O objetivo deste estudo foi comparar indicadores ergoespirométricos entre um grupo de idosos não-treinados (GINT) e o grupo de idosos treinados (GIT) em corridas de longa distância e a associação com a qualidade de vida. Uma amostra de 46 indivíduos idosos, dos quais 27 (idade = 73,1 ± 4,3 anos) estavam engajados em treinamento para corridas de longa distância e 19 (idade = 73,5 ± 6,4 anos) idosos que não praticavam exercício físico regular. Todos foram submetidos à avaliação cardiorrespiratória e metabólica, utilizando se analisador metabólico de gases (CPX/D, MedGraphics®, EUA) acoplado a eletrocardiógrafo (HeartWere®, 6.4, BRA), ambos os sistemas computadorizados. A determinação da capacidade física máxima foi verificada em esteira rolante (Inbramed®, ATL10200, BRA) utilizando se protocolo escalonado contínuo (1,2 km.h-1 a cada dois minutos) e inclinação fixa de 1%. Os seguintes resultados verificados foram: No segundo limiar ventilatório (VT2) [GINT vs. GIT]: FC (bpm) [69,4 ± 9,9 vs. 65,4 ± 6,8; p <0,05]; RQ [1,03 ± 0,03 vs.1,01 ± 0,03; p <0,05]; PO2 (mL/bpm) [11,3 ± 2,4 vs.14.4 ± 2,8; p <0,05]. No pico do esforço: VO2max (mL/kg/min) [27 ± 5,4 vs. 39,3 ± 5,6; p <0,05], TT (min) [9,6 ± 2,9 vs. 16,4 ± 2,7; p <0,05] e velocidade de corrida (km.h-1) [9,7 ± 2,5 vs. 13,3 ± 2,5; p <0,05]. Para medir a qualidade de vida foi utilizado o questionário WHOQOL. WHOQOL pontos [GINT vs. GIT: [70 ± 5 versus 71 ± 6] Avaliou-se o uso de medicamentos de diferentes grupos farmacológicos através de entrevistas e análise de pedidos médicos. Concluindo, a capacidade de desempenho cardiorrespiratório do GIT foi significativamente maior do que o GINT. No entanto, a qualidade de vida não foi diferente entre os dois grupos. Houve diferença na proporção de medicamentos utilizados entre os grupos. O GIT aparece com maior incidência no uso de Antiarrítmicos, Antiinflamatórios e Relaxantes Musculares. Ao contrário, o GINT apresentou maior uso de Hipoglicemiantes e Anti-Coagulantes. A maior utilização de antiinflamatórios e analgésicos pelo GIT pode ser devido ao fato de que os corredores têm maior prevalência de lesão muscular. Já a maior utilização de Hipoglicemiantes e Anti-Coagulantes pelo GINT, demonstra a falta de proteção cardiovascular pelo sedentarismo / The main purpose of this study was to compare ergoespirometric indicators among a group of elderly untrained (GEU) and a group of elderly old trained (GET) in long-distance race and the association with quality of life. Twenty seven (age = 73.1 ± 4.3 years) were engaged in training for distance running and 19 (age = 73.5 ± 6.4 years) older adults who did not practice regular physical exercise. All were underwent a cardiopulmonary exercise test evaluation. To this end we used a gas explorer (CPX/D, breathby breath Medgraphics®, Saint Paul, MN, USA) coupled to an electrocardiograph (HeartWere®, 6.4, BRA). Both systems were computerized. The determination of the maximum physical capacity was assessed on a treadmill (Inbramed ®, ATL-10200, BRA) using incremental protocol (1.2 km.h-1every two minutes) and a fixed inclination of 1%. The following results were observed: In second ventilatory threshold (VT2) [GEU vs. GET]: HR (bpm) [69.4 ± 9.9 vs. 65.4 ± 6.8; p <0.05], RQ [1.03 ± 0.03 vs.1.01 ± 0.03; p <0.05]; PO2 (mL/bpm) [11.3 ±2.4 vs.14.4 ± 2.8, p <0.05]. At peak effort: VO2max (mL/kg/min) [27 ± 5.4 vs. 39.3 ± 5.6; p <0.05], TT (min) [9.6 ± 2.9 vs. 16.4 ± 2.7; p <0.05] and running speed (km.h-1) [9.7 ± 2.5 vs. 13.3 ± 2.5; p <0.05]. To measure quality of life we used the WHOQOL. WHOQOL points [GEU vs. GET: [70 ± 5 vs. 71 ± 6] evaluated the use of drugs from different pharmacological groups through interviews and medical applications. In conclusion, the cardiorespiratory capacity of the GET was significantly higher than the GEU. However, the quality of life was not different between the two groups. Differences in the proportion of medicines used by the groups. GET appears with a higher incidence in antiarrhythmics, anti-inflammatory and muscle relaxants. Instead, the GEU showed greater use of hypoglycemic and anti-coagulants. The increased use of antiinflammatory and muscle relaxants effects by the GET may be due to the fact that runners have a higher prevalence of muscle damage. Instead, the increased use of hypoglycemic and anti-coagulants by GEU, demonstrates the lack of cardiovascular protection by physical inactivity

