Letícia Baltieri

Analysis of the prevalence of atelectasis in patients undergoing bariatric surgery

BACKGROUND AND OBJECTIVE To observe the prevalence of atelectasis in patients undergoing bariatric surgery and the influence of the body mass index (BMI), gender and age on the prevalence of atelectasis. METHOD Retrospective study of 407 patients and reports on chest X-rays carried out before and after bariatric surgery over a period of 14 months. Only patients who underwent bariatric surgery by laparotomy were included. RESULTS There was an overall prevalence of 37.84% of atelectasis, with the highest prevalence in the lung bases and with greater prevalence in women (RR=1.48). There was a ratio of 30% for the influence of age for individuals under the age of 36, and of 45% for those older than 36 (RR=0.68). There was no significant influence of BMI on the prevalence of atelectasis. CONCLUSION The prevalence of atelectasis in bariatric surgery is 37% and the main risk factors are being female and aged over 36 years.

Analysis of quality of life among asthmatic individuals with obesity and its relationship with pulmonary function: cross-sectional study

CONTEXT AND OBJECTIVE: The combined effect of obesity and asthma may lead to significant impairment of quality of life (QOL). The aim here was to evaluate the prevalence of asthma among obese individuals, characterize the severity of impairment of quality of life and measure its relationship with pulmonary function. DESIGN AND SETTING: Observational cross-sectional study in public university hospital. METHODS: Morbidly obese individuals (body mass index > 40 kg/m2) seen in a bariatric surgery outpatient clinic and diagnosed with asthma, were included. Anthropometric data were collected, the Standardized Asthma Quality of Life Questionnaire (AQLQ(S)) was applied and spirometry was performed. The subjects were divided into two groups based on the median of the score in the questionnaire (worse < 4 and better > 4) and were compared regarding anthropometric data and pulmonary function. RESULTS: Among the 4791 individuals evaluated, 219 were asthmatic; the prevalence of asthma was 4.57%. Of these, 91 individuals were called to start multidisciplinary follow-up during the study period, of whom 82 answered the questionnaire. The median score in the AQLQ(S) was 3.96 points and, thus, the individuals were classified as having moderate impairment of their overall QOL. When divided according to better or worse QOL, there was a statistically difference in forced expiratory flow (FEF) 25-75%, with higher values in the better QOL group. CONCLUSION: The prevalence of asthma was 4.57% and QOL was impaired among the asthmatic obese individuals. The worst QOL domain related to environmental stimuli and the best QOL domain to limitations of the activities. Worse QOL was correlated with poorer values for FEF 25-75%.

Influence of weight loss on pulmonary function and levels of adipokines among asthmatic individuals with obesity: One-year follow-up

BACKGROUND Individuals with obesity are more likely to develop asthma, but the exact mechanism is still uncertain and several hypotheses have been raised, such as the release of inflammatory mediators secreted by adipose tissue. OBJECTIVE To assess the effects of weight loss in patients submitted to bariatric surgery on pulmonary and systemic inflammation. METHOD The study evaluated patients undergoing bariatric surgery (Roux-en-Y gastric bypass) with the diagnosis of asthma, except smokers. The patients were evaluated at the time of entry into a preoperative weight loss group (T1), just before bariatric surgery (T2), six months after surgery (T3), and 12 months after surgery (T4). The following were measured: anthropometric data, dosage of systemic inflammatory markers by means of blood collection, pulmonary inflammatory markers obtained by induced sputum collection, pulmonary function parameters, and asthma activity assessed by a Asthma Control Test (ACT) questionnaire. RESULTS Nineteen patients participated in the study. There were significant reductions in the systemic levels of interleukin (IL)-8 (p = 0.002), C-reactive protein (CRP) (p = 0.003), leptin (p = 0.001) and tumor necrosis factor (TNF)-α (p = 0.007), and significant increase in the systemic levels of IL-6 (p = 0.004) over time and adiponectin in T2 (p = 0.025). In regards to pulmonary inflammation, there were significant reductions in the sputum levels of TNF-α (p < 0.001). There was no significant improvement of the pulmonary function parameters (p > 0.05) and significant improvement in asthma activity scores (p < 0.0001). CONCLUSION Weight loss was associated with significant changes in the systemic and pulmonary inflammatory profiles of individuals with asthma, leading to a better asthma control as a result of an increase in some anti-inflammatory mediators and a reduction of pro-inflammatory mediators.

