INTRODUÇÃO: Estudos recentes sugerem que o uso da estratégia protetora de ventilação mecânica no intra-operatório pode reduzir a incidência de complicações pulmonares pós-operatórias (CPP). O objetivo desta meta-análise de dados individuais de pacientes é avaliar o efeito independente do volume corrente e da pressão positiva ao final da expiração (PEEP) na ocorrência de CPP. MÉTODOS: Foram incluídos ensaios clínicos randomizados que compararam a estratégia protetora de ventilação mecânica com a estratégia convencional em pacientes submetidos à anestesia para cirurgia. O desfecho primário foi o desenvolvimento de CPP. Diversos fatores prognósticos pré-definidos foram testados por meio da regressão logística multivariada. RESULTADOS: Quatorze ensaios clínicos randomizados foram incluídos (2.095 pacientes). Houve 97 casos de CPP em 1.102 pacientes (8,8%) ventilados com a estratégia protetora e 148 casos em 993 pacientes (14,9%) ventilados com a estratégia convencional (risco ajustado relativo [RR], 0,64; 95% intervalo de confiança [IC], 0,46 - 0,88, p < 0,01). Houve 85 casos de CPP em 957 pacientes (8,9%) ventilados com volume corrente baixo e PEEP alto e 63 casos em 525 pacientes (12%) ventilados com volume corrente baixo e PEEP baixo (RR, 0,93; 95% CI, 0,64 - 1,37, p = 0,72). Foi encontrada uma relação de dose-resposta entre o aparecimento de CPP e o volume corrente (R2 por meio termo quadrático = 0,390), mas não entre o aparecimento de CPP e o nível de PEEP (R2 = 0,082). A manutenção de uma driving pressure inferior a 13 cmH2O durante a cirurgia está associado a menor incidência de síndrome do desconforto respiratório agudo (SDRA). CONCLUSÃO: Esta meta-análise de dados individuais suporta os efeitos benéficos da estratégia protetora de ventilação mecânica em pacientes submetidos à cirurgia e sugere que altos níveis de PEEP, na vigência de volume corrente baixo, não acrescentam benefícios / INTRODUCTION: Recent studies show that intraoperative mechanical ventilation using low tidal volumes can prevent postoperative pulmonary complications (PPC). The aim of this individual patient data meta-analysis is to evaluate the individual associations between tidal volume size and PEEP level, and occurrence of PPC. METHODS: Randomized controlled trials comparing protective ventilation and conventional ventilation in patients undergoing general surgery were screened for inclusion. The primary outcome was development of PPC. Predefined prognostic factors were tested using multivariate logistic regression. RESULTS: Fourteen randomized controlled trials were included (2095 patients). There were 97 cases of PPC in 1102 patients (8.8%) assigned to protective ventilation and 148 cases in 993 patients (14.9%) assigned to conventional ventilation (adjusted relative risk [RR], 0.64; 95% confidence interval [CI], 0.46 - 0.88; p < 0.01). There were 85 cases of PPC in 957 patients (8.9%) assigned to ventilation with low tidal volume and high PEEP levels and 63 cases in 525 patients (12%) assigned to ventilation with low tidal volume and low PEEP levels (RR, 0.93; 95% CI, 0.64 - 1.37; p = 0.72). A dose-response relationship was found between the appearance of PPC and tidal volume size (R2 for mean quadratic term = 0.390), but not between the appearance of PPC and PEEP level (R2 = 0.082). The maintenance of a driving pressure below 13 cmH2O during surgery is associated with reduced incidence of acute respiratory distress syndrome. CONCLUSION: This individual data meta-analysis supports the beneficial effects of protective ventilation settings in patients undergoing surgery and suggests no benefit from high PEEP levels with use of low tidal volume

