Avalia??o do uso do teste do degrau de tr?s minutos na identifica??o de exacerba??o pulmonar em crian?as e adolescentes com fibrose c?stica
Ano de defesa: | 2022 |
---|---|
Autor(a) principal: | |
Orientador(a): | |
Banca de defesa: | |
Tipo de documento: | Dissertação |
Tipo de acesso: | Acesso aberto |
Idioma: | por |
Instituição de defesa: |
Pontif?cia Universidade Cat?lica do Rio Grande do Sul
|
Programa de Pós-Graduação: |
Programa de P?s-Gradua??o em Medicina/Pediatria e Sa?de da Crian?a
|
Departamento: |
Escola de Medicina
|
País: |
Brasil
|
Palavras-chave em Português: | |
Palavras-chave em Inglês: | |
Área do conhecimento CNPq: | |
Link de acesso: | https://tede2.pucrs.br/tede2/handle/tede/10413 |
Resumo: | Introduction: Cystic Fibrosis (CF) is a chronic disease that affects the respiratory system. One of the causes of patient morbidity and mortality is a pulmonary exacerbation, which is evaluated by the use of specific scores. However, there is no consensus on the best form of diagnosis. Considering that the three-minute step test (TD3) is a test of easy application and good reproducibility, it may be useful in identifying pulmonary exacerbations in these patients. Objective: To evaluate the use of TD3 in the identification of pulmonary exacerbation in children and adolescents with CF. Methods: Cross-sectional study in which patients aged six years and older with CF confirmed by genetic testing were included. Those patients who had any limitation that prevented the realization of the TD3 were excluded. The presence of pulmonary exacerbation was assessed using the Kanga score, and quadriceps muscle strength using dynamometry. Afterwards, the TD3 was performed and the patient went up and down a step with a height of 15 cm for three minutes. Heart rate (HR), peripheral oxygen saturation (SpO2) and sensation of dyspnea and lower limb fatigue were measured using the modified Borg scale, before and after the test. The values obtained were compared between exacerbated and non-exacerbated patients and the sensitivity/specificity calculated. Results: Sixty-two patients with a mean age of 11.1?4.25 years were included. Pulmonary function was found to be reduced and the mean Kanga score in the sample was around 16, with a score above 20, which is considered moderate/severe pulmonary exacerbation, achieved by at least a quarter of the patients. Kanga score correlated with age, FEV1, 1-minute recovery HR, SpO2 after TD3, and 1-minute recovery SpO2. When comparing patients with the highest and lowest scores on the Kanga score, age, resting HR and 1-minute recovery HR were significantly higher in the group with the highest scores. On the other hand, FEV1, SpO2 at rest, SpO2 after TD3 and SpO2 after 1 minute of recovery were significantly lower in the group with the highest score. The analysis of the ROC curve showed that the HR recovery after 1 minute of performing the TD3 was the best variable to predict pulmonary exacerbation, with good sensitivity and specificity for a cut-off value of 111 bpm. Conclusion: The TD3 demonstrated good sensitivity in detecting moderate/severe pulmonary exacerbation in children and adolescents with CF and may be considered as an additional method to assist in the evaluation and follow-up of these patients. |
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Donadio, M?rcio Vin?cius Fagundeshttp://lattes.cnpq.br/8321335627100144Vendrusculo, Fernanda Mariahttp://lattes.cnpq.br/0576185305773953http://lattes.cnpq.br/0916966045534882Costa, Gisele Apolin?rio da2022-08-31T13:33:12Z2022-03-07https://tede2.pucrs.br/tede2/handle/tede/10413Introduction: Cystic Fibrosis (CF) is a chronic disease that affects the respiratory system. One of the causes of patient morbidity and mortality is a pulmonary exacerbation, which is evaluated by the use of specific scores. However, there is no consensus on the best form of diagnosis. Considering that the three-minute step test (TD3) is a test of easy application and good reproducibility, it may be useful in identifying pulmonary exacerbations in these patients. Objective: To evaluate the use of TD3 in the identification of pulmonary exacerbation in children and adolescents with CF. Methods: Cross-sectional study in which patients aged six years and older with CF confirmed by genetic testing were included. Those patients who had any