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Baretta ALR, Freitas ACTDE, Mocellin C, Cambi MPC, Ribeiro AR, Ferreira CGDAR, Baretta GAP. Comparison of respiratory muscle strength through manovacuometry in the early postoperative period of bariatric surgery by laparotomy and laparoscopy. Rev Col Bras Cir 2022; 49:e20223056. [PMID: 35858033 PMCID: PMC10578826 DOI: 10.1590/0100-6991e-20223056-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 04/06/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION surgical treatment of obesity causes important changes in respiratory mechanics. AIM Comparatively analyze respiratory muscle strength in post bariatric patients underwent to gastric bypass by laparotomy and laparoscopy during hospital stay. METHODS observational study with a non-randomized longitudinal design, of a quantitative character. Data were collected from 60 patients with BMI 40Kg/m2, divided in laparotomy group (n=30) and laparoscopy group (n=30). Smokers, patients with previous lung diseases and those unable to perform the exam correctly were excluded. Both groups were evaluated at immediate postoperative, first and second postoperative days with manovacuometry for respiratory muscle strength and visual analogue pain scale. RESULTS the sample was homogeneous in age, sex and BMI. Reduction in maximal respiratory pressures was observed after surgery for those operated on by laparotomy, no return to baseline values on discharge day on the second postoperative day. This group had also more severe pain and longer operative time. There was no difference in respiratory pressure measurements after surgery in the laparoscopy group. CONCLUSION conventional bariatric surgery reduces muscle strength in the postoperative period and leads to more intense pain during hospitalization when compared to the laparoscopy group.
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Affiliation(s)
- Arieli Luz Rodrigues Baretta
- - Universidade Federal do Paraná, Disciplina de Clínica Cirúrgica - Curitiba - PR - Brasil
- - Clínica de Cirurgia Bariátrica Dr. Giorgio Baretta, Departamento de Fisioterapia - Curitiba - PR - Brasil
- - Clínica de Cirurgia Bariátrica Dr. Giorgio Baretta, Departamento de Cirurgia - Curitiba - PR - Brasil
- - Hospital São Lucas, Departamento de Cirurgia Bariátrica - Campo Largo - PR - Brasil
| | | | - Carolina Mocellin
- - Universidade Federal do Paraná, Disciplina de Clínica Cirúrgica - Curitiba - PR - Brasil
- - Clínica de Cirurgia Bariátrica Dr. Giorgio Baretta, Departamento de Cirurgia - Curitiba - PR - Brasil
| | - Maria Paula Carlini Cambi
- - Clínica de Cirurgia Bariátrica Dr. Giorgio Baretta, Departamento de Cirurgia - Curitiba - PR - Brasil
| | - André Richter Ribeiro
- - Universidade Federal do Paraná, Disciplina de Clínica Cirúrgica - Curitiba - PR - Brasil
| | | | - Giorgio Alfredo Pedroso Baretta
- - Universidade Federal do Paraná, Disciplina de Clínica Cirúrgica - Curitiba - PR - Brasil
- - Clínica de Cirurgia Bariátrica Dr. Giorgio Baretta, Departamento de Cirurgia - Curitiba - PR - Brasil
- - Hospital São Lucas, Departamento de Cirurgia Bariátrica - Campo Largo - PR - Brasil
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Hung KC, Ko CC, Chang PC, Wang KF, Teng IC, Lin CH, Huang PW, Sun CK. Efficacy of high-flow nasal oxygenation against peri- and post-procedural hypoxemia in patients with obesity: a meta-analysis of randomized controlled trials. Sci Rep 2022; 12:6448. [PMID: 35440712 PMCID: PMC9018711 DOI: 10.1038/s41598-022-10396-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 04/05/2022] [Indexed: 11/29/2022] Open
Abstract
This meta-analysis aimed at investigating the efficacy of high-flow nasal oxygenation (HFNO) against hypoxemia in patients with obesity compared with conventional oxygenation therapy and non-invasive ventilation. Databases were searched from inception to August 2021. Studies involving peri- or post-procedural use of HFNO were included. The primary outcome was risk of hypoxemia, while the secondary outcomes included status of oxygenation and carbon dioxide elimination. Ten randomized controlled trials (RCTs) were included. We found that HFNO prolonged the safe apnea time at induction compared to control group [mean difference (MD) = 73.88 s, p = 0.0004; 2 RCTs] with no difference in risk of peri-procedural hypoxemia [relative risk (RR) = 0.91, p = 0.64; 4 RCTs], minimum SpO2 (MD = 0.09%, p = 0.95; 4 RCTs), PaO2 (MD = − 8.13 mmHg, p = 0.86; 3 RCTs), PaCO2 (MD = − 6.71%, p = 0.2; 2 RCTs), EtCO2 (MD = − 0.28 mmHg, p = 0.8; 4 RCTs) between the two groups. HFNO also did not improve postprocedural PaO2/FiO2 ratio (MD = 41.76, p = 0.58; 2 RCTs) and PaCO2 (MD = − 2.68 mmHg, p = 0.07; 2 RCTs). This meta-analysis demonstrated that the use of HFNO may be associated with a longer safe apnea time without beneficial impact on the risk of hypoxemia, oxygenation, and CO2 elimination in patients with obesity. The limited number of trials warranted further large-scale studies to support our findings.