<p>Prema literaturnim podacima poslednjih godina velika pažnja je usmerena ka operativnom riziku i mortalitetu koji su postali najvažniji kriterijumi u ocenama rezultata rada hirur&scaron;kih ustanova, ali i svakog hirurga posebno. Zahvaljujući kompleksnom profilu pacijenata koji se podvrgavaju hirur&scaron;kim intervencijama, precizna procena operativnog rizika postaje sve teža. Predikcija ishoda intervencije u najvećoj meri zavisi od preoperativnih faktora rizika. Ipak, neminovno je da i faktori koji su vezani za samu operaciju u određenom stepenu utiču na ishod hirur&scaron;ke intervencije. Shodno tome, dobar model za procenu rizika treba da obuhvati faktore koji će imati najbolju prediktivnu vrednost. Thoracoscore je prvi bodovni sistem razvijen od strane Francuskog udruženja grudnih i vaskularinih hiruga. Zbog nedovoljne primene tokom poslednje decenije i nekonzistentnih rezultata nije do&scaron;lo do &scaron;irokog međunarodnog prihvatanja ovog modela i njegove rutinske upotrebe. Ova činjenica ukazuje na nedostake samog modela i potrebu za rekalibracijom u cilju postizanja bolje saglasnosti između predikcije operativnog rizika i kliničkog stanja bolesnika. Cilj rada je bio da se ustanovi realna vrednost Thoracoscore bodovnog sistema u proceni operativnog rizika i mortaliteta nakon anatomskih i neanatomskih resekcija pluća u na&scaron;im uslovima, i da se utvrdi prediktivna vrednost faktora rizika koji nisu obuhvaćeni Thoracoscore bodovnim sistemom na ishod grudno-hirur&scaron;kih operacija. Istraživanje je sprovedeno po tipu prospektivne kliničke studije i obuhvatilo je 957 bolesnika operisanih na Klinici za grudnu hirurgiju Instituta za plućne bolesti Vojvodine. Izvr&scaron;ene hirur&scaron;ke procedure bile su anatomske resekcije (lobektomija, bilobektomija, pneumonektomija, Sleeve resekcija, segmentektomija) i neanatomske resekcije pluća (Wedge resekcija i druge atipične resekcije). Thoracoscore je izračunat za svakog bolesnika na osnovu devet parametara: godine starosti, pol, ASA skor, dispnea skor, procena op&scaron;teg stanja bolesnika, dijagnostička grupa, hitnost operacije, vrsta operacije i broj komorbiditeta. S obzirom da prediktivna vrednost Thoracoscore bodovnog sistema u proceni operativnog rizika nije bila adekvatna realnom stanju, regresionom analizom je evaluiran značaj tri nova faktora: forsirani ekspiratorni volumen u prvoj sekundi (FEV1), reoperacija i hirur&scaron;ki pristup (torakotomija, video-asistirana torakoskopija &ndash; VATS). Nakon &scaron;to je univarijantnom analizom potvrđeno da su ovi faktori nezavisni prediktori operativnog ishoda, originalni Thoracoscore model je rekalibrisan. Multivarijantnom analizom putem logističke regresije izračunati su novi beta koeficijenti za originalnih devet faktora, kao i za tri nova, te je kreiran lokalni model za procenu operativnog rizika koji je prilagođen na&scaron;oj populaciji. Prosečna starosti bolesnika bila je 62 &plusmn; 7,52 godina. Većinu uzorka (60,7%) činili su pripadnici mu&scaron;kog pola. Najveći broj resekcija činile su lobektomije (61,4%). Malignitet je bio najučestalija indikacija za operaciju (90,3%). Najveći broj bolesnika imao je 1-2 komorbiditeta (64,3%). Prosečna stopa operativnog rizika na osnovu Thoracoscore-a (4,7% ) bila je veća je od stvarnog (2,9%) intrahospitalnog mortalita (p&lt;0,01). Ovaj model je pokazao zadovoljavajuće rezultate jedino u grupi niskog rizika. Predikcija mortaliteta lokalnim modelom za procenu operativnog rizika u grudnoj hirurgiji se, u statističkom smislu, ne razlikuje od stvarnog mortaliteta (p = NS). Thoracoscore ima dobru diskriminativnu moć, ali nezadovoljavajuću kalibrisanost. Shodno tome, Thoracoscore model se može koristiti za stratifikaciju rizika, ali ne i za predikciju mortaliteta. Za razliku, lokalni model je pokazao dobru diskriminaciju i kalibrisanost u na&scaron;im uslovima. Interni model za procenu rizika bi bio od velike koristi u svakodnevnom kliničkom radu, budući da bi oslikavao realno stanje populacije u kojoj je razvijen i vr&scaron;io preciznu predikciju operativnog rizika.