The use of the Flutter(®)VRP1 for four weeks is capable of altering the respiratory secretion transport properties, and this alteration is related to the high frequency oscillation component.
A ventilação mecânica, freqüentemente necessária em pacientes em estado crítico, pode ser associada à perda de força muscular respiratória por diversos mecanismos. Nosso objetivo foi avaliar a progressão da força da musculatura respiratória durante o processo de desmame, por mensuração seriada da PImáx até a independência completa da ventilação mecânica em pacientes neurológicos. A PImáx foi avaliada evolutivamente, uma vez ao dia, durante todo o período de desmame, com auxílio de manovacuômetro e válvula unidirecional. Foram incluídos no estudo 31 pacientes neurológicos (pós acidente vascular ou trauma crânio-encefálico) em desmame ventilatório e os valores obtidos foram comparados aos previstos, segundo Black e Hyatt. A média de PImáx 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 ventilação mecânica até o 13º dia de desmame. Sendo assim, a evolução ascendente da força muscular inspiratória, em pacientes em ventilação mecânica prolongada, demonstra que a independência completa do ventilador, em paciente neurológicos, é possível a partir de 72% dos valores previstos.
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 ± 6.13° vs. 22.53 ± 5.92°, 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 ± 6.12° vs. 21.71 ± 5.89°; 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: 0.82 ± 0.22). 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.Keywords: Bronchiectasis; Mucus; Mucociliary clearance; Adhesiveness. ResumoObjetivo: Analisar e comparar as propriedades de transporte de secreções respiratórias, classificadas através de parâmetros selecionados, de indivíduos com bronquiectasias não secundárias à fibrose cística. Métodos: Foram avaliadas amostras de muco respiratório, classificadas como com propriedades de superfície adesivas ou não adesivas, assim como com aspecto mucoide ou purulento, de 35 participantes com bronquiectasias não secundárias à fibrose cística, quanto a velocidade relativa de transporte (VRT), deslocamento em máquina simuladora de tosse (MST) e ângulo de contato (AC). Para as comparações propostas, foram utilizados modelos de ANOVA, com nível de significância estabelecido em 5%. Resultados: Houve uma diminuição significativa no deslocamento em MST, assim como um aumento significativo no AC, das amostras adesivas quando comparadas às não adesivas (6,52 ± 1,88 cm vs. 8,93 ± 2,81 cm e 27,08 ± 6,13° vs. 22,53 ± 5,92°, respectivamente; p < 0,05 para ambos). O mesmo ocorreu na comparação entre as amostras purulentas e mucoides (7,57 ± 0,22 cm vs. 9,04 ± 2,48 cm e 25,61 ± 6,12° vs. 21,71 ± 5,89°; p < 0,05 para ambos). Não houve diferença na VRT entre os grupos, embora os valores estivessem diminuídos, independentemente da adesividade (adesivas: 0,81 ± 0,20; não adesivas: 0,68 ± 0,24) ou do aspecto (purulentas: 0,74 ± 0,22; mucoides: 0,82 ± 0,22) das a...
Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Fundação Adib Jatene Background/Introduction: Peak oxygen uptake (peak VO2) measures cardiovascular fitness and is a valuable diagnostic and prognostic marker in patients with heart failure with preserved ejection fraction (HFpEF). Measurement of peak VO2, however, requires specialized equipment and expert supervision, limiting its routine use by practicing clinicians. Strain curves obtained by speckle tracking echocardiography (STE) can provide different parameters of myocardial mechanics such as the Global Longitudinal Strain (GLS), which is the most robust STE feature for clinical practice. Notwithstanding, there is conflicting data on whether the GLS is associated with peak VO2 in HFpEF subjects. Moreover, few studies have addressed the relationship between peak VO2 and other interesting deformation parameters such as the left atrial (LA) reservoir strain or the left ventricular mechanical dispersion (MD). Purpose The present study aimed to examine the utility of the myocardial mechanics as assessed by STE in predicting peak VO2 in patients with HFpEF. Methods From an ongoing prospective cohort of 189 subjects, we sampled subjects with different HFpEF stages. All patients underwent cardiopulmonary exercise testing (CPX) and a 2D-STE (LV GLS, MD, LA reservoir strain, LA conduit strain, and LA contraction strain) obtained by a blinded examinator. The missing data was handled by complete case analysis approach. We excluded subjects who had atrial fibrillation/flutter, severe COPD, STE with poor tracking quality, CPX with respiratory exchange rate (RER) < 1. The Spearman"s correlation was calculated, and the 95% CI were estimated. Finally, an estimative of the STE features importance to predict peak VO2 < 20mL/Kg/min was done using the function "xgb.importance()" from machine learning model XGBoost in R software. XGBoost is a variant of Gradient Boosting Method that uses ensembles of decision trees. Results We obtained 74 subjects (23 without evidence of heart disease, 23 with pre-heart failure and 28 with HFpEF). The MD presented the highest correlation with peak VO2 (Rho=-0.48; p-value < 0.001) followed by LA reservoir strain (Rho = 0.40; p-value < 0.001), LA conduit strain (Rho= –0.36; p-value < 0.001) and LA contraction (Rho= –0.30 p-value < 0.004) as shown in Figure 1. However, no correlation was found between GLS and peak VO2 (Rho= –0.07 p-value < 0.5) (Figure 2A). The feature importance score (Figure 2B) showed the MD as the best relative contribution for VO2 prediction (gain= 0.34) superior to LA reservoir strain (gain = 0.25). GLS presented contribution (gain = 20) superior to LA conduit strain (gain =10) and LA contraction strain (gain = 0.08). Conclusion Left ventricular mechanical dispersion and left atrial reservoir strain obtained with STE were better predictors of peak VO2 than GLS in patients with different HFpEF stages and may be helpful in risk stratification and diagnosis. Abstract Figure 1 Abstract Figure 2
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