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Affiliation(s)
- Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan.,Department of Hospital and Health Care Administration, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan City, Taiwan
| | - Ching-Chung Ko
- Department of Medical Imaging, Chi Mei Medical Center, Tainan City, Taiwan.,Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan City, Taiwan
| | - Po-Chih Chang
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital/Kaohsiung Medical University, Kaohsiung City, Taiwan.,Weight Management Center, Kaohsiung Medical University Hospital/Kaohsiung Medical University, Kaohsiung City, Taiwan.,Department of Sports Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan.,Ph. D. Program in Biomedical Engineering, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Kuei-Fen Wang
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - I-Chia Teng
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Chien-Hung Lin
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Ping-Wen Huang
- Department of Emergency Medicine, Show Chwan Memorial Hospital, Changhua City, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, No.1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung City, 82445, Taiwan. .,College of Medicine, I-Shou University, Kaohsiung City, Taiwan.
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BARETTA ARIELILUZRODRIGUES, FREITAS ALEXANDRECOUTINHOTEIXEIRADE, MOCELLIN CAROLINA, CAMBI MARIAPAULACARLINI, RIBEIRO ANDRÉRICHTER, FERREIRA CLÁUDIAGISSIDAROCHA, BARETTA GIORGIOALFREDOPEDROSO. Comparação da força muscular respiratória através da manovacuometria no pós-operatório precoce de cirurgia bariátrica por laparotomia e por videolaparoscopia. Rev Col Bras Cir 2022. [DOI: 10.1590/0100-6991e-20223056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Introdução: o tratamento cirúrgico da obesidade acarreta importantes alterações na mecânica respiratória. Objetivo: analisar comparativamente a força muscular respiratória em pacientes submetidos à cirurgia bariátrica do tipo bypass gástrico por laparotomia e por videolaparoscopia durante o internamento cirúrgico. Métodos: estudo observacional com delineamento longitudinal não-randomizado, de caráter quantitativo. Foram coletados dados de 60 pacientes com índice de massa corporal igual ou superior a 40Kg/m2, candidatos a cirurgia bariátrica e divididos em grupo 1, para os operados por laparotomia (n=30), e grupo 2, para os operados por videolaparoscopia (n=30). Foram excluídos os tabagistas, os pacientes incapazes de executar o exame de forma correta e os portadores de doenças pulmonares prévias. Ambos os grupos foram avaliados no pré-operatório imediato, no primeiro e no segundo dias de pós-operatório através do teste de manovacuometria para a força muscular respiratória e da escala visual analógica de dor. Resultados: a amostra foi homogênea em relação à idade, índice de massa corporal e sexo. Foi observado redução das pressões respiratórias máximas após a cirurgia para os operados por laparotomia, sem retorno aos valores basais no dia da alta hospitalar no segundo dia pósoperatório. Esse grupo também cursou com dor mais intensa e maior tempo cirúrgico. Não houve diferença das medidas de pressão respiratória após a cirurgia no grupo operado por laparoscopia. Conclusões: a cirurgia bariátrica pela via convencional reduz a força muscular respiratória no pós-operatório e cursa com dor mais intensa durante a internação cirúrgica em relação à via laparoscópica.