Obstructive sleep apnea syndrome among obese individuals: A cross-sectional study

INTRODUCTION The obstructive sleep apnea syndrome (OSAS) is a respiratory illness, characterized by recurrent episodes of apnea and hypopnea, leading to reduction or cessation of the airflow. Obesity is one of the major risk factors for the development of OSAS. To help in the diagnosis of this disease, easily applicable and low-cost questionnaries were developed, such as the Berlin Questionnaire (BQ). OBJECTIVE To evaluate the efficacy of the BQ for the screening of OSAS among candidates to bariatric surgery in a multidisciplinary preoperative program. METHOD This is an observational, descriptive and cross-sectional study which evaluated obese individuals that were being prepared for bariatric surgery by means of the BQ. RESULTS BQ was able to detect that minimal variations in the body mass index, neck circumference and hip-to-waist ratio lead to changes in the risk to develop OSAS; the higher the values of these variables, the higher the risk for OSAS development. CONCLUSION BQ was an efficient and reliable tool to demonstrate the high risk for OSAS development in individual with obesity.

Atelectasias em pacientes submetidos à cirurgia bariátrica sem qualquer alteração pulmonar prévia: comentários do estudo de prevalência

Obesity is a risk factor intrinsic to the development of areas of atelectasis, especially when the patient undergoes to general anesthesia and, therefore, some groups of studies has been dedicated to studying such subject. The recently published letter to the editor comments on and points out some aspects regarding the article on the prevalence of atelectasis in the obese Grade III submitted to bariatric surgery. In response, the clinical relevance of this study is that there are no studies in the literature consulted to date that have observed the prevalence of atelectasis in the postoperative period of bariatric surgery since they may cause respiratory failure in these patients. Considering this prevalence, it is possible to study effective prevention and treatment measures to minimize postoperative complications. Thus, firstly, in fact, the retrospective analysis is subject to bias, but the service in which the study was carried out follows strict protocols instituted for years regarding preoperative preparation, hospitalization, medications, anesthetic and surgical staff, anesthesia and surgery techniques, recovery time in the postoperative period and complementary exams. In addition the data collection time was only 14 months and thus, these facts can minimize the biases of a retrospective study. The fact that a study with only patients with previous pulmonary alterations is against the initial proposal of the research, which aims to observe the development of atelectasis in patients without any pulmonary alterations or respiratory symptoms so that we can actually reinforce the assumption that obesity alone is a risk factor for the development of respiratory complications and such complications can be triggered by the emergence of atelectasis areas. The research group also investigated solutions to minimize the prevalence of atelectasis in these patients by applying positive pressure at different times of hospitalization and, in corroboration with the cited author, we also identified that the best time is soon after extubation, because it reduces the prevalence of atelectasis and has less loss of expiratory reserve volume. Second, regarding the predominance of the female gender, it is common to observe a higher prevalence of women in studies of obesity as already demonstrated in the study conducted by Ogden et al., in which a higher prevalence of obesity was observed in women. This fact has several explanations, ranging from the different hormonal factors involved in the gender to the greater outpatient demand for women who seem to be more concerned about health. As a result, it becomes more difficult to homogenize the sample with respect to gender. However, with the Chi-square test used in the study to analyze the association between gender and prevalence of atelectasis, it is possible to isolate the discrepancy effects of the sample. Thirdly, in fact, physiotherapy has been shown to be of extreme relevance in the treatment of patients in the pre and postoperative period of abdominal surgeries, as demonstrated in a literature review performed by Lawrence et al., in which it was concluded that respiratory physiotherapy with reexpansive techniques has proven benefits in reducing postoperative complications in abdominal surgeries. Moreover, since then, several other studies have been emerging to prove even more this finding. In view of the vast evidence of the benefits of physical therapy in these cases, the hospital conducting the study, as well as several others, already includes respiratory physiotherapy in the routine of these patients when they are hospitalized. However, the high prevalence of atelectasis in these patients must be observed, and the researchers should direct attention to new treatment techniques in order to avoid them. Finally, the authors also agree that more research is encouraged in this area to evaluate the respiratory complications related to abdominal surgeries and their possible risk factors as well as to perform the best prevention or treatment.