Valores de referência brasileiros para as pressões respiratórias máximas: uma revisão de literatura
Brazilian reference values for maximum respiratory pressures: a review of the literature
Izabela Santos Azevedo, Marcela Venâncio Da Silva, Natielle De Miranda Martins, Sandro José Mol Guimarães, Isabela Maria Braga Sclauser Pessoa
Resumo
Introdução: Há uma expressiva variabilidade dos valores de referências propostos para a força muscular respiratória por diversos autores. As variáveis biológicas e metodológicas impactam na medida da força muscular respiratória, que, no sistema respiratório, é refletida pela pressão respiratória máxima (PRM), pressão inspiratória máxima (PImáx) e pressão expiratória máxima (PEmáx). Com o intuito de padronização metodológica, criaram-se, em 2002, diretrizes nacional e internacional para a mensuração das PRM. Objetivo: Fazer uma revisão de literatura sobre as variáveis biológicas e metodológicas utilizadas por autores brasileiros para a criação dos valores de referência das PRM. Métodos: Foi realizada uma busca nas bases de dados MedLine, SciELO e LILACS, sendo critérios de inclusão artigos de valores de referência das PRM, para a população brasileira, na faixa etária acima de 20 anos, e publicados até junho de 2016. Resultado: Após levantamento bibliográfico, constatou-se haver cinco estudos brasileiros sobre valores de referência das PRM, sendo dois estudos publicados antes das diretrizes nacional e internacional para medidas das PRM e três após a publicação das mesmas. Camelo et al. foram os únicos autores brasileiros que não propuseram equações de referência, somente valores médios de normalidade. Dentre os cinco estudos, o de autoria de Pessoa et al. foi que reproduziu a metodologia proposta pelas diretrizes, uma vez que este foi pautado nas mesmas diretrizes para a sua elaboração. Conclusão: Foi possível constatar que as padronizações metodológicas propostas pelas diretrizes não são contempladas em todos os estudos brasileiros e que há ausência de relatos sobre importantes variáveis biológicas, que interferem nas PRM, em alguns estudos. A padronização das variáveis biológicas e metodológicas, para mensurar os valores das PRM, é de suma importância, uma vez que impacta na validade das medidas usadas como referência na prática clínica.
Palavras-chave
Abstract
Introduction: There is a large variability of the proposed reference values for respiratory muscle strength. Study methodology and biological variables impact on measurement of respiratory muscle strength expressed as maximum respiratory pressures (MRP). Inspiratory muscle strength is estimated from the maximum inspiratory pressure (MIP) and expiratory muscle strength is estimated from the maximum expiratory pressure (MEP). In order to standardize methodology, national and international guidelines for the measurement of the MRP were proposed in 2002. Objective: To perform a review of literature investigating methodological approaches and biological variables used by Brazilian authors for the development of reference values of the MRP. Methods: A search in the databases MedLine, SciELO and LILACS were performed. Only articles published until June 2016 that proposed reference values for the Brazilian population in subjects older than 20 years were included. Result: Five studies retrieved from the search were included (two studies published before and three studies published after the publication of national and international guidelines for the assessment of MRP. Camelo et al. was the only study that did not propose reference equations (only reported average values of normality). Amongst the five studies, only the study from Pessoa et al. followed the methodology proposed by the abovementioned guidelines. Conclusion: Most of studies included in the review did not follow the proposed methodology by international guidelines. Furthermore, there is absence of reports of important biological variables that interfere in the MRP in some studies. The standardization of biological variables and methodology to measure MRP is of paramount importance since it impacts on the validity of the measures used as a reference in clinical practice.
Keywords
Referências
1. American Thoracic Society, European Respiratory Society. ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med. 2002 Aug 15;166(4):518-624.
2. Neder JA, Andreoni S, Lerario MC, Nery LE. Reference values for lung function tests. II. Maximal respiratory pressures and voluntary ventilation. Braz J Med Biol Res. 1999 Jun;32(6):719-27.
3. Neder JA, Andreoni S, Peres C, Nery LE. Reference values for lung function tests: III. Carbon monoxide diffusing capacity (transfer factor). Braz J Med Biol Res. 1999 Jun;32(6):729-37.
4. Souza RB. Pressões respiratórias estáticas máximas. J Pneumol. 2002 Out;28(Supl 3):S155-S165.
5. Rodrigues F, Bárbara C. Pressões respiratórias máximas: proposta de um protocolo de procedimentos. Rev Port Pneumol. 2000 Jul-Ago;6(4):297-307.
6. Fregonezi G, Resqueti VR, Cury JL, Paulin E, Brunetto AF (in memoriam). Variação diurna de parâmetros de função pulmonar e de força muscular respiratória em pacientes com DPOC. J Bras Pneumol. 2012 Mar-Abr;38(2):257-63.