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Affiliation(s)
- ARIELI LUZ RODRIGUES BARETTA
- Universidade Federal do Paraná, Brazil; Clínica de Cirurgia Bariátrica Dr. Giorgio Baretta, Brasil; Clínica de Cirurgia Bariátrica Dr. Giorgio Baretta, Brasil; Hospital São Lucas, Brazil
| | | | - CAROLINA MOCELLIN
- Universidade Federal do Paraná, Brazil; Clínica de Cirurgia Bariátrica Dr. Giorgio Baretta, Brasil
| | | | | | | | - GIORGIO ALFREDO PEDROSO BARETTA
- Universidade Federal do Paraná, Brazil; Clínica de Cirurgia Bariátrica Dr. Giorgio Baretta, Brasil; Hospital São Lucas, Brazil
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4
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Fulton R, Millar JE, Merza M, Johnston H, Corley A, Faulke D, Rapchuk IL, Tarpey J, Fanning JP, Lockie P, Lockie S, Fraser JF. Prophylactic Postoperative High Flow Nasal Oxygen Versus Conventional Oxygen Therapy in Obese Patients Undergoing Bariatric Surgery (OXYBAR Study): a Pilot Randomised Controlled Trial. Obes Surg 2021; 31:4799-4807. [PMID: 34387826 DOI: 10.1007/s11695-021-05644-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/30/2021] [Accepted: 07/30/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients with obesity are predisposed to a reduction in end-expiratory lung volume (EELV) and atelectasis after anaesthesia. High flow nasal oxygen (HFNO) may increase EELV, reducing the likelihood of postoperative pulmonary complications (PPC). We conducted a pilot randomised controlled trial (RCT) of conventional oxygen therapy versus HFNO after bariatric surgery. The aim was to investigate the feasibility of using electrical impedance tomography (EIT) as a means of assessing respiratory mechanics and to inform the design of a definitive RCT. METHODS We performed a single-centre, parallel-group, pilot RCT. Adult patients with obesity undergoing elective bariatric surgery were eligible for inclusion. We excluded patients with a known contraindication to HFNO or with chronic lung disease. RESULTS Fifty patients were randomised in equal proportions. One patient crossed over from conventional O2 to HFNO. Delta EELI was higher at 1 hour in patients receiving HFNO (mean difference = 831 Au (95% CI - 1636-3298), p = 0.5). Continuous EIT beyond 1 hour was poorly tolerated. At 6 hours, there were no differences in PaO2/FiO2 ratio or PaCO2. Only one patient developed a PPC (in the HFNO group) by 6 weeks. CONCLUSIONS These data suggest that a large-scale RCT of HFNO after bariatric surgery in an 'all-comers' population is likely infeasible. While EIT was an effective means of assessing respiratory mechanics, it was impractical over time. Similarly, the infrequency of PPC precludes its use as a primary outcome. Future studies should focus on identifying patients at the greatest risk of PPC.
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Affiliation(s)
- Rachel Fulton
- Department of Anaesthesia and Critical Care, Queen Elizabeth II University Hospital, Glasgow, UK.,Critical Care Research Group, The Prince Charles Hospital, Rode Road, Brisbane, Queensland, 4032, Australia
| | - Jonathan E Millar
- Critical Care Research Group, The Prince Charles Hospital, Rode Road, Brisbane, Queensland, 4032, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia.,Roslin Institute, University of Edinburgh, Edinburgh, UK
| | - Megan Merza
- St. Andrew's War Memorial Hospital, Brisbane, Australia
| | | | - Amanda Corley
- Critical Care Research Group, The Prince Charles Hospital, Rode Road, Brisbane, Queensland, 4032, Australia.,Griffith University, Griffith, Australia
| | - Daniel Faulke
- St. Andrew's War Memorial Hospital, Brisbane, Australia
| | - Ivan L Rapchuk
- Faculty of Medicine, University of Queensland, Brisbane, Australia.,St. Andrew's War Memorial Hospital, Brisbane, Australia
| | - Joe Tarpey
- St. Andrew's War Memorial Hospital, Brisbane, Australia
| | - Jonathon P Fanning
- Critical Care Research Group, The Prince Charles Hospital, Rode Road, Brisbane, Queensland, 4032, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Philip Lockie
- St. Andrew's War Memorial Hospital, Brisbane, Australia
| | | | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Rode Road, Brisbane, Queensland, 4032, Australia. .,Faculty of Medicine, University of Queensland, Brisbane, Australia.