Nursing Procedures of Oxygen Administration to Newborns The diploma thesis is to outline the current perspective of oxygen therapy of newborns who need highly specialized care as early as in the delivery room and subsequently in intensive and resuscitation care units of perinatologic centres. The research in the diploma thesis is focused on the assessment of the level of implementation of recommendations of the Czech Neonatology Society concerning oxygen administration on all levels of neonatal care. The theoretical part addresses the first treatment and evaluation of a newborn. Then the reasons leading to oxygen administration are discussed as well as the methods of oxygen application in the delivery room and intensive and resuscitation care units. Being at the forefront, oxygen is one of the most often administered medicines. Inadequate use of oxygen as a medicine increases the risk of complications for the newborn. The delivery and the first weeks after the birth rank among the crucial periods of every child. Adherence to the recommended procedures improves the outlooks of premature newborns for leading quality life. The objective of the thesis is to ascertain the level of implementation of recommendations of the Czech Neonatology Society concerning oxygen administration on all levels of neonatal care. The research was quantitative and used the questionnaire technique. The author created one kind of the questionnaire for the selected research set. The set consisted of nurses working in neonatal wards of selected hospitals. A total of 65 questions were created to ascertain the level of implementation of recommendations of the Czech Neonatology Society concerning oxygen administration on all levels of neonatal care. The research set consisted of 184 respondents. In order to attain the objective, the following hypotheses were raised: H1: Nurses know the current recommendations for oxygen administration to newborns. H2: Delivery rooms have sufficient technical equipment for oxygen administration to newborns. H3: Nurses are theoretically and practically trained for situations requiring oxygen administration to newborns. H4: Clearly formulated rules of oxygen therapy are available for nurses in a written form in a well visible place in the delivery room. Based on the statistically processed results, the first three hypotheses have been confirmed. The fourth hypothesis was disconfirmed. The objective of the thesis has been attained. The research results may be used for better understanding of the issue of oxygen administration to newborns in a hypoxic condition with regard to the findings of its toxicity. In order to secure adherence to the recommendations for oxygen administration to newborns, it is appropriate to create a nursing procedure and standard and secure its availability in every delivery room and station.

Made available in DSpace on 2016-06-02T19:22:55Z (GMT). No. of bitstreams: 1 4118.pdf: 888617 bytes, checksum: ab0a143c06f87b0d8c255d7334f0078f (MD5) Previous issue date: 2011-11-18 / Financiadora de Estudos e Projetos / Deltamethrin is a synthetic pyrethroid pesticide, type II, considered of low persistence in the environment and widely utilized in agriculture and aquaculture to control plagues and aquatic parasites respectivamently. In spite of it low toxicity in mammals, this pesticide can be extremely toxic for fish. In this study, we evaluate the effects of a sub-lethal concentration (7.3 &#956;g L-1, 50% of LC50-96h) of deltamethrin (formulation BUTOX®CE25) on the in vivo cardio-respiratory function of Nile tilapia (Oreochromis niloticus), are species of high economic potential. The cardio-respiratory parameters (O2 uptake - V&O2 , respiratory frequency fR, gill ventilation - G V& , ventilatory tidal volume VT, O2 extraction from the ventilatory current EO2, and heart frequency fH) were measured in a group of intact fish (GC), under normoxic conditions, during 24 h. After this period, another group of fish (GE) was exposed to deltamethrin and kept under these conditions for another 24 h period. During these periods the cardio-respiratory variables were continuously monitored. In another series of experiments, a group of non-intoxicated fish (GCH) was exposed to normoxia (PwO2 ~ 140 mmHg) and subsequently submitted to graded hypoxia (PwO2 = 100, 70, 50, 30 and 20 mmHg), while the above cardio-respiratory variables were continuously measured. A fourth group (GEH) was exposed to deltamethrin and submitted to the same hypoxic leves. Just after the exposure to deltamethrin fish presented a reduction in 2 V&O (mLO2.kg-1.h-1) which recovered gradually and reached initial (control) values after 18 h. Meanwhile fR (breaths.min- 1) remained unchanged in response to the toxicant. The G V& (mLH2O.Kg-1.min-1), however, increased