</p> / <p>According to the literature data, over the past several years, great attention has been focused on operative risk and mortality which have become the most important criteria in evaluating the results from surgical departments and individual surgeons, as well. Because of complex profiles of patients undergoing surgical interventions, it is becoming more difficult to assess the risk precisely. Prediction of surgical outcomes mostly depends on the preoperative risk factors. However, factors related to the procedure itself effect the surgical outcome to a certain degree. Therefore, a good risk assessment model must contain factors which will have the best predictive value. Thoracoscore is the first scoring system developed by the French Association of Thoracic and Vascular Surgeons. Due to insufficient utilization over the past decade and inconsistent results, this model has not been widely accepted for routine use. This fact indicates that the model lacks certain aspects and needs to be recalibrated in order to achieve better concordance between the predicted operative risk and the clinical state of the patient. The aim of this study was to determine real value of Thoracoscore scoring system for estimation of operative risk and mortality following anatomic and non-anatomic lung resections in our settings, and to determine predictive value of factors not included in Thoracoscore on the outcome of thoracic surgeries. This prospective study included 957 patients who underwent lung resections at the Thoracic surgery clinic of Institute for Lung Diseases of Vojvodina. Performed surgical procedures were anatomic lung resections (lobectomy, bilobectomy, pneumonectomy, Sleeve resection, segmentectomy) and non-anatomic lung resections (Wedge resection and other atypical resections). Thoracoscore was calculated for each patient based on the following nine parameters: age, gender, ASA score, dyspnea score, performance status classification, diagnostic group, urgency of surgery, surgical procedure and number of comorbidities. Because predictive value of Thoracoscore did not correspond to the actual results, regression analysis was used to evaluate the significance of three new risk factors: forced expiratory volume in the first second (FEV1), reoperation, and surgical approach (thoracotomy, video-assisted thoracoscopy &ndash; VATS). After univariate analysis confirmed that these three factors are independent predictors of operative risk, the original Thoracoscore model was recalibrated. With the use of multivariate analysis by logistic regression, new beta coefficients were calculated for the original nine parameters, as well as for the new three, and consequently a local model for surgical risk assessment that is adapted to our population was created. Average age of patients was 62 &plusmn; 7.52 years. Most of the patients were males (60.7%). Lobectomies constituted the largest number (61.4%) of performed surgeries. The most common indications for surgery were malignant causes (90.3%). Most frequently, patients had 1-2 comorbidities (64.3%). Mean operative risk based on Thoracoscore (4.7%) was greater than the actual intrahospital mortality (2.9%) (p&lt;0.01). This model had adequate results only in the low risk group of patients. Predicted mortality by the local model was not statistically different from the actual mortality (p = NS). Thoracoscore had good discriminative ability, but inadequate calibration. Because of this, Thoracoscore model can be used for risk stratification, but not for mortality prediction. On the other hand, local model showed good discrimination and calibration in our population. Therefore, an internal model for risk assessment would be of great use in everyday clinical practice because it would reflect the real state of the population in which it was developed, predicting the risk more precisely.</p>

