Dissertations / Theses on the topic 'Pulmonary functional testing'

This thesis introduces several novel, noninvasive lung function assessment approaches in which we incorporate computer vision techniques to remotely compute standard clinical Pulmonary Function Testing (PFT) measures. Using a single depth sensor, a dynamic 3-D model of a subject's chest is reconstructed and used to generate chest volume-time data by estimating the chest volume variation throughout a sequence. Following computation of multiple keypoints and calibration of volume-time data to present real volume of exchanged air, 7 Forced Vital Capacity (FVC) measures and 4 Slow Vital Capacity (SVC) measures are computed. Evaluation on a dataset of 85 patients (529 sequences), attending a respiratory outpatient service for spirometry, shows a high correlation between the proposed depth-based PFT measures and the measures from a spirometer. Trunk motion during PFT affects the accuracy of these results, so the natural reaction of the subject's body to maximal inhalation and exhalation, must be decoupled from the chest-surface breathing motion. We present an automatic, open source data acquisition and calibration pipeline in which two opposing depth sensors are calibrated and used to reconstruct a well-defined dynamic 3-D model of the trunk during PFT performance. Our proposed method is able to reconstruct dynamic 3-D models with accurate temporal frame synchronisation and spatial registration. Then, we propose a whole body depth-based photoplethysmography (dPPG) approach which allows subjects to perform PFT, as in routine spirometry, without restraining their natural trunk reactions. By decoupling the trunk movement and the chest-surface respiratory motion, dPPG obtains more accurate respiratory volume-time data which improves the accuracy of the estimated PFT measures. A dataset spanning 35 subjects (298 sequences) was collected and used to illustrate the superiority of the proposed dPPG method by comparing its measures to those provided by a spirometer and the single Kinect approach. Although dPPG is able to improve the PFT measures accuracy to a significant extent, it is not able to filter complex trunk motions, particularly at the deep forced inhalation-exhalation stage. To effectively correct trunk motion artifacts further, we propose an active trunk shape modelling approach by which the respiratory volume-time data is computed by performing principal component analysis on temporal 3-D geometrical features, extracted from the chest and posterior shape models in R3 space. We validate the method's accuracy at the signal level by computing several comparative metrics between the depth-based and spirometer volume-time data. Evaluating on the dPPG PFT dataset (300 PFT sequences), our trunk shape modelling approach outperforms the single Kinect and dPPG methods.