significantly in the first 6 h of exposure to deltamethrin, returning to the initial values after 9 h. The G V& increased as a consequence of a proportional enhancement in VT (mLH2O.kg-1.resp-1). Immediately after the toxicant administration, fish presented a significant reduction in fH (bpm) and this bradicardia remained for a period of 12 h, after which this variable returned to the control values. Fish exposed to deltamethrin and submitted to graded hypoxia presented a significant reduction in 2 V&O , while their critical oxygen tension (PcO2) increased in relation to the control group. This indicates impairment in the capacity of oxyregulation of intoxicated fish. Also during graded hypoxia G V& and VT of fish exposed to deltamethrin increased progressively, while fR did not change. The fH was significant lower (bradicardia) in all hypoxic tensions. In conclusion, when Nile tilapia is exposed to sub-lethal concentrations of deltamethrin (formulation BUTOX ®CE25), the cardio-respiratory variables of this species stabilize after about 24 h, indicating a fast recovery to the toxicity of this pesticide. The cardio-respiratory responses to hypoxia, however, are impaired by deltamethrine exposure, suggesting that an adequate aerobic metabolism is important in the detoxification of this pesticide. / Deltametrina é um pesticida piretróide sintético do tipo II, considerado de baixa persistência no ambiente, amplamente utilizado na aquacultura e na agricultura no combate a parasitas aquáticos e no controle de pragas respectivamente. Apesar de sua baixa toxicidade em mamíferos, este piretróide pode ser extremamente tóxico para peixes. No presente estudo avaliou-se os efeitos da exposição da deltametrina (na formulação BUTOX®CE25), em uma concentração subletal (7,3 &#956;g L-1, 50% da CL50-96 h), sobre a função cardio-respiratória in vivo de tilápia-do-Nilo, Oreochromis niloticus, espécie de grande importância para a piscicultura e pesca esportiva. Os parâmetros cardio-respiratórios (tomada de O2 - V&O2 , freqüência respiratória fR, ventilação branquial - G V& , volume ventilatório VT, extração de O2 pela corrente ventilatória EO2, freqüência cardíaca fH) foram medidos, em condições normóxicas, em um grupo de peixes intactos (grupo GC). Em seguida os peixes foram expostos à deltametrina e mantidos nessas condições por um período de 24 h (grupo GE). Durante esses períodos experimentais as variáveis cardio-respiratórias foram constantemente monitoradas e medidas. Em outra série de experimentos, um grupo controle de peixes (GCH) foi submetido a normóxia (PwO2 ~ 140 mmHg) e posteriormente submetidos à hipóxia gradual (PwO2 = 100, 70, 50, 30 and 20 mmHg). Outro grupo (GEH) foi exposto à mesma concentração subletal de deltametrina e submetido às mesmas tensões hipóxicas acima descritas. Observou-se, no decorrer de 24 h em normóxia, que a deltametrina reduziu imediatamente a 2 V&O (mLO2.kg-1.h-1), sendo que esta variável retornou a seus valores iniciais (controle) após 18 h de contaminação. Não foi observada nenhuma alteração na fR (resp.min-1) durante todo o período experimental. Entretanto, a G V& (mLH2O.Kg-1.min-1) aumentou significativamente nas primeiras 6 h de exposição, retornando aos valores iniciais após 9 h. Esse aumento na G V& deveu-se a um equivalente aumento no VT (mLH2O.kg-1.resp-1). Imediatamente após a administração da deltametrina, a fH (bpm) sofreu uma significativa redução (bradicardia) que se manteve por um período de 12 h, após o qual a fH retornou aos valores controle. Durante a hipóxia gradual a 2 V&O reduziu-se significativamente e progressivamente e a tensão crítica de O2 (PcO2) dos animais intoxicados aumentou, o que significa uma diminuição na capacidade de manutenção da 2 V&O em hipóxia em comparação com os animais controle. Também, durante a hipóxia, a G V& e o VT dos peixes intoxicados com deltametrina aumentaram progressivamente enquanto que a fR não se alterou. Da mesma forma a fH manteve-se significativamente mais baixa em todas as PO2 experimentais. Concluise que a deltametrina na formulação BUTOX ®CE25 é tóxica para tilápia-do-Nilo . Todavia quando essa espécie é submetida a uma concentração subletal desse inseticida por um curto período de tempo (24 h) os parâmetros cardio-respiratórios se restabelecem ao longo desse período. Isto indica que há uma possível recuperação da espécie em resposta à toxicidade da deltametrina. A hipóxia ambiental pode agravar os efeitos deste pesticida na função cardiorespiratória da tilápia-do-Nilo, mostrando que a manutenção de um metabolismo aeróbico é importante na detoxificação deste pesticida.

