Livia Barboza de Andrade

Comparison of six-minute walk test in children with moderate/severe asthma with reference values for healthy children

OBJECTIVE to compare physical performance and cardiorespiratory responses in the six-minute walk test (6MWT) in asthmatic children with reference values for healthy children in the same age group, and to correlate them with intervening variables. METHODS this was a cross-sectional, prospective study that evaluated children with moderate/severe asthma, aged between 6 and 16 years, in outpatient follow-up. Demographic and spirometric test data were collected. All patients answered the pediatric asthma quality of life (QoL) questionnaire (PAQLQ) and level of basal physical activity. The 6MWT was performed, following the American Thoracic Society recommendations. Comparison of means was performed using Students t-test and Pearsons correlation to analyze the 6MWT with study variables. The significance level was set at 5%. RESULTS 40 children with moderate or severe asthma were included, 52.5% males, 70% with normal weight and sedentary. Mean age was 11.3±2.1 years, mean height was 1.5±0.1 m, and mean weight was 40.8±12.6 Kg. The mean distance walked in the 6MWT was significantly lower, corresponding to 71.9%±19.7% of predicted values; sedentary children had the worst values. The difference between the distance walked on the test and the predicted values showed positive correlation with age (r=0.373, p=0.018) and negative correlation with cardiac rate at the end of the test (r=-0.518, p<0.001). Regarding QoL assessment, the values in the question about physical activity limitations showed the worst scores, with a negative correlation with walked distance difference (r=-0.311, p=0.051). CONCLUSIONS asthmatic childrens performance in the 6MWT evaluated through distance walked is significantly lower than the predicted values for healthy children of the same age, and is directly influenced by sedentary life style.

I Recomendação brasileira de fisioterapia respiratória em unidade de terapia intensiva pediátrica e neonatal

Developing guidelines for the role of the physiotherapist in neonatal and pediatric intensive care units is essential because these professionals are responsible for the rehabilitation of critically ill patients. Rehabilitation includes the evaluation and prevention of functional kinetic alterations, application of treatment interventions (respiratory and/or motor physiotherapy), control and application of medical gases, care of mechanical ventilation, weaning and extubation, tracheal gas insufflation, inflation/deflation of the endotracheal cuff protocol, and surfactant application, aiming to allow patients to have a full recovery and return to their functional activities. In this article, we present guidelines that are intended to guide the physiotherapist in some of the prevention/treatment interventions in respiratory therapy (airway clearance, lung expansion, position in bed, airway suction, drug inhalation, and cough assist), which help in the rehabilitation process of newborns and children in intensive care units during mechanical ventilation and up to 12 hours following extubation.

Avaliação da função pulmonar em crianças e adolescentes no pré e pós-operatório de correção cirúrgica de valvulopatia reumática

OBJECTIVE: To assess pulmonary function in children and adolescents subjected to correction of rheumatic valve disease in order to quantify changes caused by factors inherent to surgery and rheumatic heart disease METHODS: This was a longitudinal and quantitative intervention study, undertaken at a childrens hospital that is a center of excellence for the state of Pernambuco (Instituto Materno Infantil de Pernambuco), between December 2004 and May 2005. Eighteen children suffering from rheumatic fever and indicated for surgery to repair or replace the mitral valve were assessed preoperatively and again on the first and fifth postoperative days. The parameters recorded were minute volume, rapid shallow breathing index, peak expiratory flow, forced vital capacity and inspiratory capacity RESULTS: All patients were aged 8 to 17 years (mean 12.4±2.1), they had a mean body mass index of 16.1±2.2, and were weaned off invasive mechanical ventilation during the first 10 postoperative hours. All parameters had undergone significant deterioration on the first day (statistically significant, p 0.01), without returning to baseline levels. CONCLUSION: We observed that the pulmonary dysfunction that results from this type of heart surgery is maintained until at least the fifth postoperative day. It appears that this dysfunction is influenced by the pain and mechanical alterations caused by sternotomy and reduced pulmonary compliance post surgery.

