A respiração frenolabial na doença pulmonar obstrutiva crônica: revisão da literatura

Esta revisão teve por objetivo destacar os principais achados publicados nos últimos dez anos sobre os efeitos da respiração frenolabial (RFL) em pacientes com doença pulmonar obstrutiva crônica (DPOC). A busca dos artigos foi realizada nas bases de dados Lilacs, IBECS, MEDLINE e SciELO, por meio dos seguintes descritores da área da saúde (DeCS): doença pulmonar obstrutiva crônica, reabilitação, respiração, hiperinsuflação e dispneia, e suas respectivas versões na língua inglesa (MeSH), além do termo pursed-lip breathing. Após a eliminação dos títulos repetidos, foram selecionados somente os estudos que abordavam a RFL como tema principal, resultando em 12 artigos científicos, 10 ensaios clínicos e 2 revisões bibliográficas. Segundo os achados, a RFL proporciona: alterações sobre a gasometria arterial, caracterizada pelo aumento da saturação e pressão parcial de oxigênio; padrão ventilatório, com diminuição da frequência respiratória e aumento de tempo expiratório e do volume corrente; mecânica ventilatória, por meio do recrutamento de musculatura abdominal expiratória e dos músculos da caixa torácica e acessórios da inspiração; diminuição no consumo de oxigênio; alterações na modulação autonômica cardíaca induzida pelo aumento da atividade parassimpática e, por fim, melhora na qualidade de vida destes pacientes. A RFL é considerada uma manobra de grande importância, por repercutir de forma positiva em diversos sistemas e sobre a qualidade de vida de pacientes portadores da DPOC.

Influência das variáveis antropométricas nas respostas cardiorrespiratórias de crianças durante o esforço

O objetivo deste estudo foi verificar a influência das diferentes dimensões corporais de meninos de 11 a 13 anos de idade, nas respostas cardiorrespiratórias, ao longo dos estágios de um teste incremental de esforço máximo em cicloergômetro. Vinte meninos realizaram um teste incremental máximo em cicloergômetro com carga inicial de 30 W e incrementos subsequentes de 30 W a cada três minutos. As variáveis respiratórias foram medidas respiração-a-respiracão através de um analisador metabólico de gases. A frequência cardíaca foi constantemente monitorada durante o teste. Os grupos foram divididos a posteriori em função da carga máxima atingida no teste incremental (90 ou 120 W) e em função da massa corporal (maior ou menor que 45 kg). As seguintes variáveis foram mensuradas continuamente: frequência respiratória, volume corrente, ventilação, consumo de oxigênio absoluto e relativo, produção absoluta de gás carbônico, frequência cardíaca e equivalente ventilatório de oxigênio. Foi concluído que as variáveis antropométricas, especialmente estatura e massa corporal, mostram-se estreitamente relacionadas às respostas cardiorrespiratórias, apresentando-se como fatores determinantes e limitantes do desempenho, devendo ambas ser consideradas para a prescrição e prática de exercícios físicos desta população pediátrica.

Padrões de distribuição volumétrica de pontas de pulverização de jato plano 11002, com e sem indução de ar, sob diferentes espaçamentos e alturas

O presente trabalho teve como objetivo avaliar a distribuição volumétrica de pontas de pulverização hidráulica de jato de uso ampliado 11002, com e sem indução de ar, em laboratório, bem como o padrão de deposição da pulverização, por meio da estimativa do coeficiente de variação (C.V.) obtido pela simulação da sobreposição de jatos adjacentes. As pontas foram posicionadas, isoladamente, no centro da mesa de teste, a 30; 40 e 50 cm de altura da mesa e a 300 e 500 kPa de pressão. Foram avaliadas 20 unidades de cada tipo de ponta, e a deposição média foi utilizada para a simulação da deposição ao longo da barra pulverizadora, com as pontas espaçadas em 30; 40; 50 e 60 cm entre si. A uniformidade da distribuição foi estimada pelo cálculo do C.V. resultante da simulação da sobreposição das pontas em barra de 8 m, sendo utilizados somente os 4 m centrais no cálculo do C.V. Os resultados mostraram haver diferenças relacionadas à deposição entre os dois tipos de ponta. A ponta com indução de ar resultou em área de deposição inferior à ponta sem indução de ar. Esse comportamento foi observado em todas as alturas da barra e nas duas pressões, podendo-se inferir que esse comportamento possa ser característico das pontas com indução de ar.

