This study aims to gather and present scientific evidence on the role of a physiotherapist in the pre, peri and postoperative of pediatric cardiac surgery. This professional is able to prevent, minimize or reverse possible respiratory dysfunction and motor sequelae resulting from these interventions. Studies discuss the involvement of respiratory system, specifically the clearance of bronchial secretions and ventilatory adequacy, as a result of surgical procedure. Scientific evidences suggest the effectiveness of physiotherapy in reducing indices of: pneumonia, atelectasis, hospitalization, sequelae deleterious, and length of bed restriction, beyond clinical improvement. These data confirm positive contribution of physiotherapeutic intervention in these surgeries.Descriptors: Physical Therapy Modalities. Cardiac Surgical Procedures. Heart Defects, Congenital. ResumoO objetivo deste estudo é reunir e apresentar evidências científicas sobre a atuação do fisioterapeuta nos períodos pré, peri e pós-operatório da cirurgia cardíaca pediátrica. Esse profissional está habilitado a prevenir, minimizar e reverter possíveis disfunções respiratórias e sequelas motoras decorrentes dessas intervenções. Estudos discutem o comprometimento do sistema respiratório, especificamente do clearance de secreção brônquica e da adequação ventilatória, resultantes do procedimento cirúrgico, havendo evidências científicas quanto à eficácia da fisioterapia na redução: dos índices de pneumonias, atelectasias, período de internação, sequelas deletérias, tempo de restrição ao leito, além da melhora clínica. Esses dados atestam a contribuição positiva da intervenção fisioterapêutica nessas cirurgias. Rev Bras Cir Cardiovasc 2011;26(2):264-72 Descritores

Obese children showed increased oscillometry parameters values representative of airway obstruction, compared to normal-weight children. Changes in some oscillometry parameters can already be observed in overweight school-aged children.

Background Among the many consequences of loss of CFTR protein function, a significant reduction of the secretion of bicarbonate (HCO 3 −) in cystic fibrosis (CF) is a major pathogenic feature. Loss of HCO 3 − leads to abnormally low pH and impaired mucus clearance in airways and other exocrine organs, which suggests that NaHCO 3 inhalation may be a low-cost, easily accessible therapy for CF. Objective To evaluate the safety, tolerability, and effects of inhaled aerosols of NaHCO 3 solutions (4.2% and 8.4%). Methods An experimental, prospective, open-label, pilot, clinical study was conducted with 12 CF volunteer participants over 18 years of age with bronchiectasis and pulmonary functions classified as mildly to severely depressed. Sputum rheology, pH, and microbiology were examined as well as spirometry, exercise performance, quality-of-life assessments, dyspnea, blood count, and venous blood gas levels. Results Sputum pH increased immediately after inhalation of NaHCO 3 at each clinical visit and was inversely correlated with rheology when all parameters were evaluated: [G′ (elasticity of the mucus) = − 0.241; G″ (viscosity of the mucus) = − 0.287; G* (viscoelasticity of the mucus) = − 0.275]. G* and G′ were slightly correlated with peak flow, forced expiratory volume in 1 s (FEV 1), and quality of life; G″ was correlated with quality of life; sputum pH was correlated with oxygen consumption (VO 2) and vitality score in quality of life. No changes were observed in blood count, venous blood gas, respiratory rate, heart rate, peripheral oxygen saturation of hemoglobin (SpO 2), body temperature, or incidence of dyspnea. No adverse events associated with the study were observed. Conclusion Nebulized NaHCO 3 inhalation appears to be a safe and well tolerated potential therapeutic agent in the management of CF. Nebulized NaHCO 3 inhalation temporarily elevates airway liquid pH and reduces sputum viscosity and viscoelasticity.

Introduction. The index of ventilatory efficiency (VE/VCO2) obtained by the progressive exercise test has been considered the gold standard in the prognosis of adults with heart failure, but few studies have evaluated this approach in children. Objective. To verify the scientific evidence about the VE/VCO2 in pediatric and adolescents patients. Methods. A systematic literature review was carried out using the key words VE/VCO2, children, and adolescents using the PEDro and PubMed/MedLine databases. Clinical trials published from 1987 to 2014, including children, adolescents, and young adults up to 25 years, addressing the VE/VCO2 index as a method of evaluation, monitoring, and prognosis were considered. Results. Initially, 95 articles were found; 12 were excluded as the title/abstract did not contain the VE/VCO2 index or because they included patients greater than 25 years of age. From the remaining 83, 58 were repeated between the databases. The final sample consisted of 32 studies including healthy children and children with respiratory and other diseases. Conclusion. There are few studies involving cardiorespiratory assessment by ventilatory efficiency. The studies highlight the fact that high VE/VCO2 values are associated with a worse prognosis of patients due to the relationship with the decrease in pulmonary perfusion and cardiac output.