limitation that prevented the realization of the TD3 were excluded. The presence of pulmonary exacerbation was assessed using the Kanga score, and quadriceps muscle strength using dynamometry. Afterwards, the TD3 was performed and the patient went up and down a step with a height of 15 cm for three minutes. Heart rate (HR), peripheral oxygen saturation (SpO2) and sensation of dyspnea and lower limb fatigue were measured using the modified Borg scale, before and after the test. The values obtained were compared between exacerbated and non-exacerbated patients and the sensitivity/specificity calculated. Results: Sixty-two patients with a mean age of 11.1?4.25 years were included. Pulmonary function was found to be reduced and the mean Kanga score in the sample was around 16, with a score above 20, which is considered moderate/severe pulmonary exacerbation, achieved by at least a quarter of the patients. Kanga score correlated with age, FEV1, 1-minute recovery HR, SpO2 after TD3, and 1-minute recovery SpO2. When comparing patients with the highest and lowest scores on the Kanga score, age, resting HR and 1-minute recovery HR were significantly higher in the group with the highest scores. On the other hand, FEV1, SpO2 at rest, SpO2 after TD3 and SpO2 after 1 minute of recovery were significantly lower in the group with the highest score. The analysis of the ROC curve showed that the HR recovery after 1 minute of performing the TD3 was the best variable to predict pulmonary exacerbation, with good sensitivity and specificity for a cut-off value of 111 bpm. Conclusion: The TD3 demonstrated good sensitivity in detecting moderate/severe pulmonary exacerbation in children and adolescents with CF and may be considered as an additional method to assist in the evaluation and follow-up of these patients.Introdu??o: A Fibrose C?stica (FC) ? uma doen?a cr?nica que afeta gravemente o sistema respirat?rio. Uma das causas de morbimortalidade destes pacientes ? a exacerba??o pulmonar, que normalmente ? avaliada atrav?s de escores espec?ficos. Entretanto, n?o h? um consenso sobre a melhor forma de diagnostic?-la. Como o teste do degrau de tr?s minutos (TD3) ? um teste de f?cil aplica??o e boa reprodutibilidade, pode ser ?til na identifica??o de exacerba??es pulmonares nestes pacientes. Objetivo: Avaliar o uso do TD3 na identifica??o de exacerba??o pulmonar em crian?as e adolescentes com FC. M?todos: Estudo transversal no qual foram inclu?dos pacientes a partir de seis anos com FC confirmada por teste gen?tico. Foram exclu?dos aqueles pacientes que possuissem qualquer limita??o que impedissem a reasliza??o do TD3. A presen?a de exacerba??o pulmonar foi avaliada por meio da aplica??o do escore de Kanga, e a for?a muscular do quadr?ceps utilizando dinamometria. Ap?s, foi realizado o TD3, no qual o paciente subiu e desceu durante tr?s minutos um degrau com altura de 15 cm. Foram aferidas frequ?ncia card?aca (Fc), satura??o perif?rica de oxig?nio (SpO2) e sensa??o de dispneia e fadiga de membros inferiores utilizando a escala de Borg modificada, antes e ap?s o teste. Os valores obtidos foram comparados entre os pacientes exacerbados e n?o exacerbados e a sensibilidade/especificidade calculada. Resultados: Foram inclu?dos 62 pacientes com m?dia de idade de 11,1?4,25 anos. A fun??o pulmonar encontrou-se reduzida e a pontua??o m?dia do escore de Kanga na amostra ficou perto dos 16, sendo que a pontua??o acima de 20 no escore foi considerada exacerba??o pulmonar moderada/grave, e foi atingida por pelo menos um quarto dos pacientes. Escore de Kanga se correlacionou com idade, VEF1, Fc de recupera??o em 1 minuto, SpO2 ap?s o TD3 e SpO2 de recupera??o em 1 minuto. Ao comparar os pacientes com maior e menor pontua??o no escore de Kanga, a idade, Fc em repouso e Fc de recupera??o em 1 minuto, foram significativamente maiores no grupo com maior pontua??o. J? o VEF1, SpO2 em repouso, SpO2 ap?s o TD3 e SpO2 ap?s 1 minuto de recupera??o foram significativamente menores no grupo com maior pontua??o. A an?lise de uma curva ROC mostrou que a Fc de recupera??o ap?s 1 minuto de realiza??o do TD3 foi a melhor vari?vel para predizer a exacerba??o pulmonar, sendo sens?vel e espec?fica para um ponto de corte de 111 bpm. Conclus?o: O TD3 demonstrou uma boa sensibilidade para detec??o da exacerba??o pulmonar moderada/grave em crian?as e adolescentes