Marcelo Holanda

Abstract Objective The aim of this study was to evaluate sexual function in male and female COPD (chronic obstructive pulmonary disease) patients and identify associated factors. Methods: This is a cross-sectional study on 52 COPD patients treated at an outpatient pneumology service of a referral hospital in Northeastern Brazil. Information was collected on demographic, clinical and spirometric variables and exercise capacity. The following instruments and scores were used: modified Medical Research Council (mMRC) for dyspnea, SF-36 for quality of life (QoL), the Beck Depression and Anxiety Inventory, Male and Female Sexual Quotient. Results: Sexual function was satisfactory/excellent in 17% (9/52) and poor/absent in 82% (43/52). Patients with poor/absent sexual function tended to have lower scores on the domain mental health summary score of SF-36 (p = 0.007) and higher anxiety and depression scores than patients with satisfactory/excellent sexual function (p = 0.02 and p = 0.01). In the multivariate analysis, patients with high depression scores displayed a greater likelihood of poor/absent sexual function (OR = 1.13; 95% CI = 1.02–1.25). Conclusion: COPD patients presented a high rate of sexual dysfunction and compromised sexuality was associated with depression

Undergraduate biomedical students often have difficulties in understanding basic concepts of respiratory physiology, particularly respiratory mechanics. In this study, we report the use of electrical impedance tomography (EIT) to improve and consolidate the knowledge about physiological aspects of normal regional distribution of ventilation in humans. Initially, we assessed the previous knowledge of a group of medical students ( n = 39) about regional differences in lung ventilation. Thereafter, we recorded the regional distribution of ventilation through surface electrodes on a healthy volunteer adopting four different decubitus positions: supine, prone, and right and left lateral. The recordings clearly showed greater pulmonary ventilation in the dependent lung, mainly in the lateral decubitus. Considering the differences in pulmonary ventilation between right and left lateral decubitus, only 33% of students were able to notice it correctly beforehand. This percentage increased to...

OBJETIVO: Avaliar a associação entre o estado de controle da asma e a qualidade de vida relacionada à saúde em pacientes com asma moderada ou grave. MÉTODOS: Estudo descritivo observacional com 59 pacientes portadores de asma moderada ou grave, acompanhados no Ambulatório de Asma do Hospital Universitário Walter Cantídio da Universidade Federal do Ceará, em Fortaleza (CE). Os pacientes foram avaliados quanto a dados sociodemográficos, clínicos e espirométricos. O estado de controle da asma foi avaliado através do asthma control test (ACT) e a qualidade de vida através do Saint George's Respiratory Questionnaire (SGRQ). RESULTADOS: A média de idade dos pacientes foi de 55,0 ± 12,4 anos, e 76,3% eram do sexo feminino. Foram observadas correlações negativas significantes entre os escores do ACT e todos os escores do SGRQ: total (r = -0,72); sintomas (r = -0,78); atividade (r = -0,67); e impactos (r = -0,68). A análise de regressão múltipla mostrou que o escore do SGRQ total teve co...

Objetivo: avaliar o uso da terapia de Alto Fluxo Nasal (AFN) em uma paciente com Fibrose Pulmonar Idiopática (FPI) sob cuidados paliativos. Relato de caso: mulher de 70 anos, admitida em uma Unidade de Terapia Intensiva (UTI) por insuficiência respiratória hipoxêmica grave por FPI em estágio avançado, sem indicação de intubação traqueal. Inicialmente tratada com Ventilação Não Invasiva (VNI) intercalando com máscara reservatório de oxigênio (O2), porém com baixa tolerância. Mesmo com a máscara reservatório de O2 apresentou frequência respiratória (f) de 40rpm, saturação periférica de O2 (SpO2) de 58%, frequência cardíaca (FC) de 135 bpm, pressão arterial (PA) 175x85 mmHg. A gasometria arterial revelou PaO2 de 36mmHg e SaO2 de 72%. Optou-se por usar o AFN pelo sistema Optiflow™ Fisher & Paykel® com fluxo de 30 l/min de O2 e temperatura de 37°C. Após 30 minutos houve resposta clínica imediata, apresentou: f = 30rpm, FC = 127 bpm, PA = 156x69 mmHg, SpO2 = 80%, PaO2 = 46mmHg e SaO2 = 83...

