Luciana Dias Chiavegato

Volumes, capacidades pulmonares e força muscular respiratória no pós-operatório de gastroplastia

The production process comprises A) forming an acidic aqueous solution comprising alkali metal cations, bromide anions, and sulfamate anions; B) feeding into said aqueous solution a source of alkali metal cations and chlorine-containing bromide oxidant proportioned to keep the resultant aqueous medium acidic and to form an acidic product solution containing at least about 5 wt % of active bromine, and C) raising the pH of the aqueous product solution with water-soluble base to at least about 10.

Pressões respiratórias máximas e capacidade vital: comparação entre avaliações através de bocal e de máscara facial

INTRODUCAO: A medida das pressoes respiratorias maximas e a capacidade vital sao importantes na avaliacao da funcao pulmonar, no entanto, variacoes metodologicas podem interferir na interpretacao dos resultados obtidos. OBJETIVO: Comparar os valores das pressoes respiratorias maximas e da capacidade vital, obtidos atraves de bocal e de mascara facial. METODO: Foram estudados 30 pacientes (16 homens), com idade de 55,9 ± 15,7 anos, em periodo pre-operatorio de cirurgia abdominal. As variaveis pressao inspiratoria maxima, pressao expiratoria maxima e capacidade vital foram avaliadas atraves de um bocal rigido achatado e de uma mascara facial, em ordem randomizada. RESULTADOS: A avaliacao com mascara facial nao alterou de forma significativa os valores de capacidade vital e pressao inspiratoria maxima, porem a pressao expiratoria maxima foi significantemente menor do que quando avaliado com bocal rigido. A presenca de escape aereo ao redor da mascara durante a medida da pressao expiratoria maxima foi observada em 60% das avaliacoes. Quando consideradas apenas as medidas de pressao expiratoria maxima avaliadas sem a presenca de escape de ar, os valores com o uso da mascara foram maiores do que os com o bocal. CONCLUSAO: A avaliacao da pressao inspiratoria maxima e capacidade vital pode ser realizada com uso de mascara facial, sem interferencia nos resultados obtidos. A avaliacao da pressao expiratoria maxima atraves de mascara facial mostrou-se adequado quando foi possivel evitar o escape de ar ao redor da mascara, porem a grande prevalencia de vazamentos e a consequente reducao dos valores obtidos na avaliacao tornam seu uso limitado.

Alterações funcionais respiratórias na colecistectomia por via laparoscópica

Objective: The aim of this study was to measure the changes in lung volume, pulmonary ventilation, maximum respiratory muscle strength, and the incidence of pulmonary complications in patients undergoing elective laparoscopic cholecystectomy. Type of study: Prospective study. Material and methods: Twenty patients (7 men and 13 women) with mean age of 42.7 years with normal respiratory function were studied. All patients in the preoperative period answered a long questionnaire, had a physical examination done, and had their lung volumes, respiratory muscle strength, diaphragmatic index and pulse oximetry determined. All measurements were repeated on the 1st, 2nd, 3rd and 6th postoperative days. Results: Patients showed a significant decrease (p < 0.05) on the first postoperative day: 26% ± 13% in tidal volume; 20% ± 14% in minute volume; 36% ± 17% in vital capacity; 47% ± 17% in maximum inspiratory pressure, 39% ± 27% in the maximum expiratory pressure and 36% ± 25% in diaphragmatic index. Tidal volume, minute volume and maximum expiratory pressure returned to their basal values on the third postoperative day; vital capacity, maximum inspiratory pressure and diaphragmatic index returned to their basal values between the 4th and 6th postoperative days. Among the 20 patients pulmonary complication was observed in just one patient (lobar atelectasis); there was a full recovery by the third postoperative day with the use of chest physical therapy techniques. Conclusion: The authors conclude that patients undergoing a laparoscopic cholecystectomy show a significant decrease in lung volume and in respiratory muscle strength on the first postoperative day. But, when these measurements are compared to the literature, return to their basal values is faster (between the 4th and 6th postoperative days) than with conventional surgery.

