Brazilian Journal of Pulmonology

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


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Effect of adenosine on pulmonary circulation in patients with primary pulmonary hypertension

Ação da adenosina na circulação pulmonar de pacientes com hipertensão pulmonar primária

Rogerio Souza, Marcelo Britto Passos Amato, Sergio Eduardo Demarzo, Daniel Deheinzelin, Carmen Silvia Valente Barbas, Pedro Caruso, Carlos Roberto Ribeiro Carvalho

J Bras Pneumol.2005;31(1):-

Abstract PDF PT PDF EN Portuguese Text

Background: The nucleoside adenosine is a potent vasodilator. Although its effect on the pulmonary arteries is well known, its influence on capillaries and veins has yet to be described. Objective: To evaluate the pre- and post-administration effects of adenosine on arterial and venous resistance in the pulmonary circulation of patients with primary pulmonary hypertension. Method: The study involved 7 patients with primary pulmonary hypertension and presenting a positive response to adenosine on the acute test. Before and after adenosine administration, arterial and venous resistances were determined by estimating pulmonary capillary pressure through analysis of pulmonary artery pressure decay curves. Results: Following adenosine administration, there was an increase in the cardiac index (from 1.71 ± 0.23 to 2.72 ± 0.74 L/min-1/m-2) and a decrease in pulmonary vascular resistance (from 2924 ± 1060 to 1975 ± 764 dynes/s/cm-5/m-2) with no significant variations in mean pulmonary artery pressure (pre: 75.6 ± 16.8 mmHg; post: 78.1 ± 18.8 mmHg), pulmonary wedge pressure (pre: 15.3 ± 1.5 mmHg; post: 15.4 ± 1.9 mmHg) and pulmonary capillary pressure (pre: 43.8 ± 5.8 mmHg; post: 44.5 ± 4.9 mmHg). The ratio between arterial resistance and total pulmonary vascular resistance also presented a less than significant variation (pre: 50 ± 15%; post: 49 ± 17%). These findings suggest that adenosine affects the capillaries and veins as well as the arteries. Conclusion: We can conclude that the adenosine mechanism is not restricted to the arterial aspect of the pulmonary circulation, and that analysis of pulmonary capillary pressure could prove useful in the study of various drugs that affect the pulmonary circulation.


Keywords: Key Words: Adenosine/pharmacocinetic. Adenosine/uso terapêutico. Blood pressure. Hypertension pulmonary.


Adapting the Bird Mark 7 to deliver noninvasive continuous positive airway pressure: a bench study

Adaptação do Bird Mark 7 para oferta de pressão positiva contínua nas vias aéreas em ventilação não-invasiva: estudo em modelo mecânico

Beatriz Mayumi Kikuti, Karen Utsunomia, Renata Potonyacz Colaneri, Carlos Roberto Ribeiro de Carvalho, Pedro Caruso

J Bras Pneumol.2008;34(3):167-172

Abstract PDF PT PDF EN Portuguese Text

Objective: To test the efficiency of the Bird Mark 7 ventilator adapted to deliver continuous positive airway pressure (CPAP) in noninvasive positive pressure ventilation. Methods: This was an experimental study using a mechanical model of the respiratory system. A Bird Mark 7 ventilator was supplied with 400 and 500 kPa and tested at CPAP of 5, 10 and 15 cmH2O. The following variables were analyzed: difference between the preset CPAP and the CPAP actually attained CPAP (trueCPAP); area of airway pressure at the CPAP level employed (AREACPAP); and tidal volume generated. Results: Adapting the Bird Mark 7 to offer CPAP achieved the expected tidal volume in all situations of inspiratory effort (normal or high), ventilator pressure supply (400 or 500 kPa) and CPAP value (5, 10 or 15 cmH2O). At a CPAP of 5 or 10 cmH2O, the trueCPAP was near the preset level, and the AREACPAP was near zero. However, at a CPAP of 15 cmH2O, the value remained below the preset, and the AREACPAP was high. Conclusion: The efficiency of Bird Mark 7 adaptation in offering CPAP was satisfactory at 5 and 10 cmH2O but insufficient at 15 cmH2O. If adapted as described in our study, the Bird Mark 7 might be an option for offering CPAP up to 10 cmH2O in areas where little or no equipment is available.


Keywords: Ventilators, mechanical; Positive-pressure respiration; Continuous positive airway pressure.


