak O2 in the HAP was able to statistically differentiate NYHA functional classes I, II, and III (P < .05). CONCLUSIONS: The estimated peak O2 using the HAP was not concordant with the gold standard CPET measure. On the contrary, the HAP was able to differentiate NYHA functional class associated with the 6MWT distance; therefore, the HAP is a useful tool for assessing functional performance in patients with HF.