Chez un patient, les muscles respiratoires sont mis au repos lors de la défaillance de la fonction respiratoire, que cette défaillance soit involontaire (maladie, accident…) ou volontaire (anesthésie générale). Le patient est alors relié à un ventilateur artificiel, machine qui se charge de le faire respirer. Il existe de très nombreux types de ventilateurs artificiels, de qualité inégale, et chaque dispositif propose de multiples réglages pour ventiler le patient : les modes ventilatoires. Ces machines et leurs modes ventilatoires sont commercialisés et utilisés quotidiennement, mais très peu ont été évalués en situation clinique et leurs performances restent à démontrer. L'interaction de ces modes ventilatoires avec les muscles respiratoires du patient est ainsi actuellement méconnue. Dans ce travail, premièrement nous avons fait un état des lieux des pratiques de la ventilation mécanique en médecine péri-opératoire (patients au bloc opératoire et réanimation) ; secondairement, nous avons évalué sur banc d'essai au laboratoire les performances techniques des ventilateurs d'anesthésie et de réanimation de dernière génération dans des conditions statiques (ventilation contrôlée dans différentes conditions de pathologies pulmonaires) et dans des conditions dynamiques (ventilation spontanée assistée dans différentes situations de sevrage ventilatoire) et établi des critères de choix d'un ventilateur ; dans une troisième partie nous avons analysé chez le patient de réanimation au cours du sevrage de la ventilation mécanique le fonctionnement et le comportement des modes ventilatoires les plus évolués (Neurally Adjusted Ventilatory Assist (NAVA), Proportionnal Adaptive Ventilation + (PAV+), Adaptative Support Ventilation (ASV), Intellivent, Noisy-PSV) en comparaison avec le mode de référence qu'est la Ventilation Spontanée en Aide Inspiratoire (Pressure Support Ventilation). Finalement, nous présentons les perspectives de recherche et bénéfices potentiels attendus issus de ces études à travers nos projets de travaux expérimentaux et cliniques. / In case of respiratory failure, the patient's respiratory muscles are put at rest. The patient is then linked to an artificial ventilator, which makes him breath. There are a huge number of artificial ventilators, of varying quality, and each device offers many different settings : the ventilatory modes. These devices and their ventilatory modes are marketed and used daily, but few of them have ever been evaluated in a clinical situation and their performances still need to be proven. Interactions between these ventilatory modes and respiratory muscles are presently unknown. In this work, we first made an inventory of mechanical ventilation in peri-operative medicine (patients in operating rooms and in intensive care units). Then, we evaluated on a bench test the technical performances of the latest generation of anesthesia and intensive care ventilators, in static conditions (controlled ventilation in different pathologic pulmonary conditions) and in dynamic conditions (assisted spontaneous breathing in different weaning situations), and we established criteria to check before choosing a ventilator. Third, we analysed the behaviour of several advanced ventilatory modes (Neurally Adjusted Ventilatory Assist (NAVA), Proportional Assist Ventilation Plus (PAV+), Adaptive Support Ventilation (ASV), Intellivent, Noisy-PSV) during ventilator weaning of intensive care patients compared to the reference weaning mode : Pressure Support Ventilation. Finally, we present research perspectives and potential benefits from our studies through our experimental and clinical project.

Introduction: In elderly seniors (>80 years), respiratory function may be compromised when, in addition to the presence of comorbidity and loss of mobility, there is also reduced respiratory muscle (RM) strength. The literature has shown that RM training could be an effective method to improve RM function and prevent clinical deterioration, particularly in population with RM weakness.The main purpose of this paper was to assess the effectiveness of RM training on the respiratory muscle strength and endurance of institutionalized elderly women with functional impairment. Method: Fifty-four residents (mean=85 years, SD=6.7) were randomly assigned to either a control (n=27) or training (n=27) group. A supervised training program was developed with Threshold®IMT, five times per week for 6-weeks. The main variables of the intervention were: maximum inspiratory pressure (PImax), maximum expiratory pressure (PEmax) and maximal voluntary ventilation (MVV), all of which were measured at weeks 0, 4, 7 and 10. Results: Statistical analysis revealed no significant differences in PImax (F3,114=1.04, p=0.368, R2=0.027), PEmax (F3,114=1.86, p=0.14, R2=0.047) and MVV (F3,114=1.74, p=0.162, R2=0.044) between the two groups after the intervention. However, the workload significantly improved with the training sessions (F5,100=72.031, p<0.001, R2=0.791). Conclusion: In a 6-week interval-based training program, the threshold loading device does not significantly improve parameters related to RM strength and endurance of the study population.