BackgroundExercise has been studied as a prognostic marker for patients with cystic fibrosis (CF), as well as a tool for improving their quality of life and analyzing lung disease. In this context, the aim of the present study was to evaluate and compare variables of lung functioning. Our data included: (i) volumetric capnography (VCAP) parameters: expiratory minute volume (VE), volume of exhaled carbon dioxide (VCO2), VE/VCO2, ratio of dead space to tidal volume (VD/VT), and end-tidal carbon dioxide (PetCO2); (ii) spirometry parameters: forced vital capacity (FVC), percent forced expiratory volume in the first second of the FVC (FEV1%), and FEV1/FVC%; and (iii) cardiorespiratory parameters: heart rate (HR), respiratory rate, oxygen saturation (SpO2), and Borg scale rating at rest and during exercise. The subjects comprised children, adolescents, and young adults aged 6–25 years with CF (CF group [CFG]) and without CF (control group [CG]).MethodsThis was a clinical, prospective, controlled study involving 128 male and female patients (64 with CF) of a university hospital. All patients underwent treadmill exercise tests and provided informed consent after study approval by the institutional ethics committee. Linear regression, Kruskal–Wallis test, and Mann–Whitney test were performed to compare the CFG and CG. The α value was set at 0.05.ResultsPatients in the CFG showed significantly different VCAP values and spirometry variables throughout the exercise test. Before, during, and after exercise, several variables were different between the two groups; statistically significant differences were seen in the spirometry parameters, SpO2, HR, VCO2, VE/VCO2, PetCO2, and Borg scale rating. VCAP variables changed at each time point analyzed during the exercise test in both groups.ConclusionVCAP can be used to analyze ventilatory parameters during exercise. All cardiorespiratory, spirometry, and VCAP variables differed between patients in the CFG and CG before, during, and after exercise.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-015-0056-5) contains supplementary material, which is available to authorized users.

Introdução: O retorno involuntário e frequente do conteúdo gástrico na doença do refluxo gastro-esofágico (DRGE) pode desencadear alterações respiratórias. O método fisioterapêutico de Reequilíbrio Tóraco-Abdominal (RTA) tem como característica minimizar alterações na mecânica respiratória, melhorando a ventilação e o consequente esforço respiratório. Objetivo: Avaliar efeitos imediatos dos manuseios do RTA em parâmetros cardiorrespiratórios, sinais de desconforto respiratório (Boletim de Silvermann-Anderson), dor (escala de Lawrence), comportamento (escala de Prechtl e Beinteman) e sintomas (questionário) em crianças. Métodos: Foram avaliadas dez crianças, com média de idade de 15,01+18,20 meses, sendo os parâmetros de avaliação supracitados verificados antes, imediatamente após e 15 minutos depois da aplicação do RTA. Resultados: A técnica apresentou efeitos positivos no sistema cardiorrespiratório, evidenciado pelo aumento da SpO2, e diminuição da fr, na maioria das crianças com DRGE. Conclusão: A aplicação do Reequilíbrio Tóraco-Abdominal apresentou benefícios nas crianças com DRGE, sem repercutir no comportamento ou provocar intercorrências.

Parameters of VCap such as slope 3, slope 3/VT and slope 3/PetCO correlated with sensitive variables of spirometry such as FEV, FVC and FEV/FVC ratio. For the evaluated variables, there was consistency in the correlation between the two tests, which may indicate the impact of CF on pulmonary physiology.

Objective: To verify repercussions of submaximal exercise testing on respiratory mechanics and pulmonary function in schoolchildren.Methods: Cross-sectional study, with children aged 7 to 14 years, who had their respiratory mechanics assessed by impulse oscillometry (IOS), and pulmonary function by spirometry. They performed the six-minute walk test (6MWT), as per the standards by the American Thoracic Society. The 6MWT was performed twice with a 30-minute interval. IOS and spirometry were performed before the first 6MWT (Pre-6MWT) and immediately after the first (Post-6MWT1) and second walking tests (Post-6MWT2). The results in these three phases were compared by analysis of variance for repeated measures (post-hoc Bonferroni test) or by the Friedman’s test, with p≤0.05 considered significant.Results: Twenty-one subjects participated in the study: 53% were males and mean age was 10.9±2.3 years. There were differences between total resistance (R5) and central airway resistance (R20) at the three phases of assessment (p=0.025 and p=0.041, respectively). Post-hoc analysis indicated increase in R5 when Pre-6MWT and Post-6MWT1 were compared (R5=0.540±0.100 versus 0.590±0.150 kPa/L/s, p=0.013; and R20=0.440±0.800 versus 0.470±0.100 kPa/L/s, p=0.038). Forced expiratory flow 25-75% (FEF25-75%) changed over time (p=0.003).Conclusions: Repercussions were: increase in central and total airway resistance and reduction of FEF25-75% after 6MWT in schoolchildren, suggesting that greater attention should be given to submaximal tests in children with predisposition to airways alterations.