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Alith M.B.,Federal University of Sao Paulo | Vidotto M.C.,Rua dos Acores | Jardim J.R.,Pulmonary Rehabilitation Center | Gazzotti M.R.,Neurosurgery Physiotherapy Research Group
Clinical Neurology and Neurosurgery | Year: 2014

Objective A survey of intensive care units (ICU) in São Paulo that care for patients with TBI and ICH using the hyperventilation technique. Methods A questionnaire was given to the physiotherapist coordinator at 57 hospitals in São Paulo, where 24-h neurosurgery service is provided. Results Fifty-one (89.5%) hospitals replied. From this total, thirty-four (66.7% perform the hyperventilation technique, 30 (85%) had the objective to reach values below 35 mmHg, four (11%) levels between 35 mmHg and 40 mmHg and one (3%) values over 40 mmHg. Conclusions We concluded that most hospitals in São Paulo perform hyperventilation in patients with severe brain trauma although there are not any specific Brazilian guidelines on this topic. Widespread controversy on the use of the hyperventilation technique in patients with severe brain trauma highlights the need for a specific Global policy on this topic. © 2013 Elsevier B.V. All rights reserved.


Tselebis A.,Sotiria General Hospital of Chest Diseases | Kosmas E.,Pulmonary Rehabilitation Center | Bratis D.,Sotiria General Hospital of Chest Diseases | Moussas G.,Sotiria General Hospital of Chest Diseases | And 5 more authors.
Annals of General Psychiatry | Year: 2010

Background: Chronic obstructive pulmonary disease (COPD) is a major health problem, especially in adults over 40 years of age, and has a great social and economic impact. The psychological morbidity of COPD patients with regard to anxiety and depressive symptoms has been extensively studied in the past. However, few studies have investigated the prevalence of alexithymia in these patients, as well as its association with this comorbidity. Based on this fact, we studied the prevalence of alexithymia and its association with anxiety and depressive symptoms in COPD outpatients.Methods: The present study included 167, randomly selected, outpatients diagnosed with COPD. Alexithymia, anxiety and depression were assessed using the Toronto Alexithymia Scale (TAS-20), Spielberger Trait Anxiety Inventory (STAI), and Beck Depression Inventory (BDI), respectively.Results: The mean BDI score was 12.88 (SD: 7.7), mean STAI score 41.8 (SD: 11.0) and mean TAS-20 score 48.2 (SD: 11.5). No differences were observed between genders regarding age and alexithymia (t test P > 0.05), while female patients presented higher depression and trait anxiety scores than males (t test P < 0.05). Clinically significant levels of anxiety were present in 37.1% of men, and in 45.7% of women. The mean depression score was also higher than the corresponding mean score in the general population (one-sample t test P < 0.01), while 27.7% and 30.5% of the sample presented mild and moderate to severe depression, respectively. Finally, a strong correlation was observed between alexithymia, depression and anxiety.Conclusions: This study confirms the high prevalence of anxiety and depression symptoms in Greek outpatients with COPD. The prevalence of alexithymia in COPD patients, contrary to what has been observed in patients with other chronic respiratory diseases, seem to be lower. However, we observed a strong association between alexithymia, depression and anxiety levels. This observation suggests that alexithymia should be taken into consideration when drafting specific psychotherapeutic interventions for these patients. © 2010 Tselebis et al; licensee BioMed Central Ltd.


Keyser R.E.,George Mason University | Keyser R.E.,U.S. National Institutes of Health | Woolstenhulme J.G.,George Mason University | Woolstenhulme J.G.,U.S. National Institutes of Health | And 8 more authors.
Journal of Cardiopulmonary Rehabilitation and Prevention | Year: 2015

