Brazilian Journal of Pulmonology

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

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Year 2019 - Volume 45  - Number 5  (September/October)

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Original Article

1 - Inflammatory lung injury in rabbits: effects of high-frequency oscillatory ventilation in the prone position

Lesão inflamatória pulmonar em coelhos: efeitos da ventilação oscilatória de alta frequência em posição prona

Jose Roberto Fioretto1,a, Rafaelle Batistella Pires2,b, Susiane Oliveira Klefens1,c, Cilmery Suemi Kurokawa1,d, Mario Ferreira Carpi1,e, Rossano César Bonatto1,f, Marcos Aurélio Moraes1,g, Carlos Fernando Ronchi1,3,h

J Bras Pneumol.2019;45(5):e20180067

Abstract PDF PT PDF EN Portuguese Text

Objective: To compare the effects that prone and supine positioning during high-frequency oscillatory ventilation (HFOV) have on oxygenation and lung inflammation, histological injury, and oxidative stress in a rabbit model of acute lung injury (ALI). Methods: Thirty male Norfolk white rabbits were induced to ALI by tracheal saline lavage (30 mL/kg, 38°C). The injury was induced during conventional mechanical ventilation, and ALI was considered confirmed when a PaO2/FiO2 ratio < 100 mmHg was reached. Rabbits were randomly divided into two groups: HFOV in the supine position (SP group, n = 15); and HFOV with prone positioning (PP group, n = 15). For HFOV, the mean airway pressure was initially set at 16 cmH2O. At 30, 60, and 90 min after the start of the HFOV protocol, the mean airway pressure was reduced to 14, 12, and 10 cmH2O, respectively. At 120 min, the animals were returned to or remained in the supine position for an extra 30 min. We evaluated oxygenation indices and histological lung injury scores, as well as TNF-α levels in BAL fluid and lung tissue. Results: After ALI induction, all of the animals showed significant hypoxemia, decreased respiratory system compliance, decreased oxygenation, and increased mean airway pressure in comparison with the baseline values. There were no statistically significant differences between the two groups, at any of the time points evaluated, in terms of the PaO2 or oxygenation index. However, TNF-α levels in BAL fluid were significantly lower in the PP group than in the SP group, as were histological lung injury scores. Conclusions: Prone positioning appears to attenuate inflammatory and histological lung injury during HFOV in rabbits with ALI.

 


Keywords: Respiration, artificial/adverse effects; Prone position; Lung/physiopathology; Pneumonia; Respiratory distress syndrome, adult; Acute lung injury; Disease models, animal; Rabbits.

 

2 - Effects of the implementation of a hand hygiene education program among ICU professionals: an interrupted time-series analysis

Efeitos da implementação de um programa de educação de higienização das mãos entre profissionais de uma UTI: análise de séries temporais interrompidas

Diana Marcela Prieto Romero1,a, Maycon Moura Reboredo1,2,b, Edimar Pedrosa Gomes1,2,c, Cristina Martins Coelho1,d, Maria Aparecida Stroppa de Paula1,e, Luciene Carnevale de Souza1,f, Fernando Antonio Basile Colugnati2,g, Bruno Valle Pinheiro1,2,hDiana Marcela Prieto Romero1,a, Maycon Moura Reboredo1,2,b, Edimar Pedrosa Gomes1,2,c, Cristina Martins Coelho1,d, Maria Aparecida Stroppa de Paula1,e, Luciene Carnevale de Souza1,f, Fernando Antonio Basile Colugnati2,g, Bruno Valle Pinheiro1,2,h

J Bras Pneumol.2019;45(5):e20180152

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the effects that a hand hygiene education program has on the compliance of health professionals in an ICU. Methods: This was a quasi-experimental study with an interrupted time-series design, conducted over a 12-month period: the 5 months preceding the implementation of a hand hygiene education program (baseline period); the 2 months of the intensive (intervention) phase of the program; and the first 5 months thereafter (post-intervention phase). Hand hygiene compliance was monitored by one of the researchers, unbeknownst to the ICU team. The primary outcome measure was the variation in the rate of hand hygiene compliance. We also evaluated the duration of mechanical ventilation (MV), as well as the incidence of ventilator-associated pneumonia (VAP) at 28 days and 60 days, together with mortality at 28 days and 60 days. Results: On the basis of 959 observations, we found a significant increase in hand hygiene compliance rates-from 31.5% at baseline to 65.8% during the intervention phase and 83.8% during the post-intervention phase, corresponding to prevalence ratios of 2.09 and 2.66, respectively, in comparison with the baseline rate (p < 0.001). Despite that improvement, there were no significant changes in duration of MV, VAP incidence (at 28 or 60 days), or mortality (at 28 or 60 days). Conclusions: Our findings indicate that a hand hygiene education program can increase hand hygiene compliance among ICU professionals, although it appears to have no impact on VAP incidence, duration of MV, or mortality.

 


Keywords: Hand disinfection; Health personnel; Pneumonia, ventilator-associated; Respiration, artificial; Guideline adherence.