Introdução: Desmame da ventilação mecânica representa um importante desafio no ambiente de terapia intensiva. Os preditores ao desmame têm se mostrado pouco sensíveis e a falência na extubação pode determinar prolongada ventilação mecânica, aumento do tempo de permanência na UTI, na internação hospitalar, com consequentemente aumento nos custos hospitalares e aumento da morbidade e mortalidade. O objetivo do estudo foi verificar se novos indicadores: BNP (peptídeo natriurético Tipo-B), CPO (cardiac power out put) e VeRT (tempo de recuperação do volume minuto), são mais sensíveis em comparação aos preditores já utilizado para o desmame ventilatório. Método: Foram prospectivamente avaliados 101 pacientes no pós-operatório de Revascularização do Miocárdio. As variáveis respiratórias analisadas foram: freqüência respiratória, volume corrente, volume minuto, índice de respiração rápida e superficial, complacência estática, índice de oxigenação (PaO2/FiO2). As variáveis hemodinâmicas e metabólicas foram: FC, PAM, PVC, PCP, DC, IC, Lactato, SvO2, ERO2, D(a-v)O2, DO2 e VO2. Foram também testados os novos indicadores CPO, BNP e VeRT. Consideramos aptos para extubação os pacientes que apresentaram nível de consciência adequado e critérios positivos para o desmame corriqueiramente utilizados em U.T.I. Resultados: No total de 713 pacientes observados, 105 pacientes foram incluídos no estudo, desses pacientes quatro não foram extubados por desconforto respiratório, dos 101 pacientes acompanhados, 88 (88%) evoluíram com sucesso ao desmame e 12 (12%) evoluíram com insucesso. Não houve diferença estatisticamente significante entre os grupos, no que diz respeito aos dados antropométricos. As variáveis: freqüência respiratória, volume corrente, volume minuto, índice de respiração rápida e superficial, complacência estática, PaO2/FiO2, FC, PAM, PVC, PCP, DC, IC, DO2, VO2, Lactato e os novos indicadores CPO e VeRT, não foram sensíveis como preditores de sucesso ao desmame. Na análise multivariada o grupo sucesso apresentou até o momento pré-extubação, um menor tempo de permanência de U.T.I. (3,9 x 10,33, p=0, 024), menor tempo de internação hospitalar (11,29 x 16,08, p=0,047), menor necessidade de inotrópico dobutamina (12,90 x 16,67, p=0,049), uma maior SVO2 (69,18 x 61,67, p 0,002), menor ERO2 (0,45 x 0,62, p=0,03), menor D(a-v)O2 (4,34 x 5,10, p=0,039), e um menor nível de BNP (98,94 x 303,33, p=0,020), quando comparado com grupo insucesso, nesta ultima variável BNP à análise da curva ROC, mostrou uma sensibilidade de 83% e especificidade 87%. Conclusão: A prevalência de insucesso ao desmame ventilatório no pósoperatório de cirurgia cardíaca foi de 12%, os pacientes que evoluíram com insucesso apresentaram maior tempo de U.T.I., maior tempo de internação hospitalar e maior necessidade de inotrópico. No momento pré-extubação altos níveis de BNP, D(a-v)O2, ERO2 e baixo valores de SvO2, são preditores de sucesso ao desmame. Com isso a adequada otimização hemodinâmica prévia a extubação deve ser alcançada nessa população para se conseguir um seguro e precoce desmame da ventilação mecânica / Introduction: Weaning from mechanical ventilation represents a major challenge in the intensive care setting. The weaning predictors have shown little sensitivity and extubation failure may determine prolonged mechanical ventilation, prolonged ICU stay and prolonged hospitalization, with a consequent increase in hospital costs and increased morbidity and mortality. The objective of this study was to determine whether new indicators (BNP, CPO and VeRT), are more sensitive compared with predictors already used for weaning. Method: We prospectively evaluated 101 patients in post-operation stage of Myocardial Revascularization. Respiratory variables were analyzed: respiratory rate, tidal volume, minute volume, index of rapid shallow breathing, static compliance, oxygenation index (PaO2/FiO2). The hemodynamic and metabolic variables were: HR, MAP, CVP, PCWP, DC, IC, Lactate, SvO2, ERO2, D(a-v)O2, DO2 and VO2. We also tested the new indicators CPO, BNP and VeRT. We considered suitable for extubation patients that had appropriate levels of awareness and positive criteria for weaning routinely used in ICU. Results: From a total of 713 patients observed, 105 patients were included in the study; from these patients 4 were not extubated because of respiratory distress. From the 101 patients enrolled, 89 (88%) had successful weaning and 12 (12%) developed failure. There was no statistically significant difference between groups with respect to demographics. The variables: respiratory rate, tidal volume, minute volume, index of rapid shallow breathing, static compliance, PaO2/FiO2, HR, MAP, CVP, PCWP, DC, CI, DO2, VO2, lactate and new indicators CPO and VeRT were not as sensitive predictors of successful weaning. In multivariate analysis the group that had success until the pre-extubation stage a shorter length of stay in ICU (3.9 x 10.33, p = 0 024), shorter