<p>The aim of this thesis was to test the capability of Artificial Neural Networks (ANN) to estimate respiratory mechanics during mechanical ventilation (MV). ANNs are universal function approximators and can extract information from complex signals. </p><p>We evaluated, in an animal model of acute lung injury, whether ANN can assess respiratory system resistance (R_RS) and compliance (C_RS) using the tracings of pressure at airways opening (P_AW), inspiratory flow (V’) and tidal volume, during an end-inspiratory hold maneuver (EIHM). We concluded that ANN can estimate C_RS and R_RS during an EIHM. We also concluded that the use of tracings obtained by non-biological models in the learning process has the potential of substituting biological recordings.</p><p>We investigated whether ANN can extract C_RS using tracings of P_AW and V’, without any intervention of an inspiratory hold maneuver during continuous MV. We concluded that C_RS can be estimated by ANN during volume control MV, without the need to stop inspiratory flow.</p><p>We tested whether ANN, fed by inspiratory P_AWand V’, are able to measure static total positive end-expiratory pressure (PEEP_tot,stat) during ongoing MV. In an animal model we generated dynamic pulmonary hyperinflation by shortening expiratory time. Different levels of external PEEP (PEEP_APP) were applied. Results showed that ANN can estimate PEEP_tot,stat reliably, without any influence from the level of PEEP_APP.</p><p>We finally compared the robustness of ANN and multi-linear fitting (MLF) methods in extracting C_RS when facing signals corrupted by perturbations. We observed that during the application of random noise, ANN and MLF maintain a stable performance, although in these conditions MLF may show better results. ANN have more stable performance and yield a more robust estimation of C_RS than MLF in conditions of transient sensor disconnection.</p><p>We consider ANN to be an interesting technique for the assessment of respiratory mechanics.</p>

The aim of this thesis was to test the capability of Artificial Neural Networks (ANN) to estimate respiratory mechanics during mechanical ventilation (MV). ANNs are universal function approximators and can extract information from complex signals. We evaluated, in an animal model of acute lung injury, whether ANN can assess respiratory system resistance (RRS) and compliance (CRS) using the tracings of pressure at airways opening (PAW), inspiratory flow (V’) and tidal volume, during an end-inspiratory hold maneuver (EIHM). We concluded that ANN can estimate CRS and RRS during an EIHM. We also concluded that the use of tracings obtained by non-biological models in the learning process has the potential of substituting biological recordings. We investigated whether ANN can extract CRS using tracings of PAW and V’, without any intervention of an inspiratory hold maneuver during continuous MV. We concluded that CRS can be estimated by ANN during volume control MV, without the need to stop inspiratory flow. We tested whether ANN, fed by inspiratory PAW and V’, are able to measure static total positive end-expiratory pressure (PEEPtot,stat) during ongoing MV. In an animal model we generated dynamic pulmonary hyperinflation by shortening expiratory time. Different levels of external PEEP (PEEPAPP) were applied. Results showed that ANN can estimate PEEPtot,stat reliably, without any influence from the level of PEEPAPP. We finally compared the robustness of ANN and multi-linear fitting (MLF) methods in extracting CRS when facing signals corrupted by perturbations. We observed that during the application of random noise, ANN and MLF maintain a stable performance, although in these conditions MLF may show better results. ANN have more stable performance and yield a more robust estimation of CRS than MLF in conditions of transient sensor disconnection. We consider ANN to be an interesting technique for the assessment of respiratory mechanics.

