During the anhepatic phase of conventional liver transplantation (LT), the inferior vena cava (IVC) is crossclamped and venovenous bypass (VVB) is usually indicated for diversion of IVC and portal blood flow. VVB can theoretically lead to pulmonary complications due to the contact of the blood with the surfaces of the circuit. In the piggyback method, preservation of the IVC avoids VVB. The aim of this study is to compare pulmonary alterations after conventional with VVB versus piggyback LT. Sixtyseven patients were randomized for conventional VVB (n ‫؍‬ 34) or piggyback (n ‫؍‬ 33) LT. Pulmonary static compliance (C st ) and Pa O2 /F IO2 ratio were measured preand post-LT. Chest X-rays were obtained daily from the 1st to the 5th postoperative day. Pre-and post-LT C st were 73.4 ؎ 36.0 mL/cm H 2 O and 59.7 ؎ 22.0 mL/cm H 2 O in the conventional group and 69.1 ؎ 20.0 mL/cm H 2 O and 58.7 ؎ 27.1 mL/cmH 2 O in the piggyback group. The difference between the two groups was not significant (P ‫؍‬ .702). C st significantly decreased after LT (P ‫؍‬ .008). The pre-and post-LT Pa O2 /F IO2 were 455.6 ؎ 126.6 mm Hg and 463.1 ؎ 105.9 mm Hg in the conventional group and 468.9 ؎ 114.1 mm Hg and 483.3 ؎ 119.8 mm Hg in the piggyback group. The difference among the two groups was not significant (P ‫؍‬ 0.331). There was no significant difference after LT (P ‫؍‬ .382). Upon the radiological evaluation, piggyback group presented a higher frequency of pulmonary infiltrates (80.6% vs. 50.0%; P ‫؍‬ .025). In conclusion, piggyback LT recipients have a higher rate of pulmonary infiltrates when compared to those operated upon using the conventional VVB method. (Liver Transpl 2004;10:425-433.) C urrently, 2 main methods of liver transplantation (LT) are employed. 1 In the conventional method, the retrohepatic portion of the inferior vena cava (IVC) is cross-clamped and resected in block with the native liver. This maneuver can lead to pulmonary complications secondary to the temporary reduction of the venous blood return of the lower extremities and splanchnic bed. 2 Patients with poor hemodynamic tolerance to IVC and portal vein clamping will require fluid infusion during the anhepatic phase. 2 After graft reperfusion, the restoration of the venous return results in a sudden central volume overload that can cause pulmonary edema. 2 A concurrent mechanism is the release into the systemic circulation of proinflammatory substances produced in the graft itself during the ischemia-reperfusion injury, and in the obstructed venous beds during blood stagnation. 3 These substances may produce left ventricle dysfunction, increase pulmonary capillary pressure, and alter capillary permeability. 3 All these actions can contribute to pulmonary dysfunction.To overcome these disorders, venovenous bypass (VVB) is usually indicated, allowing the diversion of the IVC and portal blood flow to the superior vena cava. 2 Despite these advantages, VVB can also cause pulmonary complications. Although rare, some can be fatal, like air or thrombotic pulmonary em...

The Flutter VRP1 and Shaker devices had a similar performance to that of Acapella in many aspects, except for PEP.

Objective: To evaluate respiratory muscle strength and hand strength in patients on a liver transplant waiting list and to associate these with mortality. Methods: one hundred and thirty-two patients who underwent routine physical therapy evaluation while waiting for liver transplantation were studied retrospectively. Respiratory muscle strength was assessed by measuring the maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP), and upper-limb strength was evaluated by dynamometry. The patients were divided into two groups: group A, consisting of 51 patients (14 females, 50.1±12.3 years) who died while on the waiting list; and group B, consisting of 81 patients (31 females, 45.0±3.8 years) who survived until the time of liver transplant. Student's t test was used with a 5% significance level. Results: The mean MIP values for groups A and B were 65.7±28.0 and 77.5±33.8mmHg (p=0.04), respectively, and the mean MEP values were 72.9±32.9 and 84.4±33.1mmHg (p=0.07), respectively. The mean values for left-hand strength in groups A and B were 18.5±8.1 and 21.5±10.5kgf (p=0.08), and the mean values for right-hand strength were 20.2±9.7 and 23.5±12.5kgf (p=0.10), respectively. Conclusions: MIP was lower in the patients who died while waiting for liver transplantation. In the same group, it was observed that the MEP values and right and left-hand strength were numerically lower, although they did not reach statistically significant differences.Key words: liver transplantation; respiratory muscles; mortality; hand strength; physical therapy. ResumoObjetivo: Avaliar a força de músculos respiratórios e de mão em pacientes na lista de espera para o transplante de fígado e associá- Palavras-chave: transplante de fígado; músculos respiratórios; mortalidade; força da mão; fisioterapia.

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Reference values were established for the 6MWT in healthy children aged 7-12 y in Brazil.