Elaine Paulin

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.

Disfunção diafragmática e mortalidade em pacientes portadores de DPOC

OBJECTIVE: To determine whether COPD patients with diaphragmatic dysfunction present higher risk of mortality than do those without such dysfunction. METHODS: We evaluated pulmonary function, diaphragm mobility and quality of life, as well as determining the Body mass index, airway Obstruction, Dyspnea, and Exercise capacity (BODE) index, in 42 COPD patients. The patients were allocated to two groups according to the degree to which diaphragm mobility was impaired: low mobility (LM; mobility xa034.00 mm). The BODE index and the quality of life were quantified in both groups. All patients were followed up prospectively for up to 48 months in order to determine the number of deaths resulting from respiratory complications due to COPD. RESULTS: Of the 42 patients evaluated, 20 were allocated to the LM group, and 22xa0were allocated to the HM group. There were no significant differences between the groups regarding age, lung hyperinflation or quality of life. However, BODE index values were higher in the LM group than in the HM group (p = 0.01). During the 48-month follow-up period, there were four deaths within the population studied, and all of those deaths occurred in the LM group (15.79%; p = 0.02). CONCLUSIONS: These findings suggest that COPD patients with diaphragmatic dysfunction, characterized by low diaphragm mobility, have a higher risk of death than do those without such dysfunction.

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.

High reliability of measure of diaphragmatic mobility by radiographic method in healthy individuals

BACKGROUNDnDiaphragmatic evaluation is crucial in clinical practice, and no studies have reported the intra- and interobserver reproducibilities of the radiographic method to evaluate diaphragmatic mobility.nnnOBJECTIVEnTo analyze the reliability of radiographic measurement as a method for assessing the mobility of the left and right hemidiaphragms.nnnMETHODnForty-two patients, who were waiting for cholecystectomy surgery, were evaluated relative to the following parameters: physical examination, pulmonary function and radiographic evaluation. The measure of mobility of each hemidiaphragm was randomly determined by two physical therapists at two different times. The intra- and interobserver reproducibilities of the measurements were determined by the intraclass correlation coefficient (ICC[2,1]) and the 95% confidence interval (CI). The Bland-Altman plot was also used. The level of significance was 5%.nnnRESULTSnIn the analysis of intra-observer reproducibility in radiographic evaluations of the left and right hemidiaphragms, ICC[2,1] indicated a very high correlation for both observer A (ICC[2,1] = 0.99, p <0.001 and ICC[2,1] = 0.97, p <0.001, respectively) and observer B (ICC[2,1] = 0.99, p <0.001 and ICC[2,1] = 0.99 p <0.001, respectively). In the analysis of interobserver reproducibility, the ICC[2,1] indicated a very high correlation for the 1st and 2nd radiographic evaluations of the right hemidiaphragm (ICC[2,1] = 0.98 and ICC[2,1] = 0,99, respectively, p <0.001) and left hemidiaphragm (ICC[2,1] = 0.98 and ICC[2,1] = 0.99, respectively, p <0.001).nnnCONCLUSIONnThe intra and interobserver tests of the radiographic measure of mobility of the left and right hemidiaphragms showed high reliability.

Variação diurna de parâmetros de função pulmonar e de força muscular respiratória em pacientes com DPOC

OBJECTIVEnTo evaluate the magnitude of diurnal changes in the parameters of pulmonary function and respiratory muscle strength/endurance in a sample of patients with COPD.nnnMETHODSnA group of 7 patients underwent spirometry, together with determination of MIP and MEP, at two distinct times (between 8:00 and 8:30 a.m. and between 4:30 and 5:00 p.m.) on a single day. Between assessments, the patients remained at rest in the laboratory.nnnRESULTSnIn accordance with the Global Initiative for Chronic Obstructive Pulmonary Disease staging system, COPD was classified as moderate, severe, and very severe in 1, 3, and 3 of the patients, respectively. From the first to the second assessment, there were significant decreases in FVC, FEV1, and MEP (of 13%, 15%, and 10%, respectively), as well as (less than significant) decreases in PEF, MIP, and maximal voluntary ventilation (of 9%, 3%, and 11%, respectively).nnnCONCLUSIONSnIn this sample of COPD patients, there were diurnal variations in the parameters of pulmonary function and respiratory muscle strength. The values of FEV1, FVC, and MEP were significantly lower in the afternoon than in the morning.

Diaphragmatic mobility: relationship with lung function, respiratory muscle strength, dyspnea, and physical activity in daily life in patients with COPD

Objetivo: Avaliar a relacao da mobilidade diafragmatica com a funcao pulmonar, forca muscular respiratoria, dispneia e atividade fisica de vida diaria (AFVD) em pacientes com DPOC. Metodos: Foram avaliados 25 pacientes com diagnostico de DPOC, classificados de acordo com criterios da Global Initiative for Chronic Obstructive Lung Disease, e 25 individuos saudaveis. Todos foram submetidos as seguintes avaliacoes: mensuracao antropometrica, espirometria, forca muscular respiratoria, mobilidade diafragmatica (por radiografia), AFVD e percepcao de dispneia. Resultados: No grupo DPOC, houve correlacoes da mobilidade diafragmatica com variaveis de funcao pulmonar, forca muscular inspiratoria e percepcao de dispneia. Nao houve correlacoes da mobilidade diafragmatica com forca muscular expiratoria e AFVD. Conclusoes: A mobilidade diafragmatica parece estar associada tanto com a obstrucao das vias aereas quanto com a hiperinsuflacao pulmonar em pacientes com DPOC, assim como com a capacidade ventilatoria e percepcao de dispneia, mas nao com AFVD.

