The correlation between pulse wave velocity (PWV) and brain compliance acquired using Brain4care (B4C) monitors is an emerging field of study that aims to better understand cerebrovascular health and its implications for cognitive function and brain aging. Increased arterial stiffness, often due to aging or hypertension, impairs brain compliance, which is crucial for maintaining cerebral homeostasis. This impairs cerebral perfusion, causing microvascular brain damage, which may contribute to long-term cognitive impairment. The B4C sensors monitor cerebral compliance through the analysis of pulsatile waves derived from the cardiac cycle and has already demonstrated a significant correlation with invasive intracranial pressure (ICP) parameters, with the advantage of being non-invasive, reusable, portable, and can be used in several clinical conditions, such as intracranial hypertension (ICH) and hydrocephalus. These methods have the potential to improve the monitoring of cerebral compliance and ICP, with the benefit of avoiding the risks associated with invasive methods. The correlation between PWV and brain compliance acquired using B4C monitors highlights the importance of monitoring vascular health to preserve brain function. Increased arterial stiffness, reflected by increased PWV, is associated with decreased brain compliance, which may have significant implications for cognitive health and the risk of cerebrovascular disease.

This review addresses the correlation between arterial stiffness, measured by pulse wave velocity (PWV), and retinal microvascular changes, highlighting the retina as an important accessible window for inferences about cardiovascular health. Arterial stiffness, intrinsically linked to vascular aging and several comorbidities, results in damage to the microcirculation, including ocular vasculature, which can act as a predictor of cardiovascular and cerebrovascular outcomes. The review highlights the relationship between PWV assessment and funduscopic examination, with the aim of improving diagnostic accuracy and optimizing the clinical application of these tools in the management of cardiovascular and ophthalmological diseases, thus promoting more effective and early intervention.

Resumo Fundamento Embora os limiares de pressão arterial (PA) estejam bem definidos, há escassez de dados sobre os possíveis fenótipos de hipertensão arterial entre os sexos. Objetivos Identificar os fenótipos de hipertensão arterial em homens e mulheres com hipertensão em tratamento. Métodos Foram incluídos adultos com hipertensão arterial, entre 18 e 80 anos, em tratamento medicamentoso, recrutados oportunisticamente em diversas regiões do Brasil. As avaliações incluíram medidas de PA em consultório e por monitorização residencial da PA (MRPA). Foram considerados quatro fenótipos de hipertensão arterial: i) hipertensão controlada: PA < 140/90 mmHg e MRPA < 130/80 mmHg; ii) hipertensão do avental branco não controlada: PA ≥ 140/90 mmHg e MRPA < 130/80 mmHg; iii) hipertensão mascarada não controlada: PA < 140/90 mmHg e MRPA ≥ 130/80 mmHg; iv) hipertensão sustentada não controlada: PA ≥ 140/90 mmHg e MRPA ≥ 130/80 mmHg. O nível de significância adotado foi de 5% (p < 0,05). Resultados Dos 7.852 pacientes avaliados, todos em uso de medicação anti-hipertensiva, 3.162 (40,3%) apresentaram hipertensão controlada, sendo 1.115 (37,6%) homens e 2.047 (41,9%) mulheres (p < 0,001); 675 (8,6%) apresentaram hipertensão do avental branco não controlada, sendo 217 (7,3%) homens e 458 (9,4%) mulheres (p < 0,001); 1.605 (20,4%) apresentaram hipertensão mascarada não controlada, sendo 645 (21,7%) homens e 960 (19,7%) mulheres (p < 0,001); e 2.410 (30,7%) apresentaram hipertensão sustentada não controlada, sendo 992 (33,4%) homens e 1.418 (29%) mulheres (p < 0,001). Conclusões Este é o primeiro estudo populacional brasileiro a avaliar fenótipos de hipertensão por sexo. As mulheres apresentaram melhor controle pressórico em comparação aos homens, tanto em consultório quanto em ambiente domiciliar.

