Results demonstrate a reduction in the IME in asthmatic adolescents with overweight and obesity, indicating an association between asthma, nutritional status and respiratory muscle function.

BACKGROUND: Pulmonary changes that occur in cystic fibrosis may influence inspiratory muscle strength and endurance. We evaluated inspiratory muscle strength and endurance in children and adolescents with cystic fibrosis in comparison with healthy subjects. METHODS: This is a crosssectional observational study with subjects with cystic fibrosis and paired healthy individuals, age 6 -18 y. Spirometry, impulse oscillometry, plethysmography, manovacuometry, and a protocol of inspiratory muscle endurance were performed. RESULTS: Subjects with cystic fibrosis (n ‫؍‬ 34) had higher maximum percent-of-predicted inspiratory pressure (P Imax ) than healthy (n ‫؍‬ 68) subjects (118.5 ؎ 25.8% vs 105.8 ؎ 18.0%) and no significant difference in endurance (60.9 ؎ 13.3% vs 65.3 ؎ 12.3%). When restricting the analysis to subjects without Pseudomonas aeruginosa colonization and with FEV 1 > 80%, P Imax values were significantly higher, and inspiratory muscle endurance was lower, in comparison with the control group. P Imax correlated significantly with FVC (r ‫؍‬ 0.44, P ‫؍‬ .02) and FEV 1 (r ‫؍‬ 0.41, P ‫؍‬ .02), whereas endurance correlated better with total airway resistance (r ‫؍‬ 0.35, P ‫؍‬ .045) and with central airway resistance (r ‫؍‬ 0.48, P ‫؍‬ .004). CONCLUSIONS: Children and adolescents with cystic fibrosis with no colonization by P. aeruginosa and normal lung function present increased inspiratory muscle strength and decreased endurance compared with healthy individuals, indicating that changes in the respiratory muscle function seem to be distinctly associated with pulmonary involvement. Strength was related to pulmonary function parameters, whereas endurance was associated with airway resistance.

Objective To describe the existing early mobilization protocols in pediatric intensive care units. Methods A systematic literature review was performed using the databases MEDLINE ® , Embase, SciELO, LILACS and PeDRO, without restrictions of date and language. Observational and randomized and nonrandomized clinical trials that described an early mobilization program in patients aged between 29 days and 18 years admitted to the pediatric intensive care unit were included. The methodological quality of the studies was evaluated using the Newcastle-Ottawa Scale, Methodological Index for Non-Randomized Studies and the Cochrane Collaboration. Results A total of 8,663 studies were identified, of which 6 were included in this review. Three studies described the implementation of an early mobilization program, including activities such as progressive passive mobilization, positioning, and discussion of mobilization goals with the team, in addition to contraindications and interruption criteria. Cycle ergometer and virtual reality games were also used as resources for mobilization. Four studies considered the importance of the participation of the multidisciplinary team in the implementation of early mobilization protocols. Conclusion In general, early mobilization protocols are based on individualized interventions, depending on the child's development. In addition, the use of a cycle ergometer may be feasible and safe in this population. The implementation of institutional and multidisciplinary protocols may contribute to the use of early mobilization in pediatric intensive care units; however, studies demonstrating the efficacy of such intervention are needed.

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Objective The primary objective of this study was to identify the occurrence and factors associated with intensive care unit (ICU)–acquired weakness (ICUAW) in patients with COVID-19. Secondarily, we monitored the evolution of muscle strength and mobility among patients with ICUAW and patients without ICUAW and the association of these variables with length of stay, mechanical ventilation (MV), and other clinical variables. Methods In this prospective observational study, patients admitted to the ICU for >72 h with COVID-19 were evaluated for muscle strength and mobility at 3 times: when being weaned from ventilatory support, discharged from the ICU, and discharged from the hospital. Risk factors for ICUAW were monitored. Results The occurrences of ICUAW at the 3 times evaluated among the 75 patients included were 52%, 38%, and 13%. The length of the ICU stay (29.5 [16.3–42.5] versus 11 [6.5–16] days; P ≤ .001), the length of the hospital stay (43.5 [22.8–55.3] versus 16 [12.5–24] days; P ≤ .001) and time on MV (25.5 [13.8–41.3] versus 10 [5–22.5] days; P ≤ .001) were greater in patients with ICUAW. Muscle strength and mobility were lower at all times assessed in patients with ICUAW (P < .05). Bed rest time for all patients (relative risk = 1.14; 95% CI = 1.02–1.28; P = .03 per week) and use of corticosteroids (relative risk = 1.01; 95% CI = 1.00–1.03; P = .01 per day) for those who required MV were factors independently associated with ICUAW. Muscle strength was found to have a positive correlation with mobility and a negative correlation with lengths of stay in the ICU and hospital and time on MV. Conclusions The occurrence of ICUAW was high upon patients’ awakening in the ICU but decreases throughout hospitalization; however, strength and mobility remained compromised at hospital discharge. Bed rest time and use of corticosteroids (for those who needed MV) were factors independently associated with ICUAW in patients with COVID-19.

