Diaphragmatic Ultrasonography in Preterm Newborns With Respiratory Distress Syndrome on Invasive Mechanical Ventilation: An Observational Study Cleuma Oliveira Soares, Caroline Almeida Campbell, Mariana Souza Azevedo Moura, Rodrigo Santiago Barbosa Rocha Journal of Paediatrics and Child Health, 2025 AimIn preterm newborns, Respiratory Distress Syndrome (RDS) is one of the leading causes of mortality. Treatment often requires invasive mechanical ventilation (IMV), which can cause diaphragmatic dysfunction. Ultrasonography is a promising tool for assessing diaphragmatic function in neonates. This study analyses changes in the diaphragm muscle of preterm newborns with RDS undergoing IMV.MethodsA longitudinal study was conducted with preterm newborns diagnosed with RDS and subjected to IMV. Clinical data were collected, and ultrasonographic evaluations of diaphragm thickness and diaphragmatic thickening fraction (DTF) were performed at two time points: within the first 48 h of life and up to 48 h after extubation.ResultsThere was a significant reduction in diaphragmatic thickness (p < 0.0001), DTF index (p = 0.01), and diaphragmatic excursion (p = 0.02) during the intubation period. A moderate correlation was observed between DTF and IMV duration (R = 0.62), hospitalisation time (R = 0.52), and the risk of reintubation (R = 0.55). A moderate correlation was also identified between IMV duration and hospitalisation time (R = 0.64) and between diaphragmatic thickness and gestational age (R = 0.58). However, the correlation between DTF and gestational age was weak (R = 0.48).ConclusionIMV leads to diaphragmatic deterioration with increased muscle atrophy in preterm newborns with respiratory distress syndrome.
Lung Ultrasound as a Tool for Analysis of Ventilation in Children With Respiratory Failure Ana Caroline Dos Santos Calandrini, Emmerson Carlos Franco De Farias, Mary Lucy Ferraz Maia, Katiane Da Costa Cunha, Rodrigo Santiago Barbosa Rocha Journal of Clinical Ultrasound, 2025 ObjectiveTo describe lung ultrasound findings in children with respiratory failure on invasive mechanical ventilation (MV).MethodThis is a longitudinal, observational, quantitative study conducted in the pediatric intensive care unit. Children with respiratory distress syndrome, aged between 6 months and 7 years, on invasive MV were included in the study. Lung ultrasound was performed using the BLUE protocol in the first 48 h of hospitalization and during ventilatory weaning.ResultsSeventeen patients who presented a significant reduction in A lines were included in the study. B lines showed worsening, indicating possible pulmonary complications. The decrease in pleural sliding from 14 to 3 (p = 0.04) and in the bat sign from 10 to 5 (p = 0.002) was statistically significant. The stratospheric sign showed a favorable trend (reduction from 3 to 0), but the p value of 0.08 was not significant. There was a moderate negative correlation between MV time and A lines, while a moderate positive correlation was observed between MV time and A lines. Furthermore, a moderate negative correlation between MV time and bat sign was also significant.ConclusionIt is indicated that bedside lung ultrasound is a valuable tool for monitoring and management of children on invasive MV, allowing the follow‐up of critical pediatric patients during the hospitalization period.