com FC, podendo ser considerado como um m?todo adicional para auxiliar a avalia??o e acompanhamento destes pacientes.Submitted by PPG Pediatria e Sa?de da Crian?a (pediatria-pg@pucrs.br) on 2022-08-29T16:20:40Z No. of bitstreams: 1 DISSERTA??O final Gisele Apolinario.pdf: 917768 bytes, checksum: 7dad0b5c2ee90759e1256af2d3903f1c (MD5)Approved for entry into archive by Sheila Dias (sheila.dias@pucrs.br) on 2022-08-31T13:23:53Z (GMT) No. of bitstreams: 1 DISSERTA??O final Gisele Apolinario.pdf: 917768 bytes, checksum: 7dad0b5c2ee90759e1256af2d3903f1c (MD5)Made available in DSpace on 2022-08-31T13:33:12Z (GMT). No. of bitstreams: 1 DISSERTA??O final Gisele Apolinario.pdf: 917768 bytes, checksum: 7dad0b5c2ee90759e1256af2d3903f1c (MD5) Previous issue date: 2022-03-07Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPESapplication/pdfhttps://tede2.pucrs.br/tede2/retrieve/185179/DIS_GISELE_APOLINARIO_DA_COSTA_CONFIDENCIAL.pdf.jpgporPontif?cia Universidade Cat?lica do Rio Grande do SulPrograma de P?s-Gradua??o em Medicina/Pediatria e Sa?de da Crian?aPUCRSBrasilEscola de MedicinaFibrose C?sticaCrian?asExacerba??o dos SintomasTeste de DegrauCystic FibrosisChildExacerbationExercise TestCIENCIAS DA SAUDE::MEDICINAMEDICINA::SAUDE MATERNO-INFANTILCLINICA MEDICA::PEDIATRIAAvalia??o do uso do teste do degrau de tr?s minutos na identifica??o de exacerba??o pulmonar em crian?as e adolescentes com fibrose c?sticainfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisTrabalho ser? publicado como artigo ou livro60 meses31/08/2027557290555552975733500500500600600600-224747486637135387-969369452308786627-8067417953925345752-70271217037790659553590462550136975366info:eu-repo/semantics/openAccessreponame:Biblioteca Digital de Teses e Dissertações da PUC_RSinstname:Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS)instacron:PUC_RSTHUMBNAILDIS_GISELE_APOLINARIO_DA_COSTA_CONFIDENCIAL.pdf.jpgDIS_GISELE_APOLINARIO_DA_COSTA_CONFIDENCIAL.pdf.jpgimage/jpeg4132https://tede2.pucrs.br/tede2/bitstream/tede/10413/4/DIS_GISELE_APOLINARIO_DA_COSTA_CONFIDENCIAL.pdf.jpg909d200ca241f9948586a84e0c7be17dMD54TEXTDIS_GISELE_APOLINARIO_DA_COSTA_CONFIDENCIAL.pdf.txtDIS_GISELE_APOLINARIO_DA_COSTA_CONFIDENCIAL.pdf.txttext/plain1218https://tede2.pucrs.br/tede2/bitstream/tede/10413/3/DIS_GISELE_APOLINARIO_DA_COSTA_CONFIDENCIAL.pdf.txtb052f0f71b741b64b42da7afb5297a83MD53ORIGINALDIS_GISELE_APOLINARIO_DA_COSTA_CONFIDENCIAL.pdfDIS_GISELE_APOLINARIO_DA_COSTA_CONFIDENCIAL.pdfapplication/pdf277336https://tede2.pucrs.br/tede2/bitstream/tede/10413/2/DIS_GISELE_APOLINARIO_DA_COSTA_CONFIDENCIAL.pdf0dcfaa64e047d09ef93c144444c58757MD52LICENSElicense.txtlicense.txttext/plain; charset=utf-8590https://tede2.pucrs.br/tede2/bitstream/tede/10413/1/license.txt220e11f2d3ba5354f917c7035aadef24MD51tede/104132022-08-31 12:00:17.919oai:tede2.pucrs.br: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Biblioteca Digital de Teses e Dissertaçõeshttp://tede2.pucrs.br/tede2/PRIhttps://tede2.pucrs.br/oai/requestbiblioteca.central@pucrs.br||opendoar:2022-08-31T15:00:17Biblioteca Digital de Teses e Dissertações da PUC_RS - Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS)false |
dc.title.por.fl_str_mv |
Avalia??o do uso do teste do degrau de tr?s minutos na identifica??o de exacerba??o pulmonar em crian?as e adolescentes com fibrose c?stica |
title |
Avalia??o do uso do teste do degrau de tr?s minutos na identifica??o de exacerba??o pulmonar em crian?as e adolescentes com fibrose c?stica |
spellingShingle |
Avalia??o do uso do teste do degrau de tr?s minutos na identifica??o de exacerba??o pulmonar em crian?as e adolescentes com fibrose c?stica Costa, Gisele Apolin?rio da Fibrose C?stica Crian?as Exacerba??o dos Sintomas Teste de Degrau Cystic Fibrosis Child Exacerbation Exercise Test CIENCIAS DA SAUDE::MEDICINA MEDICINA::SAUDE MATERNO-INFANTIL CLINICA MEDICA::PEDIATRIA |
title_short |
Avalia??o do uso do teste do degrau de tr?s minutos na identifica??o de exacerba??o pulmonar em crian?as e adolescentes com fibrose c?stica |
title_full |
Avalia??o do uso do teste do degrau de tr?s minutos na identifica??o de exacerba??o pulmonar em crian?as e adolescentes com fibrose c?stica |
title_fullStr |
Avalia??o do uso do teste do degrau de tr?s minutos na identifica??o de exacerba??o pulmonar em crian?as e adolescentes com fibrose c?stica |
title_full_unstemmed |
