Jornal Brasileiro de Pneumologia
Print version ISSN 1806-3713
J. bras. pneumol. vol.39 no.1 São Paulo Jan./Feb. 2013
http://dx.doi.org/10.1590/S1806-37132013000100010
ORIGINAL ARTICLE
Impact of the prolonged slow expiratory maneuver on respiratory mechanics in wheezing infants*
Fernanda de Cordoba LanzaI; Gustavo Falbo WandalsenII; Carolina Lopes da CruzIII; Dirceu SoléIV
IAdjunct professor. Graduate Program in Rehabilitation Sciences, Universidade Nove de Julho - UNINOVE, Nove de Julho University - São Paulo, Brazil
IIAdjunct Professor. Allergy, Clinical Immunology, and Rheumatology Section of the Department of Pediatrics, Universidade Federal de São Paulo/Escola Paulista de Medicina - UNIFESP/EPM, Federal University of São Paulo/Paulista School of Medicine - São Paulo, Brazil
IIIMaster's Student. Allergy, Clinical Immunology, and Rheumatology Section of the Department of Pediatrics, Universidade Federal de São Paulo/Escola Paulista de Medicina - UNIFESP/EPM, Federal University of São Paulo/Paulista School of Medicine - São Paulo, Brazil. And Physiotherapist. Department of Pediatrics and Neonatology, Hospital Israelita Albert Einstein, São Paulo, Brazil
IVFull Professor. Allergy, Clinical Immunology, and Rheumatology Section of the Department of Pediatrics, Universidade Federal de São Paulo/Escola Paulista de Medicina - UNIFESP/EPM, Federal University of São Paulo/Paulista School of Medicine - São Paulo, Brazil
IIAdjunct Professor. Allergy, Clinical Immunology, and Rheumatology Section of the Department of Pediatrics, Universidade Federal de São Paulo/Escola Paulista de Medicina - UNIFESP/EPM, Federal University of São Paulo/Paulista School of Medicine - São Paulo, Brazil
IIIMaster's Student. Allergy, Clinical Immunology, and Rheumatology Section of the Department of Pediatrics, Universidade Federal de São Paulo/Escola Paulista de Medicina - UNIFESP/EPM, Federal University of São Paulo/Paulista School of Medicine - São Paulo, Brazil. And Physiotherapist. Department of Pediatrics and Neonatology, Hospital Israelita Albert Einstein, São Paulo, Brazil
IVFull Professor. Allergy, Clinical Immunology, and Rheumatology Section of the Department of Pediatrics, Universidade Federal de São Paulo/Escola Paulista de Medicina - UNIFESP/EPM, Federal University of São Paulo/Paulista School of Medicine - São Paulo, Brazil
ABSTRACT
OBJECTIVE: To evaluate changes in respiratory mechanics and tidal volume (VT) in wheezing infants in spontaneous ventilation after performing the technique known as the prolonged, slow expiratory (PSE) maneuver.
METHODS: We included infants with a history of recurrent wheezing and who had had no exacerbations in the previous 15 days. For the assessment of the pulmonary function, the infants were sedated and placed in the supine position, and a face mask was used and connected to a pneumotachograph. The variables of tidal breathing (VT and RR) as well as those of respiratory mechanics-respiratory system compliance (Crs), respiratory system resistance (Rrs), and the respiratory system time constant (prs)-were measured before and after three consecutive PSE maneuvers.
RESULTS: We evaluated 18 infants. The mean age was 32 ± 11 weeks. After PSE, there was a significant increase in VT (79.3 ± 15.6 mL vs. 85.7 ± 17.2 mL; p = 0.009) and a significant decrease in RR (40.6 ± 6.9 breaths/min vs. 38.8 ± 0,9 breaths/min; p = 0.042). However, no significant differences were found in the variables of respiratory mechanics (Crs: 11.0 ± 3.1 mL/cmH2O vs. 11.3 ± 2.7 mL/cmH2O; Rrs: 29.9 ± 6.2 cmH2O • mL-1 • s-1 vs. 30.8 ± 7.1 cmH2O • mL-1 • s-1; and prs: 0.32 ± 0.11 s vs. 0.34 ±0.12 s; p > 0.05 for all).
CONCLUSIONS: This respiratory therapy technique is able to induce significant changes in VT and RR in infants with recurrent wheezing, even in the absence of exacerbations. The fact that the variables related to respiratory mechanics remained unchanged indicates that the technique is safe to apply in this group of patients. Studies involving symptomatic infants are needed in order to quantify the functional effects of the technique.
METHODS: We included infants with a history of recurrent wheezing and who had had no exacerbations in the previous 15 days. For the assessment of the pulmonary function, the infants were sedated and placed in the supine position, and a face mask was used and connected to a pneumotachograph. The variables of tidal breathing (VT and RR) as well as those of respiratory mechanics-respiratory system compliance (Crs), respiratory system resistance (Rrs), and the respiratory system time constant (prs)-were measured before and after three consecutive PSE maneuvers.
RESULTS: We evaluated 18 infants. The mean age was 32 ± 11 weeks. After PSE, there was a significant increase in VT (79.3 ± 15.6 mL vs. 85.7 ± 17.2 mL; p = 0.009) and a significant decrease in RR (40.6 ± 6.9 breaths/min vs. 38.8 ± 0,9 breaths/min; p = 0.042). However, no significant differences were found in the variables of respiratory mechanics (Crs: 11.0 ± 3.1 mL/cmH2O vs. 11.3 ± 2.7 mL/cmH2O; Rrs: 29.9 ± 6.2 cmH2O • mL-1 • s-1 vs. 30.8 ± 7.1 cmH2O • mL-1 • s-1; and prs: 0.32 ± 0.11 s vs. 0.34 ±0.12 s; p > 0.05 for all).
CONCLUSIONS: This respiratory therapy technique is able to induce significant changes in VT and RR in infants with recurrent wheezing, even in the absence of exacerbations. The fact that the variables related to respiratory mechanics remained unchanged indicates that the technique is safe to apply in this group of patients. Studies involving symptomatic infants are needed in order to quantify the functional effects of the technique.
Keywords: Physical Therapy Modalities; Respiratory Mechanics; Infant; Respiratory Function Tests.
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