The paper aims to mediate thin film chromatography analysis by means of drugs commonly found in households (analgesic-antipyretics) to secondary school and grammar students, or to college students. For this purpose, laboratory tasks have been designed to cover all levels of the Bloom pyramid so that the educational potential is as high as possible. This is closely related to the topic of drug expiration and treatment. Pupils and students should take on both the competences of knowledge, skills, and attitudes. Keywords: thin layer chromatography; TLC; chromatography in education; educational experiment; expiratory medication; drug handling; analgesic- antipyretics, acetylsalicylic acid, paracetamol

Introdução: A DPOC caracteriza-se pela limitação ao fluxo aéreo associada à resposta inflamatória anormal dos pulmões a partículas ou gases nocivos. As alterações mecânicas decorrentes da DPOC estão relacionadas com a disfunção mecânica das fibras do diafragma, já observadas nas fases iniciais da doença. Alguns estudos têm demonstrado o elevado potencial da Técnica de Oscilações Forçadas (FOT) na detecção das alterações mecânicas da DPOC. Contudo, tais aplicações da FOT não permitiam a análise em tempo real das alterações do sistema respiratório, bem como da mobilidade toracoabdominal destes indivíduos. Desta forma, os objetivos desta pesquisa foram analisar, em tempo real, as alterações de impedância do sistema respiratório nas distintas fases do ciclo em portadores de DPOC, assim como avaliar a movimentação toracoabdominal destes indivíduos. Metodologia: Trata-se de um estudo observacional controlado, prospectivo onde foram analisados 48 indivíduos, 23 indivíduos controles e 25 portadores de DPOC com grau de obstrução acentuado. Os indivíduos realizaram exames de FOT para análise da impedância do sistema respiratório e mobilidade toracoabdominal, simultaneamente. Posteriormente aos exames da FOT os indivíduos foram submetidos à Espirometria. Resultados: Os resultados demonstraram aumento da impedância do sistema respiratório nos indivíduos com DPOC em comparação ao grupo controle, em nos parâmetros estudados (Zt, Zi, Ze, Zii, Zie, Zrs e Zpp) (p<0,0001). Em relação às distintas fases do ciclo, os indivíduos deste estudo apresentaram impedâncias maiores na fase inspiratória quando comparadas à fase expiratória (p<0,004). Somente 10% dos portadores de DPOC apresentaram assincronia toracoabdominal (&#966; &#8805; 45), sendo que os valores médios não apresentaram diferença estatística quando comparados ao grupo controle. Discussão: A impedância total do sistema respiratório (Zt) aumentada nos portadores de DPOC confirma o aumento da carga mecânica do sistema respiratório destes indivíduos. Essas alterações são coerentes com o processo fisiopatológico, evidenciado pela obstrução ao fluxo aéreo e destruição do parênquima pulmonar. O aumento da impedância na fase inspiratória quando comparada à fase expiratória, sugere um aumento no trabalho resistivo e elástico. Não foram evidenciados sinais de assincronia na mobilidade toracoabdominal na maior parte dos indivíduos, sugerindo que alguns mecanismos adaptativos atuam na tentativa de evitar a fadiga do músculo respiratório. Conclusões: A DPOC resulta no aumento da carga mecânica do sistema respiratório, alterações identificadas pelo aumento da impedância do sistema respiratório, medida pela FOT em tempo real. Este aumento foi mais evidente durante a fase inspiratória. A mobilidade toracoabdominal não se mostrou alterada na maior parte dos indivíduos com DPOC. Estes resultados são consistentes com publicações prévias e fundamentos fisiopatológicos, confirmando o potencial da FOT monofreqüência na avaliação das modificações relacionadas à DPOC. / Introduction: COPD is carachterized by airflow limitation associated abnormal inflammatory response of the lung to noxious particles or gases. The mechanical alterations associated with COPD have been related with dysfunction of the diaphragm, observed since the initial phases of the disease. Several studies have confirmed the high potential of FOT in the assessment of the mechanics modifications related to COPD. However, such studies did not allow a real-time analysis of the changes in the respiratory system, and the thoracoabdominal mobility of these individuals. Thus, the goals of the present study were to analyze, in real-time, the impedance alterations of the respiratory system in different phases of the respiratory cycle of COPD