Avalia??o do uso do teste do degrau de tr?s minutos na identifica??o de exacerba??o pulmonar em crian?as e adolescentes com fibrose c?stica |
title_sort |
Avalia??o do uso do teste do degrau de tr?s minutos na identifica??o de exacerba??o pulmonar em crian?as e adolescentes com fibrose c?stica |
author |
Costa, Gisele Apolin?rio da |
author_facet |
Costa, Gisele Apolin?rio da |
author_role |
author |
dc.contributor.advisor1.fl_str_mv |
Donadio, M?rcio Vin?cius Fagundes |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/8321335627100144 |
dc.contributor.advisor-co1.fl_str_mv |
Vendrusculo, Fernanda Maria |
dc.contributor.advisor-co1Lattes.fl_str_mv |
http://lattes.cnpq.br/0576185305773953 |
dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/0916966045534882 |
dc.contributor.author.fl_str_mv |
Costa, Gisele Apolin?rio da |
contributor_str_mv |
Donadio, M?rcio Vin?cius Fagundes Vendrusculo, Fernanda Maria |
dc.subject.por.fl_str_mv |
Fibrose C?stica Crian?as Exacerba??o dos Sintomas Teste de Degrau |
topic |
Fibrose C?stica Crian?as Exacerba??o dos Sintomas Teste de Degrau Cystic Fibrosis Child Exacerbation Exercise Test CIENCIAS DA SAUDE::MEDICINA MEDICINA::SAUDE MATERNO-INFANTIL CLINICA MEDICA::PEDIATRIA |
dc.subject.eng.fl_str_mv |
Cystic Fibrosis Child Exacerbation Exercise Test |
dc.subject.cnpq.fl_str_mv |
CIENCIAS DA SAUDE::MEDICINA MEDICINA::SAUDE MATERNO-INFANTIL CLINICA MEDICA::PEDIATRIA |
description |
Introduction: Cystic Fibrosis (CF) is a chronic disease that affects the respiratory system. One of the causes of patient morbidity and mortality is a pulmonary exacerbation, which is evaluated by the use of specific scores. However, there is no consensus on the best form of diagnosis. Considering that the three-minute step test (TD3) is a test of easy application and good reproducibility, it may be useful in identifying pulmonary exacerbations in these patients. Objective: To evaluate the use of TD3 in the identification of pulmonary exacerbation in children and adolescents with CF. Methods: Cross-sectional study in which patients aged six years and older with CF confirmed by genetic testing were included. Those patients who had any limitation that prevented the realization of the TD3 were excluded. The presence of pulmonary exacerbation was assessed using the Kanga score, and quadriceps muscle strength using dynamometry. Afterwards, the TD3 was performed and the patient went up and down a step with a height of 15 cm for three minutes. Heart rate (HR), peripheral oxygen saturation (SpO2) and sensation of dyspnea and lower limb fatigue were measured using the modified Borg scale, before and after the test. The values obtained were compared between exacerbated and non-exacerbated patients and the sensitivity/specificity calculated. Results: Sixty-two patients with a mean age of 11.1?4.25 years were included. Pulmonary function was found to be reduced and the mean Kanga score in the sample was around 16, with a score above 20, which is considered moderate/severe pulmonary exacerbation, achieved by at least a quarter of the patients. Kanga score correlated with age, FEV1, 1-minute recovery HR, SpO2 after TD3, and 1-minute recovery SpO2. When comparing patients with the highest and lowest scores on the Kanga score, age, resting HR and 1-minute recovery HR were significantly higher in the group with the highest scores. On the other hand, FEV1, SpO2 at rest, SpO2 after TD3 and SpO2 after 1 minute of recovery were significantly lower in the group with the highest score. The analysis of the ROC curve showed that the HR recovery after 1 minute of performing the TD3 was the best variable to predict pulmonary exacerbation, with good sensitivity and specificity for a cut-off value of 111 bpm. Conclusion: The TD3 demonstrated good sensitivity in detecting moderate/severe pulmonary exacerbation in children and adolescents with CF and may be considered as an additional method to assist in the evaluation and follow-up of these patients. |
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2022 |
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2022-08-31T13:33:12Z |
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2022-03-07 |
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Pontif?cia Universidade Cat?lica do Rio Grande do Sul |
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