Lívia Gabriely Melo da Silva

Objective. This study aimed to summarize the accuracy of the different methods for detecting trigger asynchrony at the bedside in mechanically ventilated patients. Method. A systematic review was conducted from 1990 to 2020 in PubMed, Lilacs, Scopus, and ScienceDirect databases. The reference list of the identified studies, reviews, and meta-analyses was also manually searched for relevant studies. The reference standards were esophageal pressure catheter and/or electrical activity of the diaphragm. Studies were assessed following the QUADAS-2 recommendations, while the review was prepared according to the PRISMA criteria. Results. One thousand one hundred and eleven studies were selected, and four were eligible for analysis. Esophageal pressure was the predominant reference standard, while visual inspection and algorithms/software comprised index tests. The trigger asynchrony, ineffective expiratory effort, double triggering, and reverse triggering were analyzed. Sensitivity and specificity ranged from 65.2 to 99 and 80 to 100, respectively. Positive predictive values reached 80.3 to 100, while the negative predictive values reached 92 to 100. Accuracy could not be calculated for most studies. Conclusion. Algorithms/software validated directly or indirectly using reference standards present high sensitivity and specificity, with a diagnostic power similar to visual inspection of experts.

Summary: Tidal breathing measurements by Opto‐Electronic Plethysmography (OEP) has been reported for infants limited to protocols with two chest wall compartments. Standard protocol for the analysis of adults, with three compartments of chest wall, has been unavailable for analysis of infants. We aimed to study the agreement of simultaneous measurements of tidal volume by OEP (V_T,OEP) and a heated pneumotachograph (PNT) (V_T,PNT) performed during sleeping in 20 infants (gestational age 35.1 ± 4.6 weeks) at 3–4 months postconceptual age with a three compartment protocol. From PNT and OEP measurements, tidal volume corrected (V_T,PNT) for ambient conditions were calculated with a total number of 200 breaths. The two methods were in good agreement with tidal volume mean difference of 0.02 ml and limit of agreement −4.11 to 4.08 ml (95%CI), no relationship was found between differences and means of OEP and PNT measurements. Pulmonary rib cage, abdominal rib cage and abdomen contributed by 12.4 ± 9.7%, 5.2 ± 5.1%, and 82.4 ± 11.4% to V_T,OEP, respectively. The OEP experimental protocol based on 52 markers and a three‐compartment model of the chest wall could be used in spontaneously sleeping infants. Pediatr Pulmonol. 2016;51:850–857.

INTRODUÇÃO: A recuperação funcional após a lesão nervosa periférica está relacionada a fatores intrínsecos e extrínsecos ao sistema nervoso periférico, tais como a gravidade da lesão e a condição dos órgãos-alvo. A atrofia constitui uma das principais alterações do músculo após a lesão nervosa e, uma vez instalada, atua como barreira ao crescimento axonal durante a reinervação muscular. O uso da eletroestimulação é rotineiro no campo da fisioterapia e tem o objetivo de minimizar ou impedir a atrofia muscular e, assim, favorecer a recuperação da lesão nervosa periférica. OBJETIVO: Avaliar os efeitos da eletroestimulação sobre as características tróficas do músculo desnervado. MÉTODOS: Artigos publicados entre 1990 e 2010 e indexados aos bancos de dados da PUBMED foram selecionados utilizando os seguintes descritores: "muscle denervation AND electric stimulation" e "muscular atrophy AND electric stimulation". Foram considerados como critério de inclusão os estudos experimentais em animais (ratos) que utilizassem a lesão nervosa periférica como modelo de desnervação e que avaliassem o efeito da eletroestimulação muscular sobre a área de secção transversa e/ou a massa muscular de músculos desnervados. RESULTADOS: Nove artigos foram selecionados para a revisão. CONCLUSÕES: O efeito da eletroestimulação está diretamente relacionado à característica do protocolo de intervenção, que, quando aplicado de maneira adequada, apresenta o efeito de retardar e, em alguns casos, impedir a atrofia do músculo desnervado.