La ventilation est une fonction complexe, avec des variabilités naturelles intra- et inter-individuelles imprévisibles, parfois inhomogènes dans le volume pulmonaire. La spirométrie standard est l'examen de référence pour évaluer la fonction ventilatoire à partir de courbes débit-volume mesurées à la bouche et en respiration forcée. Cette technique simple et fiable est limité par la nécessaire coopération du patient, ainsi que par la nature globale de sa mesure. Étant donné que la respiration est intrinsèquement un phénomène tridimensionnel et que les maladies pulmonaires sont généralement régionales, la ventilation devrait être sondée localement. Malgré les difficultés inhérentes à l'application de l'IRM au poumon, de récent progrès ont permis de révéler le potentiel de l'IRM fonctionnelle pulmonaire à partir d'acquisitions standards facilement transposables en clinique. Depuis une quinzaine d'années des développements évaluent la ventilation à partir de la variation du signal IRM au cours de la respiration. Ces techniques reposent sur une hypothèse forte de linéarité du signal IRM avec la densité de tissus pulmonaire. Une nouvelle méthode évaluant la ventilation localement et dynamiquement à partir des déformations a été développée : la spirométrie 3D par IRM. A partir d'un cycle respiratoire moyen, le Jacobien des déformations et sa dérivée temporelle permettent d'inférer les courbes débit-volume locales. Cette thèse s'attache à valider la spirométrie 3D par IRM, à l'amener à la recherche clinique, et à approfondir la compréhension de la mécanique ventilatoire. Le caractère multidimensionnel de la spirométrie 3D par IRM intègre la complexité de la fonction respiratoire mais la technique encore neuve doit être développée et éprouvée. Les évolutions méthodologiques entreprises durant cette thèse incluent une reconstruction optimisée de la dynamique pulmonaire, une segmentation précise des structures lobaires, la définition de biomarqueurs quantitatifs, ainsi qu'une normalisation des cartes fonctionnelles pour permettre des comparaison intra- et inter-sujets. Une étude prospective sur 25 volontaires (10 femmes, 45 ± 17 ans) respirant librement a été menée, avec des acquisitions répétées en position allongée. La fiabilité de la technique a été approchée selon deux critères : sa répétabilité et son exactitude. Les mesures de volumes courants locaux intégrés sur le volume pulmonaire correspondent à ce qui peut être mesuré par segmentation des volumes pulmonaires. Une excellente répétabilité globale a été trouvée, avec une variabilité résiduelle induite par celle intrinsèque à la respiration.La sensibilité de la spirométrie 3D par IRM a été d'abord étudiée sur 25 volontaires sains en position allongée sur le dos puis sur le ventre. Les cartes fonctionnelles mettent en évidence un gradient de ventilation vers les régions les plus dépendantes à la gravité, démontrant la sensibilité de la technique à la physiologie. Des atlas fonctionnels ont été établis à partir des cartes individuelles normalisées, révélant les motifs nominaux de la ventilation pulmonaire reproductibles sur la cohorte de volontaire. Les distributions spatiales mettent en évidence l'inhomogénéité de la ventilation en respiration libre.Enfin, la sensibilité de la spirométrie 3D aux pathologies obstructives et restrictives est évaluée à travers plusieurs études de cas de maladies neuromusculaires, COVID-19 longue durée, asthme et bronchopneumopathie chronique obstructive (BPCO). Ces recherches soulignent l'importance de caractériser les modes de respiration avec les contributions des muscles respiratoires. La réversibilité de l'asthme à l'administration d'un bronchodilatateur a été trouvé, avec une augmentation marquée des débits après bronchodilatateurs. Une étude longitudinale sur un cas d'asthme sévère a aussi mis en évidence l'efficacité de la biothérapie pour améliorer la fonction ventilatoire, réduisant le volume résiduel ainsi que l'obstruction
Ventilation is a complex function, with unpredictable natural intra- and inter-individual variabilities, sometimes heterogeneous in lung volume. Standard spirometry is the reference exam to assess the ventilatory function from flow-volume loops measured at the mouth during forced expiration. This simple and reliable technique is limited by the necessary cooperation of the patient, as well as by the global nature of its measurement. Since breathing is inherently a three-dimensional phenomenon and lung diseases are generally regional, ventilation should be probed locally.Despite the inherent difficulties in applying MRI to the lung, recent advancements have revealed the potential of functional pulmonary MRI from easily translatable standard acquisitions in clinical settings. Over the past fifteen years, developments have evaluated ventilation based on MRI signal variation during respiration. These techniques rely on a strong assumption of linearity of the MRI signal with lung tissue density. A new method evaluating ventilation locally and dynamically from deformations has been developed: 3D spirometry by MRI. From an average respiratory cycle, the deformation Jacobian and its temporal derivative allow inference of local flow-volume curves. This thesis aims to validate 3D spirometry by MRI, bring it into clinical research, and deepen the understanding of ventilatory mechanics.The multidimensional nature of 3D spirometry by MRI integrates the complexity of respiratory function, but the new technique must still be developed and tested. Methodological developments undertaken during this thesis include optimized reconstruction of pulmonary dynamics, precise segmentation of lobar structures, definition of quantitative biomarkers, as well as normalization of functional maps to enable intra- and inter-subject comparisons. A prospective study on 25 volunteers (10 females, 45 ± 17 years old) breathing freely was conducted, with repeated acquisitions in the supine position. The reliability of the technique was approached by two criteria: its repeatability and accuracy. Measures of local tidal volumes integrated over the lung volume agreed to the measured lung volumes from segmentation. Excellent overall repeatability was found, with residual variability induced by that intrinsic to respiration.The sensitivity of 3D MR spirometry was first studied in 25 healthy volunteers in lying supine and prone positions. Functional maps highlight a gradient of ventilation toward the more gravity-dependent regions, demonstrating the sensitivity of the technique to physiology. Functional atlases were established from normalized individual maps, revealing reproducible nominal patterns of pulmonary ventilation across the volunteer cohort. Spatial distributions highlight the heterogeneity of ventilation during free breathing.Finally, the sensitivity of 3D MR spirometry to obstructive and restrictive pathologies is evaluated through several case studies of neuromuscular diseases, long COVID-19, asthma, and chronic obstructive pulmonary disease (COPD). These studies emphasize the importance of characterizing breathing patterns with contributions from respiratory muscles. Reversibility of asthma with bronchodilator administration was found, with a marked increase in flow rates after bronchodilators. A longitudinal study on a case of severe asthma also demonstrated the effectiveness of biotherapy in improving ventilatory function and reducing residual volume and obstruction

Pulmonary function testing (PFT) is recommended by guidelines for the diagnosis of chronic obstructive pulmonary disease and the diagnosis and monitoring of asthma. Portable in-office tests offer rural patients and providers information previously more difficult to obtain because of hospital closures, transportation barriers, and cost. This article describes the successful implementation and measurement of in-office PFT in 3 rural primary care offices. Providers were more likely to order a PFT for patients with asthma (33%) than a patient with chronic obstructive pulmonary disease (9.7%). Recommendations include increased staff involvement and repeat education midimplementation.