Introduction: In elderly seniors (>80 years), respiratory function may be compromised when, in addition to the presence of comorbidity and loss of mobility, there is also reduced respiratory muscle (RM) strength. The literature has shown that RM training could be an effective method to improve RM function and prevent clinical deterioration, particularly in population with RM weakness.The main purpose of this paper was to assess the effectiveness of RM training on the respiratory muscle strength and endurance of institutionalized elderly women with functional impairment. Method: Fifty-four residents (mean=85 years, SD=6.7) were randomly assigned to either a control (n=27) or training (n=27) group. A supervised training program was developed with Threshold®IMT, five times per week for 6-weeks. The main variables of the intervention were: maximum inspiratory pressure (PImax), maximum expiratory pressure (PEmax) and maximal voluntary ventilation (MVV), all of which were measured at weeks 0, 4, 7 and 10. Results: Statistical analysis revealed no significant differences in PImax (F3,114=1.04, p=0.368, R2=0.027), PEmax (F3,114=1.86, p=0.14, R2=0.047) and MVV (F3,114=1.74, p=0.162, R2=0.044) between the two groups after the intervention. However, the workload significantly improved with the training sessions (F5,100=72.031, p<0.001, R2=0.791). Conclusion: In a 6-week interval-based training program, the threshold loading device does not significantly improve parameters related to RM strength and endurance of the study population.

The objective of the thesis was to evaluate the possibility to calculate the unloading distribution between a ventilator and a patient using a new mathematical modelling of the breathing patterns. The modelling used today is considered to lack sufficient precision for clinical use, and is a somewhat simplified model. To evaluate the possibility of a new model, a volunteer test was carried out - recording data such as Edi, pressure, volume and flow. Using this data, and by using a more complex model, tidal volume was estimated and compared to the measured data. The results did not imply any improvement compared to the simpler model regarding the accuracy and the variability. However, more work should be done in this area, as time deficiency prevented further analysis.

The aim oftbe work was to get concrete and objective view of the movement of defined parts in lumbar spine during postural task. The other goal was to measure respiratory muscle strenght a find if there was a connection between measured parameters. 35 subjects with chronic low back pain and 25 asymptomatic subjects underwent dynamic MRl examination and measurement of maximal mouth pressures. This study showed lower valu es of Pimax and displacement of vertebra Ll in group of patients. AIso showed correlation between Pimax and Ll dispalcement, sacrum displacement and the sacral slope difference during postural task in group of patients. No significant correlations in control group were found. Powered by TCPDF (www.tcpdf.org)

The presented thesis is focused on the influence of postural stability changes on respiratory muscle strength. The aim of this thesis was to determinate whether the respiratory muscle strength will change during the increased demands on postural stability, and if so, then how exactly. The theoretical part summarized the findings about the diaphragm and its postural stabilizing function, about the connection between breathing and postural control as well as about the influence of body position on respiratory muscle strength. In the practical part of the thesis, the values of the maximal respiratory mouth pressures were measured (PI max and PE max) on 21 healthy subjects ranging from 20 to 26 years of age using the spirometer in three postural situations - standing, standing on the balance surface and standing on the balance surface with no visual control. Throughout the whole group, there were no significant statistical differences ( p ≥ 0,05 ) in the outcome values of the measured postural situations. Two trends were observed in the changes of values of PI max and PE max. During the increased demands for postural stability the value of PI max was higher for 29% and lower for 71% of the measured individuals. The value of PE max was higher for 33% and lower for 67% of the measured individuals. This...

