Análise da função respiratória em pacientes obesos submetidos à operação Fobi-Capella

[The profile of patients undergoing bariatric surgery in the Brazilian Unified National Health System: a systematic review]

Nearly one million Brazilians were morbidly obese in 2013. Bariatric surgery is an option for sustained weight loss, and the Brazilian Unified National Health System (SUS) had provided 50,000 such procedures as of 2014. The SUS database does not provide anthropometric and comorbidity data on these patients, so the aim of the current study was to perform a systematic review to assess the profile of SUS patients that underwent bariatric surgery from 1998 to 2014. The MEDLINE, LILACS, SciELO, and Scopus databases were searched, and the methodological quality of the included articles was assessed. Of the 1,591 identified studies, 39 were selected, 95% of which were observational. Patients had a mean age of 41.4 years and mean body mass index of 48.6kg/m2; 21% were males, 61% hypertensive, 22% diabetics, and 31% presented sleep apnea. When compared to international study samples, SUS patients showed similar a anthropometric profile and comorbidities but higher prevalence of hypertension. The studies' low methodological quality suggests caution in interpreting the results.

The influence of posture on spirometric values in grade III obese patients

BACKGROUND AND OBJECTIVES

The change from the sitting position to supine position, general anesthesia, and surgical procedure reduce lung volumes and this effect can be greater in obese patients. The objective of the present study was to evaluate the influence of the sitting position, 30 dorsal inclination, and horizontal dorsal decubitus on spirometry of grade III obese patients.

METHODS

Twenty-six adult patients in the preoperatory period were selected according to the following criteria: BMI>40kg.m(-2), age between 18 years and 60 years, and female gender. Variables analyzed included: age, weight, height, BMI, percentage of predictive values of FVC, FEV(1), and VEF(1)/FVC in the sitting position (90°), 30° dorsal elevation, and horizontal dorsal decubitus (0°). ANOVA, followed or not by Tukey test were used to compare mean predicted values on the different positions, considering significant a p value lower than 0.05.

RESULTS

Percentage values of FVC, FEV(1), and FEV(1)/FVC ratio regarding predicted values in the sitting position (90°), 30° dorsal elevation, and horizontal dorsal decubitus (0°), and p value of the corresponding statistical analysis were, respectively: FVC=92.8%, 88.2%, and 86.5%, p=0.301 (ANOVA); FEV(1): 93.1%, 83.8%, and 83.3%, p=0.023 (ANOVA), p=0.038 (Tukey test - 90°×0°); FEV(1)/FVC: 100,8%, 95.5%, and 96.8%, p=0.035 (ANOVA), p=0.035 (Tukey test - 90°×30°).

CONCLUSIONS

Changes in position produced changes in spirometry results of patients with grade III obesity.

Pulmonary function and quality of life in patients with morbid obesity six months after bariatric surgery

PURPOSE

To investigate the body weight, pulmonary function and quality of life of twenty patients with morbid obesity six months after the Fobi-Capella operation.

METHODS

Patients were evaluated before and six months after surgery. The patients were mainly female (75%), the average age was 40.5 ± 10.27 years; average weight 110.11 kg ± 21.77 and average body mass index (BMI) 39.93 ± 7.13 kg/m² in the postoperative evaluation. Pulmonary function was assessed by spirometry using a Pulmonet/Godart NV Bilt Vetr Hotland spirometer and quality of life was assessed by applying the Moorehead-Ardelt questionnaire. The pre- and postoperative spirometry values were compared by the paired Student t test and the correlation between weight loss and pulmonary function was determined by linear regression, with the level of significance set at p < 0.05.

RESULTS

The spirometry variables Respiratory Frequency (RF), Expiratory Reserve Volume (ERV) and Functional Residual Capacity (FRC) differed significantly between the pre- and postoperative periods, whereas Residual Volume (RV), Vital Capacity (VC), Total Lung Capacity (TLC), FEF25-75 (Forced Expiratory Flow between 25 and 75% FVC) and FEV1/FVC% (Forced Expiratory Volume in the 1st second/ Forced Vital Capacity ratio) did not differ between periods. Only one patient reported worsening of quality of life. There was a positive correlation between weight loss and ERV (p=0.0117, r=0.5514), but no correlations were observed for the other variables.

CONCLUSIONS

There was a significant weight loss and an improvement of pulmonary function as seen by respiratory frequency, reduction and increased expiratory reserve volume and functional residual capacity. The quality of life of the patients also improved after the Fobi-Capella operation.

Effects of chest physiotherapy on the respiratory function of postoperative gastroplasty patients

INTRODUCTION

Bariatric surgery has become increasingly more recommended for the treatment of morbidly obese individuals for whom it is possible to identify co-morbidities other than alterations in pulmonary function. The objective of this study was to evaluate the effects of conventional chest physiotherapy (CCP) and of conventional physiotherapy associated with transcutaneous electrical diaphragmatic stimulation (CCP+TEDS) on pulmonary function and respiratory muscle strength in patients who have undergone Roux-en-Y gastric bypass.

METHODS

In total, 44 female patients with an average age of 37 +/- 7.3 years and an average body mass index (BMI) of 47.4 +/- 6.5 K/m(2) were selected as candidates for Roux-en-Y gastric bypass laparoscopy. They were evaluated for pulmonary volume and flow using spirometry and maximum respiratory pressure through manovacuometry during the preoperative period and on the fifteenth and thirtieth postoperative days.

RESULTS

No differences were detected between CCP and CCP + TEDS, and both factors contributed to the maintenance of pulmonary flow and volume as well as inhalation muscle strength. Exhalation muscle strength was not maintained in the CCP group at fifteen or thirty days postoperative, but it was maintained in patients treated with conventional chest physiotherapy + transcutaneous electric diaphragmatic stimulation.

DISCUSSION

These results suggest that both conventional chest physiotherapy and conventional chest physiotherapy + transcutaneous electric diaphragmatic stimulation prevent the reduction of pulmonary function during the Roux-en-Y gastric bypass postoperative period, and that transcutaneous electric diaphragmatic stimulation also contributes to expiratory muscle strength.