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- ItemAcesso aberto (Open Access)Avaliação Dos Efeitos E Da Segurança Da Técnica De Empilhamento De Ar Em Doentes Submetidos A Operações Intratorácicas Não Cardíacas Eletivas(Universidade Federal de São Paulo (UNIFESP), 2017-06-30) Teodoro, Renata De Jesus [UNIFESP]; Faresin, Sonia Maria [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)It can usually be seen a change in the ventilatory pattern, a decrease in the pulmonary volumes and capacities, a loss of the sigh mechanism, and a decrease in the peak expiratory flow (PEF) and in the peak flow of cough (PFC) after a thoracic surgical intervention. Painful stimuli are very intense and result in the voluntary reduction of respiratory movements, making coughing less effective. The air stacking technique has been studied in patients with neuromyopathies and demonstrated to be able to act positively on the biomechanical components that make up the PEF and PFC, thus raising the hypothesis that the intervention may also be efficient in patients operated on the chest. Objectives: To evaluate the effects and safety of the air stacking technique on PEF and PFC in the postoperative period of patients undergoing intrathoracic operations. Method: Thirty patients undergoing elective non-cardiac thoracic surgery received the air stacking technique on the 3rd postoperative day. All the participants were evaluated in the preoperative period and and physical examination data recorded in an evaluation form containing, clinical diagnosis, surgical indication, comorbidities, habits, use of medications and preoperative spirometric data. The symptoms of dyspnea, pain and measurements, heart rate (HR), respiratory frequency (f), blood pressure (BP), peripheral oxygen saturation (SpO2), maximum inspirational pressure (MIP), maximum expiratory pressure (MEP), PEF and PFC were evaluated in the preoperative and 3rd postoperative days. Results: Nine patients (30%) were female and 21 (70%) were males, with a mean age of 54.1 + 11.8 years. The PFE and PFC increased significantly from 46% + 11 to 103% + 11 and from 45% + 10 to 101% + 4.2 from that predicted after the application of the technique. The Borg dyspnea scale increased from 2.43 + 0.7 to 5.0 + 0.9 points immediately after the intervention, decreasing to 3.2 + 0.84 after 5 minutes. There was significant variation in HR that went from 85 + 9.2 before to 118 + 10 bpm immediately after the technique. The respiratory rate ranged from 15 + 10 rpm before the technique to 28 + 3.4 immediately after and 22.5 + 3 rpmafter 5 minutes. Conclusion: The air stacking technique is efficient in assisting coughing, and feasible in its application, both in safety and acceptance and adherence.
- ItemAcesso aberto (Open Access)Clinical significance in non-cystic fibrosis bronchiectasis followed in a real practice(Pontifícia Universidade Católica do Paraná, 2013-12-01) Faria Júnior, Newton Santos De; Bigatão, Amilcar Marcelo [UNIFESP]; Santos, Sérgio Ricardo [UNIFESP]; Leitão Filho, Fernando Sérgio Studart; Jardim, José Roberto [UNIFESP]; Oliveira, Luis Vicente Franco; Universidade Nove de Julho; Universidade Federal de São Paulo (UNIFESP); University of Fortaleza Medicine SchoolINTRODUCTION: Bronchiectasis is a chronic disorder characterized by permanent dilation of the bronchi and bronchioles accompanied by inflammatory changes in the walls of these structures and adjacent lung parenchyma. OBJECTIVE: The aim of the present study was to perform a clinical and functional characterization of adult patients with non-cystic fibrosis bronchiectasis. METHODS: A clinical, descriptive, retrospective, case-series study was carried out involving 232 patients with non-cystic fibrosis bronchiectasis treated at a lung ambulatory between 2004 and 2012. RESULTS: The sample consisted of 232 patients (134 females; mean age: 52.9 years ± 17.7; body mass index: 23.5 kg/m² ± 4.4). The predominant symptoms were cough (91.4%), expectoration (85.8%) and dyspnea (76.3%). The majority of cases were of a non-tuberculosis etiology (64.7%). Regarding lung function, the obstructive breathing pattern was predominant (43.5%). The most common comorbidities were of a cardiovascular origin (51.0%). CONCLUSIONS: Adult patients with non-cystic fibrosis bronchiectasis (mainly post-infection or post-tuberculosis in origin) are characterized by a low educational level, excessive cough, sputum, dyspnea, muscle fatigue, an obstructive breathing pattern with frequent hypoxemia and multiple comorbidities, mainly of a cardiovascular origin. However, our patients have a low index of exacerbations and hospitalizations that can be assigned to a clinical protocol for monitoring.