Analysis of reporting of systematic reviews in physical therapy published in Portuguese

BACKGROUND Systematic reviews are considered the best design to synthesize all existing information of a given research topic. To date, there is no study that investigated the quality of reporting of systematic reviews relevant to physical therapy published in Portuguese. OBJECTIVE To analyse the quality of reporting of systematic reviews in the field of physical therapy published in Portuguese by using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) checklist. METHOD All systematic reviews published in Portuguese that were indexed on PEDro database up to August 2011 were included. The quality of reporting of the eligible papers was analysed by using the PRISMA checklist. Each quality assessment was performed by two independent reviewers with arbitration of a third reviewer if necessary. RESULTS A total of 37 systematic reviews were identified. These studies were published between 2003 and 2010. Less than 30% of the PRISMA checklist items were satisfied, being most of the items related to the introduction and discussion sections. No improvements over time were observed. CONCLUSIONS Most of the studies did not satisfy the items from the PRISMA Checklist. It seems that most of authors did not know the existence of this checklist. The implementation of reporting statements such as the PRISMA statement by Portuguese-written journals is likely to help authors to write their systematic reviews in a more transparent and clear way.

Preoperative six-min walking distance does not predict pulmonary complications in upper abdominal surgery

Background and objective:  Field exercise tests have been increasingly used for pulmonary risk assessment. The six‐min walking distance (6MWD) is a field test commonly employed in clinical practice; however, there is limited evidence supporting its use as a risk assessment method in abdominal surgery. The aim was to assess if the 6MWD can predict the development of post‐operative pulmonary complications (PPCs) in patients having upper abdominal surgery (UAS).

Oxygen delivery-utilization mismatch in contracting locomotor muscle in COPD: peripheral factors

Central cardiorespiratory and gas exchange limitations imposed by chronic obstructive pulmonary disease (COPD) impair ambulatory skeletal muscle oxygenation during whole body exercise. This investigation tested the hypothesis that peripheral factors per se contribute to impaired contracting lower limb muscle oxygenation in COPD patients. Submaximal neuromuscular electrical stimulation (NMES; 30, 40, and 50 mA at 50 Hz) of the quadriceps femoris was employed to evaluate contracting skeletal muscle oxygenation while minimizing the influence of COPD-related central cardiorespiratory constraints. Fractional O₂ extraction was estimated by near-infrared spectroscopy (deoxyhemoglobin/myoglobin concentration; deoxy-[Hb/Mb]), and torque output was measured by isokinetic dynamometry in 15 nonhypoxemic patients with moderate-to-severe COPD (SpO2 = 94 ± 2%; FEV₁ = 46.4 ± 10.1%; GOLD II and III) and in 10 age- and gender-matched sedentary controls. COPD patients had lower leg muscle mass than controls (LMM = 8.0 ± 0.7 kg vs. 8.9 ± 1.0 kg, respectively; P < 0.05) and produced relatively lower absolute and LMM-normalized torque across the range of NMES intensities (P < 0.05 for all). Despite producing less torque, COPD patients had similar deoxy-[Hb/Mb] amplitudes at 30 and 40 mA (P > 0.05 for both) and higher deoxy-[Hb/Mb] amplitude at 50 mA (P < 0.05). Further analysis indicated that COPD patients required greater fractional O₂ extraction to produce torque (i.e., ↑Δdeoxy-[Hb/Mb]/torque) relative to controls (P < 0.05 for 40 and 50 mA) and as a function of NMES intensity (P < 0.05 for all). The present data obtained during submaximal NMES of small muscle mass indicate that peripheral abnormalities contribute mechanistically to impaired contracting skeletal muscle oxygenation in nonhypoxemic, moderate-to-severe COPD patients.

Cough Impairment and Risk of Postoperative Pulmonary Complications After Open Upper Abdominal Surgery