patients. Methodology: This research consists of a controlled observational study where 48 individuals were analyzed, 23 controls and 25 individuals with COPD and severe airway obstruction. Firstly, they performed simultaneous analysis of impedance of the respiratory system and thoracoabdominal motion. In subsequent examinations, these subjects were submitted to spirometry. Results: The results demonstrated an increase of the respiratory system impedance in individuals with COPD compared with the control group in all of the studied parameters (Zt, Zi, Ze, Zii, Zie, &#916;Zrs e Zpp) (p<0.0001). Considering the different phases of the respiratory cycle, higher impedances were observed in the inspiratory phase (p<0.004). Only 10% of individuals with COPD showed thoracoabdominal asynchrony (&#966;&#8805; 45), and the mean values showed no statistical difference when compared to the control group. Discussions: The total impedance of the respiratory system increased in individuals with COPD, which describes the increase of the mechanic load of the respiratory system in these individuals. These alterations are coherent with the physiopathology of COPD, associated with airflow obstruction and lung parenchyma destruction. The increase of the impedance in the inspiratory phase suggests an increase of the resistive and elastic work. There were not signals of thoracoabdominal asynchrony in the major part of the studied individuals, suggesting that some adaptation mechanisms act to compensate respiratory muscle fatigue. Conclusion: The COPD results in the increase of the mechanic load of the respiratory system. These alterations were identified by the increase of the respiratory system impedance, which was more evidence in the inspiratory phase. The thoracoabdominal asynchrony was not usual in individuals with COPD. Those results are consistent with previously published data and physiopathological fundamentals, confirming the potential of monofrequency FOT in the assessment of the modifications related to COPD.

Introdução: A DPOC caracteriza-se pela limitação ao fluxo aéreo associada à resposta inflamatória anormal dos pulmões a partículas ou gases nocivos. As alterações mecânicas decorrentes da DPOC estão relacionadas com a disfunção mecânica das fibras do diafragma, já observadas nas fases iniciais da doença. Alguns estudos têm demonstrado o elevado potencial da Técnica de Oscilações Forçadas (FOT) na detecção das alterações mecânicas da DPOC. Contudo, tais aplicações da FOT não permitiam a análise em tempo real das alterações do sistema respiratório, bem como da mobilidade toracoabdominal destes indivíduos. Desta forma, os objetivos desta pesquisa foram analisar, em tempo real, as alterações de impedância do sistema respiratório nas distintas fases do ciclo em portadores de DPOC, assim como avaliar a movimentação toracoabdominal destes indivíduos. Metodologia: Trata-se de um estudo observacional controlado, prospectivo onde foram analisados 48 indivíduos, 23 indivíduos controles e 25 portadores de DPOC com grau de obstrução acentuado. Os indivíduos realizaram exames de FOT para análise da impedância do sistema respiratório e mobilidade toracoabdominal, simultaneamente. Posteriormente aos exames da FOT os indivíduos foram submetidos à Espirometria. Resultados: Os resultados demonstraram aumento da impedância do sistema respiratório nos indivíduos com DPOC em comparação ao grupo controle, em nos parâmetros estudados (Zt, Zi, Ze, Zii, Zie, Zrs e Zpp) (p<0,0001). Em relação às distintas fases do ciclo, os indivíduos deste estudo apresentaram impedâncias maiores na fase inspiratória quando comparadas à fase expiratória (p<0,004). Somente 10% dos portadores de DPOC apresentaram assincronia toracoabdominal (&#966; &#8805; 45), sendo que os valores médios não apresentaram diferença estatística quando comparados ao grupo controle. Discussão: A impedância total do sistema respiratório (Zt) aumentada nos portadores de DPOC confirma o aumento da carga mecânica do sistema respiratório destes indivíduos. Essas alterações são coerentes com o processo fisiopatológico, evidenciado pela obstrução ao fluxo aéreo e destruição do parênquima pulmonar. O aumento da impedância na fase inspiratória quando comparada à fase expiratória, sugere um aumento no trabalho resistivo e elástico. Não foram evidenciados sinais de assincronia na mobilidade toracoabdominal na maior parte dos indivíduos, sugerindo que alguns mecanismos adaptativos atuam na tentativa de evitar a