Levomepromazina e atropina como medicações pré-anestésicas na anestesia pela associação tiletamina/zolazepam, em cães

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Efeitos cardiorrespiratórios do butorfanol em cães pré-tratados ou não pela levomepromazina

Objetivou-se com este experimento avaliar os efeitos do butorfanol precedido ou não pela levomepromazina sobre a freqüência cardíaca (FC), as pressões arteriais sistólica, diastólica e média (PAS, PAD e PAM, respectivamente), a freqüência respiratória (f), a concentração de dióxido de carbono ao final da expiração (ETCO2), a saturação da oxihemoglobina (SpO2), o volume corrente (VC) e o volume minuto (VM), em cães. Para tal, foram empregados vinte animais adultos, clinicamente saudáveis, distribuídos igualmente em dois grupos (GC e GL). Ao GC administrou-se solução salina a 0,9% (Controle), no volume de 0,2mL kg-1, pela via intravenosa (IV). Decorridos 15 minutos, administrou-se butorfanol na dose de 0,3mg kg-1 pela mesma via. Aos animais do GL foi adotada a mesma metodologia, porém substituindo-se a solução salina pela levomepromazina na dose de 1mg kg-1. As medidas das variáveis cardiorrespiratórias iniciaram-se imediatamente antes da aplicação dos fármacos (M1). Novas mensurações foram realizadas 15 minutos após a administração da solução salina a 0,9% ou levomepromazina (M2) e 10 minutos após a administração de butorfanol (M3). As demais colheitas foram realizadas a intervalos de 10 minutos, durante 30 minutos (M4, M5 e M6, respectivamente). Os dados numéricos colhidos foram submetidos à Análise de Variância (ANOVA), seguida pelo teste de Tukey (p<0,05) para as comparações das médias. O emprego do butorfanol promoveu diminuição significativa das freqüências cardíaca e respiratória e do volume minuto no grupo previamente tratado pela levomepromazina; entretanto, essas alterações foram discretas, não comprometendo os demais parâmetros circulatórios e respiratórios.

Mass fractal characteristics of wet sonogels as determined by small-angle x-ray scattering and differential scanning calorimetry

Low density silica sonogels were prepared from acid sonohydrolysis of tetraethoxysilane. Wet gels were studied by small-angle x-ray scattering (SAXS) and differential scanning calorimetry (DSC). The DSC tests were carried out under a heating rate of 2 degrees C/min from -120 degrees C up to 30 degrees C. Aerogels were obtained by CO(2) supercritical extraction and characterized by nitrogen adsorption and SAXS. The DSC thermogram displays two distinct endothermic peaks. The first, a broad peak extending from about -80 degrees C up to practically 0 degrees C, was associated to the melting of ice nanocrystals with a crystal size distribution with pore diameter ranging from 1 or 2 nm up to about 60 nm, as estimated from Thomson's equation. The second, a sharp peak with onset temperature close to 0 degrees C, was attributed to the melting of macroscopic crystals. The DSC incremental nanopore volume distribution is in reasonable agreement with the incremental pore volume distribution of the aerogel as determined from nitrogen adsorption. No macroporosity was detected by nitrogen adsorption, probably because the adsorption method applies stress on the sample during measurement, leading to a underestimation of pore volume, or because often positive curvature of the solid surface is in aerogels, making the nitrogen condensation more difficult. According to the SAXS results, the solid network of the wet gels behaves as a mass fractal structure with mass fractal dimension D=2.20 +/- 0.01 in a characteristic length scale below xi=7.9 +/- 0.1 nm. The mass fractal characteristics of the wet gels have also been probed from DSC data by means of an earlier applied modeling for generation of a mass fractal from the incremental pore volume distribution curves. The results are shown to be in interesting agreement with the results from SAXS.