ABSTRACT Pulmonary complications are common post-transplant and may lead to increased mortality. Pulmonary function tests (PFTs) are routinely obtained preoperatively, but their usefulness in liver transplantation is unknown. The objective of this study was to assess the impact of preoperative PFTs on postoperative pulmonary complications (PPCs), ICU stay, and death post-liver transplant. This single site historical cohort study encompassed all 531 liver transplants performed in 462 patients at the Royal Victoria Hospital through June 30, 2006. Outcomes included death, PPCs, and length of intubation and ICU stay. Independent variables including PFTs, age, gender, race, smoking history, etiology of liver disease, MELD score, and ischemia time were used in logistic regression and Cox proportional hazards models to assess their impact on the outcomes listed above. 205 patients had complete PFT data. Decreased total lung capacity (TLC) was a predictor of increased length of ICU stay, duration of intubation, and mortality. A 10% decrease in TLC increased the mortality risk by 43%. Increased residual volume (RV), cold ischemia time, and age were predictors of mortality. Predictors of prolonged ICU stay or intubation were TLC, MELD score, male gender and cold ischemia time. PFTs were not significant predictors of PPCs. PFTs do not predict pulmonary complications but predict length of ICU stay and intubation, as well as mortality. PFTs may reflect the severity of underlying liver disease as well as intrinsic lung disease.
RÉSUMÉ Les complications respiratoires sont fréquentes après les greffes et peuvent amener un taux accru de mortalité. Les tests de fonction pulmonaire sont maintenant obtenus régulièrement en phase pré-opératoire. Cependant, leur pertinence dans les cas de greffes hépatique est inconnue. Le but de cette étude est d'évaluer la capacité de prédiction des tests de fonction pulmonaire pré-opératoires sur les complications post-opératoires, la durée de séjour aux soins intensifs et les risques de mortalité post-greffe hépatique. Cette étude rétrospective fut menée à un site de référence pour les greffes hépatiques, soit l'Hôpital Royal Victoria. Nous avons révisé toutes les opérations (531) qui furent effectués chez 462 patients jusqu'au 30 juin 2006. Nous avons considéré les décès, les complications pulmonaires, ainsi que la durée d'intubation et la durée de séjour aux soins intensifs en tant que variables dépendants. Les facteurs prédictives étaient des tests de fonction pulmonaire, l'âge, le sexe, l'origine ethnique, l'histoire de tabagisme, le type de maladie hépatique sous-jacent, le score MELD et le temps ischémique de la greffe. Nous avons utilisé des modèles de régression logistique et de Cox afin d'évaluer la capacité prédictive indépendante des tests de fonction pulmonaire ainsi que des autres variables. 205 patients avaient des données complètes de leurs tests de fonction respiratoire en pré-opératoire. Une réduction dans la capacité pulmonaire totale étant associée de façon significative à la durée de séjour aux soins intensifs, ainsi qu'une durée accrue d'intubation et à un taux accru de mortalité. Ainsi, une diminution de 10% dans la capacité pulmonaire totale respiratoire en pré-opératoire était associée de façon indépendante à une augmentation de 43% du risque de mortalité. Une augmentation du volume résiduel, ainsi qu'une augmentation du temps ischémique et

Background: Lung clearance index (LCI), obtained by multiple breath washout testing (MBW), is a sensitive measure of lung disease in infants. It has been identified as a particularly suitable endpoint for clinical trials in cystic fibrosis (CF), but has potential applications in many other conditions. However, MBW in infants presents a number of technical challenges. Conventional MBW is based on simultaneous measurement of flow and gas. These two signals are then aligned and combined to derive expired gas volumes and measures of ventilation inhomogeneity: this process becomes increasingly vulnerable to errors in gas signal alignment at rapid respiratory rates. At present, no existing system for infant MBW meets all the criteria set out in international guidelines, and there is no simple method of assessing lung function outside research laboratories in this population. This thesis describes an alternative method of performing MBW in infants. In this method, expired gas is collected and analysed to derive functional residual capacity (FRC) and LCI. There is no need to simultaneously measure flow, and therefore no need for the complicated step of integrating flow and gas signals. Dead space is also significantly reduced by removing the flowmeter. Methods: In the first phase of testing, an existing lung model was modified to generate realistic infant breathing parameters with high accuracy. The prototype system was modified to improve accuracy and subsequently tested at FRC of 100-250mls with respiratory rates of 20-60min-1. In the second phase, testing proceeded to an in vivo pilot study of the novel method in children with cystic fibrosis and healthy controls. Practical applicability of the system was determined by the number of successful duplicate tests, and within-subject repeatability. Comparison was made with LCI measurements obtained using a respiratory mass spectrometer, currently considered the gold standard for infant LCI. Results: In a total of 103 tests performed in the lung model, overall mean error (standard deviation) of FRC measurement was -1.0(3.3)%, with 90% of tests falling within +/-5%. 13 patients were excluded from the clinical study due to being unsedated or inadequately sedated and therefore failing to tolerate the test. A total of 25 patients (7 children with CF, 18 healthy control children) were deemed to be adequately sedated at the start of the test, of these 20 patients (7 with CF) successfully underwent duplicate testing (80% success rate). Mean FRC for healthy controls was 19.5ml/kg, and mean LCI 6.45. For children with CF, mean FRC was 21.8ml/kg and mean LCI 6.98. Mean within-subject coefficient of variation for FRC was 7.18% and for LCI 5.94%. Of 4 infants assessed with both the novel method and the respiratory mass spectrometer, there was good correlation in FRC measurement (mean difference -8.1%). Comparison of LCI with the mass spectrometer was affected by technical difficulties with the test; in those patients who underwent technically adequate tests with both methods, mean difference in LCI between the two methods was 1.65%. Discussion: FRC measurement using the novel method has superior accuracy in vitro than previously described systems. Data from the pilot study suggest that this is a feasible and reproducible method of performing LCI in infants and young children, as long as they are adequately sedated. Results in both children with CF and controls fall within the expected range, and well within accuracy limits set by international guidelines. However, the system and testing protocol could be further improved to reduce the number of technically inadequate tests having to be excluded. This could provide a more accessible alternative to previously described systems for infant MBW.

