Sex differences in healthy human heart rate variability: A meta-analysis.

Hypertension in women

Background
Postoperative pulmonary complications (PPCs) have an impact on the recovery of adults after surgery. It is therefore important to establish whether preoperative respiratory rehabilitation can decrease the risk of PPCs and to identify adults who might benefit from respiratory rehabilitation.

Objectives
Our primary objective was to assess the effectiveness of preoperative inspiratory muscle training (IMT) on PPCs in adults undergoing cardiac or major abdominal surgery. We looked at all-cause mortality and adverse events.

Search methods
We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 10), MEDLINE (1966 to October 2014), EMBASE (1980 to October 2014), CINAHL (1982 to October 2014), LILACS (1982 to October 2014), and ISI Web of Science (1985 to October 2014). We did not impose any language restrictions.

Selection criteria
We included randomized controlled trials that compared preoperative IMT and usual preoperative care for adults undergoing cardiac or major abdominal surgery.

Data collection and analysis
Two or more review authors independently identified studies, assessed trial quality, and extracted data. We extracted the following information: study characteristics, participant characteristics, intervention details, and outcome measures. We contacted study authors for additional information in order to identify any unpublished data.

Main results
We included 12 trials with 695 participants; five trials included participants awaiting elective cardiac surgery and seven trials included participants awaiting elective major abdominal surgery. All trials contained at least one domain judged to be at high or unclear risk of bias. Of greatest concern was the risk of bias associated with inadequate blinding, as it was impossible to blind participants due to the nature of the study designs. We could pool postoperative atelectasis in seven trials (443 participants) and postoperative pneumonia in 11 trials (675 participants) in a meta-analysis. Preoperative IMT was associated with a reduction of postoperative atelectasis and pneumonia, compared with usual care or non-exercise intervention (respectively; risk ratio (RR) 0.53, 95% confidence interval (CI) 0.34 to 0.82 and RR 0.45, 95% CI 0.26 to 0.77). We could pool all-cause mortality within postoperative period in seven trials (431 participants) in a meta-analysis. However, the effect of IMT on all-cause postoperative mortality is uncertain (RR 0.40, 95% CI 0.04 to 4.23). Eight trials reported the incidence of adverse events caused by IMT. All of these trials reported that there were no adverse events in both groups. We could pool the mean duration of hospital stay in six trials (424 participants) in a meta-analysis. Preoperative IMT was associated with reduced length of hospital stay (MD -1.33, 95% CI -2.53 to -0.13). According to the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) Working Group guidelines for evaluating the impact of healthcare interventions, the overall quality of studies for the incidence of pneumonia was moderate, whereas the overall quality of studies for the incidence of atelectasis, all-cause postoperative death, adverse events, and duration of hospital stay was low or very low.

Authors' conclusions
We found evidence that preoperative IMT was associated with a reduction of postoperative atelectasis, pneumonia, and duration of hospital stay in adults undergoing cardiac and major abdominal surgery. The potential for overestimation of treatment effect due to lack of adequate blinding, small-study effects, and publication bias needs to be considered when interpreting the present findings.

Preoperative inspiratory muscle training for postoperative pulmonary complications in adults undergoing cardiac and major abdominal surgery.

Objective:To evaluate whether preoperative inspiratory muscle training is effective in preventing postoperative pulmonary complications and reducing length of hospital stay in people undergoing cardiothoracic or upper abdominal surgery.Data sources:Medline, CINAHL, AMED, PsychINFO, Scopus, PEDro, and the Cochrane Library.Review methods:A systematic review and meta analysis of randomized controlled trials (or quasi-randomized controlled trials) investigating a form of preoperative inspiratory muscle training, compared with sham or no inspiratory muscle training. Participants were adults (16 years and over) awaiting elective open cardiac, thoracic, or upper abdominal surgery. Methodological quality was assessed using the PEDro scale.Results:Eight studies involving 295 participants were eligible for inclusion. The trained group had significantly higher maximal inspiratory pressure at the end of the preoperative training period (mean difference: 15 cm H2O, 95% confidence interval (CI): 9 to 21). This benefit ...