BACKGROUND:Although blood pressure (BP) thresholds are well established, there is a lack of data on potential hypertension phenotypes across sexes. OBJECTIVES:To identify hypertension phenotypes in men and women undergoing antihypertensive treatment. METHODS:Adults aged 18 to 80 years with diagnosed hypertension and undergoing pharmacological treatment were opportunistically recruited from various regions of Brazil. Assessments included office BP measurements and home blood pressure monitoring (HBPM). Four hypertension phenotypes were defined: (i) controlled hypertension: office BP < 140/90 mmHg and HBPM < 130/80 mmHg; (ii) white-coat uncontrolled hypertension: office BP ≥ 140/90 mmHg and HBPM < 130/80 mmHg; (iii) masked uncontrolled hypertension: office BP < 140/90 mmHg and HBPM ≥ 130/80 mmHg; (iv) sustained uncontrolled hypertension: office BP ≥ 140/90 mmHg and HBPM ≥ 130/80 mmHg. A significance level of 5% (p < 0.05) was adopted. RESULTS:Among the 7,852 patients on antihypertensive therapy, 3,162 (40.3%) had controlled hypertension, including 1,115 (37.6%) men and 2,047 (41.9%) women (p < 0.001); 675 (8.6%) had white-coat uncontrolled hypertension, with 217 (7.3%) men and 458 (9.4%) women (p < 0.001); 1,605 (20.4%) had masked uncontrolled hypertension, including 645 (21.7%) men and 960 (19.7%) women (p < 0.001); and 2,410 (30.7%) had sustained uncontrolled hypertension, including 992 (33.4%) men and 1,418 (29%) women (p < 0.001). CONCLUSIONS:This is the first Brazilian population-based study to assess hypertension phenotypes by sex. Women demonstrated better BP control than men, both in clinical settings and at home.

BACKGROUND AND PURPOSE:TAR method recommends reorganizing ventilatory muscle synergism, reducing respiratory effort, removing secretions from the lungs and upper airways, in addition to promoting diaphragmatic juxtaposition and increasing respiratory muscle strength and adjusting muscle tone. However, there are few scientific publications on this method in cardiac patients CABG. To evaluate the effects of the TAR method on hemodynamic variables, respiratory distress and pulmonary complications in patients after CABG surgery. METHODS:This is a single-blind, randomized, clinical trial. Adults (> 35 years old), hemodynamically stable, who had undergone CABG (< 24 h) and with a prescription for physiotherapy were included. Patients were randomized into two groups: IG - TAR; CG-standard physiotherapeutic approach. Interventions were carried out in two days (twice/day), totaling 04 sessions. The following parameters were evaluated pre- and post-intervention: HR, RR, SpO2, MAP, respiratory distress scale. The pulmonary complications scale was applied at the end of the interventions. The sample consisted of 58 patients, 30 in the CG and 28 in the IG. RESULTS:There was no significant difference (p < 0.05) in sample characteristics, clinical and perioperative data between groups. There was a significant increase (p < 0.05) in RR and MAP after the intervention in CG and IG. Only in GI there was a significant reduction in the respiratory distress score (p = 0.001). Furthermore, there was a lower score (p < 0.0001) on the scale of pulmonary complications at the end of the interventions in the IG group, compared to the CG. DISCUSSION:The TAR method reduced respiratory distress and pulmonary complications in patients after CABG surgery. Given our findings, it becomes feasible to aim for the applicability of the method in other populations, expanding it to other elective or non-elective surgical conditions, in oncology, traumatology, and neurology, making the recovery process more effective. KEYWORDS:Physiotherapy; Cardiology; Thoracic-abdominal rebalancing. TRIAL REGISTRATION:NTC 04631198.

Objetivos: Avaliar a segurança e eficácia da manobra de hiperinsuflação pulmonar com o ventilador mecânico em pacientes cardiopatas. Métodos: Trata-se de um ensaio clínico randomizado cruzado, onde foram incluídos 31 indivíduos, ventilados por mais de 48 horas, estáveis hemodinamicamente e foram exclusos indivíduos com diagnóstico de pneumonia associada ao ventilador, pneumotórax e hemotórax não drenado, enfisema subcutâneo, pressão de pico > 40 cmH2O, diagnóstico de doença neurológica recente (˂72h). No grupo controle, os pacientes eram ventilados por 1 minuto com fração inspirada de oxigênio (FiO2) a 100%, seguidos de três aspirações durante 15 segundos e com intervalo de 30 segundos. Nos participantes do momento intervenção, a pressão inspiratória foi aumentada a 10 cmH2O ou o volume foi aumentado 50% do volume corrente pelo período de 10 minutos e em seguida foi realizado uma nova aspiração da mesma maneira do grupo controle. Resultados: Os participantes tinham idade média de 71 anos, 58% eram mulheres. As variáveis hemodinâmicas não apresentaram alteração significativa no contexto clinico. Observou-se aumento das complacências estática (p=0,006) e dinâmica (p=0,013), e diminuição das pressões de pico (p=0,040) e platô (p=0,020). Conclusão: Aparentemente a técnica de hiperinsuflação pulmonar mecânica se mostrou segura para a remoção de secreção em pacientes cardiopatas.

