Navegando por Autor "Sarmento, Antonio"
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Artigo Effects of air stacking maneuver on cough peak flow and chest wall compartmental volumes of subjects with amyotrophic lateral sclerosis(Elsevier, 2017) Dourado Junior, Mário Emílio Teixeira; Sarmento, Antonio; Resqueti, Vanessa Resqueti; Saturnino, Lailane; Aliverti, Andrea; Fregonezi, Guilherme; Andrade, Armele Dornelas de; https://orcid.org/0000-0002-9462-2294Objectives To assess the acute effects of air stacking on cough peak flow (CPF) and chest wall compartmental volumes of persons with amyotrophic lateral sclerosis (ALS) versus healthy subjects positioned at 45° body inclination. Design Cross-sectional study with a matched-pair design. Setting University hospital. Participants Persons (N=24) with ALS (n=12) and age-matched healthy subjects (n=12). Main Outcomes Measures CPF, chest wall compartmental inspiratory capacity, chest wall vital capacity, chest wall tidal volume and operational volumes, breathing pattern, and percentage of contribution of the compartments to the inspired volume were measured by optoelectronic plethysmography. Results Compared with healthy subjects, significantly lower CPF (P=.007), chest wall compartmental inspiratory capacity (P<.001), chest wall vital capacity (P<.001), and chest wall tidal volume (P<.001) were found in subjects with ALS. Immediately after air stacking, CPF (P<.001) and chest wall compartmental inspiratory capacity (P<.001) significantly increased in both groups, with values returning to basal only in healthy subjects. After air stacking, the abdominal compartment (P=.004) was determined to be responsible for the inspired volume in subjects with ALS. Significantly higher chest wall vital capacity (P=.05) was observed in subjects with ALS 5 minutes after air stacking, with the rib cage compartment (P=.049) being responsible for volume change. No differences were found in chest wall vital capacity and compartmental volumes of healthy subjects. Chest wall tidal volume (P<.001) significantly increased during the protocol in the healthy subjects, mainly because of end-inspiratory (P<.001) and abdominal volumes (P=.008). No significant differences were observed in percentage of contribution of the compartments to the inspired volume and end-expiratory volume of both groups. No significant differences were found in chest wall tidal volume, operational volume, and breathing pattern in persons with ALS. Conclusions Air stacking is effective in increasing CPF, chest wall compartmental inspiratory capacity, and chest wall vital capacity of persons with ALS with no hyperinflation. Differences in compartmental volume contributions are probably because of lung and chest wall physiological changes.Artigo Effects of positioning on cough peak flow and muscular electromyographic activation in duchenne muscular dystrophy(Respiratory Care, 2020) Dourado Junior, Mário Emílio Teixeira; Marques, Layana; Santos, Ilsa Priscila; Marcelino, Ana Aline; Fonseca, Jessica Danielle Medeiros da; Aliverti, Andrea; Sarmento, Antonio; Resqueti, Vanessa Regiane; Fregonezi, Guilherme Augusto de Freitas; https://orcid.org/0000-0002-9462-2294Advanced stages of Duchenne muscular dystrophy (DMD) result in muscle weakness and the inability to generate an effective cough. Several factors influence the effectiveness of cough in patients with DMD. The aim of this study was to assess whether differences in positioning affect cough peak flow (CPF) and muscular electromyographic activation in subjects with DMD compared with paired healthy subjects. METHODS: Optoelectronic plethysmography and surface electromyography were used to assess chest wall volumes, chest wall inspiratory capacity, CPF, breathing pattern, and electromyographic activity of sternocleidomastoid, scalene, rectus abdominis, and external oblique muscles during inspiratory and expiratory cough phases in the supine position, supine position with headrest raised at 45 , and sitting with back support at 80 in 12 subjects with DMD and 12 healthy subjects. RESULTS: Subjects with DMD had lower CPF (P < .01) in comparison to control subjects in all positions; the DMD group also exhibited lower CPF (P 5 .045) in the supine position versus 80 . Moreover, the relative volume contributions of the rib cage and abdominal compartments to tidal volume modified significantly with posture. The electromyographic activity during inspiratory and expiratory cough phases was lower in subjects with DMD compared to healthy subjects for all evaluated