PURPOSE:: To characterize the cardiorespiratory response to exercise before and after aerobic exercise training in patients with interstitial lung disease. METHODS:: We performed a clinical study, examining 13 patients (New York Heart Association/World Health Organization Functional class II or III) before and after 10 weeks of supervised treadmill exercise walking, at 70% to 80% of heart rate reserve, 30 to 45 minutes per session, 3 times a week. Outcome variables included measures of cardiorespiratory function during a treadmill cardiopulmonary exercise test, with additional near infrared spectroscopy measurements of peripheral oxygen extraction and bioimpedance cardiography measurements of cardiac output. Six-minute walk test distance was also measured. RESULTS:: All subjects participated in at least 24 of their 30 scheduled exercise sessions with no significant adverse events. After training, the mean 6-minute walk test distance increased by 52 ± 48 m (P = .001), peak treadmill cardiopulmonary exercise test time increased by 163 ± 130 s (P = .001), and time to achieve gas exchange threshold increased by 145 ± 37 s (P < .001). Despite a negligible increase in peak (Equation is included in full-text article.)o2 with no changes to cardiac output, the overall work rate/(Equation is included in full-text article.)o2 relationship was enhanced after training. Muscle O2 extraction increased by 16% (P = .049) after training. CONCLUSIONS:: Clinically significant improvements in cardiorespiratory function were observed after aerobic exercise training in this group of subjects with interstitial lung disease. These improvements appear to have been mediated by increases in the peripheral extraction of O2 rather than changes in O2 delivery. © 2015 Wolters Kluwer Health Lippincott Williams & Wilkins.


Voica A.S.,Victor Babes University of Medicine and Pharmacy Timisoara | Oancea C.,Victor Babes University of Medicine and Pharmacy Timisoara | Tudorache E.,Victor Babes University of Medicine and Pharmacy Timisoara | Crisan A.F.,Pulmonary Rehabilitation Center | And 3 more authors.
International Journal of COPD | Year: 2016

Background/objective: Chronic obstructive pulmonary disease (COPD) is a respiratory disease that results in airflow limitation and respiratory distress, also having many nonrespiratory manifestations that affect both function and mobility. Preliminary evidence suggests that balance deficits constitute an important secondary impairment in individuals with COPD. Our objective was to investigate balance performance in two groups of COPD patients with different body compositions and to observe which of these groups are more likely to experience falls in the future. Methods: We included 27 stable COPD patients and 17 healthy individuals who performed a series of balance tests. The COPD patients were divided in two groups: emphysematous and bronchitic. Patients completed the activities balance confidence scale and the COPD assessment test questionnaire and afterward performed the Berg Balance Scale, timed up and go, single leg stance and 6-minute walking distance test. We analyzed the differences in the balance tests between the studied groups. Results: Bronchitic COPD was associated with a decreased value when compared to emphysematous COPD for the following variables: single leg stance (8.7 vs 15.6; P<0.001) and activities balance confidence (53.2 vs 74.2; P=0.001). Bronchitic COPD patients had a significantly higher value of timed up and go test compared to patients with emphysematous COPD (14.7 vs 12.8; P=0.001). Conclusion: Patients with COPD have a higher balance impairment than their healthy peers. Moreover, we observed that the bronchitic COPD phenotype is more likely to experience falls compared to the emphysematous phenotype. © 2016 Voica et al.


Vogiatzis I.,National and Kapodistrian University of Athens | Vogiatzis I.,Pulmonary Rehabilitation Center | Vogiatzis I.,Pulmonary Rehabilitation Unit | Vogiatzis I.,University of West of Scotland | Zakynthinos S.,Pulmonary Rehabilitation Center
Journal of Applied Physiology | Year: 2013

Cardiopulmonary rehabilitation is recognized as a core component of management of individuals with congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD) that is designed to improve their physical and psychosocial condition without impacting on the primary organ impairment. This has lead the scientific community increasingly to believe that the main effects of cardiopulmonary rehabilitative exercise training are focused on skeletal muscles that are regarded as dysfunctional in both CHF and COPD. Accordingly, following completion of a cardiopulmonary rehabilitative exercise training program there are important peripheral muscular adaptations in both disease entities, namely increased capillary density, blood flow, mitochondrial volume density, fiber size, distribution of slow twitch fibers, and decreased lactic acidosis and vascular resistance. Decreased lactic acidosis at a given level of submaximal exercise not only offsets the occurrence of peripheral muscle fatigue, leading to muscle task failure and muscle discomfort, but also concurrently mitigates the additional burden on the respiratory muscles caused by the increased respiratory drive, thereby reducing dyspnea sensations. Furthermore in patients with COPD, exercise training reduces the degree of dynamic lung hyperinflation leading to improved arterial oxygen content and central hemodynamic responses, thus increasing systemic muscle oxygen availability. In patients with CHF, exercise training has beneficial direct and reflex sympathoinhibitory effects and favorable effects on normalization of neurohumoral excitation. These physiological benefits apply to all COPD and CHF patients independently of the degree of disease severity and are associated with improved exercise tolerance, functional capacity, and quality of life. Copyright © 2013 the American Physiological Society.

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