Brazilian Journal of Pulmonology

ISSN (on-line): 1806-3756 | ISSN (printed): 1806-3713

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Adhesiveness and purulence of respiratory secretions: implications for mucociliary transport in patients with bronchiectasis

Adesividade e purulência de secreções respiratórias: implicações no transporte mucociliar em pacientes com bronquiectasias

Joana Tambascio, Roberta Marques Lisboa, Rita de Cássia Vianna Passarelli, José Antonio Baddini Martinez, Ada Clarice Gastaldi

J Bras Pneumol.2010;36(5):545-553

Abstract PDF PT PDF EN Portuguese Text

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.

 


Effects of manually assisted coughing on respiratory mechanics in patients requiring full ventilatory support

Efeitos da tosse manualmente assistida sobre a mecânica do sistema respiratório de pacientes em suporte ventilatório total

Katia de Miranda Avena, Antonio Carlos Magalhães Duarte, Sergio Luiz Domingues Cravo, Maria José Junho Sologuren, Ada Clarice Gastaldi

J Bras Pneumol.2008;34(6):380-386

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Objective: Manually assisted coughing (MAC) consists of a vigorous thrust applied to the chest at the beginning of a spontaneous expiration or of the expiratory phase of mechanical ventilation. Due to routine use of MAC in intensive care units, the objective of this study was to assess the effects of MAC on respiratory system mechanics in patients requiring full ventilatory support. Methods: We assessed 16 sedated patients on full ventilatory support (no active participation in ventilation). Respiratory system mechanics and oxyhemoglobin saturation were measured before and after MAC, as well as after endotracheal aspiration. Bilateral MAC was performed ten times on each patient, with three respiratory cycle intervals between each application. Results: Data analysis demonstrated a decrease in resistive pressure and respiratory system resistance, together with an increase in oxyhemoglobin saturation, after MAC combined with endotracheal aspiration. No evidence of alterations in peak pressures, plateau pressures or respiratory system compliance change was observed after MAC. Conclusions: The use of MAC alters respiratory system mechanics, increasing resistive forces by removing secretions. The technique is considered safe and efficacious for postoperative patients. Using MAC in conjunction with endotracheal aspiration provided benefits, achieving the proposed objective: the displacement and removal of airway secretions.

 


Keywords: Cough; Sputum; Respiratory mechanics; Respiration, artificial.

 


Physicochemical properties of human tracheobronchial sputum maintained at room temperature

O muco traqueobrônquico humano mantido em temperatura ambiente e suas propriedades físico-químicas

Renata Claudia Zanchet, Gilvânia Feijó, Ada Clarice Gastaldi, José Roberto Jardim

J Bras Pneumol.2007;33(1):57-61

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Objective: To evaluate the effect that maintaining tracheobronchial sputum at room temperature has on the analysis of ciliary transport and cough, as well as on the contact angle. Methods: Hyaline sputum was collected from 30 individuals without pulmonary diseases, and purulent sputum was collected from patients with bronchiectasis. The samples were analyzed immediately after collection and again after 24 h. Results: After 24 h at room temperature, the purulent sputum presented an increase in cough-induced dislodgment (96 ± 50 vs. 118 ± 61 mm) and a decrease in the contact angle (32 ± 6 vs. 27 ± 6 degrees) (p < 0.05). For the hyaline sputum, there were no alterations in the parameters analyzed. Conclusion:  Hyaline tracheobronchial sputum can be stored in room temperature for 24 h without presenting alterations in ciliary transport or contact angle. However, purulent sputum should not be stored at room temperature for many hours, since ciliary transport and contact angle might be altered as a result.

 


Keywords: Temperature; Sputum; Cough; Mucociliary clearance

 


Inspiratory muscle training in quadriplegic patients

Treinamento de músculos inspiratórios em pacientes com quadriplegia

Janne Marques Silveira, Ada Clarice Gastaldi, Cristina de Matos Boaventura, Hugo Celso Souza

J Bras Pneumol.2010;36(3):-

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine whether inspiratory muscle training can increase strength and endurance of these muscles in quadriplegic patients. Methods: Eight quadriplegic patients (7 males and 1 female) with injury to the lower cervical spine (segments C4-C7) were submitted to inspiratory muscle training with a threshold inspiratory muscle trainer adjusted to 30% of MIP. The training sessions were carried out with the patients in a sitting position, 5 days a week for 8 weeks. Endurance time, MIP, MEP and FVC were determined at baseline, week 4 and week 8. Results: In comparison with the mean baseline value, there was an increase in MIP, measured in the sitting position, at weeks 4 and 8 (−83.0 ± 18.9 cmH2O vs. −104.0 ± 19.4 cmH2O and −111.3 ± 22.7 cmH2O). There was an increase in MEP, also in the sitting position, at week 4 (from 36.8 ± 8.1 to 42.6 ± 8.8 cmH2O). There was an improvement in FVC at week 4 (from 2.1 ± 0.8 to 2.5 ± 0.6 L, representing an increase of 24 ± 22%). Although there was an increase in endurance (sitting) at week 8, the difference was not significant in comparison with the baseline value (29.8 ± 21.0 vs. 35.9 ± 15.5 min, an increase of 173 ± 233%). Conclusions: Quadriplegic patients can benefit from training at low loads (30% of MIP), which can improve inspiratory muscle strength, FVC and expiratory muscle performance.

 


Keywords: Respiratory mechanics; Quadriplegia; Breathing exercises.

 


A six-minute step test protocol for the investigation of dyspnea

Um protocolo de teste do degrau de seis minutos para a investigação de dispneia

Aline Aparecida Simsic, Ada Clarice Gastaldi, José Baddini-Martinez

J Bras Pneumol.2014;40(6):673-674

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