Inflammatory airway disease (IAD) describes a condition of non-septic inflammation of the lower airways in horses. The disease occurs principally in adult horses and has an apparent worldwide distribution. The most common clinical signs of IAD include poor athletic performance, cough, and/or increased tracheobronchial secretions. Inconsistencies in disease definition, sampling methods and laboratory techniques have limited comparisons between studies. Essential criteria for diagnosis of IAD, as stated by the 2007 ACVIM consensus statement, include documentation of non-septic inflammation or pulmonary dysfunction based on evidence of lower airway obstruction, airway hyperresponsiveness, or impaired blood gas exchange at rest or during exercise. A definitive diagnosis is currently based on bronchoalveolar lavage fluid (BALF) cytology and/or pulmonary function testing (PFT). The correlation between BALF cytology and pulmonary function testing (PFT) has been poorly defined. The primary aim of this study was to characterise the relationship between BALF cytology and PFT with histamine bronchoprovocation methods in a population of sedentary asymptomatic horses. The principal hypothesis was that a strong association exists between these two diagnostic methods. On the basis of BALF cytology the majority of horses in this study had lower airway inflammation as defined by published criteria. The study thus highlights that normal values for cell proportions in BALF might vary between populations of horses. Despite an obvious overlap between inflammatory BALF cytological profiles and airway hyperresponsiveness, no statistical association between these two diagnostic methods was found in this population of horses. The secondary aim was to assess the reliability of the Open Pleth™ PFT system Acceptable reliability {ICC: 0.655 (95% CI: 0.098, 0.952; significance: 0.011)}) was demonstrated using the Flowmetrics Plethysmography™ system with histamine bronchoprovocation. In conclusion, airway inflammation and airway hyperreactivity are loosely related to each other in this population of horses. The presence of inflammatory cells does not necessarily predict airway hyperresponsiveness on the basis of histamine bronchoprovocation. Likewise, airway hyperresponsiveness can occur in the absence of a BALF inflammatory profile. Further investigation of other potential factors such as inherited abnormalities of smooth muscle contractility, airway wall remodelling, autonomic dysfunction, and the presence of inflammatory cell mediators in bronchoalveolar lavage fluid are warranted.

Purpose/Aims: The American Thoracic Society (ATS) published recommendations for alpha-1 antitrypsin deficiency (AATD) testing in 2003. This descriptive project evaluates the outcomes of ATS AATD guideline use in the setting of the pulmonary function testing (PFT) lab.The specific aims met by this descriptive project describe the prevalence of AATD cases and carriers in the sample, examine to what degree the established clinical guideline promoted accurate patient selection for the alpha-1 test in the sample, and aimed to determine whether alpha-1 antitrypsin blood levels are reduced in current smokers compared to former or never smokers.Background: Alpha-1 antitrypsin prevents lung tissue breakdown by attenuating excess elastase released from neutrophils during the inflammatory response. Smoking impairs alpha-1 antitrypsin protection at the site of lung inflammation promoting emphysema development. In the case of genetic mutation, protective alpha-1 antitrypsin levels are reduced, causing emphysema even in non-smokers. Significantly reduced protective levels of alpha-1 antitrypsin increase the odds for morbidity and early mortality from emphysema. The literature provides support for targeted testing in the population most affected.Sample/Methods: The sample population included adults 21 through 79 years completing pulmonary function testing over 18 months in a metropolitan pulmonary medicine practice and was retrospectively reviewed.Of the 521 in the sample, 190 were tested for AATD, and 24 were found to carry an abnormal genotype. However, using Table 11 from the ATS CPG failed to provide structured, consistent guidance in selecting patients for AATD testing. Still, the prevalence of the abnormal genotypes MS, MZ, SZ, and ZZ was increased in this pulmonary population compared to the published estimated prevalence for the general population.A structured decision-tree, developed from the original guideline for diagnostic testing, may provide superior guidance for AATD test patient selection in this setting. Increased case finding by targeted testing of patients in the setting of the pulmonary function lab can serve to integrate this clinical practice guideline in a consistent streamlined fashion.In this sample, no difference between AAT blood levels among ever, never, and current tobacco smokers was detected. A more powerful sample is needed.