Availability and use of noninvasive ventilation in the intensive care units of public, private and teaching hospitals in the greater metropolitan area of São Paulo, Brazil

Conhecimento da disponibilidade e sobre o uso da ventilação não invasiva em unidades de terapia intensiva de hospitais públicos, privados e de ensino da região metropolitana de São Paulo

Lara Maris Nápolis, Leila Mara Jeronimo, Danila Vieira Baldini, Michelle Pinheiro Machado, Virgínia Aparecida de Souza, Pedro Caruso

J Bras Pneumol.2006;32(1):29-34

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the availability of noninvasive positive-pressure ventilation equipment, as well as the level of expertise and familiarity of physicians, nurses and physiotherapists with noninvasive positive-pressure ventilation in the intensive care units of public, private and teaching hospitals in the greater metropolitan area of São Paulo, Brazil. Methods: On-site administration of questionnaires. Results: Noninvasive positive-pressure ventilation equipment was widely available and was more commonly found in private hospitals than in teaching hospitals. Such equipment was least available in public hospitals, in which the predominant method was the use of mechanical ventilators designed for invasive ventilation and adapted to noninvasive positive-pressure ventilation. In private hospitals, continuous flow ventilators were more common, whereas, in teaching hospitals, ventilators specifically designed for noninvasive ventilation were typically employed. All physiotherapists felt themselves capable of initiating noninvasive positive pressure ventilation, compared with 72.6% of physicians and 33.3% of nurses. Physicians and physiotherapists presented high percentages of correct answers when asked about the indications and contraindications for the use of noninvasive positive-pressure ventilation. Over a one year period, more physiotherapists read articles about noninvasive positive-pressure ventilation and participated in related classes than did physicians, who in turn did so more than did nurses. Conclusion: Noninvasive positive-pressure ventilation equipment is widely available in the greater metropolitan area of São Paulo, although differences exist among public, private and teaching hospitals in terms of the type of equipment used. Physicians and physiotherapists exhibited considerable knowledge regarding the indications and contraindications for the use of noninvasive positive-pressure ventilation. More physiotherapists felt themselves able to initiate noninvasive positive-pressure ventilation, and their knowledge of the subject was more current than was that of physicians or nurses.


Keywords: Ventilators, mechanical; Positive-pressure respiration/methods; Respiratory insuficiency; Intensive care units; Hospitals


Publication of the impact factor of the Brazilian Journal of Pulmonology: a milestone on a long and arduous journey

Divulgação do fator de impacto do Jornal Brasileiro de Pneumologia: consolidação de um longo e árduo trabalho

Carlos Roberto Ribeiro Carvalho, Bruno Guedes Baldi, Carlos Viana Poyares Jardim, Pedro Caruso

J Bras Pneumol.2012;38(4):417-418

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Identifying decreased diaphragmatic mobility and diaphragm thickening in interstitial lung disease: the utility of ultrasound imaging

Identificação da diminuição da mobilidade diafragmática e do espessamento diafragmático na doença pulmonar intersticial: utilidade da ultrassonografia

Pauliane Vieira Santana1,2, Elena Prina1, André Luis Pereira Albuquerque1, Carlos Roberto Ribeiro Carvalho1, Pedro Caruso1,2

J Bras Pneumol.2016;42(2):88-94

Abstract PDF PT PDF EN Portuguese Text

Objective: To investigate the applicability of ultrasound imaging of the diaphragm in interstitial lung disease (ILD). Methods: Using ultrasound, we compared ILD patients and healthy volunteers (controls) in terms of diaphragmatic mobility during quiet and deep breathing; diaphragm thickness at functional residual capacity (FRC) and at total lung capacity (TLC); and the thickening fraction (TF, proportional diaphragm thickening from FRC to TLC). We also evaluated correlations between diaphragmatic dysfunction and lung function variables. Results: Between the ILD patients (n = 40) and the controls (n = 16), mean diaphragmatic mobility was comparable during quiet breathing, although it was significantly lower in the patients during deep breathing (4.5 ± 1.7 cm vs. 7.6 ± 1.4 cm; p < 0.01). The patients showed greater diaphragm thickness at FRC (p = 0.05), although, due to lower diaphragm thickness at TLC, they also showed a lower TF (p < 0.01). The FVC as a percentage of the predicted value (FVC%) correlated with diaphragmatic mobility (r = 0.73; p < 0.01), and an FVC% cut-off value of < 60% presented high sensitivity (92%) and specificity (81%) for indentifying decreased diaphragmatic mobility. Conclusions: Using ultrasound, we were able to show that diaphragmatic mobility and the TF were lower in ILD patients than in healthy controls, despite the greater diaphragm thickness at FRC in the former. Diaphragmatic mobility correlated with ILD functional severity, and an FVC% cut-off value of < 60% was found to be highly accurate for indentifying diaphragmatic dysfunction on ultrasound.