SAXS study of formation and growth of tin oxide nanoparticles in the presence of complexing ligands

The effect of acetylacetone (acac) complexing ligand on the formation and growth of tin oxide-based nanoparticles during thermohydrolysis at 70 degreesC of a tin precursor SnCl4-n(acac)(n) (0 less than or equal to n less than or equal to 2) solution was analyzed by in situ small-angle X-ray scattering. A. transparent and stable sol was obtained after 2 h of thermohydrolysis at 70 degreesC, allowing the quantitative determination of the particle volume distribution function and its variation with the reaction time. The number of colloidal particles for equivalent thermohydrolysis temperature and time decreases as the [acac]/[Sn] ratio in initial solution increases from 0.5 to 6. Instead, the amount of soluble species remaining in solution increases for increasing [acac]/[Sn] ratio within the same range. This indicates that increasing amounts of Sn-acetylacetone complexes partially prevent the hydrolysis and consequent formation of colloidal particles. The N-2 adsorption isotherm characterization of freeze-dried powders demonstrates that the average pore size is approximately equal to the average size (approximate to9 Angstrom) of the colloidal primary particles in the sol, and that the porosity and surface area (approximate to200 m(2) g(-1)) are independent of the acac content in the initial solution.

Raphe magnus nucleus is involved in ventilatory but not hypothermic response to CO2

There is evidence that serotonin [ 5- hydroxytryptamine ( 5- HT)] is involved in the physiological responses to hypercapnia. Serotonergic neurons represent the major cell type ( comprising 15 - 20% of the neurons) in raphe magnus nucleus ( RMg), which is a medullary raphe nucleus. In the present study, we tested the hypothesis 1) that RMg plays a role in the ventilatory and thermal responses to hypercapnia, and 2) that RMg serotonergic neurons are involved in these responses. To this end, we microinjected 1) ibotenic acid to promote nonspecific lesioning of neurons in the RMg, or 2) anti- SERT- SAP ( an immunotoxin that utilizes a monoclonal antibody to the third extracellular domain of the serotonin reuptake transporter) to specifically kill the serotonergic neurons in the RMg. Hypercapnia caused hyperventilation and hypothermia in all groups. RMg nonspecific lesions elicited a significant reduction of the ventilatory response to hypercapnia due to lower tidal volume ( V-T) and respiratory frequency. Rats submitted to specific killing of RMg serotonergic neurons showed no consistent difference in ventilation during air breathing but had a decreased ventilatory response to CO2 due to lower VT. The hypercapnia- induced hypothermia was not affected by specific or nonspecific lesions of RMg serotonergic neurons. These data suggest that RMg serotonergic neurons do not participate in the tonic maintenance of ventilation during air breathing but contribute to the ventilatory response to CO2. Ultimately, this nucleus may not be involved in the thermal responses CO2.

Thermoregulatory responses of Alpine goats during thermal stress

Eight non-lactating Alpine goats, averaging 57kg, were paired according to weight and assigned randomly to 2 groups of 4 animals, control (CG) and treatment (TG) with feed and water ad libitum. An adjustment period of 7 days with all animals at thermoneutral conditions was followed by a 28-day period when TG was exposed to air temperatures averaging 35.0 degrees C, from 0800 to 1700h, including simulated solar radiation, and thermoneutral conditions from 2700 to 0800h. CG remained under thermoneutral conditions. Respiratory frequency was greater, tidal volume lower, and respiratory minute volume greater for TG than CG (176 vs 30 breaths/min, P<.001, 105 vs 293ml, P<.01; 18.4 vs 9.21, P<.05). Respiratory evaporation and sweating rate as well as rectal and skin temperatures were greater for TG than CG (14.59 vs 6.32 kcal h(-1), P<.01; 43.97 vs.00 g m(-2) h(-1), P<.001; 40.0 vs 38.9 degrees C, P<.001; 39.3 vs 35.8 degrees C, P<.01). There was no difference between groups for hematocrit and feed intake, but water consumption was greater for stressed goats than control ones (28.3 vs 29.7%; 1.44 vs 1.49 kg/day; 3.07 vs 1.26 I/day, P<.05), Final body weights of both groups were similar to initial ones. It was concluded that non-lactating goats tolerated well a 35 degrees C day temperature which is 5 degrees C above the upper critical temperature, with a black-globe temperature of 39.1 degrees C and a Botsball temperature of 28.3 degrees C, though a certain degree of hyperthermia may occur, as long as thermoneutral conditions have prevailed during the night.