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
Algumas variáveis propostas para predizer o risco de complicação pósoperatória (CPO) são a altura no teste da escada (TE) e a distância do teste de caminhada de seis minutos (TC6) e acreditamos que o tempo no teste da escada (tTE) também pode ser utilizado para este fim. Além disso, são utilizados a prova de função pulmonar e os índices pré-operatórios. Objetivo: Determinar se os índices de Torrington e Henderson, American Society of Anesthesiologists, Goldman, Detsky e Charlson, a variável VEF1 da espirometria e as variáveis obtidas nos testes de esforço (TC6 e TE) podem ser preditivos das complicações pós-toracotomia e qual deles seria o melhor preditor dessas complicações. Método: Foram avaliados pacientes com indicação de toracotomia para ressecção pulmonar ou não, maiores de 18 anos. As comorbidades foram obtidas e traçados os índices de Comorbidade de Charlson, de risco de Torrington e Henderson, de Goldman, de Detsky e o ASA. A espirometria foi realizada de acordo com a ATS, em espirômetro Medgraphics Pulmonary Function System 1070. O TC6 foi realizado segundo os critérios da ATS e a distância prevista calculada. O TE foi realizado numa escada à sombra, composta por seis lances, num total de 12,16m de altura. O tTE em segundos percorrido na subida da altura total foi obtido e a partir deste a Potência (P) foi calculada utilizando a fórmula clássica. Também foi estimado o VO2 a partir do tTE (VO2 t) e da P (VO2 P). No intra-operatório foram registradas as complicações e o tempo cirúrgico. E no pós-operatório foram registradas as CPOs. Para análise estatística os pacientes foram divididos em grupos sem e com CPO. Foi aplicado o teste de acurácia para obtenção dos valores preditivos para o TC6 e para o tTE, a curva ROC e dessa o ponto de corte. As variáveis foram testadas para uma possível associação com as CPO pelo teste t de...
Some varieties purposed to predict the postoperative complication (POC) risk are the height in the stair-climbing test (SCT) and the distance in the six minute walk test (6MWT), we also believe that the time on the stair-climbing test can also be used for this purpose. Besides, the pulmonary function test and the preoperative index are also used. Objectives: We aim to determine if the Charlson, Torrington and Henderson, Goldman, Detsky and American Society of Anesthesiologists indexes, the variable FEV1 obtained on the Spirometry and on the Cardiopulmonary Exercise Testing (6MWT, SCT) can be predictive of the complication after thoracic surgery and which one of them would be the best. Method: Patients with indication to thoracic surgery, for resection or not, and older than 18 years old were evaluated. The comorbidities were obtained and the Comorbidity Charlson, Torrington and Henderson risk, Goldman, the Detsky and ASA indexes were calculated. The spirometry was performed according to ATS in Medgraphics Pulmonary Function System 1070. The 6MWT was performed according to the ATS criteria and the predicted distance was calculated. The SCT was performed indoor, on six flights of stairs, which results as a 12,16m climb. The time on the SCT was obtained after finished the stair height total in seconds and the Power (P) was calculated using the class formula. The maximum oxygen uptake (VO2) was estimated from the time of SCT (VO2 t) and the P (VO2 P). In the intraoperative was registered the complication and the surgery time. And in the postoperative was registered the POC. In the statistics analysis, the patients were divided in groups with and without POC. It was applied the accuracy test for the distance 6MWT and for the time in the SCT. We have found the cutoff from the ROC curve. The correlation between the variables and POC were tested using the t test for independent population ... (Complete abstract click electronic access below)