Keywords: Diaphragm/ultrasonography; Lung diseases, interstitial; Respiratory muscles; Respiratory function tests.


Diagnostic methods to assess inspiratory and expiratory muscle strength

Métodos diagnósticos para avaliação da força muscular inspiratória e expiratória

Pedro Caruso, André Luis Pereira de Albuquerque, Pauliane Vieira Santana, Leticia Zumpano Cardenas, Jeferson George Ferreira, Elena Prina, Patrícia Fernandes Trevizan, Mayra Caleffi Pereira, Vinicius Iamonti, Renata Pletsch, Marcelo Ceneviva Macchione, Carlos Roberto Ribeiro Carvalho

J Bras Pneumol.2015;41(2):110-123

Abstract PDF PT PDF EN Portuguese Text

Impairment of (inspiratory and expiratory) respiratory muscles is a common clinical finding, not only in patients with neuromuscular disease but also in patients with primary disease of the lung parenchyma or airways. Although such impairment is common, its recognition is usually delayed because its signs and symptoms are nonspecific and late. This delayed recognition, or even the lack thereof, occurs because the diagnostic tests used in the assessment of respiratory muscle strength are not widely known and available. There are various methods of assessing respiratory muscle strength during the inspiratory and expiratory phases. These methods are divided into two categories: volitional tests (which require patient understanding and cooperation); and non-volitional tests. Volitional tests, such as those that measure maximal inspiratory and expiratory pressures, are the most commonly used because they are readily available. Non-volitional tests depend on magnetic stimulation of the phrenic nerve accompanied by the measurement of inspiratory mouth pressure, inspiratory esophageal pressure, or inspiratory transdiaphragmatic pressure. Another method that has come to be widely used is ultrasound imaging of the diaphragm. We believe that pulmonologists involved in the care of patients with respiratory diseases should be familiar with the tests used in order to assess respiratory muscle function.Therefore, the aim of the present article is to describe the advantages, disadvantages, procedures, and clinical applicability of the main tests used in the assessment of respiratory muscle strength.


Keywords: Respiratory muscles; Muscle weakness; Diaphragm; Respiratory function tests; Diagnostic tests, routine.


New steps for the international consolidation of the Brazilian Journal of Pulmonology

Novos passos para a consolidação internacional do Jornal Brasileiro de Pneumologia

Carlos Roberto Ribeiro Carvalho, Bruno Guedes Baldi, Carlos Viana Poyares Jardim, Pedro Caruso, Rogério Souza

J Bras Pneumol.2014;40(4):325-326

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Ischemia/reperfusion-induced lung injury prevention: many options, no choices

Prevenção de lesão pulmonar induzida por isquemia/reperfusão: muitas opções, nenhuma escolha

Pedro Caruso1,2, Susimeire Gomes1

J Bras Pneumol.2016;42(1):7-8

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Adult respiratory distress syndrome due to fat embolism in the postoperative period following liposuction and fat grafting

Síndrome da angústia respiratória do adulto por embolia gordurosa no período pós-operatório de lipoaspiração e lipoenxertia

André Nathan Costa, Daniel Melo Mendes, Carlos Toufen, Gino Arrunátegui, Pedro Caruso, Carlos Roberto Ribeiro de Carvalho

J Bras Pneumol.2008;34(8):622-625

Abstract PDF PT PDF EN Portuguese Text

Fat embolism is defined as mechanical blockage of the vascular lumen by circulating fat globules. Although it primarily affects the lungs, it can also affect the central nervous system, retina, and skin. Fat embolism syndrome is a dysfunction of these organs caused by fat emboli. The most common causes of fat embolism and fat embolism syndrome are long bone fractures, although there are reports of its occurrence after cosmetic procedures. The diagnosis is made clinically, and treatment is still restricted to support measures. We report the case of a female patient who developed adult respiratory distress syndrome due to fat embolism in the postoperative period following liposuction and fat grafting. In this case, the patient responded well to alveolar recruitment maneuvers and protective mechanical ventilation. In addition, we present an epidemiological and pathophysiological analysis of fat embolism syndrome after cosmetic procedures.


Keywords: Respiratory distress syndrome, adult; Embolism, fat; Lipectomy.




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