RESUMO Objetivo avaliar os diferentes componentes da resistência do sistema respiratório e a força muscular respiratória, bem como investigar a ocorrência de limitação de fluxo expiratório (LFE) de pacientes obesos mórbidos (OM) na posição sentada. Métodos a amostra foi composta de OM (IMC ≥ 40 kg/m2) e de indivíduos não obesos (NO) com IMC entre 18 e 30 kg/m2. O protocolo foi composto de: avaliação antropométrica e da função respiratória (espirometria, pressões inspiratória (PIM) e expiratória máximas (PEM) e oscilometria de impulso). Na comparação entre os grupos, foi utilizado o teste T para amostras não pareadas. As correlações foram avaliadas pelo teste de Pearson, e o nível de significância foi de 5%. Resultados Foram avaliados 50 OM (idade 40,0 ± 10,4 anos, 1,64 ± 0,09 m, 138,8 ± 33,6 kg e 50,7 ± 8,9 kg/m2), além de 30 NO (idade 37,6 ± 11,5 anos, 1,67 ± 0,09 m, 65,2 ± 10,3 kg e 23,2 ± 22 kg/m2). Os OM apresentaram maiores valores de resistência total, central, de vias aéreas, tecidual e periférica quando comparados aos NO. Nenhum paciente apresentou LFE. A circunferência abdominal se associou com variáveis espirométricas PIM e PEM. A relação cintura-quadril se correlacionou com variáveis de mecânica respiratória, além das espirométricas PIM e PEM. Conclusões pacientes com obesidade mórbida e sem padrão espirométrico obstrutivo apresentam aumento nas resistências total, de vias aéreas, periférica e tecidual do sistema respiratório quando comparados a não obesos. Esses indivíduos, entretanto, não apresentam limitação de fluxo expiratório e redução da força muscular respiratória.
Background: During the COVID-19 pandemic the application of awake prone position (PP) in subjects has been describing such as a new procedures in combating the acute hypoxemic. Aim: Evaluate the efficacy of the awake PP in patients with hypoxemic respiratory failure by COVID-19 to avoid mechanical ventilation (MV). Methods: a clinical study. The subjects who were showing signs of hypoxemic respiratory failure were divided into two groups: the intervention group receiving treatment with oxygen therapy plus awake PP, and the control group only oxygen therapy. The primary outcome was the success to avoid the MV, and secondary outcomes were complications, length of stay and mortality rate in the ICU. Results: Thirty-two subjects underwent the PP in the Intervention group, and 35 maintained the conventional treatment with the oxygen therapy in the control group. The mean of the clinical variables analyzed did not show difference when comparing the groups. The rate of need of invasive mechanical ventilation (60% vs. 41%, P=0.18) and death rate (29% vs. 13%, P=0.29) was higher in the control group; however statistical diferences not were found. In the Kaplan-Meyer curves, the awake PP presented a tendency of reduction in mortality rate (15%), P=0.29 and presented a tendency of increase (30%) successful to avoid MV, P=0.16. Conclusion:The present study despite demonstrating that a simple procedure seems to contribute with a success rate to avoid the mechanical ventilator, however we cannot affirm this result. Lastly, we suggest that news RCT studies be carried out to confirm this find.
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