muscles (P < .05), but no significant differences were observed with posture change. CONCLUSIONS: In subjects with DMD, posture influenced CPF and the relative contribution of the rib cage and abdominal compartments to tidal volume. However, muscular electromyographic activation was not influenced by posture in subjects with DMD and healthy subjects.Artigo Multiparametric analysis of sniff nasal inspiratory pressure test in middle stage amyotrophic lateral sclerosis(Frontiers in Neurology, 2018-05-02) Dourado Junior, Mário Emílio Teixeira; Sarmento, Antonio; Aliverti, Andrea; Marques, Layana; Pennati, Francesca; Fregonezi, Guilherme; Fregonezi, Vanessa Regiane Resqueti; https://orcid.org/0000-0002-9462-2294The relaxation rates and contractile properties of inspiratory muscles are altered with inspiratory muscle weakness and fatigue. This fact plays an important role in neuromuscular disorders patients and had never been extensively studied in amyotrophic lateral sclerosis (ALS). In this cross-sectional study, these parameters were investigated non-invasively through nasal inspiratory sniff pressure test (SNIP) in 39 middle stage spinal onset ALS subjects and compared with 39 healthy controls. ALS patients were also divided into three subgroups according to a decline in their percentage of predicted forced vital capacity (FVC%pred) as well as a decline in the ALS functional rating scale score and its respiratory subscore (R-subscore) in order to determine the best parameter linked to early respiratory muscle weakness. When compared with healthy subjects, middle stage ALS subjects exhibited a significantly lower (p < 0.0001) maximum relaxation rate and maximum rate of pressure development (MRPD), as well as a significantly higher (p < 0.0001) tau (τ), contraction time, and half-relaxation time. The results from receiver operating characteristic curves showed that MRPD (AUC 0.735, p < 0.001) and FVC%pred (AUC 0.749, p = 0.009) were the best discriminator parameters between ALS patients with ≤30 and >30 points in the ALS functional rating scale. In addition, 1/2RT (AUC 0.720, p = 0.01), FVC%pred (AUC 0.700, p = 0.03), τ (AUC 0.824, p < 0.0001), and MRPD (AUC 0.721, p = 0.01) were the parameters more sensitive in detecting a fall of three points in the R-subscore. On the other hand, MRPD (AUC 0.781, p < 0.001), τ (AUC 0.794, p = 0.0001), and percentage of predicted of SNIP (AUC 0.769, p = 0.002) were the parameters able to detect a fall in 30% of the FVC%pred in middle stage ALS patients. The contractile properties and relaxation rates of the diaphragm are altered in middle stage spinal onset ALS when compared with healthy subjects. These parameters are able to discriminate between those middle stage ALS subjects with early decline in inspiratory muscle function and those who not.Artigo Noninvasive assessment of respiratory muscle strength and activity in Myotonic dystrophy(Public Library of Science, 2017-06-08) Evangelista, Morgana de Araújo; Dias, Fernando Augusto Lavezzo; Dourado Júnior, Mário Emílio Teixeira; Nascimento, George Carlos; Sarmento, Antonio; Gualdi, Lucien Peroni; Aliverti, Andrea; Resquetti, Vanessa; Fregonezi, Guilherme Augusto de FreitasObjective: To evaluate sensitivity/specificity of the maximum relaxation rate (MRR) of inspiratory muscles, amplitude of electromyographic activity of the sternocleidomastoid (SCM), scalene (SCA), parasternal (2ndIS) and rectus abdominis (RA) muscles; lung function and respiratory muscle strength in subjects with Myotonic dystrophy type 1 (DM1) compared with healthy subjects. Design and methods: Quasi-experimental observational study with control group. MRR of inspiratory muscles, lung function and amplitude of the electromyographic activity of SCM, SCA, 2ndIS and RA muscles during maximum inspiratory pressure (PImax), maximum expiratory pressure (PEmax) and sniff nasal inspiratory pressure (SNIP) tests were assessed in eighteen DM1 subjects and eleven healthy. Results: MRR was lower in DM1 group compared to healthy (P = 0.001) and was considered sensitive and specific to identify disease in DM1 and discard it in controls, as well as SNIP% (P = 0.0026), PImax% (P = 0.0077) and PEmax% (P = 0.0002). Contraction time of SCM and SCA was higher in DM1 compared to controls, respectively, during PImax (P = 0.023 and P = 0.017) and SNIP (P = 0.015 and P = .0004). The DM1 group showed lower PImax (P = .0006), PEmax (P = 0.0002), SNIP (P = 0.0014), and higher electromyographic activity of the SCM (P = 0.002) and SCA (P = 0.004) at rest; of 2ndIS (P = 