Jet nebulization (JN) and non-invasive mechanical ventilation (NIMV) through bi-level pressure is commonly used in emergency and intensive care of patients experiencing an acute exacerbation of asthma. However, a scientific basis for effect of JN coupled with NIMV is unclear. Objective. To evaluate the effect of jet nebulization administered during spontaneous breathing with that of nebulization with NIV at two levels of inspiratory and expiratory pressures resistance in patients experiencing an acute asthmatic episode. Methods. A prospective, randomized controlled study of 36 patients with severe asthma (forced expiratory volume in 1 second [FEV(1)] less than 60% of predicted) selected with a sample of patients who presented to the emergency department. Subjects were randomized into three groups: control group (nebulization with the use of an unpressured mask), experimental group 1 (nebulization and non-invasive positive pressure with inspiratory positive airway pressure [IPAP] = 15 cm H(2)O, and expiratory positive airway pressure [EPAP] = 5 cm H(2)O), and experimental group 2 (nebulization and non-invasive positive pressure with IPAP = 15 cm H(2)O and EPAP = 10 cm H(2)O). Bronchodilators were administered with JN for all groups. Dependent measures were recorded before and after 30 minutes of each intervention and included respiratory rate (RR), heart rate (HR), oxygen saturation (SpO(2)), peak expiratory flow (PEF), forced expiratory volume in 1 second (FEV(1)), forced vital capacity (FVC), and forced expiratory flow between 25 and 75% (FEF(25-75)). Results. The group E2 showed an increase of the peak expiratory flow (PEF), forced vital capacity (FVC), FEV(1) (p < 0.03) and F(25-75%) (p < 0.000) when compared before and 30 minutes after JN+NIMV. In group E1 the PFE (p < 0.000) reached a significant increase after JN+ NIMV. RR decreased before and after treatment in group E1 only (p = 0.04). Conclusion. Nebulization coupled with NIV in patients with acute asthma has the potential to reduce bronchial obstruction and symptoms secondary to augmented PEF compared with nebulization during spontaneous breathing. In reversing bronchial obstruction, this combination appears to be more efficacious when a low pressure delta is used in combination with a high positive pressure at the end of expiration.

BACKGROUND:The aim of the present study was to assess how volume-oriented incentive spirometry applied to patients after a stroke modifies the total and compartmental chest wall volume variations, including both the right and left hemithoraces, compared with controls. METHODS: Twenty poststroke patients and 20 age-matched healthy subjects were studied by optoelectronic plethysmography during spontaneous quiet breathing (QB), during incentive spirometry, and during the recovery period after incentive spirometry. RESULTS: Incentive spirometry was associated with an increased chest wall volume measured at the pulmonary rib cage, abdominal rib cage and abdominal compartment (P ‫؍‬ .001) and under 3 conditions (P < .001). Compared with healthy control subjects, the tidal volume (V T ) of the subjects with stroke was 24.7, 18.0, and 14.7% lower during QB, incentive spirometry, and postincentive spirometry, respectively. Under all 3 conditions, the contribution of the abdominal compartment to V T was greater in the stroke subjects (54.1, 43.2, and 48.9%) than in the control subjects (43.7, 40.8, and 46.1%, P ‫؍‬ .039). In the vast majority of subjects (13/20 and 18/20 during QB and incentive spirometry, respectively), abdominal expansion precedes rib cage expansion during inspiration. Greater asymmetry between the right and left hemithoracic expansions occurred in stroke subjects compared with control subjects, but it decreased during QB (62.5%, P ‫؍‬ .002), during incentive spirometry (19.7%), and postincentive spirometry (67.6%, P ‫؍‬ .14). CONCLUSIONS: Incentive spirometry promotes increased expansion in all compartments of the chest wall and reduces asymmetric expansion between the right and left parts of the pulmonary rib cage; therefore, it should be considered as a tool for rehabilitation.