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5
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Baltieri L, Cazzo E, Oliveira Modena DA, Gobato Rentel RC, Martins LC, Chaim EA. Correlation between levels of adipokines and inflammatory mediators with spirometric parameters in individuals with obesity and symptoms of asthma: Cross-sectional study. Pulmonology 2020; 28:105-112. [PMID: 32561351 DOI: 10.1016/j.pulmoe.2020.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/31/2020] [Accepted: 04/03/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The adipose tissue secretes adipokines and influences the release of inflammatory mediators contributing to a state of low-grade systemic inflammation that may change lung function. OBJECTIVE To correlate levels of adipokines and inflammatory mediators with lung function in individuals with obesity and bronchial asthma symptoms. MATERIALS AND METHODS A cross-sectional study, including women with obesity (grade II and III) with symptoms and clinical diagnosis of asthma. Anthropometric measurements (weight, height, BMI), pulmonary function test (spirometry), asthma control test questionnaire, collection of systemic inflammatory markers (blood collection) and pulmonary markers (sputum collection) were collected and were analyzed: IL-6, IL-8, TNF-α, adiponectin, resistin, leptin and C-reactive protein (CRP). The patients were stratified into two groups according to asthma control. RESULTS 80 women were analyzed and 40% had an ACT score greater than or equal to 18 and were classified as "controlled asthma". More than half of the patients of ACT<18 score obtaining measures of FEV1, PEF and FEF25-75% below and 80% of predicted. There was a significant and negative correlation between IL-6 in the sputum with FVC and FEF25-75% in the group ACT<18 and with FVC and FEV1 in the group ACT≥18. CONCLUSIONS Therefore, we concluded that the increase of interleukin-6 in the sputum is related to worse pulmonary function even in patients with controlled asthma, especially in the translate airway permeability measures.
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Affiliation(s)
- L Baltieri
- University of Campinas, Campinas, Brazil.
| | - E Cazzo
- Universidade Estadual de Campinas, Brazil
| | | | | | | | - E A Chaim
- Universidade Estadual de Campinas, Brazil
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6
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Abstract
Metabolic and bariatric surgical procedures have increased in the pediatric-age population over the past decade. Three operations, laparoscopic adjustable gastric banding, vertical sleeve gastrectomy, and Roux-en Y gastric bypass, are the most commonly performed procedures for weight reduction. This article will examine the specifics of each procedure along with the complications associated with any metabolic or bariatric surgery. Complications unique to each operation will be reviewed as well as recommendations for the management of these patients.
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7
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Wang ZG, Sun JR, Sha HW. Efficacy of ventilator for patients with atelectasis: A systematic review protocol of randomized controlled trials. Medicine (Baltimore) 2019; 98:e17259. [PMID: 31574839 PMCID: PMC6775436 DOI: 10.1097/md.0000000000017259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND This study aims to assess the efficacy and safety of ventilator for the treatment of atelectasis. METHODS We will search Cochrane Library, MEDLINE, EMBASE, CINAHL, EBSCO, Chinese database Chinese Biomedical Literature Database, China National Knowledge Infrastructure, and Wanfang data from inceptions to June 30, 2019 without language limitations. We will include randomized controlled trials (RCTs) of ventilator on evaluating the efficacy and safety of ventilator for atelectasis. We will use Cochrane risk of bias tool to assess the methodological quality for all included RCTs. RevMan 5.3 software will be used for statistical analysis. RESULTS The primary outcome is lung function. The secondary outcomes comprise of airway pressure, mean arterial pressure, arterial blood gas, heart rate, respiratory rate, oxygen saturation, and adverse events. CONCLUSION The findings of this study will provide most recent evidence of ventilator for the treatment of atelectasis. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019139329.