hospital stay (11.29 x 16.08, p = 0.047), less need for inotropic dobutamine (12.90 x 16.67, p = 0.049) greater SVO2 (69.18 x 61.67, p <0.002), lower ERO2 (0.45 x 0.62, p = 0.03), lower D(a-v)O2 (4.34 x 5.10, p = 0.039), and a lower level of BNP (98.94 x 303.33, p = 0.020) when compared to the failure group; this last variable BNP, in the ROC curve analysis, showed a sensitivity of 83 % and specificity of 87%. Conclusion: The prevalence of failure in ventilatory weaning in post-operatory of cardiac surgery was 12%; patients who developed failure had longer ICU and hospital stay and greater need for inotropic medicine. Upon pre-extubation high levels of BNP, D(a-v)O2, ERO2 and low values of SvO2 are strong predictors of successful weaning. With that, adequate hemodynamic optimization prior to extubation in this population must be reached to achieve a safe and early weaning from mechanical ventilation

Orientador: Luiz Eduardo Barreto Martins / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Educação Fisica / Made available in DSpace on 2018-08-14T08:00:32Z (GMT). No. of bitstreams: 1 Lourenco_ThiagoFernando_M.pdf: 1713436 bytes, checksum: d718517b4524a25dc81ced71623cc066 (MD5) Previous issue date: 2009 / Resumo: O consumo máximo de oxigênio (VO2max) é considerado medida padrão de potência aeróbica e desempenho físico, por integrar os sistemas nervoso, cardiopulmonar e metabólico e foi considerado fator determinante para o desempenho de corredores devido as boas correlações encontradas em corridas de 10 a 90 km. Além dele, parâmetros submáximos relacionados ao teste de esforço máximo como limiar ventilatório (LV) e ponto de compensação respiratória (PCR) são usados para a prescrição de intensidades de exercício. Durante a década de 80 inúmeros trabalhos sugeriram que a velocidade de corrida referente ao LV (vLV) seria um bom indicador da capacidade de realizar esforços de longa duração. No entanto, recentes achados relacionando a velocidade entre LV e PCR contradizem tais afirmações. Além disso, poucos trabalhos na literatura buscaram investigar a possível correlação entre a velocidade de corrida referente ao PCR (vPCR) e corrida de 10km. Já que a determinação das vLV, vPCR e vVO2max parecem ser importantes na determinação de desempenho e prescrição de treinamento, os protocolos de esforço máximo aplicados nessa população deveriam se aproximar das condições reais de treinamento e competições desses atletas, bem como determinar claramente tais parâmetros. No entanto, protocolos clássicos ainda são utilizados, devido à tradição e familiaridade dos avaliadores, sem a preocupação do embasamento metabólico e estatístico. Essa escassez de protocolos acaba por dificultar a aplicação prática dos dados obtidos e a determinação do desempenho de corredores. Nesse sentido, buscamos neste trabalho i) propor e verificar a reprodutibilidade de um protocolo incremental em esteira ergométrica específico para corredores e ii) investigar possível relação entre vPCR e desempenho na corrida de 10km (v10km) dessa população. Primeiramente, foram avaliados onze corredores amadores, os quais foram submetidos a quatro repetições do protocolo proposto: estágios de 25 segundos, com incrementos de 0.3 kmoh?1 na velocidade de corrida e inclinação fixa da esteira em 1%. Não encontramos diferenças significativas em nenhum parâmetro analisado no LV, PCR e VO2max (p>0.05). Todos os resultados mostraram alta reprodutibilidade (CV<9.1%) e valores de erro típico (TE) encontrados para vVT (TE = 0.62 km o h?1), vPCR (TE = 0.35 km o h-1) e vVO2max (TE = 0.43 km o h?1) indicaram alta sensibilidade e reprodutibilidade do protocolo. Posteriormente, vinte corredores realizaram uma simulação de prova de 10km em pista de atletismo e, após 72h, um teste de esforço máximo em esteira ergométrica para a determinação dos parâmetros máximos e submáximos. Valores de v10km foram significativamente superiores aos de vLV e inferiores aos de vVO2max (p>0.05). Nenhuma diferença significativa foi observada entre v10km e vPCR (p<0.05). Fortes correlações entre v10km e vLV (r = 0.92; R2 = 0.84) e vVO2max (r = 0.93; R2 = 0.86) foram encontradas. Sendo a maior delas observada entre vPCR e v10km (r = 0.96; R2 = 0.92). Esses resultados indicam que o protocolo de esforço máximo sugerido aqui é possivelmente capaz de avaliar pequenos efeitos do treinamento nos parâmetros máximos e submáximos, além mostrar a vPCR como um parâmetro interessante na predição de desempenho para corredores de 10km. / Abstract: The maximum oxygen uptake (VO2max) is considered a standard measure of aerobic capacity and physical performance for integrating the nervous systems, cardiopulmonary and metabolic and was considered a decisive factor for runners due good correlations found in run from 10 to 90 km. Besides him, sub maximal parameters related to the maximum effort test as ventilatory threshold (VT) and respiratory compensation point (RCP) are used for prescription of exercise intensities. During