Resumo: Algumas variáveis propostas para predizer o risco de complicação pósoperatória (CPO) são a altura no teste da escada (TE) e a distância do teste de caminhada de seis minutos (TC6) e acreditamos que o tempo no teste da escada (tTE) também pode ser utilizado para este fim. Além disso, são utilizados a prova de função pulmonar e os índices pré-operatórios. Objetivo: Determinar se os índices de Torrington e Henderson, American Society of Anesthesiologists, Goldman, Detsky e Charlson, a variável VEF1 da espirometria e as variáveis obtidas nos testes de esforço (TC6 e TE) podem ser preditivos das complicações pós-toracotomia e qual deles seria o melhor preditor dessas complicações. Método: Foram avaliados pacientes com indicação de toracotomia para ressecção pulmonar ou não, maiores de 18 anos. As comorbidades foram obtidas e traçados os índices de Comorbidade de Charlson, de risco de Torrington e Henderson, de Goldman, de Detsky e o ASA. A espirometria foi realizada de acordo com a ATS, em espirômetro Medgraphics Pulmonary Function System 1070. O TC6 foi realizado segundo os critérios da ATS e a distância prevista calculada. O TE foi realizado numa escada à sombra, composta por seis lances, num total de 12,16m de altura. O tTE em segundos percorrido na subida da altura total foi obtido e a partir deste a Potência (P) foi calculada utilizando a fórmula clássica. Também foi estimado o VO2 a partir do tTE (VO2 t) e da P (VO2 P). No intra-operatório foram registradas as complicações e o tempo cirúrgico. E no pós-operatório foram registradas as CPOs. Para análise estatística os pacientes foram divididos em grupos sem e com CPO. Foi aplicado o teste de acurácia para obtenção dos valores preditivos para o TC6 e para o tTE, a curva ROC e dessa o ponto de corte. As variáveis foram testadas para uma possível associação com as CPO pelo teste t de ... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Some varieties purposed to predict the postoperative complication (POC) risk are the height in the stair-climbing test (SCT) and the distance in the six minute walk test (6MWT), we also believe that the time on the stair-climbing test can also be used for this purpose. Besides, the pulmonary function test and the preoperative index are also used. Objectives: We aim to determine if the Charlson, Torrington and Henderson, Goldman, Detsky and American Society of Anesthesiologists indexes, the variable FEV1 obtained on the Spirometry and on the Cardiopulmonary Exercise Testing (6MWT, SCT) can be predictive of the complication after thoracic surgery and which one of them would be the best. Method: Patients with indication to thoracic surgery, for resection or not, and older than 18 years old were evaluated. The comorbidities were obtained and the Comorbidity Charlson, Torrington and Henderson risk, Goldman, the Detsky and ASA indexes were calculated. The spirometry was performed according to ATS in Medgraphics Pulmonary Function System 1070. The 6MWT was performed according to the ATS criteria and the predicted distance was calculated. The SCT was performed indoor, on six flights of stairs, which results as a 12,16m climb. The time on the SCT was obtained after finished the stair height total in seconds and the Power (P) was calculated using the class formula. The maximum oxygen uptake (VO2) was estimated from the time of SCT (VO2 t) and the P (VO2 P). In the intraoperative was registered the complication and the surgery time. And in the postoperative was registered the POC. In the statistics analysis, the patients were divided in groups with and without POC. It was applied the accuracy test for the distance 6MWT and for the time in the SCT. We have found the cutoff from the ROC curve. The correlation between the variables and POC were tested using the t test for independent population ... (Complete abstract click electronic access below)
Orientador: Daniele Cristina Cataneo
Coorientador: Antônio José Maria Cataneo
Banca: Roberto Saab Junior
Banca: Paulo Monoel Pego Fernandes
Banca: Irma de Godoy
Banca: Lidia Raquel de Carvalho
Doutor

Objective - evaluate horses with acute airway obstruction using three treatment regimens: tapering doses of dexamethasone (DEX), environmental modification (ENV), and a combination of both treatments (DEX + ENV) by analyzing clinical parameters, pulmonary function testing, bronchoalveolar lavage fluid (BALF) cytology and BALF cell expression of the cytokines IFN-? and IL-4 Animals - 6 horses with recurrent airway obstruction (RAO) Procedures - Clinical examination, pulmonary function test, and collection of BALF prior to treatment and during 22 day treatment period Hypothesis - Alterations in clinical parameters, pulmonary function and airway inflammation in acute equine RAO will return to remission values by treating with DEX, ENV or DEX + ENV Results - All horses demonstrated clinical disease, reduced pulmonary dynamic compliance (Cdyn) and an increased maximum change in pleural pressures (?Pplmax) when in a challenge environment. All treatments improved clinical parameters, ?Pplmax and Cdyn. BALF cytology during an RAO crisis demonstrated neutrophilic inflammation. ENV or DEX + ENV resulted in a significant decrease in airway neutrophilia that was maintained throughout the treatment period. In contrast, treatment with DEX caused a reduction in airway neutrophilia initially followed by a rebound neutrophilia as the period between administrations of dexamethasone (0.05mg/kg) was increased to 72 hours. The rebound neutrophilia was not accompanied by equivalent deterioration in clinical parameters or pulmonary function. Conclusions - Environmental modification is important in the management of RAO horses. Treatment of clinical RAO with a decreasing dosage protocol of corticosteroids in the absence of environmental modification results in the persistence of airway inflammation without recrudescence of clinical disease.
Master of Science