BACKGROUND: Cough impairment is often described as part of the pathophysiological basis of postoperative pulmonary complications (PPCs). However, there have been few studies examining cough effectiveness and its relationship with PPCs following open upper abdominal surgery. The goal of this study was to estimate (1) changes in cough efficacy after upper abdominal surgery through the assessment of peak cough flow and (2) the extent to which cough impairment is associated with postoperative pain, FVC, and risk of PPCs. METHODS: This prospective cohort study assessed 101 subjects (45% male, 56 ± 16 y old) admitted for elective upper abdominal surgery. Measurements of peak cough flow and FVC were performed on the day before surgery and repeated on postoperative days 1, 3, and 5. PPCs were assessed daily by a pulmonologist blinded to the cough measurement results. RESULTS: Peak cough flow dropped to 54% of the preoperative value on postoperative day 1 and gradually increased on postoperative days 3 (65%) and 5 (72%) (P < .05). On all postoperative days, peak cough flow was strongly correlated with FVC (P < .001) and weakly correlated with pain (P = .006). Six subjects (6%) developed PPCs. The association between peak cough flow and risk of PPCs was not statistically significant (unadjusted odds ratio of 0.80, 95% CI 0.45–1.40, P = .44; adjusted odds ratio of 0.66, 95% CI 0.32–1.38, P = .41). CONCLUSIONS: Cough effectiveness is impaired after upper abdominal surgery. Postoperative restrictive lung dysfunction seems to be associated with this impairment. There is no significant association between peak cough flow and PPCs; however, cough impairment might result in clinically important consequences in a high-risk population.

Surgical Approach Does Not Affect Perioperative Respiratory Morbidity in Living Donor Nephrectomy: Comparison Between Anterior Subcostal Incision and Flank Incision

BACKGROUND Living donor nephrectomy has been a routine surgical procedure that significantly increased the number of organs for patients with end-stage renal disease. Upper abdominal surgeries, especially when performed with an open approach, usually lead to a postoperative reduction in lung volumes and pulmonary compliance, which may predispose to the development of atelectasis and pulmonary mucus retention, important risk factors for postoperative pulmonary infections. AIM This study sought to compare lung function impairment, pain, and the incidence of postoperative pulmonary complications among live nephrectomy donors undergoing either an open donor nephrectomy through an anterior subcostal incision (SC) or a flank incision (FL). PATIENTS AND METHODS Between 2006 and 2008, 110 subjects (44 SC/66 FL) had their pulmonary functions (spirometry) and pain (visual analog scale) evaluated preoperatively as well as on postoperative days 1, 2, 3, and 5. Postoperative pulmonary complications were evaluated daily by a pulmonary physician. A chest radiograph was obtained on postoperative day 2 to evaluate the presence of atelectasis. RESULTS Both groups were similar before surgery. Patients in both groups showed decreased pulmonary function from day 1 to 3 (P < .05). Subjective pain was increased until day 5 (P < .05) with a higher incidence of atelectasis among 36% FL vs. 25% SC. (P > .05). CONCLUSION Living donor nephrectomy through either a flank incision or an anterior subcostal incision showed similar degrees of postoperative pain, decreased lung function, and pulmonary complications.

Measurement properties of the Human Activity Profile questionnaire in hospitalized patients

Highlights • Inactivity is an important predictor of poor outcomes in inpatients.• The HAP has been used in healthy and symptomatic populations.• The HAP assesses physical activities ranging from very easy to very strenuous.• The HAP has adequate measurement properties to assess inpatients.

Lung function and functional capacity among foundry workers using effective risk control measures.

BACKGROUND Inhaled dust in the environment can trigger specific reactions in the airways and cause various respiratory diseases. OBJECTIVE Evaluate the lung function and functional capacity of foundry workers who are exposed to metals and use effective control measures. METHOD A cross-sectional study was realized with 108 workers at a bronze foundry and machining plant and in maintenance at a private university, both in Brazil. The workers were divided into two groups: the study group exposed to metals but using risk control measues and a control group not exposed to metal work. The Medical Research Council Questionnaire on Respiratory Symptoms and the International Physical Activity Questionnaire were administered, and lung function and functional capacity were evaluated. Comparative statistics were used to identify differences in the outcome measures between the two groups. RESULTS The groups had similar personal and anthropometric characteristics and time on the job. Spirometry and peak expiratory flow presented no significant differences between the groups. And there was also no statistically significant difference between groups in functional capacity as assessed by performance on the six-minute walk test. CONCLUSION Foundry industry workers in Brazil who were exposed to metal but used risk control measures had similar lung function and functional capacity when compared to the control group who were not exposed to metal. This is a positive results and maybe related to age, time exposure and control of occupational hazards. However, these workers need to continue being monitored in longitudinal studies.