0.003) during PEmax and of SCM (P = 0.02) and SCA (P = 0.03) during SNIP test. Conclusions: MD1 subjects presented restrictive pattern, reduced respiratory muscle strength, muscular electrical activity and MRR when compared to higher compared to controls. In addition, the lower MRR found in MD1 subjects showed to be reliable to sensitivity and specificity in identifying the delayed relaxation of respiratory musclesArtigo Thoracoabdominal asynchrony and paradoxical motion in Duchenne muscular dystrophy and healthy subjects during cough: a case control study(Wiley, 2021) Dourado Junior, Mário Emílio Teixeira; Marques, Layana; Fregonezi, Guilherme Augusto de Freitas; Marcelino, Ana Aline; Sarmento, Antonio; Pennati, Francesca; Aliverti, Andrea; Resqueti, Vanessa Regiane; https://orcid.org/0000-0002-9462-2294Objective:To assess thoracoabdominal asynchrony (TAA) and inspiratory para-doxical motion at different positionings in subjects with Duchenne muscular dys-trophy (DMD) versus healthy subjects during quiet spontaneous breathing (QB) andcough.Methods:This is a case control study with a matched‐pair design. We assessed 14DMD subjects and 12 controls using optoelectronic plethysmography (OEP) duringQB and spontaneous cough in 3 positions: supine, supine with headrest raised at45°, and sitting with back support at 80°. The TAA was assessed using phase angle(θ) between upper (RCp) and lower rib cage (RCa) and abdomen (AB), as well as thepercentage of inspiratory time the RCp (IPRCp), RCa (IPRCa), and AB (IPAB) moved inopposite directions.Results:During cough, DMD group showed higher RCp and RCaθ(p< .05), RCp andABθ(p< .05) in supine and 45° positions, and higher RCp and Rcaθ(p= .006) only insupine position compared with controls. Regarding the intragroup analysis, duringcough, DMD group presented higher RCp and ABθ(p= .02) and RCa and ABθ(p= .002) in supine and higher RCa and ABθ(p= .002) in 45° position when com-pared to 80°. Receiver operating characteristic curve analyzes were able to dis-criminate TAA between controls and DMD in RCa supine position (area under thecurve: 0.81, sensibility: 78.6% and specificity: 91.7%,p= .001).Conclusion:Subjects with DMD yields TAA with insufficient deflation of chest wallcompartments and rib cage distortion during cough, by noninvasive assessment.Artigo Thoracoabdominal asynchrony and paradoxical motion in middle stage amyotrophic lateral sclerosis(Elsevier, 2019) Dourado Junior, Mário Emílio Teixeira; Sarmento, Antonio; Fregonezi, Guilherme; Aliverti, Andrea; Andrade, Armele Dornelas de; Parreira, Verônica Franco; Resqueti, Vanessa; https://orcid.org/0000-0002-9462-2294Aim: To assess thoracoabdominal asynchrony (TAA) and the presence of paradoxical motion in middle stage amyotrophic lateral sclerosis (ALS) and its relationships with chest wall tidal volume (VT,CW), breathing pattern and cough peak flow (CPF). Methods: Phase angle (θ) between upper (RCp) and lower ribcage (RCa) and abdomen (AB), as well as percentage of inspiratory time for the lower ribcage (IPRCa) and abdomen (IPAB) moving in opposite directions were quantified using optoelectronic plethysmography in 12 ALS patients during quiet breathing and coughing. Paradoxical motion of the compartments was based on threshold values of θ and IP, obtained in twelve age and sex matched healthy persons. Results: During quiet breathing, significantly higher RCa and AB θ (p < .05), IPRCa (p = 0.001) and IPAB (p < 0.05) were observed in ALS patients as compared to controls. In ALS patients, correlations between RCa and AB θ with forced vital capacity (FVC) (r=–0.773, p < 0.01), vital capacity (r=–0.663, p < 0.05) and inspiratory capacity (IC) (r=–0.754, p < 0.01), as well as between RCp and RCa θ with FVC (r=–0.608, p < 0.05) and CPF (r=–0.601, p < 0.05) were found. During coughing, correlations between RCp and AB θ with CPF (r=–0.590, p < 0.05), IC (r=–0.748, p < 0.01) and VT,CW (r=–0.608, p < 0.05), as well as between RCa and AB θ with CPF (r=–0.670, p < 0.05), IC (r=–0.713, p < 0.05) and peak expiratory flow (r=–0.727, p < 0.05) were also observed in ALS patients. ALS patients with paradoxical motion presented lower vital capacity and FVC%pred (p < 0.05) compared to those without paradoxical motion. Conclusions: Middle stage ALS patients exhibit TAA and paradoxical motion during quiet spontaneous breathing and coughing. In addition, diaphragmatic weakness (i.e. decrease in excursion of the RCa and AB compartments) was observed earlier in the lower ribcage rather than the abdominal compartment in this population.