The purpose of this study was to determine the effects of 4 week respiratory muscle training (RMT) on intermittent recovery performance, pulmonary functions and maximum oxygen consumption capacity (Vo2max) of young soccer players. Eighteen young soccer player who were playing in the Turkey PAF League (league for candidate professional soccer players) from Hacettepe Sports Club with a mean age of 18.4 &plusmn / 0.8 years (ranging from 17 to 19 years) and 8.5 &plusmn / 0.7 (ranging from 7 to 9 years) years experience in soccer participated. Players&rsquo / weekly metabolic equivalent score (MET) was 120. Their maximum oxygen consumption (Vo2max) on a treadmill, pulmonary function with a spirometer, and recovery performance with a yo-yo intermittent recovery test level 2 were measured and then they were randomly assigned into two groups as either RMT (n = 9) or control (n = 9). The RMT group continued both their regular training and RMT treatment with a commercially available powerlung sport respiratory muscle trainer (Powerlung Inc., TX, and USA) for 4 weeks. The control group only continued with their regular training. After completing 4 week RMT implementation (composed of 30 sets of inhalation, two times a day, 5 days of the week), the same tests were performed in order to see the v effects of 4 week RMT treatment on selected parameters mentioned above. Findings of this study indicated that 4 week of RMT treatment significantly improved (% 39) yo-yo intermittent recovery test level 2 performances of the RMT group from pre to post test measurements when compared to subjects in the control group. However, there were no significant improvements in both RMT and control group&rsquo / s Vo2max capacity, Vital capacity (VC), Forced vital capacity (FVC), forced expiratory flow (FEV1.0) and Peak expiratory flow performances (PEF). As a conclusion, 4 week of RMT implementation improves the intermittent recovery performance of young soccer players.

Introdução: Pacientes com hipertensão pulmonar (HP) além de apresentar redução da capacidade funcional, da qualidade de vida e da sobrevida, apresentam fraqueza dos músculos respiratórios, o que pode contribuir para o aumento dos sintomas de fadiga e dispneia. Objetivos: Verificar o efeito do treinamento muscular inspiratório (TMI) sobre a capacidade funcional, a qualidade de vida, a força muscular respiratória, pressão sistólica da artéria pulmonar, a função pulmonar e o nível de atividade física de pacientes com HP. Métodos: Doze pacientes com HP foram randomizados em um grupo controle (n=7) e um grupo TMI (n=5). O protocolo do TMI foi realizado durante 8 semanas. Foram feitas avaliações da pressão arterial pulmonar média, através do ecocardiograma; da qualidade de vida, através do questionário SF-36; da capacidade funcional, através do teste de caminhada de 6 minutos e da força muscular respiratória, através de transdutor de pressão. Todos os pacientes foram avaliados na fase pré e pós protocolo. Resultados: A força muscular inspiratória aumentou significativamente no grupo TMI quando comparado ao grupo controle (105,2±6,6 vs 82,9±6,1; p=0,01), e o escore de saúde mental avaliado pelo questionário SF-36 aumentou no grupo TMI (de 70,4±21,6 para 80±14,4; p=0,05). Entretanto a capacidade funcional não apresentou alteração após o protocolo de TMI de 8 semanas. Conclusão: O TMI é capaz de aumentar a força muscular inspiratória e melhorar a qualidade de vida, em relação a saúde mental, de pacientes com HP. / Introduction: Besides showing pulmonary hypertension (PH), decreased functional capacity, quality of life and survival, patients also present respiratory muscle weakness, which may contribute to increased fatigue and dyspnea symptoms. Objectives: Evaluate the effects of inspiratory muscle training (IMT) on functional capacity, quality of life, respiratory muscle strength, pulmonary artery pressure, pulmonary function and level of physical activity. Methods: Twelve chronic PH patients randomized to a control group (n = 7) and an IMT group (n = 5) were studied. The IMT program was performed for 8 weeks. The following measures were obtained before and after the program: respiratory muscle function; function capacity (6-min walk test); pulmonary artery pressure; quality of life (SF-36); and level de physical activity (IPAQ). Results: Maximal inspiratory pressure (PI,max) was higher in the IMT group than in the control group (105.2±6.6 vs 82.9±6.1; p=0.01), and the mental health score by SF-36 increased in de IMT group (from 70.4±21.6 to 80±14.4; p=0.05). However, the six-min walk test did not change after the IMT program. Conclusions: This study indicates that IMT results in improvement in inspiratory muscle strength and in the quality of life regarding PH.