Objetivos: Avaliar a percepção da dispneia em pacientes com fibrose cística (FC) comparando com indivíduos normais, durante teste com cargas resistivas inspiratórias e durante teste de caminhada de seis minutos (TC6M). Secundariamente, avaliar a correlação entre os escores de dispneia induzida pelas cargas resistivas e os escores de dispneia provocada pelo TC6M. Métodos: estudo transversal em pacientes com FC (≥15 anos) e indivíduos normais. Os voluntários foram submetidos a teste com cargas resistivas inspiratórias, medida das pressões respiratórias máximas, espirometria, avaliação nutricional e TC6M. Resultados: Foram incluídos no estudo 31 pacientes com FC pareados com 31 indivíduos normais. À medida que a magnitude das cargas resistivas inspiratórias aumentou, os escores de dispneia aumentaram (p<0,001), porém não houve diferença entre grupos quanto ao escore de dispneia (p=0,654) e não houve efeito de interação (p=0,654). SpO2 foi menor em pacientes com FC (p<0,001) e aumentou à medida que a magnitude das cargas aumentou (p<0,001), sem ocorrer efeito de interação (p=,364). Vinte e seis (84%) indivíduos normais completaram o teste com cargas resistivas, comparado com apenas 12 (39%) dos pacientes com FC (p<0,001). Os escores de dispneia foram maiores ao final do TC6M do que no repouso (p<0,001), mas não houve diferença entre os grupos (p=0,080) e não houve efeito de interação (p=0,091). SpO2 foi menor nos pacientes com FC (p<0,001) e diminuiu do repouso ao final do TC6M nos pacientes com FC (p<0,001) com efeito de interação (p=0,004). Os escores de dispneia ao final do TC6M correlacionaram-se significativamente com os escores de dispneia induzidos pelo teste com cargas resistivas. Conclusão: a percepção da dispneia em pacientes com FC induzidos por teste com cargas resistivas inspiratórias e pelo TC6M não diferiu dos indivíduos normais. Contudo, os pacientes com FC descontinuaram o teste com cargas resistivas inspiratórias mais frequentemente. Além disso, houve correlação significativa entre o escore de percepção da dispneia induzida pelas cargas resistivas inspiratórias e pelo TC6M.
Objectives: To evaluate dyspnea perception in cystic fibrosis (CF) patients compared with normal subjects, during inspiratory resistive loading and the six-minute walk test (6MWT). Secondarily, to assess the correlation between dyspnea scores induced by resistive loads and those induced by the 6MWT. Methods: cross-sectional study in patients with CF (≥15 years old) and normal subjects. Volunteers underwent inspiratory resistive loading, measurement of maximal respiratory pressures, spirometry, nutritional evaluation, and the 6MWT. Results: Thirty-one CF patients and 31 paired normal subjects were included in the study. As the magnitude of the inspiratory loads increased, dyspnea scores increased (p<.001), but there was no difference between groups in dyspnea score (p=.654) and no group interaction effect (p=.654). SpO2 was lower in CF patients (p<.001) and increased as the magnitude of the loads increased (p<.001), with no interaction effect (p=.364). Twenty-six (84%) normal subjects completed the whole test, compared to only 12 (39%) CF patients (p<.001). Dyspnea scores were higher post-6MWT than at rest (p<.001), but did not differ between groups (p=.080) with no interaction effect (p=.091). SpO2 was lower in CF patients (p<.001) and decreased from resting to post-6MWT in CF patients (p<.001) with an interaction effect (p=.004). Post-6MWT dyspnea scores were significantly correlated with dyspnea scores induced by resistive loads. Conclusion: dyspnea perception in CF patients induced by inspiratory resistive loading and by 6MWT did not differ from normal subjects. However, CF patients discontinued inspiratory resistive loading more frequently. In addition, there were significant correlations between dyspnea perception score induced by inspiratory resistance loading and by the 6MWT.

Aim: To determine the prognostic value of cardiopulmonary exercise testing (CPET) for major vascular surgery in South African patients. Methods: CPET has been used in Durban since October 2004 to predict cardiac risk for high-risk patients undergoing major vascular surgery. A submaximal 'anaerobic threshold' (AT) test was conducted on all high-risk patients. Patients were classified into two groups: 'low AT' where the oxygen consumption at the AT was <1 lml.kg^.min"1 for cycling or < 9ml.kg"1.mkf1 for arm cranking and 'high AT' when the patient surpassed these targets. Analysis of all in-hospital deaths following surgery was conducted by two independent assessors blinded to the CPET test result. Deaths classified as primarily 'cardiac in origin' have been used in this retrospective cohort analysis. Results: The AT measured during CPET was not a statistically significant pre-operative prognostic marker of cardiac mortality. However, the survivors of the patients with a 'low AT' may be identified by their response to increasing metabolic demand between 5 and 7 ml.kg^.min"1. Survivors were more dependent on increasing heart rate, while non-survivors were more dependent on oxygen extraction. When this information is added to the AT, CPET was the only test statistically associated with cardiac mortality, in comparison to Lee's Revised Cardiac Risk Index and the resting left ventricular ejection fraction which were not statistically associated with cardiac death. A hundred percent of patients with a positive test died of cardiac causes, while 11% of the patients with a negative test had cardiac deaths. The risk ratio associated with cardiac death following a positive test was 8.00 [95% CI 3.8-16.9]. The sensitivity was 0.25 [95% CI 0.04-0.64], the specificity was 1.00 [95% CI 0.90-1.00], the positive predictive value was 1.00 [95% CI 0.20-0.95] and the negative predictive value was 0.88 [95% CI 0.74-0.95]. Conclusions: CPET provides valuable prognostic information in our surgical population.
Thesis (M.Sc.)-University of KwaZulu-Natal, Westville, 2007.

