Impact of the COVID-19 pandemic on emergency department visits: experience of a Brazilian reference center Impacto da pandemia da COVID-19 no volume de atendimentos no pronto atendimento: experiência de um centro de referência no Brasil

Evaluation of lung volumes, vital capacity and respiratory muscle strength after cervical, thoracic and lumbar spinal surgeryAvaliação dos volumes pulmonares, capacidade vital e força dos músculos respiratórios no pós-operatório de cirurgia na coluna cervical, torácica e lombar Marcio Aparecido Oliveira I , Milena Carlos Vidotto II , Oliver Augusto Nascimento III , Renato Almeida IV , Ilka Lopes Santoro V , Evandro Fornias Sperandio VI , José Roberto Jardim VII , Mariana Rodrigues Gazzotti VIII Universidade Federal de São Paulo ABSTRACTCONTEXT AND OBJECTIVE: Studies have shown that physiopathological changes to the respiratory system can occur following thoracic and abdominal surgery. Laminectomy is considered to be a peripheral surgical procedure, but it is possible that thoracic spinal surgery exerts a greater influence on lung function. The aim of this study was to evaluate the pulmonary volumes and maximum respiratory pressures of patients undergoing cervical, thoracic or lumbar spinal surgery. DESIGN AND SETTING: Prospective study in a tertiary-level university hospital. METHODS: Sixty-three patients undergoing laminectomy due to diagnoses of tumors or herniated discs were evaluated. Vital capacity, tidal volume, minute ventilation and maximum respiratory pressures were evaluated preoperatively and on the first and second postoperative days. Possible associations between the respiratory variables and the duration of the operation, surgical diagnosis and smoking status were investigated. RESULTS: Vital capacity and maximum inspiratory pressure presented reductions on the first postoperative day (20.9% and 91.6%, respectively) for thoracic surgery (P = 0.01), and maximum expiratory pressure showed reductions on the first postoperative day in cervical surgery patients (15.3%; P = 0.004). The incidence of pulmonary complications was 3.6%. CONCLUSIONS: There were reductions in vital capacity and maximum respiratory pressures during the postoperative period in patients undergoing laminectomy. Surgery in the thoracic region was associated with greater reductions in vital capacity and maximum inspiratory pressure, compared with cervical and lumbar surgery. Thus, surgical manipulation of the thoracic region appears to have more influence on pulmonary function and respiratory muscle action.RESUMO CONTEXTO E OBJETIVO: Estudos têm demonstrado que alterações fisiopatológicas no sistema respirató-rio podem ocorrer após cirurgia torácica e abdominal. A laminectomia é considerada uma cirurgia perifé-rica, mas é possível que as cirurgias de coluna torácica exerçam maior influência sobre a função pulmonar. O objetivo do estudo foi avaliar os volumes pulmonares e as pressões respiratórias máximas em pacientes submetidos a cirurgia de coluna cervical, torácica ou lombar. TIPO DE ESTUDO E LOCAL: Estudo prospectivo em hospital universitário terciário. MÉTODOS: Sessenta e três pacientes submetidos a laminectomia com diagnóstico tumor ou hérnia de disco foram avaliados. Foram avaliados, no pré-operatório, no primeiro e no segundo ...

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