Respiratory heat loss of Holstein cows in a tropical environment

In order to develop statistical models to predict respiratory heat loss in dairy cattle using simple physiological and environmental measurements, 15 Holstein cows were observed under field conditions in a tropical environment, in which the air temperature reached up to 40 &DEG; C. The measurements of latent and sensible heat loss from the respiratory tract of the animals were made by using a respiratory mask. The results showed that under air temperatures between 10 and 35 &DEG; C sensible heat loss by convection decreased from 8.24 to 1.09 W m(-2), while the latent heat loss by evaporation increased from 1.03 to 56.51 W m(-2). The evaporation increased together with the air temperature in almost a linear fashion until 20 &DEG; C, but it became increasingly high as the air temperature rose above 25 &DEG; C. Convection was a mechanism of minor importance for respiratory heat transfer. In contrast, respiratory evaporation was an effective means of thermoregulation for Holsteins in a hot environment. Mathematical models were developed to predict both the sensible and latent heat loss from the respiratory tract in Holstein cows under field conditions, based on measurements of the ambient temperature, and other models were developed to predict respiration rate, tidal volume, mass flow rate and expired air temperature as functions of the ambient temperature and other variables.

Serotonergic mechanisms on breathing modulation in the rat locus coeruleus

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Investigation into the use of the Laryngeal Mask Airway in pentobarbital anesthetized dogs

Objective - To investigate the use of the laryngeal mask airway (LMA) in dogs. Study Design - Prospective experimental study. Animals - Eight healthy adult mixed breed dogs weighing from 15 to 20 kg. Methods - The dogs were anesthetized with intravenous pentobarbital. An LMA was introduced after the induction of anesthesia and 1 L/min O2 plus 1 L/min air was delivered using a circle anesthetic system. Respiratory rate, tidal volume, arterial O2 saturation (pulse oximetry), end tidal CO2, inspired fraction of O2, pulse rate, and mean arterial blood pressure were measured after the insertion of the LMA and 30, 60, 90, and 120 minutes afterwards. Results - There were no changes in respiratory rate, tidal volume, arterial O2 saturation, and pulse rate during anesthesia. End tidal CO2 decreased significantly by the end of anesthesia and ventilation appeared satisfactory. Conclusions - An LMA appeared to be an alternative option to maintain the patency of the airway in dogs. Clinical Relevance - This device may allow safe maintenance of an airway in dogs when intubation is difficult or when it interferes with the procedure (eg, cervical myelography). ©Copyright 1999 by The American College of Veterinary Surgeons.

Tracheobronchial consequences of the use of heat and moisture exchangers in dogs

Purpose: To determine the effect of heat and moisture exchange (HME) on the tracheobronchial tree (TBT) using a unidirectional anesthesic circuit with or without CO2 absorber and high or low fresh gas flow (FGF), in dogs. Methods: Thirty-two dogs were randomly allocated to four groups: G1 (n = 8) valvular circuit without CO2 absorber and high FGF (5 L·min-1); G2 (n = 8) as G1 with HME; G3 (n = 8) circuit with CO2 absorber with a low FGF (1 L·min-1); G4 (n = 8) as G3 with HME. Anesthesia was induced and maintained with pentobarbital. Tympanic temperature (TT), inhaled gas temperature (IGT), relative (RH) and absolute humidity (AH) of inhaled gas were measured at 15 (control), 60, 120 and 180 min of controlled ventilation. Dogs were euthanized and biopsies in the areas of TBT were performed by scanning electron microscopy. Results: The G2 and G4 groups showed the highest AH (>20 mgH2O·L-1) and G1 the lowest (< 10 mgH2O·L-1) and G3 was intermediate (<20 mgH2O·L-1) (P < 0.01). There was no difference of TT and IGT among groups. Alterations of the mucociliary system were greatest in G1, least in G2 and G4, and intermediate in G3. Conclusion: In dogs, introduction of HME to a unidirectional anesthetic circuit with/without CO2 absorber and high or low FGF preserved humidity of inspired gases. HME attenuated but did not prevent alterations of the mucociliary system of the TBT.

Different doses of exogenous surfactant for treatment of meconium aspiration syndrome in newborn rabbits.