7. Aldrich TK, Spiro P. Maximal inspiratory pressure: does reproducibility indicate full effort? Thorax. 1995 Jan;50(1):40-3.
8. Chen HI, Kuo CS. Relationship between respiratory muscle function and age, sex, and other factors. J Appl Physiol (1985). 1989 Feb;66(2):943-8.
9. Carpenter MA, Tockman MS, Hutchinson RG, Davis CE, Heiss G. Demographic and anthropometric correlates of maximum inspiratory pressure: the atherosclerosis risk in communities study. Am J Respir Crit Care Med. 1999 Feb;159(2):415-22.
10. Koulouris N, Mulvey DA, Laroche CM, Green M, Moxham J. Comparison of two different mouthpieces for the measurement of PImax and PEmax in normal and weak subjects. Eur Respir J. 1988 Oct;1(9):863-7.
11. Mayos M, Giner J, Casan P, Sanchis J. Measurement of maximal static respiratory pressures at the mouth with different air leaks. Chest. 1991 Aug;100(2):364-6.
12. Fiz JA, Carreres A, Rosell A, Montserrat JM, Ruiz J, Morera JM. Measurement of maximal expiratory pressure: effect of holding the lips. Thorax. 1992 Nov;47(11):961-3.
13. Heijdra YF, Dekhuijzen PN, van Herwaarden CL, Folgering HT. Effects of body position, hyperinflation, and blood gas tensions on maximal respiratory pressures in patients with chronic obstructive pulmonary disease. Thorax. 1994 May;49(5):453-8.
14. Karvonen J, Saarelainen S, Nieminen MM. Measurement of respiratory muscle forces based on maximal inspiratory and expiratory pressures. Respiration. 1994;61(1):28-31.
15. Evans JA, Whitelaw WA. The assessment of maximal respiratory mouth pressures in adults. Respir Care. 2009 Oct;54(10):1348-59.
16. Wohlgemuth M, van der Kooi EL, Hendriks JC, Padberg GW, Folgering HT. Face mask spirometry and respiratory pressures in normal subjects. Eur Respir J. 2003 Dec;22(6):1001-6.
17. Montemezzo D, Vieira DS, Tierra-Criollo CJ, Britto RR, Veloso M, Parreira VF. Influence of 4 interfaces in the assessment of maximal respiratory pressures. Respir Care. 2012 Mar;57(3):392-8.
18. Black LF, Hyatt RE. Maximal respiratory pressures: normal values and relationship to age and sex. Am Rev Respir Dis. 1969 May;99(5):696-702.
19. Gopalakrishna A, Vaishali K, Prem V, Aaron P. Normative values for maximal respiratory pressures in an Indian Mangalore population: cross-sectional pilot study. Lung India. 2011 Oct;28(4):247-52.
20. Cook CD, Mead J, Orzalesi MM. Static volume-pressure characteristics of the respiratory system during maximal efforts. J Appl Physiol.1964 Sep;19:1016-22.
21. Smyth RJ, Chapman KR, Rebuck AS. Maximal inspiratory and expiratory pressures in adolescents: normal values. Chest. 1984 Oct;86(4):568-72.
22. Bruschi C, Cerveri I, Zoia MC, Fanfulla F, Fiorentini M, Casali L, et al. Reference values of maximal respiratory mouth pressures: a population-based study. Am Rev Respir Dis. 1992 Sep;146(3):790-3.
23. Johan A, Chan CC, Chia HP, Chan OY, Wang YT. Maximal respiratory pressures in adult Chinese, Malays and Indians. Eur Respir J. 1997 Dec;10(12):2825-8.
24. Hautmann H, Hefele S, Schotten K, Huber RM. Maximal inspiratory mouth pressures (PIMAX) in healthy subjects--what is the lower limit of normal? Respir Med. 2000 Jul;94(7):689-93.
25. Costa D, Gonçalvez HA, Lima LP, Ike D, Cancelliero KM, Montebelo MI. New reference values for maximal respiratory pressures in the Brazilian population. J Bras Pneumol. 2010 MayJun;36(3):306-12.
26. Simões RP, Deus AP, Auad MA, Dionísio J, Mazzonetto M, Borghi-Silva A. Maximal respiratory pressure in healthy 20 to 89 year-old sedentary individuals of central Sao Paulo State. Rev Bras Fisioter. 2010 Jan-Feb;14(1):60-7.
27. Pessoa IM, Houri Neto M, Montemezzo D, Silva LA, Andrade AD, Parreira VF. Predictive equations for respiratory muscle strength according to international and Brazilian guidelines. Braz J Phys Ther. 2014 Sep-Oct;18(5):410-8.
28. Camelo Júnior JS, Terra Filho J, Manço JC. Pressões respiratórias máximas em adultos normais. J Pneumol. 1985 Dez;11(4):181-4.