Postoperative outcomes following preoperative inspiratory muscle training in patients undergoing cardiothoracic or upper abdominal surgery: a systematic review and meta analysis

http://www.scielo.br/pdf/clin/v66n10/09.pdf

Effects of preoperative inspiratory muscle training in obese women undergoing open bariatric surgery: respiratory muscle strength, lung volumes, and diaphragmatic excursion.

Background 
Aerobic physical capacity plays an important role in reducing morbidity and mortality rates in subjects with cardiovascular diseases. This action is often related to an improvement in the autonomic modulation of heart rate variability (HRV). However, controversies remain regarding the effects of physical training on cardiac autonomic control in healthy subjects. Therefore, our objective was to investigate whether aerobic capacity interferes with the autonomic modulation of HRV and whether gender differences exist.


Methods 
Healthy men and women (N=96) were divided into groups according to aerobic capacity: low (VO2: 22-38 ml/kg-1 min-1), moderate (VO2: 38-48 ml/kg-1 min-1) and high (VO2 >48 ml/kg-1 min-1.) We evaluated the hemodynamic parameters and body composition. The autonomic modulation of HRV was investigated using spectral analysis. This procedure decomposes the heart rate oscillatory signal into frequency bands: low frequency (LF=0.04-0.15Hz) is mainly related to sympathetic modulation, and high frequency (HF=0.15-0.5Hz) corresponds to vagal modulation.


Results 
Aerobic capacity, regardless of gender, determined lower values of body fat percentage, blood pressure and heart rate. In turn, the spectral analysis of HRV showed that this parameter did not differ when aerobic capacity was considered. However, when the genders were compared, women had lower LF values and higher HF values than the respective groups of men.


Conclusion 
The results suggest that aerobic physical capacity does not interfere with HRV modulation; however, the cardiac modulatory balance differs between genders and is characterized by a greater influence of the autonomic vagal component in women and by the sympathetic component in men.

/pdf/cardiac-autonomic-modulation-is-determined-by-gender-and-is-1nmei6mivg.pdf

Cardiac autonomic modulation is determined by gender and is independent of aerobic physical capacity in healthy subjects.

O desenvolvimento socioeconomico, a oferta e a complexidade das acoes e dos servicos de saude no contexto regional podem ser considerados condicionantes estruturais para o exito do atual processo de regionalizacao da saude no Brasil. O presente estudo tem como objetivo identificar os condicionantes estruturais do processo de regionalizacao por meio da construcao de uma tipologia das regioes de saude no Brasil. Foi construida tipologia das regioes de saude brasileiras a partir de fonte de dados secundarios disponivel. A identificacao das dimensoes e dos grupos - que compoem a tipologia - foi realizada por meio de analise fatorial e de agrupamentos/clusters. Tambem foram identificados o tipo de prestador de acoes e os servicos predominantes na regiao tanto para a producao ambulatorial quanto para a internacao. As regioes foram classificadas em cinco grupos, de forma independente, de acordo com suas caracteristicas socioeconomicas e de oferta de servicos de saude. A caracterizacao das regioes de saude brasileiras, a partir da tipologia apresentada, demonstra heterogeneidade do territorio nacional e a complexidade de organizar sistemas de saude regionais. A tipologia proposta pode auxiliar na investigacao e no melhor entendimento desse cenario contraditorio e complexo, apoiando o urgente desenvolvimento de politicas publicas regionais integradas que envolvam, concomitantemente, desenvolvimento economico e social; e o fortalecimento dos espacos de governanca regional, a fim de promover a organizacao de sistemas de saude regionais alicercados nos principios do SUS e numa gestao compartilhada e solidaria que tenha como imagem-objetivo a garantia do direito a saude.