OBJECTIVE: To evaluate the effects of 2 different doses of exogenous surfactant on pulmonary mechanics and on the regularity of pulmonary parenchyma inflation in newborn rabbits. METHOD: Newborn rabbits were submitted to tracheostomy and randomized into 4 study groups: the Control group did not receive any material inside the trachea; the MEC group was instilled with meconium, without surfactant treatment; the S100 and S200 groups were instilled with meconium and were treated with 100 and 200 mg/kg of exogenous surfactant (produced by Instituto Butantan) respectively. Animals from the 4 groups were mechanically ventilated during a 25-minute period. Dynamic compliance, ventilatory pressure, tidal volume, and maximum lung volume (P-V curve) were evaluated. Histological analysis was conducted using the mean linear intercept (Lm), and the lung tissue distortion index (SDI) was derived from the standard deviation of the means of the Lm. One-way analysis of variance was used with a = 0.05. RESULTS: After 25 minutes of ventilation, dynamic compliance (mL/cm H2O.kg) was 0.87 +/- 0.07 (Control); 0.49 +/- 0.04 (MEC*); 0.67 +/- 0.06 (S100); and 0.67 +/- 0.08 (S200), and ventilatory pressure (cm H2O) was 9.0 +/- 0.9 (Control); 16.5 +/- 1.7 (MEC*); 12.4 +/- 1.1 (S100); and 12.1 +/- 1.5 (S200). Both treated groups had lower Lm values and more homogeneity in the lung parenchyma compared to the MEC group: SDI = 7.5 +/- 1.9 (Control); 11.3 +/- 2.5 (MEC*), 5.8 +/- 1.9 (S100); and 6.7 +/- 1.7 (S200) (*P < 0.05 versus all the other groups). CONCLUSIONS: Animals treated with surfactant showed significant improvement in pulmonary mechanics and more regularity of the lung parenchyma in comparison to untreated animals. There was no difference in results after treatment with either of the doses used.

Control of breathing and blood pressure by parafacial neurons in conscious rats

New Findings: • What is the central question of this study? The main purpose of the present manuscript was to investigate the cardiorespiratory responses to hypoxia or hypercapnia in conscious rats submitted to neuronal blockade of the parafacial region. We clearly showed that the integrity of parafacial region is important for the respiratory responses elicited by peripheral and central chemoreflex activation in freely behavior rats. • What is the main finding and its importance? Since the parafacial region is part of the respiratory rhythm generator, they are essential for postnatal survival, which is probably due to their contribution to chemoreception in conscious rats. The retrotrapezoid nucleus (RTN), located in the parafacial region, contains glutamatergic neurons that express the transcriptor factor Phox2b and that are suggested to be central respiratory chemoreceptors. Studies in anaesthetized animals or in vitro have suggested that RTN neurons are important in the control of breathing by influencing respiratory rate, inspiratory amplitude and active expiration. However, the contribution of these neurons to cardiorespiratory control in conscious rats is not clear. Male Holtzman rats (280-300 g, n= 6-8) with bilateral stainless-steel cannulae implanted into the RTN were used. In conscious rats, the microinjection of the ionotropic glutamatergic agonist NMDA (5 pmol in 50 nl) into the RTN increased respiratory frequency (by 42%), tidal volume (by 21%), ventilation (by 68%), peak expiratory flow (by 24%) and mean arterial pressure (MAP, increased by 16 ± 4, versus saline, 3 ± 2 mmHg). Bilateral inhibition of the RTN neurons with the GABAA agonist muscimol (100 pmol in 50 nl) reduced resting ventilation (52 ± 34, versus saline, 250 ± 56 ml min-1 kg-1 with absolute values) and attenuated the respiratory response to hypercapnia and hypoxia. Muscimol injected into the RTN slightly reduced resting MAP (decreased by 13 ± 7, versus saline, increased by 3 ± 2 mmHg), without changing the effects of hypercapnia or hypoxia on MAP and heart rate. The results suggest that RTN neurons activate facilitatory mechanisms important to the control of ventilation in resting, hypoxic or hypercapnic conditions in conscious rats. © 2012 The Authors. Experimental Physiology © 2012 The Physiological Society.