Avaliação das pressões respiratórias máximas em pacientes renais crônicos nos momentos pré e pós-hemodiálise

Abstract

Introduction and Objective: Maximal inspiratory and expiratory pressures (PI max and PE max ) are used to assess the integrity of respiratory muscles by measuring their strength. The aim of this study was to assess the immediate influence of hemodialysis (HD) on respiratory muscle strength by measuring PI max and PE max , investigating the integrity of that musculature and/or the presence of muscular weakness. Method: A prospective, crosssectional study was carried out on a convenience sample of 35 patients with chronic kidney disease (26 men and 9 women; mean age, 51.7 ± 14.7 years) at the Nephrology Division of the Hospital Universitário Alzira Vellano, in the city of Alfenas, in the state of Minas Gerais, Brazil. Patients had their PI max and PE max taken in the seated position (at 90°) by using a digital manovacuometer (MVD 300®) attached to a notebook for reading and recording data obtained before and after the HD session. Results: Both PI max and PE max were lower than the values predicted for pre-and post-HD (p < 0.0001). Comparing the values obtained pre-HD and post-HD, PImax showed a slight improvement (p = 0.0420), evidenced only in patients with pre-HD values below 60 cmH 2 O (Wilcoxon; p = 0.0480). Post-HD PE max did not differ from the pre-HD measure (p = 0.4987). Conclusion: The CKD patients showed a serious impairment of their respiratory muscle function, and only one isolated HD session could not significantly improve their maximum respiratory pressures. A slight improvement in the inspiratory strength was observed in patients whose PI max was lower than 60 cm-H 2 O before the procedure.

Repercussão de um protocolo fisioterapêutico intradialítico na funcionalidade pulmonar, força de preensão manual e qualidade de vida de pacientes renais crônicos

“…Parreira et al (2007) 25 , assessing the maximal respiratory pressures of healthy patients, have reported that measurements are influenced by the understanding about the maneuvers to be performed and by the will of the participants to cooperate and perform really maximum respiratory movements and efforts. That is in accordance with the study by Rocha et al (2010) 16 , who have discussed measurement as depending on the understanding and collaboration of the participants, and have concluded that learning the technique has a determinant effect, either positive or negative, on the results obtained. Those aspects can be considered as qualitatively influencing the results of the present study.…”

“…12 Alterations in the respiratory muscle function, pulmonary mechanics, and gas exchanges are frequent in patients with CKD . 6 Several studies have shown that such patients undergoing HD have a reduction in the respiratory muscle strength 3,6,7,14,[16][17][18]20 and pulmonary function. 3,13,14,18,20 On reassessment, the MIP and MEP values showed no statistically significant changes, which may have been due to lack of specific training to strengthen respiratory muscles.…”

“…3,13,14,18,20 On reassessment, the MIP and MEP values showed no statistically significant changes, which may have been due to lack of specific training to strengthen respiratory muscles. Rocha et al (2010) 16 have reported that values greater than 60 cmH 2 O clinically exclude respiratory muscle weakness, and they have also questioned the consensus that only patients with MIP below 60 cmH 2 O need specific training for inspiratory and expiratory muscles. In that same study, the authors have reported reductions in MIP and MEP in patients with CKD undergoing HD when compared with healthy individuals.…”

“…13 Despite its confirmed efficacy, alterations in the patients' quality of life (QOL), as well as in their physical and functional capacity, have been observed. [14][15][16][17] According to Soares et al (2007) 4 , HD is responsible for a monotonous and limited daily life. Jatobá et al (2008) 6 have supported that statement, emphasizing that as a mandatory condition HD also significantly interferes with those patients' QOL.…”

Avaliação funcional pré e pós-programa de exercício físico de pacientes em hemodiálise

“…Este resultado corrobora o estudo realizado por Rocha e Araújo (2010), 30 mostrando redução dos valores da PImax e PEmax em relação aos valores preditos nos momentos pré e pós-intervenção. Porém, relacionando os momentos pré e pós-programa de exercícios, apenas a PImax apresentou aumento.…”