Pulmonary function assessment in children and teenagers before and after surgical treatment for rheumatic valve disease

OBJECTIVE To assess pulmonary function in children and adolescents subjected to correction of rheumatic valve disease in order to quantify changes caused by factors inherent to surgery and rheumatic heart disease. METHODS This was a longitudinal and quantitative intervention study, undertaken at a childrens hospital that is a center of excellence for the state of Pernambuco (Instituto Materno Infantil de Pernambuco), between December 2004 and May 2005. Eighteen children suffering from rheumatic fever and indicated for surgery to repair or replace the mitral valve were assessed preoperatively and again on the first and fifth postoperative days. The parameters recorded were minute volume, rapid shallow breathing index, peak expiratory flow, forced vital capacity and inspiratory capacity. RESULTS All patients were aged 8 to 17 years (mean 12.4+/-2.1), they had a mean body mass index of 16.1+/-2.2, and were weaned off invasive mechanical ventilation during the first 10 postoperative hours. All parameters had undergone significant deterioration on the first day (statistically significant, p < or = 0.01), demonstrating gradual improvement up to the last day of assessment, although, with the exception of minute volume which was no longer significantly different from the fourth day onwards (p > 0.01), without returning to baseline levels. CONCLUSION We observed that the pulmonary dysfunction that results from this type of heart surgery is maintained until at least the fifth postoperative day. It appears that this dysfunction is influenced by the pain and mechanical alterations caused by sternotomy and reduced pulmonary compliance post surgery.

A comparison of the continuous positive airway pressures produced by two systems

OBJECTIVE To compare the generation of continuous positive airway pressure using a hand-made device (underwater seal) or a ventilator (Inter 3). METHOD Two positive airway pressure generation systems were compared through laboratory simulations. Measurements were not considered if the mechanical ventilator required calibration or in the presence of gas flow variation (flowmeter sphere oscillation). Recordings were assessed in terms of the capacity to produce the desired pressure (3, 5 and 6 cmH2O) when submitted to three different flow values (8, 10 and 12 l/min). For that end, Students t test for paired samples and the nonparametric Man-Whitney test for independent samples were employed. RESULTS We verified that the systems behave in different manners under the same conditions of flow and positive end expiratory pressure. For the mechanical ventilator, the mean pressure behavior under continuous positive airway pressure at 3 cmH2O with flows of 8, 10 and 12 l/min were 2.26+/-0.41, 2.22+/-0.37, 2.04+/-0.41, respectively; under positive end-expiratory pressure at 5 cmH2O we found 3.96+/-0.41, 3.87+/-0.43 and 3.75+/-0.52; and under positive end-expiratory pressure at 6 cmH2O the values recorded were 4.94+/-0.40, 4.85+/-0.41 and 4.72+/-0.37. For the underwater seal, the mean pressure behavior under continuous positive airway pressure at 3 cmH2O with flows of 8, 10 and 12 l/min were 4.24+/-0.24, 4.46+/-0.26, 4.72+/-0.37, respectively; at 5 cmH2O the values were 5.97+/-0.17, 6.28+/-0.18, 6.47+/-0.31; and at 6 cmH2O we recorded 6.85+/-0.20, 7.17+/-0.29 and 7.53+/-0.31. All the comparisons were statistically significant (p = 0.000). CONCLUSION Through our recordings it was possible to observe that the Inter 3 continuous positive airway pressure system was more stable than the underwater seal.

Influência de fatores maternos e neonatais no desenvolvimento da displasia broncopulmonar

OBJECTIVE: To review epidemiological features of bronchopulmonary dysplasia (BPD) and its relationship with maternal and neonatal conditions in a neonatal unit. METHODS: Cross-sectional, descriptive and analytical study involving preterm newborns (NBs) with a birth weight lower than 1,500 g and gestational age under 37 weeks. Data was collected through a review of medical records of these newborns admitted to a neonatal unit. RESULTS: The study included 323 newborns with a mean birth weight of 1,161 g (± 231 g), gestational age between 24 and 36.5 weeks, with a BPD incidence of 17.6%. Among the NBs developing BPD, the mean of days using invasive mechanical ventilation (IMV), non-invasive ventilation (NIMV), and supplemental oxygen was 17.6, 16.2, and 46.1 days, respectively, with a time significantly longer for those NBs developing BPD (p < 0.001). BPD occurred significantly more often in NBs with a patent ductus arteriosus (PDA). CONCLUSION: BPD incidence in this study was similar to that found in the literature. No BPD association with maternal infection and antenatal corticosteroid use was found. NBs receiving exogenous surfactant had a higher BPD incidence because they had lower BW and GA. Concomitant occurrence of PDA and BPD is associated with staying longer on IMV, NIMV and supplemental oxygen

Effectiveness of prophylactic non-invasive ventilation on respiratory function in the postoperative phase of pediatric cardiac surgery: a randomized controlled trial.