BACKGROUND:Several preoperative pulmonary assessment protocols have been established over the years, but assessments of this magnitude are lacking in the bariatric population. Therefore, the assessment of lung capacity, maximum inspiratory and expiratory pressures, the peak expiratory flow and mobility can be predictors of operative safety and determine the time of hospital discharge. OBJECTIVE:To evaluate lung capacity, respiratory muscle strength and level of mobility in the pre, immediate post-operative and hospital discharge of patients undergoing bariatric surgery. METHODS:Cross-sectional study, with 38 bariatric patients undergoing surgical intervention. Anthropometric data, lung function, respiratory muscle strength and mobility level were evaluated pre-, post-operatively and at hospital discharge. Statistical Analysis: GEE; P<0.05. RESULTS:In relation to the preoperative period, in the POi there was a significant reduction in mobility, respiratory muscle strength, FVC, FEV1, PEF and a significant increase in these variables at hospital discharge, however, not reaching the same conditions as the preoperative period, except the Tiffeneau index (P<0.644). CONCLUSION:Bariatric surgery impacts the mobility, respiratory muscle strength and lung function of patients with grade II and III obesity, leading to longer hospital stays and possible major complications. The role of physiotherapy in the prevention and rehabilitation of these patients must be strongly considered.

Aim: This study aimed to investigate the acute effects of dietary nitrate ingestion through L-arginine supplementation or dehydrated beet consumption on endothelial function in chronic obstructive pulmonary disease (COPD) patients. The secondary outcome was to analyze arterial stiffness, plasma nitrate, and nitrate/protein concentration. Methods: In this randomized crossover study, subjects with COPD underwent three series of supplementation: (1) L-arginine, (2) dehydrated beetroot, and (3) a placebo that appeared like the other supplements. Each intervention lasted 14 days, with a 7-day washout period between series. Participants underwent endothelial function assessment using flow-mediated dilatation (FMD), and plasma nitrate levels were measured at the end of each supplementation series. Results: Seventeen subjects (twelve male) completed the study protocol. Only five subjects presented endothelial dysfunction (RHI <= 0.51) at baseline. The mean baseline characteristics included age 66.5 +/- 9.4 years, BMI 27.5 +/- 4.5 kg/m(2), FEV1, 0.79 (0.67-1.06) L. There were no differences (p > 0.05) between the groups or from pre-to post-interventions for RHI and arterial stiffness index (AIx) values, as well as parameters of endotheliumdependent vasodilation, such as blood flow velocity (BFV), shear stress, shear rate, FMD (mm), and FMD%. There was also no differences (p > 0.05) between the groups or from pre-to post-interventions plasma nitrate levels. Conclusions: Acute dietary supplementation with nitrates, at the doses provided, did not show a significant improvement in endothelial function assessed by FMD, EndoPAT, or plasma nitrate levels in COPD. These findings suggest that a higher dose or prolonged supplementation might be required to achieve a therapeutic effect.

CardioBreath is an application of slow deep breath for increasing cardiovascular performance in health and sports. Biological signals like spontaneous respiratory rate (SRR) are employed to prescribe slow respiratory exercises. Heart rate (HR) collected by the app is employed to track results. It aims to increase vagal modulation and decrease arterial pressure. The aim of this study is to verify the accuracy of CardioBreath data collection of SRR and HR. Following this, the evaluation of the cardiac vagal modulation evoked by the audiovisual lessons of slow breath of CardioBreath. Methods: Coherence of biological signals: Healthy individuals have been assessed using CardioBreath data collection of HR to compare their values simultanealy with those from Polar V 800, (ten sets each participant. SRR was collected by CardioBreath compared to visual counting (five sets). Pair wise t-test comparisons were performed in order to detect diferences between evaluations. Cardiac vagal modulation has been collected by Finometer and analyzed by Cardioseries, before (baseline evaluation) and after randomized audiovisual lessons of the CardioBreath App. These data will be analyzed by GEE (generalized estimation equation). All data are demonstrated as Mean (M) ± Standard deviation (SD) (p< 0,05) Partial Results: 50 healthy individuals participated of the first phase of the research, aged from 21 to 57 years old generating 460 analyzed pairs: HRApp 71.66 ± 11.68 bpm versus HRPolar 72.02 ± 13.24 bpm (p = 0.66). A total of 225 pairs have been analyzed for SRR: SRRApp 13.88 ± 4.63 cpm versus SRRvisual 13.82 ± 4.48 com (p = 0.44). Conclusions: The comparison of biological signals of CardioBreath App demonstrate that either HR and SRR are in coherence with data obtained by the Polar V 800 (HR) and visual method (SRR). New data of the autonomic responses of lessons of the CardioBreath App will be available in September. More on CardioBreath App at www.cardiobreath.com (only in Portuguese)