eighties, countless works suggested that the race speed regarding VT (sVT) would be good indicators of the capacity to accomplish long duration efforts. However, recent discoveries relating the speed between VT and RCP contradict such statements. Besides, few works in the literature looked for to investigate the possible correlation among the race speed regarding RCP (sRCP) and race of 10km. Since the determination of the sVT, sRCP and sVO2max seem to be important in the acting determination and training prescription, the protocols of maximum effort applied in runners would approximate of the real training conditions and those athletes' competitions, as well as to determine such parameters clearly. However, classic protocols are still used, due to the tradition and the appraisers' familiarity, without the concern of the metabolic and statistical concepts. That shortage of protocols used for runners hinders the practical application of obtained data and determination of their performance. In that sense, we looked for in this work i) to propose and verify the reproducibility of an incremental protocol in treadmill specific for runners and ii) investigate possible relationship between sRCP and the average running speed in a 10km race (s10km). Firstly, were appraised eleven amateur runners, which were submitted to four repetitions of proposed protocol: stage durations of 25 seconds, with increments of 0.3km·h-1 in the race speed and treadmill inclination stayed fixed in 1%. We didn't find significant differences in any parameter analyzed in VT, RCP and VO2max (p>0.05). All the results showed high reproducibility (CV <9.1%) and values of typical error (TE) found for sVT (TE = 0.62 km ·h-1), vPCR (TE = 0.35 km ·h-1) and sVO2max (TE = 0.43 km · h-1) indicated high protocol's sensibility and reproducibility. Later, nineteen runners accomplished a 10km race simulation in an outdoor track and, after 72 hours, a maximum effort test in a treadmill for the determination of the maximum and sub maximal parameters. v10km values were superiors significantly to the sVT and inferior to the vVO2max (p>0.05). No significant difference was observed between v10km and sRCP (p <0.05). Strong correlations between v10km and sVT (r = 0.92; R2 = 0.84) and vVO2max (r = 0.93; R2 = 0.86) were found. Being the largest observed between sRCP and v10km (r = 0.96; R2 = 0.92). Those results indicate that maximum effort protocol suggested here is possibly capable to evaluate small effects during the training process in the maximum and sub maximal parameters, beyond to show the sRCP as an interesting parameter in the prediction of runner's performance in 10km races. / Mestrado / Biodinamica do Movimento e Esporte / Mestre em Educação Física

O objetivo deste estudo foi comparar indicadores ergoespirométricos entre um grupo de idosos não-treinados (GINT) e o grupo de idosos treinados (GIT) em corridas de longa distância e a associação com a qualidade de vida. Uma amostra de 46 indivíduos idosos, dos quais 27 (idade = 73,1 ± 4,3 anos) estavam engajados em treinamento para corridas de longa distância e 19 (idade = 73,5 ± 6,4 anos) idosos que não praticavam exercício físico regular. Todos foram submetidos à avaliação cardiorrespiratória e metabólica, utilizando se analisador metabólico de gases (CPX/D, MedGraphics®, EUA) acoplado a eletrocardiógrafo (HeartWere®, 6.4, BRA), ambos os sistemas computadorizados. A determinação da capacidade física máxima foi verificada em esteira rolante (Inbramed®, ATL10200, BRA) utilizando se protocolo escalonado contínuo (1,2 km.h-1 a cada dois minutos) e inclinação fixa de 1%. Os seguintes resultados verificados foram: No segundo limiar ventilatório (VT2) [GINT vs. GIT]: FC (bpm) [69,4 ± 9,9 vs. 65,4 ± 6,8; p <0,05]; RQ [1,03 ± 0,03 vs.1,01 ± 0,03; p <0,05]; PO2 (mL/bpm) [11,3 ± 2,4 vs.14.4 ± 2,8; p <0,05]. No pico do esforço: VO2max (mL/kg/min) [27 ± 5,4 vs. 39,3 ± 5,6; p <0,05], TT (min) [9,6 ± 2,9 vs. 16,4 ± 2,7; p <0,05] e velocidade de corrida (km.h-1) [9,7 ± 2,5 vs. 13,3 ± 2,5; p <0,05]. Para medir a qualidade de vida foi utilizado o questionário WHOQOL. WHOQOL pontos [GINT vs. GIT: [70 ± 5 versus 71 ± 6] Avaliou-se o uso de medicamentos de diferentes grupos farmacológicos através de entrevistas e análise de pedidos médicos. Concluindo, a capacidade de desempenho cardiorrespiratório do GIT foi significativamente maior do que o GINT. No entanto, a qualidade de vida não foi diferente entre os dois grupos. Houve diferença na proporção de medicamentos utilizados entre os grupos. O GIT aparece com maior incidência no uso de Antiarrítmicos, Antiinflamatórios e Relaxantes Musculares. Ao contrário, o GINT apresentou maior uso de Hipoglicemiantes e Anti-Coagulantes. A maior utilização de antiinflamatórios e analgésicos pelo GIT pode ser devido ao fato de que os corredores têm maior prevalência de lesão muscular. Já a maior utilização de Hipoglicemiantes e Anti-Coagulantes pelo GINT, demonstra a falta de proteção cardiovascular