Rodrigo Cerqueira Borges

Physical Activity In Daily Life In Brazilian COPD Patients During and After Exacerbation

Abstract Background: Although hospitalization is recognized as an important cause of reduction in physical activity in daily life (PADL) in COPD, there is only one study evaluating this effect, and it was performed in European COPD patients who have a lower PADL than that of South American COPD patients. Objectives: To investigate the effect of hospitalization due to acute exacerbation of PADL in Brazilian COPD patients and to evaluate the factors that determines the physical activity levels during hospitalization and after discharge. Methods: PADL was quantified using a 3-axis accelerometer on the 3rd day of hospitalization and 1 month after discharge in Brazilian COPD patients who were hospitalized due to disease exacerbation. Six-minute walking distance (6MWD), lower limb strength and pulmonary function were also evaluated. Results: A total of 20 patients completed the study. During hospitalization, patients spent most of the time (87%) lying down or sitting; however, 1 month after they were walking >40 min/day. In addition, patients with prior hospitalization had a lower level of physical activity compared to those without a previous history of hospitalization. The time spent walking during hospitalization was significantly explained by the quadriceps strength (r2 = 0.29; p < 0.05), while 1 month after, the time spent walking was only significantly explained by the 6MWD (r2 = 0.51; p = 0.02). Conclusions: Brazilian COPD patients are inactive during hospitalization but become active 1 month after discharge. Previously hospitalized are more inactive both during and after exacerbation. The quadriceps strength and 6MWD explain the physical activity levels during hospitalization and at home, respectively.

Impact of Resistance Training in Chronic Obstructive Pulmonary Disease Patients During Periods of Acute Exacerbation

OBJECTIVE To evaluate the effects of whole-body resistance training on exercise capacity, health-related quality of life (HRQOL), and muscle strength in patients hospitalized for exacerbation of chronic obstructive pulmonary disease. DESIGN Randomized controlled trial. SETTING University hospital. PARTICIPANTS Patients (N=46) were randomized to either a control group (CG) or training group (TG), and 29 patients completed the study. INTERVENTION Training consisted of weight-lifting exercises for 6 muscle groups in the upper and lower limbs (2 sets of 8 repetitions each), and the initial load was set at 80% of the 1-repetition maximum load. MAIN OUTCOME MEASURES Patients were evaluated on the second day of hospitalization, at hospital discharge, and 30 days postdischarge. Patients were evaluated on the basis of the 6-minute walking distance (6MWD), HRQOL, muscle strength, systemic inflammatory markers, and level of physical activity in daily life (PADL). RESULTS The CG showed a reduction in the strength of lower-limb muscles (P<.05) but not in the 6MWD (P>.05). In contrast, patients from the TG improved strength in the lower-limb muscles and 6MWD during and 30 days after hospitalization (P<.05). The TG also improved the impact domain in HRQOL after hospitalization. No improvement in PADL was observed in the TG. Finally, a reduction in the blood levels of inflammatory markers was observed only in the TG after hospitalization. CONCLUSIONS Our results suggest that resistance training during hospitalization improves the 6MWD, HRQOL, and lower-limb muscle strength, without altering the levels of systemic inflammation. However, future research should explore this intervention in larger randomized trials.

Changes in plasma free fatty acid levels in septic patients are associated with cardiac damage and reduction in heart rate variability

Free fatty acids (FFAs) have been shown to produce alteration of heart rate variability (HRV) in healthy and diabetic individuals. Changes in HRV have been described in septic patients and in those with hyperglycemia and elevated plasma FFA levels. We studied whether sepsis-induced heart damage and HRV alteration are associated with plasma FFA levels in patients. Thirty-one patients with sepsis were included. The patients were divided into two groups: survivors (n = 12) and nonsurvivors (n = 19). The following associations were investigated: (a) troponin I elevation and HRV reduction; and (b) clinical evolution and HRV index, plasma troponin, and plasma FFA levels. Initial measurements of C-reactive protein and gravity Acute Physiology and Chronic Health Evaluation scores were similar in both groups. Overall, an increase in plasma troponin level was related to increased mortality risk. From the first day of study, the nonsurvivor group presented a reduced left ventricular stroke work systolic index and a reduced low frequency (LF) that is one of the HRV indexes. The correlation coefficient for LF values and troponin was r2 = 0.75 (P < 0.05). All patients presented elevated plasma FFA levels on the first day of the study (5.11 ± 0.53 mg/ml), and this elevation was even greater in the nonsurvivor group compared with the survivors (6.88 ± 0.13 vs 3.85 ± 0.48 mg/ml, respectively; P < 0.05). Cardiac damage was confirmed by measurement of plasma troponin I and histological analysis. Heart dysfunction was determined by the left ventricular stroke work systolic index and the HRV index in nonsurvivor patients. A relationship was found between plasma FFA levels, Lfnu index, troponin levels, and histological changes. Plasma FFA levels emerged as a possible cause of heart damage in sepsis.

Two 6-minute Walk Tests Are Required During Hospitalisation for Acute Exacerbation of COPD

Abstract The 6-minute walk test (6MWT) is recommended to be performed twice to accurately assess exercise performance in stable chronic obstructive pulmonary disease (COPD) due to the presence of a learning effect. It is unknown whether a learning effect exists when the 6MWT is performed during hospitalisation for acute exacerbation of COPD (AECOPD). This study investigated whether repeat 6MWTs are necessary when conducted in inpatients with AECOPD. Pooled analysis was undertaken of data from two studies (Australia and Brazil) involving 46 participants (25 males, mean age 67.2 years, FEV1 43% predicted) admitted with AECOPD. Two 6MWTs, separated by ≥20 minutes, were performed on the day of discharge. Six-minute walk distance (6MWD; primary outcome), perceived dyspnoea (Borg scale), heart rate and oxyhaemoglobin saturation were recorded. 6MWD data from tests one (T1) and two (T2) were analysed via visual inspection of Bland-Altman plots. Factors associated with test improvement or decline were explored. Mean 6MWD difference between T1 and T2 was 6.2 m, however limits of agreement were wide (−92.2 m to 104.5 m). 32 (70%) participants improved (by any distance) from T1 to T2 by a mean (± standard deviation) of 32 m ± 28 m. Of these, 14 (30%) improved by a distance > 30 m. Fourteen (30%) participants recorded poorer 6MWD at T2 by a mean of 52 m ± 36 m. No factors were able to identify participants who improved or declined upon repeat testing. When performed in patients admitted to hospital with AECOPD, the 6MWT needs to be conducted twice in order to better estimate 6MWD.

Acute effect of low-dose corticosteroids on muscle function in patients with severe sepsis and septic shock

The rationale for the use of glucocorticoids in severe sepsis and septic shock can be attributed to well-defined anti-inflammatory and hemodynamic effects recognized for decades. However, with the introduction of corticosteroid therapy for a variety of conditions, it was reported that this treatment could induce a myopathy. Animal studies have confirmed that the administration of high doses of corticosteroid can produce myopathy affecting both ventilatory and peripheral skeletal muscles. Actually, it remains uncertain whether doses of corticosteroid, typically used to manage patients with severe sepsis and septic shock, do in fact cause peripheral and respiratory muscle weakness.

Predictive factors of noninvasive ventilation failure in a pediatric ICU.

Noninvasive ventilation (NIV) has been developed to reduce complications associated with tracheal intubation and conventional mechanical ventilation. The aim of NIV is to gain control of acute respiratory failure, avoiding intubation; however, when intubation is required, its application should not be delayed, as this may result in a worse prognosis. This is the main reason to look for reliable failure signs of the technique.