- ItemAcesso aberto (Open Access)Efeitos da tosse manualmente assistida sobre a mecânica do sistema respiratório de pacientes em suporte ventilatório total(Sociedade Brasileira de Pneumologia e Tisiologia, 2008-06-01) Avena, Katia de Miranda; Duarte, Antonio Carlos Magalhães; Cravo, Sergio Luiz [UNIFESP]; Sologuren, Maria José Junho; Gastaldi, Ada Clarice [UNIFESP]; Centro Universitário do Triângulo; Hospital Português Serviço de Fisioterapia; Universidade Federal de São Paulo (UNIFESP); Universidade Federal do Estado do Rio de JaneiroOBJECTIVE: Manually assisted coughing (MAC) consists of a vigorous thrust applied to the chest at the beginning of a spontaneous expiration or of the expiratory phase of mechanical ventilation. Due to routine use of MAC in intensive care units, the objective of this study was to assess the effects of MAC on respiratory system mechanics in patients requiring full ventilatory support. METHODS: We assessed 16 sedated patients on full ventilatory support (no active participation in ventilation). Respiratory system mechanics and oxyhemoglobin saturation were measured before and after MAC, as well as after endotracheal aspiration. Bilateral MAC was performed ten times on each patient, with three respiratory cycle intervals between each application. RESULTS: Data analysis demonstrated a decrease in resistive pressure and respiratory system resistance, together with an increase in oxyhemoglobin saturation, after MAC combined with endotracheal aspiration. No evidence of alterations in peak pressures, plateau pressures or respiratory system compliance change was observed after MAC. CONCLUSIONS: The use of MAC alters respiratory system mechanics, increasing resistive forces by removing secretions. The technique is considered safe and efficacious for postoperative patients. Using MAC in conjunction with endotracheal aspiration provided benefits, achieving the proposed objective: the displacement and removal of airway secretions.
- ItemAcesso aberto (Open Access)Empilhamento de ar e compressão torácica aumentam o pico de fluxo da tosse em pacientes com distrofia muscular de Duchenne(Sociedade Brasileira de Pneumologia e Tisiologia, 2009-10-01) Brito, Magneide Fernandes [UNIFESP]; Moreira, Gustavo Antonio [UNIFESP]; Pradella-Hallinan, Márcia Lurdes de Cássia [UNIFESP]; Tufik, Sergio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To evaluate cough efficiency using two manually-assisted cough techniques. METHODS: We selected 28 patients with Duchenne muscular dystrophy. The patients were receiving noninvasive nocturnal ventilatory support and presented FVC values < 60% of predicted. Peak cough flow (PCF) was measured, with the patient seated, at four time points: at baseline, during a spontaneous maximal expiratory effort (MEE); during an MEE while receiving chest compression; during an MEE after air stacking with a manual resuscitation bag; and during an MEE with air stacking and compression (combined technique). The last three measurements were conducted in random order. The results were compared using Pearson's correlation test and ANOVA with repeated measures, followed by Tukey's post-hoc test (p < 0.05). RESULTS: The mean age of the patients was 20 ± 4 years, and the mean FVC was 29 ± 12%. Mean PCF at baseline, with chest compression, after air stacking and with the use of the combined technique was 171 ± 67, 231 ± 81, 225 ± 80, and 292 ± 86 L/min, respectively. The results obtained with the use of the combined technique were significantly better than were those obtained with the use of either technique alone (F[3.69] = 67.07; p < 0.001). CONCLUSIONS: Both chest compression and air stacking techniques were efficient in increasing PCF. However, the combination of these two techniques had a significant additional effect (p < 0.0001).
- ItemAcesso aberto (Open Access)O muco traqueobrônquico humano mantido em temperatura ambiente e suas propriedades físico-químicas(Sociedade Brasileira de Pneumologia e Tisiologia, 2007-02-01) Zanchet, Renata Claudia; Feijó, Gilvânia; Gastaldi, Ada Clarice [UNIFESP]; Jardim, José Roberto [UNIFESP]; Universidade de Brasília; Universidade Católica de Brasília; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To evaluate the effect that maintaining tracheobronchial sputum at room temperature has on the analysis of ciliary transport and cough, as well as on the contact angle. METHODS: Hyaline sputum was collected from 30 individuals without pulmonary diseases, and purulent sputum was collected from patients with bronchiectasis. The samples were analyzed immediately after collection and again after 24 h. RESULTS: After 24 h at room temperature, the purulent sputum presented an increase in cough-induced dislodgment (96 ± 50 vs. 118 ± 61 mm) and a decrease in the contact angle (32 ± 6 vs. 27 ± 6 degrees) (p < 0.05). For the hyaline sputum, there were no alterations in the parameters analyzed. CONCLUSION: Hyaline tracheobronchial sputum can be stored in room temperature for 24 h without presenting alterations in ciliary transport or contact angle. However, purulent sputum should not be stored at room temperature for many hours, since ciliary transport and contact angle might be altered as a result.