Background and Objectives: Perform the bag squeezing and PEEP-ZEEP techniques associated with manual chest compression in mechanically ventilated cardiac patients in order to observe their effectiveness in the removal of pulmonary secretions and safety from a hemodynamic and ventilatory point of view. Methods: This is a randomized crossover clinical trial developed in a hospital in southern Brazil. We included hemodynamically stable male and female patients aged over 18 years who used invasive mechanical ventilation for at least 48 h. The control group was established for the bag-squeezing technique and the intervention group for the PEEP-ZEEP maneuver, both associated with manual chest compression. Tracheal aspiration was performed 2 h before in order to match the groups in relation to the volume of secretion, and also immediately at the end of the techniques in order to measure the amount of secretion collected. Results: The sample had 36 individuals with a mean age of 70.3 years, 21% of the patients were male, and the majority (10.4%) were hospitalized for ischemic heart disease. DBP (p = 0.024), MAP (p = 0.004) and RR (p = 0.041) showed a significant difference in the post-moment in both groups. There was a significant difference in the reduction of peak pressure values (p = 0.011), in the moment after performing the techniques, and also in the Cdyn (p = 0.004) in the control group versus moment. Conclusions: Both maneuvers are safe in terms of hemodynamics and ventilatory mechanics, in addition to being capable of favoring airway clearance through secretion removal, and they can be used in routine physiotherapeutic care.

Objective: To evaluate the effects of cardiopulmonary rehabilitation on the functional capacity of post-COVID-19 individuals. Methods: Clinical trial, 7 patients participated in the study who tested positive for COVID-19. Participants underwent a 30-session rehabilitation program. They were evaluated using: Post COVID-19 Functional Scale (PCFS), inspiratory and expiratory muscle strength, 6-minute walk test (6MWT), 30-second sit-to-stand test (SE30’), hand grip (HG), VO2max, maximum HR, resting and reserve. Functional variables were analyzed using ANOVA for repeated measures and the Bonferroni multiple comparison test, considering a significance level of 5%. Results: The participants showed improvement in their functional status, with a decrease in the PCFS score (p=0.006), improvement in MIP (p=0.013), distance covered in the 6MWT (p=0.022), HGSR (p=0.005) and HGSL (p=0.009). In SE30’, they showed improvement in the intermediate (p=0.002) and final (p=0.046) assessments. Conclusions: The individuals demonstrated a decrease in functional limitations, improvement in functional capacity, inspiratory and lower limb muscle strength, handgrip strength after the 7th week of rehabilitation, with maintenance of the functional status being promoted until the end of the program. Implying the reestablishment of the global functional state of the pa-tients.

Introduction and objectives: Classifying elderly people with and without frailty referred to surgery can be a way to prevent, delay or even reverse the syndrome. To compare the clinical and functional profile of elderly people with and without frailty undergoing cardiac surgery. Methods: This is a cross-sectional study of an applied and comparative nature in patients over 60 years of age with advanced ischemic or valvular heart disease. Results: Frail elderly have lower hand grip strength (21.96±6.15), p=0.00; gait speed (5.44±1.53), p=0.04 and self-reported fatigue, with 7 (77.78%), p=0.00. Conclusion: Clinical variables are similar between groups. Handgrip strength, gait speed and self-reported fatigue may be more sensitive to detect frailty in the elderly. Possibly future studies with greater n bring significance to assess frailty or refer patients to prehabilitation before cardiac surgery.