AimsTo generate reference values for two inspiratory muscle endurance (IME) protocols in healthy children and adolescents.Materials and methodsThis is an observational, cross-sectional study, in healthy children and adolescents from 4 to 18 years of age. Weight, height, maximal inspiratory pressure (MIP) and IME were measured using two protocols. A fixed load of 30% of MIP with a 10% increment every 2 minutes was used in the incremental threshold loading protocol. As for the maximal loading protocol, a fixed load of 70% of MIP was used and the time limit (Tlim) achieved until fatigue was measured.ResultsA total of 462 participants were included, 281 corresponding to the incremental loading protocol and 181 to maximal loading. There were moderate and positive correlations between IME and age, MIP, weight and height in the incremental threshold loading. However, the regression model demonstrated that MIP and age were the best variables to predict the IME. Otherwise, weak and positive correlations with age, weight and height were found in the maximal loading. Only age and height influenced endurance in the regression model. The predictive power (r2) of the incremental threshold loading protocol was 0.65, while the maximal loading was 0.15. The reproducibility measured by the intraclass correlation coefficient (ICC) was higher in the incremental loading (0.96) compared to the maximal loading test (0.69).ConclusionIME in healthy children and adolescents can be explained by age, height and MIP. The incremental threshold loading protocol showed more reliable results and should be the model of choice to evaluate IME in the pediatric age group.

| The aim of the present study was to compare the results of standardization of ventilatory muscle strength data using three international reference values and one Brazilian reference in children and adolescents with cystic fibrosis (CF). This was a retrospective study, which included patients with CF aged 8 to 12 years and in regular follow-up at an outpatient facility. Demographic and anthropometric data were collected. All patients included in the sample should have had ventilatory muscle strength and lung function measured in the past 12 months. The standardization of the results was made using predicted values from each equation. Data were compared using one-way ANOVA. We included 24 patients, 62.5% males, with mean age of 10.5±1.53 years, height 138. 0±0. 08 cm, weight 34. 6±7.9 kg, FEV1 93.29±29. 02% and FVC 103. 78±26. 12%. The maximum inspiratory (MIP) and expiratory (MEP) pressures (cmH2O) observed were 92. 1±22.8 and 98.9±24.5, respectively. After standardization by the different equations, we found that the international reference tend to overestimate the findings. The Brazilian equation showed values significantly lower (p<0. 05) for MIP and MEP compared to international reference equations, and these would consider MIP values above normal (>100%) in 91. 6, 79. 1, and 75. 0% of the subjects and MEP in 66. 6, 87.5 and 50% of them, while using the national equation only 50. 0 and 37.5% of subjects were above 100%, respectively. The results of standardization of ventilatory muscle strength in children and adolescents with CF aged 8 to 12 years using international equations overestimate the values of maximal respiratory pressures.

RESUMO Este estudo teve como objetivo descrever a função pulmonar e a força muscular respiratória (FMR) na alta hospitalar de pacientes com quadros críticos da COVID-19 e correlacioná-las com a força muscular periférica, tempo de ventilação mecânica (VM) e de internação hospitalar e uso de medicações. Trata-se de um estudo transversal, incluindo pacientes que estiveram internados na UTI devido à COVID-19. A avaliação, na alta hospitalar, incluiu as seguintes variáveis: FMR, função pulmonar e força muscular periférica (escore Medical Research Council (MRC) e dinamometria de preensão palmar). Foram incluídos 25 pacientes, com idade média de 48,7±12,3 anos. Observou-se que 72% dos pacientes apresentaram distúrbio ventilatório restritivo, além de redução da FMR (pressão inspiratória máxima (PImáx) de 74% e pressão expiratória máxima (PEmáx) de 78% do predito). A FMR (PImáx e PEmáx, respectivamente) apresentou correlação negativa com o tempo de VM (r=−0,599, p=0,002; r=−0,523, p=0,007) e de internação hospitalar (r=−0,542, p=0,005; r=−0,502, p=0,01) e correlação positiva com a capacidade vital forçada (CVF) (r=0,825, p=0,000; r=0,778, p=0,000), o volume expiratório forçado no primeiro segundo (VEF1) (r=0,821, p=0,000; r=0,801, p=0,000), o pico de fluxo expiratório (PFE) (r=0,775, p=0,000; r=0,775, p=0,000) e a força de preensão palmar (r=0,656, p=0,000; r=0,589, p=0,002). Concluímos que pacientes com quadros críticos da COVID-19 apresentaram, na alta hospitalar: redução da FMR; alterações da função pulmonar; correlação negativa entre a FMR e o tempo de ventilação mecânica invasiva (VMI) e de internação hospitalar; e correlação positiva com a função pulmonar e a força de preensão palmar.