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IntroductionExergames training, as an additional therapy to standard care, has been widely used for motor recovery after patients who had a stroke, and it is a valuable and positive tool in the rehabilitation of this population. This study describes a single-blind randomised clinical trial that will aim to investigate the effects of exergames training on postural balance in patients with chronic stroke.Methods and analysisForty-two individuals with chronic stroke (>6 months), aged 20–75 years, will be randomised into two groups: the experimental group, which will be subjected to an exergames protocol, and control group, which will undergo a kinesiotherapy protocol. Both protocols are based on postural balance. The intervention will consist of 40-minute sessions two times per week for 10 consecutive weeks. The volunteers will be evaluated before the treatment, at the end of the interventions and 8 weeks thereafter. The primary outcome will be postural balance (Berg Balance Scale, Functional Reach Test, Timed Up and Go test and Centre of Pressure variables) and secondary outcomes will include gait (6 m timed walk and Kinovea Software), cortical activation patterns (electroencephalography Emotiv EPOC), functional independence (Functional Independence Measure), quality of life (Stroke-Specific Quality of Life Scale) and motivation (Intrinsic Motivation Inventory).Ethics and disseminationThis protocol was approved by the Ethics Committee of the Federal University of Rio Grande do Norte (number 3.434.350). The results of the study will be disseminated to participants through social networks and will be submitted to a peer-reviewed journal and scientific meetings.Trial registration numberBrazilian Registry of Clinical Trials (RBR-78v9hx).

Introdução: As leucemias destacam-se como a neoplasia infantil mais comum e o tratamento eleito para a doença é a quimioterapia. Entre outras, a quimioterapia provoca, em nível do sistema respiratório, danos ao tecido epitelial, que podem culminar em pneumonite ou até mesmo em fibrose pulmonar. Objetivo: Comparar a força dos músculos respiratórios e a mobilidade da caixa torácica de crianças e adolescentes com leucemia aguda na fase de manutenção da quimioterapia e de indivíduos saudáveis. Método: A amostra foi composta por 48 participantes distribuídos em dois grupos (grupo A, formado por 16 crianças e adolescentes com leucemia aguda; e grupo B, formado por 32 escolares saudáveis). Foram realizadas cirtometria torácica, manovacuometria e avaliação antropométrica dos sujeitos. Posteriormente à análise descritiva, a prova de Kolmogorov-Smirnov identificou as variáveis com distribuição normal. Estas foram comparadas através do teste t’student não pareado e, as demais, através do teste de Mann-Whitney. Atribuiu-se nível de significância p<0,05. Resultados: Observou-se diferença significativa entre os grupos A e B nas variáveis pressões inspiratórias máximas (p=0,01), retração axilar (p=0,012), expansão (p=0,007) e retração xifoidiana (p=0,005). Conclusão: Os achados indicam que pode ocorrer um déficit na mobilidade torácica e na força dos músculos respiratórios em crianças e adolescentes na fase de manutenção da quimioterapia para a leucemia aguda. Isso pode apontar para a necessidade de avaliar e monitorar periodicamente a musculatura respiratória dessa população, o que permitiria diagnóstico e intervenção precoces na evidência de dano à função pulmonar.

Objectives

Introdução: O acidente vascular cerebral (AVC) gera numerosas repercussões no sistema respiratório. Objetivos: Comparar as variações volumétricas da caixa torácica durante o uso da espirometria de incentivo (EI) volume-orientada e avaliar seu comportamento entre indivíduos hemiparéticos pós-AVC e sujeitos saudáveis. Foram estudados 14 indivíduos (7 hemiparéticos e 7 saudáveis) utilizando a Pletismografia Opto-eletrônica. Resultados: O grupo AVC em relação ao controle apresentou, em mediana, valores menores de CVF (L), CVF%, VEF1(L), PEmáx (cmH2O) e PEmáx (%), assim como mostrou volume corrente 32,3% menor (p = 0,031), durante a realização da EI. Conclusão: Houve participação 25% menor do compartimento caixa torácica pulmonar, no grupo AVC no volume corrente, comparada a do controle (p = 0, 0156), e para o compartimento abdominal, o grupo AVC apresentou 43% maior participação no volume corrente, comparada a do controle (p = 0,031), no período pré EI.

In the present study, MIP reached higher levels at FRC during the five days of evaluation, and a learning effect occurred in the patients. Motor units from the respiratory muscles may have been recruited in order to perform the manoeuvres during the days of evaluation. The study suggests that there is good evidence for the use of the FRC as a parameter to find the major MIP value.