A lesão de isquemia-reperfusão constitui-se em um evento fisiopatológico comum a diversas doenças da prática clínica diária. O pulmão pode ser alvo da lesão de isquemia-reperfusão diretamente, como no edema pulmonar após transplante ou na resolução de tromboembolismo; ou ainda ser atingido à distância, como nos casos de choque ou por lesão de reperfusão em intestino ou em membros inferiores, como ocorre no pinçamento da aorta, utilizado nas cirurgias de aneurisma. Dentre os mediadores envolvidos na lesão de isquemia-reperfusão, foram identificados espécies reativas tóxicas de oxigênio (ERTO), mediadores lipídicos, como a tromboxana, moléculas de adesão em neutrófilos e endotélio, fator de necrose tumoral, dentre outros. As medidas terapêuticas para a lesão de reperfusão ainda são utilizadas no plano experimental e em poucos estudos clínicos. São utilizados: antioxidantes, bloqueadores de mediadores lipídicos, inibidores da interação entre leucócito e endotélio ou substâncias que fav...

Pressure support ventilation (PSV) is often associated with patient-ventilator asynchrony. Proportional assist ventilation (PAV) offers inspiratory assistance proportional to patient effort, minimizing patient-ventilator asynchrony. The objective of this study was to evaluate the influence of respiratory mechanics and patient effort on patient-ventilator asynchrony during PSV and PAV plus (PAV+). We used a mechanical lung simulator and studied 3 respiratory mechanics profiles (normal, obstructive, and restrictive), with variations in the duration of inspiratory effort: 0.5, 1.0, 1.5, and 2.0 s. The Auto-Trak system was studied in ventilators when available. Outcome measures included inspiratory trigger delay, expiratory trigger asynchrony, and tidal volume (VT). Inspiratory trigger delay was greater in the obstructive respiratory mechanics profile and greatest with a effort of 2.0 s (160 ms); cycling asynchrony, particularly delayed cycling, was common in the obstructive profile, wh...

OBJETIVO: Avaliar a qualidade de vida dos pacientes com DPOC através dos questionários Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) e Saint George's Respiratory Questionnaire (SGRQ), correlacionando-os com parâmetros funcionais respiratórios. MÉTODOS: Este foi um estudo transversal com 42 pacientes com DPOC. Foram utilizados um questionário específico (SGRQ) e um questionário geral (SF-36) e seus componentes sumarizados para a determinação da qualidade de vida desses pacientes. O quadro funcional foi avaliado pela espirometria, gasometria arterial e teste da caminhada de seis minutos. RESULTADOS: Dos 42 pacientes, 30 (71,4%) eram do sexo masculino e 12 (28,6%) do sexo feminino. A média de idade foi de 65,4 ± 8,0 anos. O escore médio dos componentes físico e mental sumarizados foi 37,05 ± 11,19 e 45,61 ± 15,65, respectivamente. O componente físico sumarizado correlacionou-se significativamente com o valor médio do VEF1 em L/s (r = 0,38; p = 0,012). O escore tot...

Introdução: Persiste a questão sobre se há vantagens mecânicas ou de trocas gasosas no uso da ventilação pressão-controlada (VPC) sobre a ciclada a volume (VCV). Objetivos: Comparar, de forma randômica, a VPC com a VCV com fluxo desacelerado nos modos assistido e controlado em modelo experimental de lesão pulmonar aguda. Métodos: Sete cães com lesão pulmonar aguda grave (PaO2/FIO2 < 100mmHg) induzida por ácido oléico intravenoso (0,05mg/kg) foram ventilados em VPC ou VCV, mantidos constantes o volume corrente e o tempo inspiratório. Nas duas modalidades os animais foram ventilados por 40 minutos no modo assistido seguido do modo controlado após curarização. Resultados: Não houve diferenças em relação às trocas gasosas (PaO2 e PaCO2), ao débito, ao transporte de oxigênio e à mecânica respiratória entre a VCV e a VPC. O consumo de oxigênio (VO2) após a curarização foi semelhante (124 ± 48 na VCV versus 143 ± 50ml/min na VPC, com p = 0,42). Entretanto, no modo assistido, houve tendê...

... experimental, Documentos relacionados. Id: 283771. Autor: Rocha, Emilia Maria Matos; Holanda, Marcelo Alcantara; Monte, Ana Karina Cunha; Freitas, Carlos Henrique Oliveira; Aguiar, Isabel Cristina Veras; Bandeira, Rita Moara; Leal, Walteria Moreira; Rodrigues, Silvia Carla ...