pelo sedentarismo / The main purpose of this study was to compare ergoespirometric indicators among a group of elderly untrained (GEU) and a group of elderly old trained (GET) in long-distance race and the association with quality of life. Twenty seven (age = 73.1 ± 4.3 years) were engaged in training for distance running and 19 (age = 73.5 ± 6.4 years) older adults who did not practice regular physical exercise. All were underwent a cardiopulmonary exercise test evaluation. To this end we used a gas explorer (CPX/D, breathby breath Medgraphics®, Saint Paul, MN, USA) coupled to an electrocardiograph (HeartWere®, 6.4, BRA). Both systems were computerized. The determination of the maximum physical capacity was assessed on a treadmill (Inbramed ®, ATL-10200, BRA) using incremental protocol (1.2 km.h-1every two minutes) and a fixed inclination of 1%. The following results were observed: In second ventilatory threshold (VT2) [GEU vs. GET]: HR (bpm) [69.4 ± 9.9 vs. 65.4 ± 6.8; p <0.05], RQ [1.03 ± 0.03 vs.1.01 ± 0.03; p <0.05]; PO2 (mL/bpm) [11.3 ±2.4 vs.14.4 ± 2.8, p <0.05]. At peak effort: VO2max (mL/kg/min) [27 ± 5.4 vs. 39.3 ± 5.6; p <0.05], TT (min) [9.6 ± 2.9 vs. 16.4 ± 2.7; p <0.05] and running speed (km.h-1) [9.7 ± 2.5 vs. 13.3 ± 2.5; p <0.05]. To measure quality of life we used the WHOQOL. WHOQOL points [GEU vs. GET: [70 ± 5 vs. 71 ± 6] evaluated the use of drugs from different pharmacological groups through interviews and medical applications. In conclusion, the cardiorespiratory capacity of the GET was significantly higher than the GEU. However, the quality of life was not different between the two groups. Differences in the proportion of medicines used by the groups. GET appears with a higher incidence in antiarrhythmics, anti-inflammatory and muscle relaxants. Instead, the GEU showed greater use of hypoglycemic and anti-coagulants. The increased use of antiinflammatory and muscle relaxants effects by the GET may be due to the fact that runners have a higher prevalence of muscle damage. Instead, the increased use of hypoglycemic and anti-coagulants by GEU, demonstrates the lack of cardiovascular protection by physical inactivity

Abstract Guidelines and instructions derived from adult randomized controlled trials are generally followed in pediatric ventilation, as there have been no large trials of this kind in children. Current treatment strategies aim at preventing ventilator-induced lung injury by avoiding too large tidal volumes, supporting patient's spontaneous breathing and preventing lung collapse with positive end-expiratory airway pressure. Neurally adjusted ventilatory assist (NAVA) is a novel ventilation mode that provides respiratory support proportional to the electrical activity of the diaphragm (Edi). The aims of this thesis were to assess daily practices in pediatric ventilation in Finland and to compare NAVA with conventional ventilation in terms of safety and quality of care. Current treatment practices were studied with a preliminary enquiry and a 3-month prospective survey that was offered to all hospital units providing ventilatory care for children &lt;16 years of age. NAVA was compared with current standard ventilation in a crossover trial involving 18 pediatric patients and in a larger controlled trial in which 170 patients were randomized to receive either NAVA or conventional ventilation. Respiratory distress was the most common indication for invasive ventilation in neonates, and postoperative care in older children. The principles of lung-protective ventilation were generally accepted and the goals were achieved in the majority of treatment episodes. The low incidence of pediatric invasive ventilation favours centralization. NAVA proved to be a safe and feasible primary ventilation mode in pediatric intensive care. It improved patient-ventilator synchrony and led to lower peak inspiratory pressures and oxygen requirements. It also reduced the need for sedation during longer treatment periods. Information derived from the Edi-signal could be used to optimize the level of sedation and to identify patients with a potential risk of extubation failure. / Tiivistelmä Nykyisin käytössä olevat menetelmät lasten hengityskonehoidossa perustuvat suurelta osin aikuisilla tehtyihin tutkimuksiin ja totuttuihin tapoihin, sillä lasten hengityskonehoidosta on olemassa vain vähän tutkittua tietoa. Hengityskonehoidon aiheuttamaa keuhkovauriota pyritään ehkäisemään välttämällä suuria kertahengitystilavuuksia, tukemalla potilaan omia hengityksiä ja säilyttämällä ilmateissä positiivinen paine uloshengityksen aikanakin. Neuraalisesti ohjattu ventilaatio (NAVA) on uusi hengityskonehoitomuoto, joka tukee potilaan omia hengityksiä ohjaamalla koneen antamaa tukea pallealihaksen sähköisen signaalin avulla. Tämän tutkimuksen tavoitteena oli selvittää lasten hengityskonehoidon nykytilaa Suomessa sekä tutkia, voidaanko NAVAa käyttämällä parantaa hoidon laatua ja turvallisuutta. Nykyisiä hoitokäytäntöjä