29. Jalayondeja W, Verner O, Jarungjitaree S, Tscheikuna J. Respiratory muscle strength explained by age and weight in female and male. J Med Assoc Thai. 2014 Jul;97(7 Supl 7):S16-20.
30. Larson JL, Kim MJ. Reliability of maximal inspiratory pressure. Nurs Res. 1987 Sep-Oct;36(5):317-9.
31. Harik-KhanRI, Wise RA, Fozard JL. Determinants of maximal inspiratory pressure – the Baltimore longitudinal study of aging. Am J Respir Crit Care Med. 1998 Nov;158 (Suppl 5, Pt 1):1459-64.
32. Vincken W, Ghezzo H, Cosio MG. Maximal static respiratory pressures: normal values and their relationship to determinate of respiratory function. Bull Eur Physiopathol Respir. 1987 SepOct;23(5):435-9.
33. Giua R, Pedone C, Scarlata S, Carrozzo I, Rossi FF, Valiani V, Incalzi RA. Relationship between respiratory muscle strength and physical performance in elderly hospitalized patients. Rejuvenation Res. 2014 Aug;17(4):366-71.
34. Mcconnell AK, Copestake AJ. Maximum static respiratory pressures in healthy elderly men and women: issues of reproducibility and interpretation. Respiration. 1999;66(3):251-8.
35. Berry JK, Vitalo CA, Larson JL, Patel M, Kim MJ. Respiratory muscle strength in older adults. Nurs Res. 1996 May-Jun;45(3):154-9.
36. Chaunchaiyakul R, Groeller H, Clarke JR, Taylor NA. The impact of aging and habitual physical activity on static respiratory work at rest and during exercise. Am J Physiol Lung Cell Mol Physiol. 2004 Dec;287(6):L1098-1106.
37. Ringqvist T. The ventilatory capacity in healthy subjects. An analysis of causal factors with special reference to the respiratory forces. Scand J Clin Lab Invest Suppl. 1966;88:5-179.
38. Enright PL, Kronmal RA, Manolio TA, Schenker MB, Hyatt RE. Respiratory muscle strength in the elderly: correlates and reference values. Cardiovascular Health Study Research Group. Am J Respir Crit Care Med. 1994 Feb;149(2 Pt 1):430-8.
39. Lemos A, de Souza AI, Figueiroa JN, Cabral-Filho JE, de Andrade AD. Respiratory muscle strength in pregnancy. Respir Med. 2010 Nov;104(11):1638-44.
40. Pinto AVA, Schleder JC, Penteado C, Gallo RBS. Avaliação da mecânica respiratória em gestantes. Fisioter Pesq. 2015;22(4):348-54.
41. Wilson SH, Cooke NT, Edwards RH, Spiro SG. Predicted normal values for maximal respiratory pressures in Caucasian adults and children. Thorax. 1984 Jul;39(7):535-8.
42. Lopata M, Freilich RA, Önal E, Pearle J, Lourenço RV. Ventilatory control and the obesity hypoventilation syndrome. Am Rev Respir Dis. 1979 Feb;119(2 Suppl Pt 2):165-8.
43. Parameswaran K, Todd DC, Soth M. Altered respiratory physiology in obesity. Can Respir J. 2006 May-Jun;13(4):203–10.
44. De Lorenzo A, Maiolo C, Mohamed EI, Andreoli A, Petrone-De Luca P, Rossi P. Body composition analysis and changes in airways function in obese adults after hypocaloric diet. Chest. 2001 May;119(5):1409-15.
45. Costa Junior D, Peixoto-Souza FS, Araujo PN, Barbalho-Moulin MC, Alves VC, Gomes EL, Costa D. Influence of body composition on lung function and respiratory muscle strength in children with obesity. J Clin Med Res. 2016 Feb;8(2):105-10.
46. Schoenberg JB, Beck GJ, Bouhuys A. Growth and decay of pulmonary function in healthy blacks and whites. Respir Physiol. 1978 Jun;33(3):367-93.
47. Trisltz CM, Ruas G, Jamami LK, Jamami M, Couto VF. Avaliação da tolerância ao esforço em indivíduos fumantes. Fisioter Mov. 2007 Out-Dez;20(4):55-61.
48. Gonçalves MP, Tomaz CAB, Cassiminho ALF, Dutra MF. Avaliação da força muscular inspiratória e expiratória em idosas praticantes de atividade física e sedentárias. Rev Bras Ciênc Mov. 2006;14(1):37-44.
49. Baecke JA, Burema J, Frijters JE. A short questionnaire for the measurement of habitual physical activity in epidemiological studies. Am J Clin Nutr. 1982 Nov;36(5):936-42.
50. Pereira CAC. Espirometria. J Pneumol. 2002 Out;28 (3 Suppl 3):S1-S82.
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