/pdf/tipologia-das-regioes-de-saude-condicionantes-estruturais-2qpwo5qxfs.pdf

Tipologia das regiões de saúde: condicionantes estruturais para a regionalização no Brasil

This study seeks to assess the effect of inspiratory muscle training (IMT) on pulmonary function, respiratory muscle strength, and endurance in morbidly obese patients submitted to bariatric surgery. Thirty patients were randomly assigned to sham muscular training, or to IMT with a threshold device (40% of maximum inspiratory pressure, MIP), for 30 min/day, from the 2nd until 30th postoperative (PO) day. All of them were submitted to a standard respiratory kinesiotherapy and early deambulation protocol. Data on spirometry, maximum static respiratory pressures, and respiratory muscle endurance were collected on the PO days 2, 7, 14, and 30 in a blinded matter. IMT enabled increases in PO MIP and endurance, and an earlier recovery of the spirometry parameters FEV1, PEF, and FEF25–75%. Comparing to preoperative values, MIP was increased by 13% at the 30th PO day in the trained group, whereas control group had a reduction of 8%, with higher values for the IMT group (30th PO, IMT—130.6 ± 22.9 cmH2O; controls—112.9 ± 25.1 cmH2O; p < 0.05). Muscular endurance at the 30th PO day was increased in the trained group comparing to preoperative value (61.5 ± 39.6 s vs 114.9 ± 55.2 s; p < 0.05), a finding not observed in the control group (81.7 ± 44.3 vs 95.2 ± 42.0 s). IMT improves inspiratory muscle strength and endurance and accounts for an earlier recovery of pulmonary airflows in morbidly obese patients submitted to bariatric surgery.

Effects of inspiratory muscle training on muscular and pulmonary function after bariatric surgery in obese patients.

/pdf/cuantas-medidas-de-presiones-respiratorias-son-necesarias-521bf03ovs.pdf

Cuántas medidas de presiones respiratorias son necesarias para obtener mediciones máximas en pacientes con tetraplejia

INTRODUCAO: pressoes inspiratorias (PImax) ou expiratorias (PEmax) maximas constituem um metodo simples e nao-invasivo para avaliacao da forca de musculos respiratorios e auxiliam na identificacao de fraqueza dos musculos respiratorios, presente em diversas doencas e situacoes clinicas, como a tetraplegia. OBJETIVO: avaliar o numero de manobras necessarias para atingir as pressoes maximas em pacientes com tetraplegia. METODOS: oito pacientes com tetraplegia (sete homens), media de idade de 37,8±11,96 anos, com diagnostico de lesao raquimedular cervical completa realizaram 10 medidas de PImax e PEmax nas posicoes sentada e deitada, totalizando 320 medidas. Os dados foram comparados pelo teste de Wilcoxon (p<0,05). RESULTADOS: os valores obtidos na primeira e na decima medida de PImax na posicao sentada variaram de 74,1±15,1 a 74,8±19,8 cmH2O e de PEmax de 32,4±6,8 a 32,4±9,0 cmH2O; na posicao deitada, de 76,5±18,6 a 91,1±13,3 cmH2O (p<0,05) e de 32,5±5,8 a 32,9±5,1 cmH2O, respectivamente. Os resultados das 3 e 5 primeiras medidas com 10 medidas de PImax na posicao sentada foram 81,1±19,5; 81,5±18,8 e 83,0±18,9 cmH2O e de PEmax 35,0±8,2; 35,3±7,9 e 36,8±8,0 cmH2O. A PImax na posicao deitada foi 90,3±17,8; 94,6±16,0 e 97,4±17,8 cmH2O (p<0,05) e a PEmax 33,3±5,8; 35,6±5,4 e 36,9±4,9 cmH2O. O maior valor ocorreu a partir da 6a medida em 40% dos testes. CONCLUSOES: para obtencao de valores maximos de pressoes respiratorias em pacientes com tetraplegia, e necessaria a repeticao de ao menos 10 medidas em cada avaliacao.

/pdf/quantas-medidas-de-pressoes-respiratorias-sao-necessarias-2upamzv4id.pdf

Ana Paula M. Pereira

Papers

Cardiac autonomic modulation is determined by gender and is independent of aerobic physical capacity in healthy subjects.

Tipologia das regiões de saúde: condicionantes estruturais para a regionalização no Brasil

Effects of inspiratory muscle training on muscular and pulmonary function after bariatric surgery in obese patients.

Cuántas medidas de presiones respiratorias son necesarias para obtener mediciones máximas en pacientes con tetraplejia

Quantas medidas de pressões respiratórias são necessárias para se obterem medidas máximas em pacientes com tetraplegia