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Affiliation(s)
- Zhi-Guo Wang
- Department of Elderly Respiratory Medicine, Cardiovascular and Cerebrovascular Specialist Ward Affiliated to Yanan University
| | - Jian-Rong Sun
- Department of Elderly Respiratory Medicine, Dongguan Hospital of Yanan University Affiliated Hospital
| | - Hai-Wang Sha
- Surgical Intensive Care Center, Yanan University Affiliated Hospital, Yan’an, China
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8
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Modena DAO, Moreira MM, Paschoal IA, Pereira MC, Martins LC, Cazzo E, Chaim EA. Respiratory evaluation through volumetric capnography among grade III obese and eutrophic individuals: a comparative study. SAO PAULO MED J 2019; 137:177-183. [PMID: 29340500 PMCID: PMC9721226 DOI: 10.1590/1516-3180.2017.0085011017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 10/01/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Excess trunk body fat in obese individuals influences respiratory physiological function. The aims of this study were to compare volumetric capnography findings (VCap) between severely obese patients and normal-weight subjects and to assess whether there is any association between neck circumference (NC), waist-hip ratio (WHR) and VCap among grade III obese individuals. DESIGN AND SETTING Analytical observational case-matched cross-sectional study, University of Campinas. METHODS This cross-sectional study compared VCap variables between 60 stage III obese patients and 60 normal-weight individuals. RESULTS In comparison with the normal-weight group, obese patients presented higher alveolar minute volume (8.92 ± 4.94 versus 6.09 ± 2.2; P = < 0.0001), CO2 production (278 ± 91.0 versus 209 ± 60.23; P < 0.0001), expiratory tidal volume (807 ± 365 versus 624 ± 202; P = 0.005), CO2 production per breath (21.1 ± 9.7 versus 16.7 ± 6.16; P = 0.010) and peak expiratory flow (30.9 ± 11.9 versus 25.5 ± 9.13; P = 0.004). The end-expiratory CO2 (PetCO2) concentration (33.5 ± 4.88 versus 35.9 ± 3.79; P = 0.013) and the phase 3 slope were normalized according to expired tidal volume (0.02 ± 0.05 versus 0.03 ± 0.01; P = 0.049) were lower in the obese group. CONCLUSIONS The greater the NC was, the larger were the alveolar minute volume, anatomical dead space, CO2 production per minute and per breath and expiratory volume; whereas the smaller were the phase 2 slope (P2Slp), phase 3 slope (P3Slp) and pressure drop in the mouth during inspiration.
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Affiliation(s)
| | - Marcos Mello Moreira
- PT, PhD. Professor, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Ilma Aparecida Paschoal
- MD, PhD. Pneumologist and Professor, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Mônica Corso Pereira
- MD, PhD. Pneumologist and Professor, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Luiz Cláudio Martins
- MD, PhD. Pneumologist and Professor, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Everton Cazzo
- MD, PhD. Attending Physician and Assistant Lecturer, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Elinton Adami Chaim
- MD, PhD. General Surgeon and Professor, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
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Rocha MRSD, Merino DFB, Souza SCD, Montebelo MIDL, Rasera Júnior I, Pazzianotto-Forti EM. Inspiratory loading exercises on respiratory muscle function in post-operative gastroplasty patients: a randomized clinical trial. FISIOTERAPIA EM MOVIMENTO 2019. [DOI: 10.1590/1980-5918.032.ao13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: The gastroplasty post-operative period can alter respiratory mechanics and predispose patients to respiratory complications. Objective: The objective was to evaluate the effects of exercises with inspiratory load on respiratory muscle function and on the prevalence of atelectasis after gastroplasty. Method: 40 participants were randomly allocated into two groups: Control Group (CG), its members underwent conventional respiratory physical therapy (CRP) and the Inspiratory Load Group (ILG), its members performed exercises with linear inspiratory pressure load, with 40% of the maximum inspiratory pressure (MIP), associated with CRP. Therapy procedures were conducted twice during the immediate post-operative period and thrice on the first post-operative day. In addition to evaluating the MIP, the nasal inspiratory pressure (NIP) and the sustained maximum inspiratory pressure (SMIP) were evaluated before and after treatment. Analysis of variance followed by the Bonferroni correction were applied considering a 5% significance level (p < 0.05). Results: There was no significant difference in NIP and SMIP values when the pre- and post-operative periods were compared for the ILG; however, these values were significantly lower for the CG, also with intergroup differences in NIP values. Atelectasis prevalence was 5% for ILG and 15% for CG, with no intergroup difference. Conclusion: The inspiratory muscle strength and resistance of the respiratory muscles were maintained in the group that performed exercises with inspiratory load associated with CRP, with a low rate of atelectasis after gastroplasty.