博士
國立臺灣大學
獸醫學研究所
104
Respiratory or pulmonary function testing is an objective assessment for evaluating chronic airway diseases, for aiding diagnosis, for stratifying preoperative risk, and for assessing disease progression and therapeutic response in clinical medicine. Although respiratory/pulmonary function assessment is routinely performed in human medicine, it is not widely used in veterinary medicine because of the uncooperative nature of small animal patients. Direct measurement of lung compliance and resistance can be performed to provide information of ventilatory mechanics, nevertheless, the requirement for general anesthesia and intubation could increase risk for respiratory patients and is not acceptable for most of pet owners. As a result, the development of a non-invasive method for assessing pulmonary function is of great importance in small animal clinical medicine. In the past few decades, attempts utilizing different instruments and techniques have been made for potential non-invasive respiratory/pulmonary function testing in cats and dogs, such as tidal breathing flow-volume loop (TBFVL) method that first developed for use in human infants, or barometric whole body plethysmography (BWBP) system that initially used in laboratory rodents. The limits of either method prevent the extensive application of respiratory/pulmonary function assessment in clinical feline and canine patients. The aims of this dissertation were to find out an alternative methodology to analyze natural tidal breathing signals, and seek for a clinically applicable, non-invasive respiratory/pulmonary function testing procedure that can be safely applied on small animal clinical patients. The result of our study has demonstrated a clinically applicable, non-invasive respiratory/pulmonary function testing by natural tidal breathing analysis. Simultaneous visual inspection for breathing waveforms facilitated the identification of artefacts and allowed the recording of stable tidal breathing signals. With the combination of advantages of previously existed instruments and methods, natural tidal breathes can be recorded with the BWBP system and analyzed by a different way that similar to conventional TBFVL method. Breathing pattern recognition is possible under the depiction of pseudoflow and pseudovolume with visual inspection for graphic tracing. Natural tidal breathing patterns could differ between normal animals and diseased ones. In specific disease entity such as feline lower airway disease, selected indices could be useful in indicating disease severity and monitoring therapeutic response. By qualifying and quantifying natural tidal breathing signals, respiratory/pulmonary mechanics could be assessed accordingly and utilized as a non-invasive respiratory/pulmonary function testing.

of the dissertation Impact of minimally invasive approach on pulmonary function in patients undergoing aortic valve replacement MUDr. Ján Gofus The most common minimally invasive approach to aortic valve replacement is upper hemisternotomy, which has been implemented at our department, as well. Preserving the lower half of thoracic cage could lead to lower postoperative drop of pulmonary function, apart from other benefits. Nevertheless, publications on this topic are insufficient and controversial. Our aim was to perform a prospective randomized trial comparing upper hemisternotomy with standard (median) sternotomy in terms of pulmonary function changes perioperatively. We also added a novel exercise tolerance test, one-minute sit-to-stand test, and a quality of life evaluation to the study. We included patients indicated for elective isolated aortic valve replacement with bioprosthesis who were older than 65 years, signed informed consent, and in which both surgical approaches were technically feasible. Exclusion criteria were re-do surgery and concomitant cardiac surgery. Patients were randomized to minimally invasive and standard group in 1:1 ratio. On the day of admission, on the 7th postoperative day and 3 months postoperatively, the patients underwent pulmonary function testing and one-minute...

Detection of early pathophysiological changes of breathing in children with chronic respiratory disease MD. Vaclav Koucky - Ph.D. thesis Abstract Introduction: Currently, there are different methods for infant pulmonary function testing (iPFT) and morphological assessment of microscopic changes in endobronchial biopsy samples (EBB). In research setting, they allow detection of early pathophysiological changes of breathing in small children with chronic respiratory disease, respectively in risk of its development. Their clinical significance, however, is not fully acknowledged. The aim of this thesis is to evaluate the safety, feasibility and clinical significance of iPFT and EBB in infants younger than 2 years of age. In addition, the relationship between functional and morphological changes of respiratory tract and the function of peripheral chemoreceptors was studied in selected patients' subgroups. Methods: Fifty-five infants with cystic fibrosis (CF), 35 physician-confirmed recurrent wheezers (AB), 9 infants with congenital diaphragmatic hernia, 7 with interstitial lung disease (chILD) and 3 with primary ciliary dyskinesia (PCD) were enrolled. All infants underwent iPFT and relevant clinical history data were recorded. Based on patients' age, CF group was divided into CFmalí (< 6 months) and CFvelcí (>...