Made available in DSpace on 2016-06-02T20:18:20Z (GMT). No. of bitstreams: 1 4986.pdf: 16630247 bytes, checksum: 510ccc41e3366827608d039b6736424a (MD5) Previous issue date: 2013-01-28 / Financiadora de Estudos e Projetos / The present thesis has a result three studies in which the aims were: Study I To propose an assessment method of inspiratory muscle endurance (IME) using the traditional manuvacuometry and the PowerBreathe® device. Moreover, the aim was to verify its viability in patients with Chronic Obstructive Pulmonary Disease (COPD) and healthy. Study II To compare the inspiratory muscle training (IMT) and respiratory exercise (RE) effects associated with physical training (PT) regarding to strength and endurance gain of inspiratory muscles, thoracoabdominal mobility, physical exercise capacity and dyspnea during physical efforts in patients with COPD. In additional, it was to verify if there is a relation of changing gained post training among these variables. Study III To verify if the IMT and/or RE modality associated to PT can provide changes in inspiratory muscle strength, in thoracoabdominal asynchronism and dyspnea at rest and during unsupported upper limb (UL) exercises. Additionally, it was to verify if there is a difference between these both technics modalities. The total sample was composed of 19 healthy subjects and 25 patients with COPD; 13 in the GPT+IMT group and 12 in the GPT+RE. All subjects were assessed before and after training by spirometry; measures of maximum inspiratory (MIP) and expiratory pressures (MEP), IME test, in which was determined the sustained maximum inspiratory pressure (SMIP) and the limit time (Tlim), cirtometry, sixminute walking test (6MWT) and treadmill exercise test (TT). Moreover, reported the modified Medical Research Council (mMRC) and the assessment of respiratory inductance plethysmography (RIP). The IME test was well tolerated. The MIP, MIP %pred, SMIP and SMIP/MIP values were significant lower (p<0.05) in patient with COPD. There was no significant difference between COPD and healthy subjects regarding to Tlim. In the GPT+IMT the MIP, SMIP, abdominal mobility values were significant higher (p<0.05); and, the dyspnea was significantly lower in the 6MWTpeak, TT and mMRC post treatment. However, in both groups there was a significant rise of MIP and SMIP, thoracoabdominal mobility, 6MWD and inclination at TT; and, fall of dyspnea at 6MWTpeak (p<0.05). Only in the GPT+IMT there was a decreased of thoracoabdominal asynchronism at rest and during UL exercises. The PowerBreathe® device associated with the manovacuometry makes acceptable the IME test in patients with COPD and healthy subjects, specially using the incremental load. Both technics increased the exercise capacity and decrease dyspnea at efforts clinically significant. Although, due to the training specificity, only the IMT group was able to improve the inspiratory strength and endurance, which results in a pronounced reduction of dyspnea and thoracoabdominal asynchronism at rest and during UL