selvitettiin vuonna 2010 kysely- ja seurantatutkimuksella, johon kutsuttiin mukaan kaikki Suomessa lapsia ja vastasyntyneitä hoitavat tehohoito-osastot. NAVAa verrattiin nykyiseen hengityskonehoitoon 18 potilaan vaihtovuoroisessa tutkimuksessa sekä suuremmassa 170 lapsipotilaan satunnaistetussa kontrolloidussa tutkimuksessa. Eri syistä johtuvat hengitysvaikeudet ovat yleisin syy hengityskonehoitoon vastasyntyneillä ja suurten leikkausten jälkeinen hoito isommilla lapsilla. Keuhkoja säästävän hoidon periaatteet ovat Suomessa yleisesti hyväksyttyjä ja toteutuvat valtaosassa hoitojaksoja. Hengityskonehoitojaksojen määrän vähäisyys puoltaa hoidon keskittämistä suuriin sairaaloihin. NAVAa käyttämällä hengityskoneen antama tuki ajoittuu paremmin potilaan omien hengitysten mukaan ja sen avulla saavutetaan matalammat ilmatiepaineet sekä vähäisempi lisähapen tarve. Pitkissä hoitojaksoissa NAVA vähentää rauhoittavan lääkityksen tarvetta, ja pallealihaksen signaalia seuraamalla on mahdollista optimoida sedaatioaste aikaisempaa tarkemmin. Palleasignaalia voidaan myös hyödyntää arvioitaessa potilaan valmiutta hengitystuesta vieroittamiseen.

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.

L’activité musculaire peut être caractérisée par la performance et un état de fatigue. Le muscle diaphragmatique est caractérisé par sa résistance à la fatigue, en faisant un témoin de capacité à l'autonomie respiratoire. Bien que cliniquement d'intérêt, la mesure de l'état de fatigue de ce muscle est difficile. Nous avons approché cette mesure en analysant les signaux de son activité électrique recueillis par contact. L'obtention des paramètres requière un traitement du signal. Nous avons développé les outils de recueil et de traitement de ce signal et les avons analysé pendant l'anesthésie. Le recueil a fait l'objet du développement d'une sonde multiélectrodes et des logiciels hardware et software de recueil du signal. L'analyse du signal a été l'objet de différentes méthodes mathématiques de débruitage temps réel sur des processeurs RISC-ARM, comparant des algorithmes de deux types d’ondelettes (MuRw, LiFw), et un filtre morphologique (MoFi), le choix portant finalement sur l'ondelette MuRw offrant le meilleur compromis en temps de calcul et en rapport signal sur bruit. L'évaluation clinique de sujets sains et de patients a montré la pertinence des paramètres fréquentiels de l'activité électrique MuRw du diaphragme comme représentants de son état de fatigue, en particulier par le rapport hautes sur basses fréquences obtenu par analyse spectrale / Muscular activity can be described in terms of performance and fatigue. Diaphragmatic muscle is charactarized by its resistance to fatigue, making of it a good representative of ventilatory autonomy. While of clinical interest, its measurement is difficult. We considered this measurement by analyzing the electrical diaphragmatic signal gathered from direct recordings. To be obtained, the parameters have to be filtered. We developped the tools to record as well as to filter the signal and have validated them in clinical settings during anesthesia and intensive care. A multielectrodes probe and the associated hardware and software were developped for the signal recording. The filtering which followed compared using differnt wavelet analysis algorithms (MuRw, LiFw), and a morphological filter (MoFi), through a RISC-ARM processor for a real-time measurement. MuRw was the best compromise for calcul duration and signal noise ratio. Clinical evaluation on patients and healthy volounteers demonstrated the pertinence of frequential parameters extracted from the filtered signal, particularly the High Low ratio obtained after spectral analysis

We measured ventilation, oxygen consumption and blood gases in burrowing owls (Athene cunicularia) breathing moderate and extreme hypoxic gas mixtures to determine their hypoxic ventilatory threshold (HVT) and to assess if they, like other birds and mammals, exhibit a relationship between HVT and hemoglobin O2 affinity (P50) of their blood. An earlier report of an attenuated ventilatory responsiveness of this species to hypoxia was enigmatic given the low O2 affinity (high P50) of burrowing owl hemoglobin. In the current study, burrowing owls breathing 11% and 9% O2 showed a significantly elevated total ventilation. The arterial partial pressure of oxygen (PaO2) at which ventilation is elevated above normoxic values in burrowing owls was 58 mm Hg. This threshold value conforms well to expectations based on the high P50 of their hemoglobin and the HVT vs. P50 relationship for birds developed in this study. Correcting for phylogenetic relatedness in the multi-species analysis had no effect on the HVT vs. P50 relationship. Also, because burrowing owls in this study did not show a hypometabolic response at any level of hypoxia (even at 9% O2); HVT described in terms of percent change in oxygen convection requirement is identical to that based on ventilation alone.