The effects of nasal continuous positive airway pressure (CPAP) on the lung parenchyma of patients with COPD, to our knowledge, have never been assessed by high-resolution CT (HRCT) scanning. HRCT scans were obtained at the apex, hilum, and basis of the lungs at functional residual capacity while on spontaneous respiration and at the end of CPAP trials of 5 cm water (H(2)O), 10 cm H(2)O, and 15 cm H(2)O in 11 stable patients with COPD and eight healthy volunteers. Lung aeration was assessed by quantitative density parameters and by qualitative analysis of each CT image after processing by means of a density-based color-mask computational algorithm. The quantitative parameters were density histograms, the relative area of the lungs with attenuation values < -950 Hounsfield units (percentage of hyperaerated areas) and the 15th percentile (the density value separating the 15% voxels of least density). A CPAP of 5 cm H(2)O caused little increase in lung aeration in both groups, but in some patients with COPD, CPAP deflated some regions of the lungs. CPAP levels of 10 cm H(2)O and 15 cm H(2)O increased the emphysematous zones in all sectors of the lungs, including dorsal and apical regions in patients with COPD compared to little hyperaeration predominantly in the ventral areas in healthy volunteers. Nasal CPAP causes variable effects on regional lung aeration in relation to the applied pressure and the regional distribution of emphysema in patients with COPD. Low pressure levels may cause regional lung deflation in some patients. High levels increase the emphysematous areas wherever they are located inside the lungs.

ABSTRACT Improving Quality and Reducing CostSESSION TYPE: Original Investigation SlidePRESENTED ON: Tuesday, October 29, 2013 at 02:45 PM - 04:15 PMPURPOSE: Mechanical ventilators (MV) are increasingly complex. Inadequate orientation and training on MV operation are associated to preventable deaths or injuries. The development of user-machine interfaces designed to facilitate cognitive processes may increase the ease of caregiver experience and reduce accidents. We propose a method of iterative design for an ICU MV (ix5, Intermed/CareFusion) by provision of feedback from usability tests, based on heuristic evaluation (HE), into design decisions.METHODS: The usability tests included the following procedures. 1.Users were defined as: physicians, respiratory therapists and nurses. Fifteen competencies were tested, for example: Turning on/off; Setting ventilation modes; Managing alarms; Monitoring mechanics; Using Non-Invasive Ventilation (NIV); etc.2. HE: Three experts on MV for each professional category individually performed specific tasks concerning the competencies above in a realistic simulated clinical scenario. The ASL 5000 simulator was adapted to a mannequin connected to the MV trying to reproduce a real ICU bed environment. All tests were filmed while the experts were oriented to "think aloud" during the process. A score sheet of the heuristics principles of Nielsen was filled in after discussion with the research team just after each test. The problems were classified as critical; important; minimum or esthetical. 3.The results were compiled, organized and presented to the manufacturer's engineers and designers. 4. An agenda for correction of the problems was set. 5. The process is repeated with the modified interface.RESULTS: The experts were concordant that the ix5 interface could change to: Induce adjustments based on the patient's ideal body weight; Facilitate measurements of respiratory mechanics; Help in alarms interpretation and troubleshooting; Facilitate NIV settings; Facilitate data interpretation by showing only 5 to 6 parameters in the MV display at the same time. These indications for improvement are now being incorporated into a new interface for the ix5 MV.CONCLUSIONS: The HE seems to be a feasible method for usability testing of MV.CLINICAL IMPLICATIONS: Improvements in the care of mechanically ventilated patients are to be expected by use of MV designed with this new methodology.DISCLOSURE: Marcelo Holanda: Grant monies (from industry related sources): i have received an scholarship for this resarch José Lonardoni: Employee: Design engineer Jorge Bonassa: Shareholder: Director The following authors have nothing to disclose: Nathalia Parente de sousa, Raquel SalesThe work provides an original methodology for testing the usability of ICU mechanical ventilators.

The incidental diagnosis of two cases of silicosis at Messejana Hospital, Fortaleza, capital of Ceará state, triggered a field research conducted with the objective of investigating the incidence of silicosis in pit diggers in four towns in the Ibiapaba Mountain Range, at the state's northwestern area, northeastern Brazil. Out of a universe of 1,050 pit diggers in the area, 366 participated in the study; they were all males ranging in age between 16 and 76 years old (average 39 years). The excavation and the sickening process were described and a dust exposure index in pit diggers (DEIPD) was defined. The study sample indicated a rate of 121 (33.06%) silicotics and possibly silicotics. The radiologic findings were related to the DEIPD and indicated significant prevalence of disease. Furthermore, during the research period, from 1986 to 1989, 30 (34.9%) silicotics died of respiratory failure and wasting of body tissues. The data suggested that these men were afflicted with a severe occupational health problem, possibly scattered throughout a large area in northeastern Brazil, where manual pit excavations occur during the whole year and increase during drought periods.