exercises. / Esta tese resultou na elaboração de três estudos, cujos objetivos foram: Estudo I - Propor um método de avaliação da endurance muscular inspiratória, utilizando o manovacuômetro e o PowerBreathe®, e verificar sua viabilidade em pacientes com Doença Pulmonar Obstrutiva Crônica (DPOC) e inidivíduos saudáveis. Estudo II Comparar os efeitos do treinamento muscular inspiratório (TMI) e da cinesioterapia respiratória (cinesio) associados ao treinamento físico (TF) quanto ao ganho de força e endurance dos músculos inspiratórios, mobilidade tóracoabdominal, capacidade de exercício físico e a dispneia no esforço físico em pacientes com DPOC. Verificar se há relação das mudanças obtidas após treinamento entre essas variáveis. Estudo III - Verificar se o TMI e/ou a cinesio associados ao TF podem proporcionar mudanças na força muscular inspiratória, no assincronismo tóraco-abdominal e na dispneia, no repouso e durante exercícios de membros superiores (MMSS) sem suporte. E se há diferença entre essas duas modalidades de intervenção. Partciparam 19 indivíduos saudáveis (GS) e 25 pacientes com DPOC, 13 no grupo GTF+TMI e 12 no GTF+Cinesio. Foram submetidos, antes e após o treinamento, a: espirometria; medidas da pressão inspiratória (PImáx) e expiratória máxima (PEmáx); endurance dos músculos inspiratórios, em que se determinou a pressão inspiratória máxima sustentada (PImáxS) e o tempo limite (Tlim); cirtometria; teste de caminhada de seis minutos (TC6 ); teste ergométrico em esteira (TE); aplicação da escala Medical Research Council modificada (MRCm), e a avaliação da pletismografia respiratória de indutância (PRI). O teste de endurance dos músculos inspiratórios foi bem tolerado. Os valores da PImáx, PImáx %predito, PImáxS e PImáxS/PImáx foram significativamente menores (p<0,05) nos pacientes com DPOC. Não houve diferença significativa entre DPOC e o GS quanto ao Tlim. No GTF+TMI a PImáx, PImáxS, mobilidade abdominal foram significativamente maiores (p<0,05), e significativamente menor a dispneia no pico do TC6 e do TE e a MRCm pós tratamento. Porém, tanto no GTF+TMI quanto GTF+Cinesio houve aumento significativo da PImáx e da PImáxS, da mobilidade tóraco-abdominal, da distância percorrida no TC6 e da inclinação no TE, além de diminuição da dispneia no pico do TC6 (p<0,05). Somente no GTF+TMI houve diminuição do assincronismo tóraco-abdominal no respouso e em exercícios MMSS. O equipamento PowerBreathe®, associado ao manovacuômetro, torna viável o teste de endurance muscular inspiratória, tanto em indivíduos com DPOC quanto saudáveis, especialmente utilizando-se o teste de carga incremental. Ambas as intervenções aumentaram a capacidade de exercício e diminuíram a dispneia no esforço físico de forma clinicamente significativa. Porém, pela especificidade do treinamento somente o TMI foi capaz de aumentar de forma clinicamente significativa a força e a endurance muscular inspiratória o que resultou em uma mais pronunciada redução da dispneia e redução do assincronismo tóraco-abdominal no repouso e em exercícios de MMSS.