Comparação entre as medidas de cirtometria tóraco-abdominal realizadas em decúbito dorsal e em ortostatismo

With the objective to evaluate possible differences in the values obtained in the thoracoabdominal cirtometry in orthostatism compared with the results in supine, 30 subjects with mean age 27.8±4.4 years were evaluated according to the following parameters: anthropometry, pulmonary function test and thocacoabdominal cirtometry. Shapiro-Wilk test was used to verify data normality and the t test was performed in order to compare the thoracoabdominal cirtometry measurements in supine and in orthostatism positions. There were no significant differences in axillar and xiphoid mobility between measurements obtained in supine and orthostatism. The abdominal mobility measured in orthostatism (2.54±1.39 cm) was significantly lower (34.35%) when compared to the mobility obtained in supine (3.71±1.78 cm; p<0.001). The thoracic cirtometry can be performed in orthostatism as an alternative for the evaluation of patients with orthopnea. The abdominal cirtometry can also be performed in this posture, with the expected one-third reduction in the abdominal mobility obtained in supine.

Comparação da mobilidade diafragmática em pacientes com DPOC com e sem hipercifose torácica: um estudo transversal

OBJECTIVE:To compare diaphragmatic mobility, lung function, and respiratory muscle strength between COPD patients with and without thoracic hyperkyphosis; to determine the relationship of thoracic kyphosis angle with diaphragmatic mobility, lung function, and respiratory muscle strength in COPD patients; and to compare diaphragmatic mobility and thoracic kyphosis between male and female patients with COPD. METHODS:Participants underwent anthropometry, spirometry, thoracic kyphosis measurement, and evaluation of diaphragmatic mobility. RESULTS:A total of 34 patients with COPD participated in the study. Diaphragmatic mobility was significantly lower in the group of COPD patients with thoracic hyperkyphosis than in that of those without it (p = 0.002). There were no statistically significant differences between the two groups of COPD patients regarding lung function or respiratory muscle strength variables. There was a significant negative correlation between thoracic kyphosis angle and diaphragmatic mobility (r = -0.47; p = 0.005). In the sample as a whole, there were statistically significant differences between males and females regarding body weight (p = 0.011), height (p < 0.001), and thoracic kyphosis angle (p = 0.036); however, there were no significant differences in diaphragmatic mobility between males and females (p = 0.210). CONCLUSIONS:Diaphragmatic mobility is lower in COPD patients with thoracic hyperkyphosis than in those without it. There is a negative correlation between thoracic kyphosis angle and diaphragmatic mobility. In comparison with male patients with COPD, female patients with COPD have a significantly increased thoracic kyphosis angle.

Tecnicas de fisioterapia respiratoria: efeito nos parametros cardiorrespiratorios e na dor do neonato estavel em UTIN

OBJECTIVES: to identify the effects of respiratory physiotherapy techniques (RPTs) on pain and cardiorespiratory functioning in clinically stable newborns, in a neonatal intensive care unit. METHODS: a blind randomized clinical assay was carried out. The newborns were allocated to three groups: G1-control; G2-conventional physiotherapy; G3-thoracic-abdominal re-equilibrium therapy. The newborns in G2 and G3 received a single intervention. All were evaluated prior to, immediately after and 15 minutes after the intervention and subsequent rest for cardio-respiratory parameters (peripheral oxygen/SpO2 saturation, cardiac /fc and respiratory /fr frequency) and pain (specific scales: NIPS, NFCS and PIPP). The data were analyzed using the chisquared, Friedman, and Kruskal-Wallis tests, then by way of multiple comparisons. The level of significance was p 0.05). In relation to pain, there were significant changes in the NIPS scale (G1 and G2, p=0.037 and p=0.011, respectively) and in the PIPP scale (G2, p=0.005). CONCLUSIONS: respiratory physiotherapy techniques did not produce pain or cardio-respiratory instability in the newborns studied.

Mobilidade diafragmática direita e esquerda em indivíduos saudáveis e na doença pulmonar obstrutiva crônica

Corresponding address: Elaine Paulin – Center of Health and Sport Sciences (Cefid) – Rua Pascoal Simone, 358 – Coqueiros – Florianópolis (SC), Brazil – Zip Code: 88080-350 – Phone: (48) 3664-8602 – E-mail: elaine.paulin@udesc.br – Finance source: Nothing to declare – Conflict of interests: Nothing to declare – Presentation: Mar. 3rd, 2016 – Accepted for publication: Feb. 10th, 2018 – Approved by the Research Ethics Committee of Udesc, under protocol no. 668,409. Mobility of right and left hemidiaphragms in healthy individuals and in individuals with chronic obstructive pulmonary disease Mobilidade diafragmática direita e esquerda em indivíduos saudáveis e na doença pulmonar obstrutiva crônica Movilidad diafragmática derecha e izquierda en individuos saludables y en la enfermedad pulmonar obstructiva crónica Ana Karla Vieira Brüggemann1, Bruna Estima Leal2, Márcia Aparecida Gonçalves2, Liseane Lisboa3, Michelle Gonçalves de Souza Tavares4, Elaine Paulin5