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10
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Marini JJ. Acute Lobar Atelectasis. Chest 2018; 155:1049-1058. [PMID: 30528423 DOI: 10.1016/j.chest.2018.11.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/15/2018] [Accepted: 11/17/2018] [Indexed: 01/06/2023] Open
Abstract
Lobar atelectasis (or collapse) is an exceedingly common, rather predictable, and potentially pathogenic companion to many forms of acute illness, postoperative care, and chronic debility. Readily diagnosed by using routine chest imaging and bedside ultrasound, the consequences from lobar collapse may be minor or serious, depending on extent, mechanism, patient vulnerability, abruptness of onset, effectiveness of hypoxic vasoconstriction, and compensatory reserves. Measures taken to reduce secretion burden, assure adequate secretion clearance, maintain upright positioning, reverse lung compression, and sustain lung expansion accord with a logical physiologic rationale. Both classification and logical approaches to prophylaxis and treatment of lobar atelectasis derive from a sound mechanistic knowledge of its causation.
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Affiliation(s)
- John J Marini
- Pulmonary & Critical Care Medicine Divisions, Regions Hospital & University of Minnesota, Minneapolis/St. Paul, MN.
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11
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Abstract
Background Laparoscopic sleeve gastrectomy (LSG) with staple line reinforcement (SLR) is a popular and safe treatment option for morbid obesity. We have developed, devised, and described our own method of stapleless laparoscopic sleeve gastrectomy, which in our limited study appeared safe, efficacious, and potentially cost-effective. Methods We analyzed the outcome of our modified LSG in a case series of three middle-aged women (median age 42 years old). Our main modification was sutured closure of the stomach rather than the commonly utilized technique of stapled closure. Our primary measure of success was the occurrence of post-operative leak. Secondary measures were (a) length of operation, (b) duration of inpatient stay, and (c) percentage of weight loss at 6 and 12 months post operation. Results Median operative time = 132 min (120–195 min), and median inpatient stays were 2 days. No post-operative leaks were recorded. The median excess weight loss at 6 months was 39% of initial weight loss and 57.7% at 12 months. Conclusions Stapleless LSG has the potential to be an affordable alternative to the traditional LSG. High-powered studies and a formal cost analysis are required.
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Affiliation(s)
- Matteo Catanzano
- Department of Surgery, Aberdeen Royal Infirmary, Foresterhill Health Campus, Aberdeen, AB252ZN, UK
| | - Lisa Grundy
- Department of Surgery, Aberdeen Royal Infirmary, Foresterhill Health Campus, Aberdeen, AB252ZN, UK
| | - Mohamed Bekheit
- Department of Surgery, Aberdeen Royal Infirmary, Foresterhill Health Campus, Aberdeen, AB252ZN, UK.
- Department of Surgery, El kabbary General Hospital, Alexandria, Egypt.
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK.
- Centre Hépato-Biliaire, 12 av. Paul Vaillant Couturier, AP-HP, Hôpital Paul Brousse, 94800, Villejuif, France.
- Inserm Unité 1193, 12 av. Paul Vaillant Couturier, 94800, Villejuif, France.
- Ecole doctorale Innovation Therapeutique, Universite Pais-Sud, Châtenay-Malabry Cedex, France.
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12
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Fulton R, Millar JE, Merza M, Johnston H, Corley A, Faulke D, Rapchuk I, Tarpey J, Lockie P, Lockie S, Fraser JF. High flow nasal oxygen after bariatric surgery (OXYBAR), prophylactic post-operative high flow nasal oxygen versus conventional oxygen therapy in obese patients undergoing bariatric surgery: study protocol for a randomised controlled pilot trial. Trials 2018; 19:402. [PMID: 30053897 PMCID: PMC6062994 DOI: 10.1186/s13063-018-2777-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/29/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The incidence of obesity is increasing worldwide. In selected individuals, bariatric surgery may offer a means of achieving long-term weight loss, improved health, and healthcare cost reduction. Physiological changes that occur because of obesity and general anaesthesia predispose to respiratory complications following bariatric surgery. The aim of this study is to determine whether post-operative high flow nasal oxygen therapy (HFNO2) improves respiratory function and reduces the incidence of post-operative pulmonary complications (PPCs) in comparison to conventional oxygen therapy in these patients. METHOD The OXYBAR study is a prospective, un-blinded, single centre, randomised, controlled pilot study. Patients with body mass index (BMI) > 30 kg/m2, undergoing laparoscopic bariatric surgery, will be randomised to receive either standard low flow oxygen therapy or HFNO2 in the post-operative period. The primary outcome measure is the change in end expiratory lung impedance (∆EELI) as measured by electrical impedance tomography (EIT). Secondary outcome measures include change in tidal volume (∆Vt), partial arterial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) ratio, incidence of PPCs, hospital length of stay and measures of patient comfort. DISCUSSION We hypothesise that the post-operative administration of HFNO2 will increase EELI and therefore end expiratory lung volume (EELV) in obese patients. To our knowledge this is the first trial designed to assess the effects of HFNO2 on EELV in this population. We anticipate that data collected during this pilot study will inform a larger multicentre trial. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12617000694314 . Registered on 15 May 2017.