Made available in DSpace on 2014-12-17T14:10:24Z (GMT). No. of bitstreams: 1 ThiagoCVN_DISSERT.pdf: 3967132 bytes, checksum: 808ab0fb6d42acf030afd829319cfe49 (MD5) Previous issue date: 2012-03-30 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico / The human respiratory system was so designed that would allow efficient ventilation, regardless of variations in the external environment that may hinder the act of breathing, such an act involves dozens of variables, among them we find the respiratory depression, which is nothing more than respiratory muscle strength. The pressures are widely used in several cases: Neuro-muscular; evolution of pulmonary dysfunction and a predictor for discontinuation of mechanical ventilation. Therefore it was proposed to carry out evaluations of these respiratory pressures for children and adolescents aged 10 to 16 years and propose a predictive equation that involves the anthropometric variables age (A, years), body mass (BM, kilograms) and height (H, meters) with maximal respiratory pressures (maximum inspiratory and expiratory pressure). Evaluations were performed in this age group of students in public and private schools of the Grande Natal , measurements were performed using the analogue manometer, were children and adolescents and their parents gave informed consent. 517 samples were taken, and 250 for males (M), 255 for females (F) and 12 were excluded according to our exclusion criteria. The sample was subdivided into three age groups (10-11, 12-13 and 14 to 16 years old). It was found through the student s t test (p &#8804; 0.05) for all variables studied, children and male adolescents had higher means than females, except for the MC. For the correlation between the variables found significant correlation (p <0.05) among all the variables when analyzed as pairs except between MIP and height for females. The development of predictive equations (for p &#8804; 0.05) based on three types of strategies adopted were restricted to two association between anthropometric variables isolated, resulting in: for males: MIP = -32.29 + (-2.11*A) + (-0.52*BM), MIP = 9.99 + (-0.36*BM) + (-49.40*H); MEP = 18.54 + 3.53*A + 0, 42*BM, MEP = -33.37 + 2.78*A + 52.18* H, MEP = -17.39 + 0.33*BM + 55.04*H; and, for females we find: MEP = 24.32 + 2.59 * A + 0.24*BM / O sistema respirat?rio do ser humano foi concebido de maneira que possibilitasse uma ventila??o eficiente, independente das varia??es do meio externo que possam vir a dificultar o ato da respira??o, tal ato envolve dezenas de vari?veis, dentre elas encontramos a press?o respirat?ria, que nada mais ? do que a for?a muscular respirat?ria. As press?es s?o amplamente utilizadas em diversos casos: Doen?as neuro-musculares; evolu??o de disfun??es pulmonares e par?metro preditivo para a descontinuidade da ventila??o mec?nica. Assim sendo foi proposto a realiza??o de avalia??es dessas press?es respirat?rias para as crian?as e adolescentes de 10 aos 16 anos e propor uma equa??o preditiva que envolvesse as vari?veis antropom?tricas idade (ID, anos); massa corporal (MC, Kilogramas) e estatura (E, metros) com as press?es respirat?rias m?ximas (press?o inspirat?ria e expirat?ria m?xima). Foram realizadas as avalia??es nessa faixa et?ria em estudantes de escolas p?blicas e privadas da grande natal, as mensura??es foram realizadas atrav?s da manovacuometria anal?gica, as crian?as e adolescentes foram informadas e seus respons?veis deram o consentimento. Foram realizadas 517 coletas, sendo 250 para o g?nero masculino (M), 255 para o g?nero feminino (F) e 12 foram exclu?dos de acordo com nossos crit?rios de exclus?o. A amostra foi subdividida em 3 faixas et?rias (10 a 11; 12 a 13 e 14 a 16 anos de idade). Constatou-se atrav?s do teste t de student (p&#8804;0,05) que para todas as vari?veis pesquisadas, as crian?as e adolescentes do g?nero masculino apresentaram m?dias superiores aos do g?nero feminino, exceto para a MC. Para a correla??o entre as vari?veis encontramos significativa correla??o (p<0,05) entre todos as vari?veis quando analisadas par a par exceto entre Estatura e a PIm?x para o g?nero feminino. A elabora??o das equa??es preditivas (para p&#8804;0,05) baseadas nos 3 tipos de estrat?gias adotadas ficaram restritas a associa??o entre duas vari?veis antropom?tricas isoladas, resultando em: para o g?nero masculino: PIm?x= -32,29 + (-2,11*ID) + (-0,52*MC); PIm?x= 9,99 + (-0,36*MC) + (-49,40*E); PEm?x= 18,54 + 3,53*ID + 0,42*MC; PEm?x= -33,37 + 2,78*ID + 52,18*E e PEm?x= -17,39 + 0,33*MC + 55,04*E; para o g?nero feminino encontramos: PEm?x= 24,32 + 2,59*ID + 0,24*MC