ABSTRACT Objective To evaluate the effectiveness of prophylactic, non-invasive ventilation (NIV) on respiratory function in seven- to 16-year-old children in the post-operative phase of cardiac surgery. Method A randomized, controlled trial with 50 children who had undergone cardiac surgery with median sternotomy. After extubation, patients were randomly assigned to one of two groups: control group (n=26), which received instructions regarding posture, early ambulation, and cough stimulation, and CPAP group (continuous positive airway pressure; n=24), which received the same instructions as the control group and CPAP=10 cmH20 twice daily for 30 minutes from the 1st to the 5th post-operative day (POD). As a primary outcome, lung function was evaluated before and on the 1st, 3rd, and 5th PODs with measures of respiratory rate (RR), tidal volume (TV), slow vital capacity (SVC), inspiratory capacity (IC), minute volume (MV), peak expiratory flow (PEF), and maximal inspiratory pressure (MIP). As secondary outcomes, the time of hospitalization and intensive care were recorded. A mixed, linear regression model and z-test were used to analyze respiratory function, considering p<0.05. Results All variables, except RR and MV, showed a significant drop on the 1st POD, with gradual recovery; however, only MIP had returned to pre-operative values on the 5th POD in both groups. The RR showed a significant increase on the 1st POD, with a gradual reduction but without returning to baseline. In the intergroup analysis, significant improvement (p=0.04) was observed only in PEF in the CPAP group on the 1st DPO. The length of hospitalization and intensive care showed no significant differences. Conclusion NIV was safe and well accepted in this group of patients, and the protocol used was effective in improving PEF on the 1st DPO in the CPAP group.

Mucopolysaccharidosis type VI: Assessment of functionality, functional capacity and respiratory muscle strength

Introduction: Maroteaux-Lamy Syndrome (MPS VI) is a rare type of mucopolysaccharidosis in the world, however in Brazil it is one of the most commonly diagnosed. Objectives: to measure the functionality, functional capacity and strength of the respiratory muscles of MPS type VI carriers in a Brazilian Center of inborn errors of metabolism. Method: cross sectional study. Pediatric Evaluation of Disability Inventory (PEDI) or Functional Independence Measure (FIM) was applied according with the age. Relation between muscles strength and total distance walked on the test (6MWD) were analyzed based on simple linear regression models. Students t test and ANOVA test were performed to measure the average difference between groups. Relations between Maximal Inspiratory Pressure (MIP), Maximal Expiratory Pressure (MEP) and the total distance walked on 6MWT were analysed based on simple linear regression models, significant p<0.05. Results: from the 24 MPS VI carriers, the average distance walked on the 6MWT was 300 meters (about 984ft) and it´s average predicted value was 585 meters (p<0.001) (about 1919ft). The average values found in the respiratory muscles strength tests was MIP -56 ± 36.0 cmH2O, and the predicted average MIP= -62±12,7cmH2O ( p =0,002). In the PEDI evaluation, 33.3% showed lower performance than expected in the self-care and mobility areas. In the FIM evaluation, 53.3% showed modified dependence and 41.7% showed modified independence. Conclusion: we observed reduction on the functional capacity and significant reduction strength of the respiratory muscles in MPS VI patients, besides the functional dependence in most of the patients.

ARTIGO ORIGINALComparison of six-minute walk test in children with moderate/severe asthma with reference values for healthy childrenComparação do teste de caminhada de 6 minutos em crianças com asma moderada/grave com valores de referência para saudáveis☆

Objective to compare physical performance and cardiorespiratory responses in the six-minute walk test (6MWT) in asthmatic children with reference values for healthy children in the same age group, and to correlate them with intervening variables.