Rita C. V. Passarelli

Adhesiveness and purulence of respiratory secretions: implications for mucociliary transport in patients with bronchiectasis

OBJECTIVE To analyze and compare the transport properties of respiratory secretions, classified by selected parameters, in individuals with bronchiectasis unrelated to cystic fibrosis. METHODS We collected mucus samples from 35 individuals with bronchiectasis unrelated to cystic fibrosis. The samples were first classified by their surface properties (adhesive or nonadhesive), as well as by their aspect (mucoid or purulent). We then tested the samples regarding relative transport velocity (RTV), displacement in a simulated cough machine (SCM), and contact angle (CA). For the proposed comparisons, we used ANOVA models, with a level of significance set at 5%. RESULTS In comparison with nonadhesive samples, adhesive samples showed significantly less displacement in the SCM, as well as a significantly higher CA (6.52 ± 1.88 cm vs. 8.93 ± 2.81 cm and 27.08 ± 6.13º vs. 22.53 ± 5.92º, respectively; p < 0.05 for both). The same was true in the comparison between purulent and mucoid samples (7.57 ± 0.22 cm vs. 9.04 ± 2.48 cm and 25.61 ± 6.12º vs. 21.71 ± 5.89º; p < 0.05 for both). There were no significant differences in RTV among the groups of samples, although the values were low regardless of the surface properties (adhesive: 0.81 ± 0.20; nonadhesive: 0.68 ± 0.24) or the aspect (purulent: 0.74 ± 0.22; mucoid: CONCLUSIONS The respiratory secretions of patients with bronchiectasis showed decreased mucociliary transport. Increased adhesiveness and purulence cause the worsening of transport properties, as demonstrated by the lesser displacement in the SCM and the higher CA.

Effects of dorsal and lateral decubitus on peak expiratory flow in healthy subjects

BACKGROUND One of the measures of the pulmonary function is the peak expiratory flow (PEF) that can be defined as the major flow obtained in an expiratory pressure after a complete inspiration to the level of the total lung capacity. This measure depends on the effort and strength of expiratory muscles, the airway diameter and the lung volume. OBJECTIVE To compare the results of the peak expiratory flow in healthy male and female obtained in a seated position and dorsal decubitus (DD), right lateral decubitus (RLD) and left lateral decubitus (LLD). METHOD Thirty young subjects with mean age 22.7 years, healthy and non-smokers were included at the study, 15 of male sex. They did spirometry and IPAQ questionnaire to check the normal pulmonary function and physical activity level. The measures of PEF were performed in four positions, being performed 3 measures in which position, in a random order. Statistical analysis was performed according to Students t test, with significance level set at 5%. RESULTS There was a difference between the values obtained in sitting position (481±117.1 L/min) with DD(453.2±116.3 L/min) and RLD (454±112.9 L/min) (p<0.05), however, did not find a significant difference between the sitting position and LLD (469±83 L/min). CONCLUSIONS Body position affects the values of PEF, with decreasing values in DD and RLD. The LLD can be an alternative to optimize the expiratory flow in situations of constraint to the sitting position.

Avaliação da força muscular inspiratória (PImáx) durante o desmame da ventilação mecânica em pacientes neurológicos internados na unidade de terapia intensiva

A ventilacao mecânica, frequentemente necessaria em pacientes em estado critico, pode ser associada a perda de forca muscular respiratoria por diversos mecanismos. Nosso objetivo foi avaliar a progressao da forca da musculatura respiratoria durante o processo de desmame, por mensuracao seriada da PImax ate a independencia completa da ventilacao mecânica em pacientes neurologicos. A PImax foi avaliada evolutivamente, uma vez ao dia, durante todo o periodo de desmame, com auxilio de manovacuometro e valvula unidirecional. Foram incluidos no estudo 31 pacientes neurologicos (pos acidente vascular ou trauma crânio-encefalico) em desmame ventilatorio e os valores obtidos foram comparados aos previstos, segundo Black e Hyatt. A media de PImax inicial (primeiro dia do desmame) foi - 40,0±20,0 cmH2O (39% do previsto) (p< 0, 05); 50% no 5o e 60% no 10o dia de desmame. Houve um aumento de 21% (p<0,05) do 1o ao 10o dia. Todos os pacientes foram completamente retirados da ventilacao mecânica ate o 13o dia de desmame. Sendo assim, a evolucao ascendente da forca muscular inspiratoria, em pacientes em ventilacao mecânica prolongada, demonstra que a independencia completa do ventilador, em paciente neurologicos, e possivel a partir de 72% dos valores previstos.