Excess body weight has been associated with endothelial dysfunction and increased arterial stiffness. Foods rich in polyphenols and anthocyanins such as acai-jucara (Euterpe edulis Martius) fruit may have protective vascular effects. Thus, we examined the effect of dietary intake of anthocyanins (acai-jucara fruit) on endothelial function (flow-mediated dilation [FMD]) and arterial stiffness (pulse wave velocity [PWV]) in individuals with excess body weight. Fifty-five individuals with BMI >= 25 kg/m(2) were randomized into non-anthocyanin (N-ATH, n = 25) or anthocyanin (ATH, n = 30) intake groups. A 12-week individualized diet plan (20% reduction in total energy intake) was prescribed and included daily intake of acai-jucara 200 g (anthocyanins 293.6 mg) in the ATH diet plan. We evaluated anthropometric and biochemical parameters, FMD, PWV, and peripheral vascular resistance (PVR). A GEE (Bonferroni post-hoc) was used (p <= 0.05). No change in FMD was observed. However, PWV showed a reduction from baseline in the ATH (p = 0.002) and vs. N-ATH (p = 0.036). Both groups showed reduced peripheral vascular resistance (N-ATH, p = 0.005; ATH, p = 0.040) with no significant differences between them. In conclusion, dietary intake of anthocyanins proved effective in protecting against arterial stiffness (by PWV) in individuals with excess weight. PVR was reduced in both diet groups regardless of dietary intake of anthocyanins.

ABSTRACT Objective Anger may cause adverse cardiovascular responses, but the effects of anger management on clinical cardiovascular outcomes are insufficiently understood. We sought to assess the influence of anger management through a cognitive behavioral intervention on endothelial function in patients with a recent myocardial infarction (MI). Methods Patients with ST-elevation MI and a low anger control score were enrolled during hospitalization in a randomized, parallel, controlled clinical trial. Intervention was anger management with cognitive behavioral techniques implemented by a psychologist in two individual monthly sessions. The primary end point was the between-group difference in the variation of flow-mediated dilation (FMD) in the brachial artery from baseline to the 3-month follow-up. The second end point comprised major cardiovascular events at 24-month follow-up. Results A total of 43 patients (age = 56 [9] years; 23.3% women) were randomized to the intervention group and 47 patients (age = 58 [10] years; 19.1% women) to the control group. Baseline clinical characteristics were not statistically different between groups. Both groups showed a significant improvement in anger control from baseline to end point; however, the difference in intergroup variation was not statistically significant. The difference in FMD variation from baseline to the 3-month follow-up was significantly higher in the intervention group. The partial η 2 was 0.057 (p = .024), indicating a medium effect size. There was no difference between groups regarding major cardiovascular events. Conclusions Anger management by cognitive behavioral techniques may improve endothelial function in post-MI patients with low anger control, but it remains unclear via which mechanism these effects occurred. Further studies with larger numbers of patients, assessments of changes in anger, improved comparability of preintervention FMD, and longer follow-up are warranted. Trial Registration: ClinicalTrials.gov identifier: NCT02868216.

Background Cardiovascular diseases are the major cause of hospitalization. Dietary salt restriction is indicated as part of clinical treatment, however, it is not always well accepted by the patients, resulting in low food intake and malnutrition. Objective To compare acceptance of a low-sodium diet cooked with salt with a standard low-sodium diet in cardiac inpatients. Methods A randomized controlled crossover trial in patients with low-sodium diet prescriptions (Clinical Trials NCT03481322). Patients were given a control standard low sodium diet (cooked without salt; salt [2g per meal] added by the patient at the time of consumption) on one day and on the next day patients were given the intervention diet – a low sodium diet cooked with salt (2 grams of salt, divided between preparations). Dietary acceptance was evaluated by weighing leftover food and calculating intake. A questionnaire was used to verify reasons that influenced acceptance. For data analysis, parametric data are presented as mean and standard deviation, Student’s t test was used to compare means, with significance defined as p<0.05. Results Sixty-four patients were evaluated, with a mean age of 66 ± 11.3 years; 64% were male. There were no differences in percentage acceptance between the standard low-sodium diet and the low-sodium diet cooked with salt at lunch (p= 0.876) or at dinner (p= 0.255). Around 80% of what was offered at each meal was consumed by the patients, with no significant difference between groups. Conclusions The low-sodium diet cooked with salt was well accepted, but there was no difference when compared with the standard low-sodium diet, which also had adequate acceptance.