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Affiliation(s)
- Rachel Fulton
- Critical Care Research Group, The Prince Charles Hospital, Rode Road, Brisbane, QLD 4032 Australia
| | - Jonathan E. Millar
- Critical Care Research Group, The Prince Charles Hospital, Rode Road, Brisbane, QLD 4032 Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Wellcome-Wolfson Centre for Experimental Medicine, Queen’s University Belfast, Belfast, Northern Ireland UK
| | - Megan Merza
- Critical Care Research Group, The Prince Charles Hospital, Rode Road, Brisbane, QLD 4032 Australia
- St Andrews War Memorial Hospital, Brisbane, Australia
| | | | - Amanda Corley
- Critical Care Research Group, The Prince Charles Hospital, Rode Road, Brisbane, QLD 4032 Australia
- Griffith University, Griffith, Queensland Australia
| | - Daniel Faulke
- St Andrews War Memorial Hospital, Brisbane, Australia
| | - Ivan Rapchuk
- St Andrews War Memorial Hospital, Brisbane, Australia
| | - Joe Tarpey
- St Andrews War Memorial Hospital, Brisbane, Australia
| | - Philip Lockie
- St Andrews War Memorial Hospital, Brisbane, Australia
| | | | - John F. Fraser
- Critical Care Research Group, The Prince Charles Hospital, Rode Road, Brisbane, QLD 4032 Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
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Rocha MRSD, Souza S, Costa CMD, Merino DFB, Montebelo MIDL, Rasera-Júnior I, Pazzianotto-Forti EM. AIRWAY POSITIVE PRESSURE VS. EXERCISES WITH INSPIRATORY LOADING FOCUSED ON PULMONARY AND RESPIRATORY MUSCULAR FUNCTIONS IN THE POSTOPERATIVE PERIOD OF BARIATRIC SURGERY. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2018; 31:e1363. [PMID: 29972391 PMCID: PMC6031315 DOI: 10.1590/0102-672020180001e1363] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/06/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Bariatric surgery can trigger postoperative pulmonary complications due to factors inherent to the procedure, mainly due to diaphragmatic dysfunction. AIM To evaluate and compare the effects of two levels of positive pressure and exercises with inspiratory load on lung function, inspiratory muscle strength and respiratory muscle resistance, and the prevalence of atelectasis after gastroplasty. METHODS Clinical, randomized and blind trial, with subjects submitted to bariatric surgery, allocated to two groups: positive pressure group, who received positive pressure at two levels during one hour and conventional respiratory physiotherapy and inspiratory load group, who performed exercises with load linear inspiratory pressure, six sets of 15 repetitions, in addition to conventional respiratory physiotherapy, both of which were applied twice in the immediate postoperative period and three times a day on the first postoperative day. Spirometry was performed for pulmonary function analysis, nasal inspiratory pressure for inspiratory muscle strength and incremental test of respiratory muscle resistance for sustained maximal inspiratory pressure, both preoperatively and on hospital discharge on the second postoperative day. RESULTS There was no significant difference (p> 0.05) in the expiratory reserve volume and in the tidal volume in the pre and postoperative periods when compared intra and intergroup. There was no significant difference (p>0.05) in the nasal inspiratory pressure and the maximal inspiratory pressure maintained in the inspiratory load group in the intragroup evaluation, but with a significant difference (p<0.05) compared to the positive pressure group. The prevalence of atelectasis was 5% in both groups with no significant difference (p>0.05) between them. CONCLUSION Both groups, associated with conventional respiratory physiotherapy, preserved expiratory reserve volume and tidal volume and had a low atelectasis rate. The inspiratory loading group still maintained inspiratory muscle strength and resistance of respiratory muscles.