fadiga do músculo respiratório. Conclusões: A DPOC resulta no aumento da carga mecânica do sistema respiratório, alterações identificadas pelo aumento da impedância do sistema respiratório, medida pela FOT em tempo real. Este aumento foi mais evidente durante a fase inspiratória. A mobilidade toracoabdominal não se mostrou alterada na maior parte dos indivíduos com DPOC. Estes resultados são consistentes com publicações prévias e fundamentos fisiopatológicos, confirmando o potencial da FOT monofreqüência na avaliação das modificações relacionadas à DPOC. / Introduction: COPD is carachterized by airflow limitation associated abnormal inflammatory response of the lung to noxious particles or gases. The mechanical alterations associated with COPD have been related with dysfunction of the diaphragm, observed since the initial phases of the disease. Several studies have confirmed the high potential of FOT in the assessment of the mechanics modifications related to COPD. However, such studies did not allow a real-time analysis of the changes in the respiratory system, and the thoracoabdominal mobility of these individuals. Thus, the goals of the present study were to analyze, in real-time, the impedance alterations of the respiratory system in different phases of the respiratory cycle of COPD patients. Methodology: This research consists of a controlled observational study where 48 individuals were analyzed, 23 controls and 25 individuals with COPD and severe airway obstruction. Firstly, they performed simultaneous analysis of impedance of the respiratory system and thoracoabdominal motion. In subsequent examinations, these subjects were submitted to spirometry. Results: The results demonstrated an increase of the respiratory system impedance in individuals with COPD compared with the control group in all of the studied parameters (Zt, Zi, Ze, Zii, Zie, &#916;Zrs e Zpp) (p<0.0001). Considering the different phases of the respiratory cycle, higher impedances were observed in the inspiratory phase (p<0.004). Only 10% of individuals with COPD showed thoracoabdominal asynchrony (&#966;&#8805; 45), and the mean values showed no statistical difference when compared to the control group. Discussions: The total impedance of the respiratory system increased in individuals with COPD, which describes the increase of the mechanic load of the respiratory system in these individuals. These alterations are coherent with the physiopathology of COPD, associated with airflow obstruction and lung parenchyma destruction. The increase of the impedance in the inspiratory phase suggests an increase of the resistive and elastic work. There were not signals of thoracoabdominal asynchrony in the major part of the studied individuals, suggesting that some adaptation mechanisms act to compensate respiratory muscle fatigue. Conclusion: The COPD results in the increase of the mechanic load of the respiratory system. These alterations were identified by the increase of the respiratory system impedance, which was more evidence in the inspiratory phase. The thoracoabdominal asynchrony was not usual in individuals with COPD. Those results are consistent with previously published data and physiopathological fundamentals, confirming the potential of monofrequency FOT in the assessment of the modifications related to COPD.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Introduction: The neuromuscular and respiratory systems are significantly affected during the sedentary aging, but these modifications can be minimized/attenuated by practice of resistance training Purpose: Compare the effects of different volumes of resistance training on the maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), functional performance, and muscle strength in elderly women. Methods: Nineteen elderly women were randomly assigned to a group performing either single sets (1-SET) or three sets (3-SET) of exercises. The sit-to-stand test, MIP, MEP, and muscle strength were assessed before and after 24 training sessions. Progressive resistance training was performed two times per week for a total of 8 12 repetitions, using the main muscle groups of the upper and lower limbs. Results: The main results showed that the participants significantly increased their MEP (p<0,05; 1-SET: 34,6%; 3-SET: 35,8%) and MIP (p<0,05; 1-SET: 13,7%; 3- SET: 11,2%). Both groups also improved in the sit-to-stand test (p<0,05; 1-SET: 10,6%; 3-SET: 17,1%). After 24 training sessions, muscle strength also