Background: Patients affected by COVID-19 may develop an impaired lung function, with reduced lung capacities and volumes, respiratory muscle weakness, changes in radiographic and tomographic findings, limitations in exercising, decreased functional capacity, depression, anxiety and reduced quality of life. Thus, we aimed to analyze the effects of a pulmonary and functional rehabilitation program on the functional capacity, lung function and respiratory muscle strength in patients who were affected by COVID-19 syndrome. Methods: This is a pilot clinical trial, composed of post-COVID-19 patients with mild, moderate or severe involvement, in which, they underwent a pulmonary and functional rehabilitation program. Patients were evaluated for functional capacity by the 6 min walk test, pulmonary function by spirometry, respiratory muscle strength by manovacuometry, handgrip strength by dynamometry, quality of life by the COPD Assessment Test and functional status by the PCFS. After the initial assessments, the patients performed the rehabilitation protocol in 16 sessions (inspiratory muscle training, aerobic exercise and peripheral muscle strength) and, at the end, they were evaluated again. Results: A total of 29 patients completed the program (12.7 ± 2.7 sessions). The functional capacity increased in meters walked from 326.3 ± 140.6 to 445.4 ± 151.1 (p < 0.001), with an increase in the predicted value from 59.7% to 82.6% (p < 0.001). The lung function increased in liters from 2.9 ± 0.8 to 3.2 ± 0.8 (p = 0.004) for forced vital capacity and from 2.5 ± 0.7 to 2.7 ± 0.7 (p = 0.001) for forced expiratory volume in the first second. The respiratory muscle strength increased in cmH2O from 101.4 ± 46.3 to 115.8 ± 38.3 (p = 0.117) for inspiratory pressure and from 85.8 ± 32.8 to 106.7 ± 36.8 (p < 0.001) for expiratory pressure. Conclusions: The pulmonary and functional rehabilitation program provided an improvement in the functional capacity, pulmonary function and respiratory muscle strength in post-COVID-19 patients, restoring their quality of life.

Background: Cardiac rehabilitation with aerobic exercises is the first strategy for nonpharmacological treatment in the postoperative period of individuals undergoing coronary artery bypass grafting (CABG) to improve functional capacity and vascular health. However, other exercise modalities remain uncertain regarding the same benefits. Objectives: Evaluation of the effect of different modalities of exercise, such as early cardiac rehabilitation on subjects submitted to CABG in the six-minute walk test (6-MWT) and on the percentage of flow-mediated dilatation (FMD) of the brachial artery. Methods: A randomized clinical trial in which 15 patients (62.7 ± 6.7 years) who underwent CABG were randomly assigned to the following groups: isometric (IG, Handgrip Jamar®), ventilatory muscle training (VG, PowerBreathe®) and control (CG, conventional respiratory and motor physiotherapy). All patients were attended to physically twice a day (20 min/session) for a consecutive week after the CABG (hospital admission). Functional capacity was assessed by 6-MWT and endothelial function was assessed through the technique of FMD, before and after (~7 days) admission to CABG. The doppler ultrasound videos were analyzed by Cardiovascular Suite® software (Quipu, Pisa, Italy) to measure %FMD. Statistics: Generalized estimation equation, followed by Bonferroni post hoc (p < 0.05). Results: Systolic, diastolic and mean arterial pressure (SBP/DBP/MAP, respectively) were 133, 76 and 95 mmHg. The groups presented walking meters (m) distance before and after intervention of: IGbasal 357.80 ± 47.15 m vs. IGpost 306.20 ± 61.63 m, p = 0.401 (+51 m); VGbasal 261.50 ± 19.91 m vs. VGpost 300.75 ± 26.29 m, p = 0.052 (+39 m); CG basal 487.83 ± 83.23 m vs. CGpost 318.00 ± 31.08, p = 0.006 (−169 m). %FMD before and after intervention was IGbasal 10.4 ± 4.8% vs. IGpost 2.8 ± 2.5%, p = 0.152; VGbasal 9.8 ± 5.1% vs. VGpost 11.0 ± 6.1%, p = 0.825; CGbasal 9.2 ± 15.8% vs. CGpost 2.7 ± 2.6%, p = 0.710 and resting mean basal blood flow was IGbasal 162.0 ± 55.0 mL/min vs. IGpost 129.9 ± 63.7 mL/min, p = 0.662; VGbasal 83.74 ± 12.4 mL/min vs. VGpost 58.7 ± 17.1 mL/min, p = 0.041; CGbasal 375.6 ± 183.7 mL/min vs. CGpost 192.8 ± 115.0 mL/min, p = 0.459. Conclusions: Ventilatory muscle training for early cardiac rehabilitation improved acute functional capacity and modulated mean flow of individuals undergoing CABG.