 

3 - Familial pulmonary fibrosis: a heterogeneous spectrum of presentations

Fibrose pulmonar familiar: um espectro heterogêneo de apresentações

Ana Beatriz Hortense1,a, Marcel Koenigkam dos Santos2,b, Danilo Wada3,c, Alexandre Todorovic Fabro4,d, Mariana Lima5, Silvia Rodrigues5,e, Rodrigo Tocantins Calado2,f, José Baddini-Martinez2,g

J Bras Pneumol.2019;45(5):e20180079

Abstract PDF PT PDF EN Portuguese Text Appendix

Objective: To describe the clinical, functional, and radiological features of index cases of familial pulmonary fibrosis (FPF) in Brazil. Methods: We evaluated 35 patients with FPF - of whom 18 (51.4%) were women - with a median age of 66.0 years (range, 35.5-89.3 years). All of the patients completed a standardized questionnaire, as well as undergoing pulmonary function tests and HRCT of the chest. In 6 cases, lung tissue samples were obtained: from surgical biopsies in 5 cases; and from an autopsy in 1 case. Results: A history of smoking and a history of exposure to birds or mold were reported in 45.7% and 80.0% of the cases, respectively. Cough and marked dyspnea were reported by 62.8% and 48.6% of the patients, respectively. Fine crackles were detected in 91.4% of the patients. In 4 patients, the findings were suspicious for telomere disease. The median FVC and DLCO, as percentages of the predicted values, were 64.9% (range, 48.8-105.7%) and 38.9% (range, 16.0-60.0%), respectively. Nine patients had reduced DLCO despite having normal spirometry results. Regarding HRCT, patterns typical of usual interstitial pneumonia were found in 6 patients (17.1%). In 25 cases (71.5%), the HRCT features were consistent with a diagnosis other than idiopathic pulmonary fibrosis. In 11 cases (31.4%), the radiological patterns were uncharacteristic of interstitial lung disease. Of the six lung tissue samples analyzed, four showed interstitial pneumonia with bronchiolocentric accentuation, and, on the basis of the clinical and radiological data, the corresponding patients were diagnosed with hypersensitivity pneumonitis. Conclusions: Patients with FPF can present with a wide variety of clinical features. Most HRCT scans of these patients exhibit patterns not typical of usual interstitial pneumonia. The family history of fibrotic lung diseases should be investigated in all patients under suspicion, regardless of their age.

 


Keywords: Idiopathic pulmonary fibrosis; Respiratory function tests; Tomography, X-ray computed.

 

4 - Accuracy of chest auscultation in detecting abnormal respiratory mechanics in the immediate postoperative period after cardiac surgery

Acurácia da ausculta torácica na detecção de mecânica respiratória anormal no pós-operatório imediato de cirurgia cardíaca

Glaciele Xavier1,2,a, César Augusto Melo-Silva1,3,b, Carlos Eduardo Ventura Gaio dos Santos1,4,c, Veronica Moreira Amado1,4,d

J Bras Pneumol.2019;45(5):e20180032

Abstract PDF PT PDF EN Portuguese Text

Objective: To investigate the accuracy of chest auscultation in detecting abnormal respiratory mechanics. Methods: We evaluated 200 mechanically ventilated patients in the immediate postoperative period after cardiac surgery. We assessed respiratory system mechanics - static compliance of the respiratory system (Cst,rs) and respiratory system resistance (R,rs) - after which two independent examiners, blinded to the respiratory system mechanics data, performed chest auscultation. Results: Neither decreased/abolished breath sounds nor crackles were associated with decreased Cst,rs (≤ 60 mL/cmH2O), regardless of the examiner. The overall accuracy of chest auscultation was 34.0% and 42.0% for examiners A and B, respectively. The sensitivity and specificity of chest auscultation for detecting decreased/abolished breath sounds or crackles were 25.1% and 68.3%, respectively, for examiner A, versus 36.4% and 63.4%, respectively, for examiner B. Based on the judgments made by examiner A, there was a weak association between increased R,rs (≥ 15 cmH2O/L/s) and rhonchi or wheezing (ϕ = 0.31, p < 0.01). The overall accuracy for detecting rhonchi or wheezing was 89.5% and 85.0% for examiners A and B, respectively. The sensitivity and specificity for detecting rhonchi or wheezing were 30.0% and 96.1%, respectively, for examiner A, versus 10.0% and 93.3%, respectively, for examiner B. Conclusions: Chest auscultation does not appear to be an accurate diagnostic method for detecting abnormal respiratory mechanics in mechanically ventilated patients in the immediate postoperative period after cardiac surgery.

 


Keywords: Diagnostic tests, routine; Physical examination; Respiratory sounds; Respiratory mechanics; Data accuracy; Respiration, artificial.

 

Letters to the Editor

5 - Prescribing trends in and perceptions of the treatment of asthma: a survey among pulmonologists in Brazil

Tendências prescritivas e percepções no tratamento da asma: um inquérito entre pneumologistas brasileiros

José Eduardo Delfini Cançado1,a, Rodrigo Abensur Athanazio2,b, Luis Fernando Rensi Cunha3,c, Marcia Margaret Menezes Pizzichini4,d

J Bras Pneumol.2019;45(5):e20190083

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