significantly increased (p<0,0001; 40 80%) in both groups. An intergroup comparison did not show any statistically significant differences between the groups in any of the parameters analyzed. Conclusion: Single- and multiple-set resistance training programs increased MIP, MEP, muscle strength, and sit-to-stand test performance in elderly women after 24 sessions of training. In conclusion, our results suggested that elderly women who are not in the habit of physical activity may start with single-set resistance training programs as a short-term strategy for the maintenance of health. / Introdução: Os sistemas neuromuscular e respiratório são significativamente afetados durante o envelhecimento sedentário, contudo estas modificações podem ser minimizadas/atenuadas pela prática do treinamento resistido. Objetivo: Comparar os efeitos de diferentes volumes de treinamento resistido sobre a pressão muscular inspiratória (Pimax), pressão muscular expiratória (Pemax), desempenho funcional e força muscular de idosas. Métodos: Dezenove mulheres idosas foram divididas randomicamente em dois grupos, série simples (1-SET) ou três séries (3 SET) de exercícios resistidos. O teste de sentar e levantar, Pemax, Pimax e força muscular foram avaliados antes e após 24 sessões de treinamento. O treinamento resistido progressivo foi realizado durante 12 semanas com frequência de duas vezes por semana, entre 8-12 repetições, utilizando-se os principais grupos musculares dos membros superiores e inferiores. Resultados: Os principais resultados demonstram que ocorreram aumentos significativos na Pemax (p<0,05; 1-SET: 34,6%; 3-SET: 35,8%) e Pimax (p<0,05; 1-SET: 13,7%; 3-SET: 11,2%). Ambos os grupos também melhoraram no teste de sentar e levantar (p<0,05; 1-SET: 10.6%; 3-SET: 17.1%). Após 24 sessões de treinamento resistido, a força muscular aumentou significativamente (p<0,001; 40-80%) nos grupos. A comparação intergrupo não revelou diferença significativa em nenhum parâmetro analisado. Conclusão: Séries simples e múltiplas de treinamento resistido melhoram a Pemax, Pimax, força muscular e o desempenho funcional no teste de sentar e levantar após 24 sessões de treinamento. Estes resultados sugerem que mulheres idosas que não possuem o hábito de praticar atividade física podem iniciar programas de séries simples de treinamento resistido, como estratégia de curto tempo para a manutenção da saúde.

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With the rapid somatic growth and development in infants, simultaneous accurate measurements of lung volume and airway function are essential. Raised volume rapid thoracoabdominal compression (RTC) is widely used to generate forced expiration from an airway opening pressure of 30 cmH2O (V30). The (dynamic) functional residual capacity (FRCdyn) remains the lung volume most routinely measured. The aim of this study was to develop comprehensive integrated spirometry that included all subdivisions of lung volume at V30 or total lung capacity (TLC30). Measurements were performed on 17 healthy infants aged 8.6-119.7 weeks. A commercial system for multiple-breath nitrogen washout (MBNW) to measure lung volumes and a custom made system to perform RTC were used in unison. A refined automated raised volume RTC and the following two novel single maneuvers with dual volume measurements were performed from V30 during a brief post-hyperventilation apneic pause: (1) the passive expiratory flow was integrated to produce the inspiratory capacity (IC) and the static (passive) FRC (FRCst) was estimated by initiating MBNW after end-passive expiration; (2) RTC was initiated late during passive expiration, flow was integrated to produce the slow vital capacity (jSVC) and the residual volume (RV) was measured by initiating MBNW after end-expiration while the jacket (j) was inflated. Intrasubject FRCdyn and FRCst measurements overlapped (p = 0.6420) but neither did with the RV (p < 0.0001). Means (95% confidence interval) of FRCdyn, IC, FRCst, jSVC, RV, forced vital capacity and tidal volume were 21.2 (19.7-22.7), 36.7 (33.0-40.4), 21.2 (19.6-22.8), 40.7 (37.2-44.2), 18.1 (16.6-19.7), 40.7 (37.1-44.2) and 10.2 (9.6-10.7) ml/kg, respectively. Static lung volumes and capacities at V30 and variables from the best forced expiratory flow-volume curve were dependent on age, body length and weight. In conclusion, we developed a comprehensive physiologically integrated approach for in-depth investigation of lung function at V30 in infants.