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Atelectasis in patients undergoing bariatric surgery without any previous pulmonary alterations: comments from the prevalence study. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2018. [PMID: 29137872 PMCID: PMC9391826 DOI: 10.1016/j.bjane.2017.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Forgiarini LA, Esquinas AM. Atelectasis in postoperative bariatric surgery: how many understand them? BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2018. [PMID: 28551061 PMCID: PMC9391678 DOI: 10.1016/j.bjane.2017.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Baltieri L, Pazzianotto-Forti EM. [Atelectasis in patients undergoing bariatric surgery without any previous pulmonary alterations: comments from the prevalence study]. Rev Bras Anestesiol 2017; 68:214-215. [PMID: 29137872 DOI: 10.1016/j.bjan.2017.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 07/24/2017] [Accepted: 08/11/2017] [Indexed: 11/16/2022] Open
Affiliation(s)
- Letícia Baltieri
- Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brasil
| | - Eli Maria Pazzianotto-Forti
- Universidade Metodista de Piracicaba (UNIMEP), Programa de Pós-Graduação em Ciências do Movimento Humano (PPG-CMH), Piracicaba, SP, Brasil.
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Baltieri L, Martins LC, Cazzo E, Modena DAO, Gobato RC, Candido EC, Chaim EA. Analysis of quality of life among asthmatic individuals with obesity and its relationship with pulmonary function: cross-sectional study. SAO PAULO MED J 2017; 135:332-338. [PMID: 28767991 PMCID: PMC10016004 DOI: 10.1590/1516-3180.2016.0342250217] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 02/25/2017] [Indexed: 11/21/2022] Open
Abstract
CONTEXT AND OBJECTIVE: The combined effect of obesity and asthma may lead to significant impairment of quality of life (QOL). The aim here was to evaluate the prevalence of asthma among obese individuals, characterize the severity of impairment of quality of life and measure its relationship with pulmonary function. DESIGN AND SETTING: Observational cross-sectional study in public university hospital. METHODS: Morbidly obese individuals (body mass index > 40 kg/m2) seen in a bariatric surgery outpatient clinic and diagnosed with asthma, were included. Anthropometric data were collected, the Standardized Asthma Quality of Life Questionnaire (AQLQ(S)) was applied and spirometry was performed. The subjects were divided into two groups based on the median of the score in the questionnaire (worse < 4 and better > 4) and were compared regarding anthropometric data and pulmonary function. RESULTS: Among the 4791 individuals evaluated, 219 were asthmatic; the prevalence of asthma was 4.57%. Of these, 91 individuals were called to start multidisciplinary follow-up during the study period, of whom 82 answered the questionnaire. The median score in the AQLQ(S) was 3.96 points and, thus, the individuals were classified as having moderate impairment of their overall QOL. When divided according to better or worse QOL, there was a statistically difference in forced expiratory flow (FEF) 25-75%, with higher values in the better QOL group. CONCLUSION: The prevalence of asthma was 4.57% and QOL was impaired among the asthmatic obese individuals. The worst QOL domain related to environmental stimuli and the best QOL domain to limitations of the activities. Worse QOL was correlated with poorer values for FEF 25-75%.
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Affiliation(s)
- Letícia Baltieri
- PT, MSc. Doctoral Student, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Luiz Claudio Martins
- MD, PhD. Pneumologist, Professor of Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Everton Cazzo
- MD, PhD. Attending Physician and Assistant Lecturer, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | | | - Renata Cristina Gobato
- MSc. Nutritionist and Doctoral Student, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Elaine Cristina Candido
- MSc. Nurse and Doctoral Student, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
| | - Elinton Adami Chaim
- MD, PhD. General Surgeon and Professor, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
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Forgiarini Junior LA, Esquinas AM. [Atelectasis in postoperative bariatric surgery: how many understand them?]. Rev Bras Anestesiol 2017; 68:109-110. [PMID: 28551061 DOI: 10.1016/j.bjan.2017.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/12/2017] [Indexed: 11/29/2022] Open
Affiliation(s)
- Luiz Alberto Forgiarini Junior
- Centro Universitário Metodista - IPA, Programa de Pós-Graduação em Biociências e Reabilitação, Porto Alegre, RS, Brasil.
| | - Antonio M Esquinas
- Hospital Morales Meseguer, Unidad de Cuidados Intensivos, Murcia, Espanha
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