Pressões respiratórias máximas: da busca de evidências à aplicabilidade clínica

• Ano de defesa: 2022
• Autor(a) principal: Bruna Mara Franco SIlveira
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de Minas Gerais
• Palavras-chave em Português: Pulmões; Sistema respiratório; Exercícios respiratórios; Fisioterapia; Capacidade residual funcional; Confiabilidade e validade; Músculos respiratórios; Pressões respiratórias máximas; Questionário
• Link de acesso: https://hdl.handle.net/1843/44281

Maximal respiratory pressures (MRP) measurements are widely used to assess respiratory muscle strength. This is a simple, fast, non-invasive, and well-tolerated method in which individuals generate maximal inspiratory and expiratory pressures (PImax and PEmax, respectively) against an occluded mouthpiece. The values obtained during these measurements are influenced by the lung volume in which the test is performed. MRP measurements obtained at the functional residual capacity (FRC) level may minimize the influence of the elastic recoil pressure of the respiratory system on the measures. The aims of the present thesis were: i) to summarize and critically appraise the evidence on the measurement properties reliability and validity of MRP measurements using the COSMIN recommendations, ii) to evaluate concurrent validity of the TrueForce (LabCare/LEB – UFMG, Brazil) for MRP obtained at residual volume (RV) and total lung capacity (TLC), and test-retest and inter-rater reliability of MRP obtained at FRC with the TrueForce in healthy individuals, as well as to compare values obtained at different volumes in healthy individuals and individuals with COPD, iii) to compare inspiratory pressures obtained at functional residual capacity FRC with measures at RV, and expiratory pressures obtained at FRC with measures at TLC in individuals with health conditions (post-COVID-19, chronic obstructive pulmonary chronic, idiopathic pulmonary fibrosis, heart failure and stroke), and to compare the mean differences between measurements at FRC and RV/TLC among the groups, iv) to investigate the use of MRP by physiotherapists with experience in the cardiorespiratory and intensive care fields. The first study of this thesis is a systematic review that gathered studies evaluating the measurement properties reliability and validity of MRP. The literature search was performed in PubMed and EMBASE databases. This review was designed following the COSMIN recommendations, and reported according to PRISMA statement. Twenty-six studies were included. Test-retest reliability was graded as moderate level of evidence for PImax and PEmax, interrater reliability was low for PImax and very low for PEmax, and measurement error was very low for PImax and PEmax. Concurrent validity was graded as high level of evidence for PImax and PEmax. Test-retest and measurement error for PImax obtained at functional residual capacity were graded as very low quality evidence, with no sufficient evidence for conclusions on the other measurement properties and PEmax at FRC. For the second study, MRP of 100 healthy individuals were obtained using the TrueForce and the gold-standard (MicroRPM®) at RV and TLC to evaluate concurrent validity. MRP were obtained at FRC using the TrueForce to evaluate test-retest and interrater reliability. The intraclass correlation coefficient were 0.77 and 0.86 for concurrent validity for PImax and PEmax, respectively. The coefficients were 0.87 and 0.78 for test-retest reliability (PImax and PEmax, respectively) and 0.91 and 0.84 for inter-rater reliability (PImax and PEmax, respectively). MRP were lower When obtained at FRC for healthy individuals and with COPD. For the third study, inspiratory and expiratory pressures were obtained at RV, TLC and FRC in a random order with individuals with different health conditions (15 individuals were included in each group). Inspiratory pressures at FRC were lower than RV, and expiratory pressures at FRC were lower than TLC (p≤0.005 for all). The mean differences between PImax at RV and FRC were between 8.0 and 12.8 cmH2O, and the mean differences between PEmax at TLC and FRC were between 51.9 and 62.9 cmH2O. All mean differences were similar among groups (p≥0.227 for all). For the fourth study, an online, cross-sectional, survey was developed for physiotherapists in the cardiorespiratory and intensive care fields in Brazil, and sent via electronic mail. Of the 179 responses obtained, 168 were included in the analyses. Most physiotherapists reported that currently use (109/168, 65%), or already used MRP measurements (44/59, 75%). The majority reported using the aneroid manometer (70/109, 64%), choosing the reference values proposed by Neder et al. (35/109, 32%), recording peak (34/109, 31%) and sustained pressures (34/109, 31%), and performing the measurements at RV for PImax (59/109, 54%), and at TLC for PEmax (34/109, 31%). Most physiotherapists were not aware of all indications and contraindications for MRP measurements. Summarizing, the results of the four studies included in this thesis contribute to the knowledge regarding MRP measures, from the scientific evidence presented ins a systematic review to the understanding of the clinical applicability of the measures.