Introdução: Designada COVID-19 pela Organização Mundial da Saúde, a SARS-CoV-2 é um vírus que surgiu no final de 2019, na cidade de Wuhan, na China, que rapidamente se espalhou por todo o mundo. Paciente com COVID-19 podem apresentar sintomas leves que variam desde de tosse seca, dor de garganta, febre, fadiga, produção de catarro e dispneia, até consequências mais graves, levando o tratamento a uma Unidade de Terapia Intensiva. Os acometimentos mais graves atingem principalmente aqueles com mais de 65 anos ou com comorbidades como hipertensão, diabetes, asma, doença pulmonar obstrutiva crônica, insuficiência renal e câncer. Métodos e delineamento: Será realizado um ensaio clínico não randomizado com pacientes pós COVID-19 com acometimento moderado e grave, que serão avaliados por dinamometria, manovacuometria, espirometria, Timed Up And Go Test, teste de caminhada de 6 minutos e questionários COPD Assessment Test, Modified Medical Research Council e Post-COVID-19 Functional Status. O tratamento conta com alongamentos, exercícios aeróbicos, exercícios resistidos e treinamento da musculatura inspiratória. Discussão: A adição de treinamento da musculatura inspiratória, exercício aeróbico e exercícios resistidos podem melhorar a capacidade funcional do paciente pós COVID-19, através do aumento da distância percorrida no teste de caminhada de seis minutos e diminuição do tempo ao realizar o Timed Up And Go Test. Melhorar a força dos músculos respiratórios, com o aumento da pressão inspiratória máxima e pressão expiratória máxima; melhorar a função pulmonar, comprovada através da espirometria; aumento da força periférica, testada através da dinamometria; melhorar o status funcional destes indivíduos o que refletirá na sua qualidade de vida.

Introduction Manual hyperinflation (MHI) or with a mechanical ventilator (VHI) are alternatives in bronchial hygiene therapy, in recent years several studies have emerged with the objective of verifying the effectiveness and safety of the techniques. Objective Systematically review and analyze the most recent studies in the literature on MHI and VHI, compare both techniques and demonstrate their effectiveness in bronchial hygiene therapy in mechanically ventilated patients. Methods We conducted this systematic review based on the PICO strategy and used the databases Ovid, LILACS, CINAHL, Pubmed and CENTRAL. Search, selection and analysis of randomized controlled trials on MHI, VHI or comparing both techniques. We performed a comparison on secretion elimination, static and dynamic compliance, oxygenation and clinical outcomes. The studies were analyzed by two independent evaluators. Results Nine articles were selected comparing MHI with usual care, demonstrating improved compliance in the MHI group, but with no impact on secretion removal. Four studies compared VHI with usual care, with three showing increased secretion elimination and compliance in the HVM group. Another four articles compared MHI with VHI but none of the studies showed superiority in terms of elimination of secretion and three studies found improvement in static compliance. Conclusion Both techniques have proven to be effective alternatives to bronchial hygiene therapy.

Este estudo objetiva descrever o protocolo de um Ensaio Clínico Randomizado (ECR) (NCT 02868216), controlado, paralelo, por intenção de tratar, de intervenção de manejo da raiva na função endotelial de pacientes pós-infarto e baixo controle dessa emoção. A intervenção consistiu em dois encontros individuais de 40 minutos com frequência mensal. No grupo intervenção foram realizadas entrevistas semiestruturadas e focais baseadas na psicoeducação e técnicas cognitivo-comportamentais. A psicoeducação envolveu a caracterização da raiva e sua influência no sistema cardiovascular e ativação simpática. O treino de habilidades visou a identificação dos gatilhos e sinais de aviso. A técnica “time-out” foi empregada para recrutamento de forças para mudança de expressão. A tríade da raiva (pensamento, emoção e ação) foi trabalhada na reestruturação cognitiva para promover respostas adaptativas e manejo da emoção. Desta maneira, essa intervenção utiliza técnicas cognitivo-comportamentais para manejar a raiva e promover a melhoria da função vascular dos pacientes pós-infarto.