Can walking capacity predict respiratory functions of people with Parkinson’s disease? Lucas Meireles Matos, Francisca Maria de Araujo Oliveira, Rodrigo Santiago Barbosa Rocha, Aline da Silva Pimentel, Laura Maria Tomazi Neves, et al. Frontiers in Neurology, 2025 IntroductionPeople with Parkinson’s Disease (PwPD) and an impaired respiratory profile show a lower walking ability. Still, it is unknown if there is a relationship between walking ability and respiratory function that can be used to predict the latter. This cross-sectional study evaluated the relationship between walking ability and respiratory function in PwPD.MethodsSeventeen older PwPD, between 60 and 80 years old were asked to perform a 10-m walking test at self-selected, fast speed, and respiratory tests and these variables analyzed by an multiple linear regression.ResultsThe respiratory profile revealed that 44% of the patients were restrictive, 33% were obstructive, and 22% were mixed. 73% of the PwPD presented a low lung capacity, as demonstrated by the forced expiratory volume in 1 s divided by the forced vital capacity (FEV1/FVC). Multiple linear regression demonstrated that self-selected walking speed explained 53 and 58% (p = 0.027 and p = 0.016) of the variation in maximal inspiratory and expiratory pressures, respectively. The fast walking speed explained 62 and 66% (p = 0.008 and p = 0.005) of the maximal inspiratory and expiratory pressure variation, respectively. Furthermore, the locomotor rehabilitation index explained 39% (p = 0.022) of the variance in the FEV1/FVC.ConclusionThese results suggest that walking ability, particularly at self-selected and fast speeds, is a suitable screening parameter for pulmonary impairments in PwPD. Furthermore, the locomotor rehabilitation index indicates the ability to expire rapidly as a proportion of forced vital capacity in PwPD. Thus, the walking ability test can be an easily applicable and low-cost biomarker for assessing respiratory changes in PwPD.
Physical Exercise Affects Quality of Life and Cardiac Autonomic Modulation in Patients With Chronic Kidney Failure Submitted to Hemodialysis: A Randomized Clinical Trial Ana Beatriz Nunes Pereira, Larissa Lopes Santana, Letícia De Barros Rocha, Katiane Da Costa Cunha, Larissa Salgado De Oliveira Rocha, et al. Perceptual and Motor Skills, 2022 Performing physical exercise during hemodialysis has been debated regarding safety and efficacy for improving life quality for patients with chronic kidney disease (CKD). Thus, we explored the influence of physical exercise during hemodialysis on both autonomic modulation of heart rate and quality of life for patients with CKF in a randomized clinical trial. We randomly allocated participants requiring hemodialysis to an experimental exercise group (EG) and a control no-exercise group (CG) and assessed their quality of life with the Kidney Disease Quality of Life Short Form—KDQOL-SF™ 1.3 and with Polar RS800CX to monitor their heart rate variability (HRV) before and three months after the end of the exercise intervention. EG participants reported a significant increase in their quality of life ( p = .05, physical function, physical aspects, pain, emotional well-being, emotional function; p = .03, energy and fatigue) and showed HRV improvement ( p = .05, RMSSD, SDNN, and SD2; p = .004, SD1) after three months of exercise. Thus, we recommend supervised physical exercise during hemodialysis for carefully selected patients.
Reduction of Cardiac Autonomic Modulation and Increased Sympathetic Activity by Heart Rate Variability in Patients With Long COVID Karina Carvalho Marques, Camilla Costa Silva, Steffany da Silva Trindade, Márcio Clementino de Souza Santos, Rodrigo Santiago Barbosa Rocha, et al. Frontiers in Cardiovascular Medicine, 2022 Although several clinical manifestations of persistent long coronavirus disease (COVID-19) have been documented, their effects on the cardiovascular and autonomic nervous system over the long term remain unclear. Thus, we examined the presence of alterations in cardiac autonomic functioning in individuals with long-term manifestations. The study was conducted from October 2020 to May 2021, and an autonomic assessment was performed to collect heart rate data for the heart rate variability (HRV) analysis. The study participants were divided into the long COVID clinical group, the intragroup, which included patients who were hospitalized, and those who were not hospitalized and were symptomatic for different periods (≤3, &gt;3, ≤6, and &gt;6 months), with and without dyspnoea. The control group, the intergroup, comprised of COVID-free individuals. Our results demonstrated that the long COVID clinical group showed reduced HRV compared with the COVID-19-uninfected control group. Patients aged 23–59 years developed COVID symptoms within 30 days after infection, whose diagnosis was confirmed by serologic or reverse-transcription polymerase chain reaction (swab) tests, were included in the study. A total of 155 patients with long COVID [95 women (61.29%), mean age 43.88 ± 10.88 years and 60 men (38.71%), mean age 43.93 ± 10.11 years] and 94 controls [61 women (64.89%), mean age 40.83 ± 6.31 and 33 men (35.11%), mean age 40.69 ± 6.35 years] were included. The intragroup and intergroup comparisons revealed a reduction in global HRV, increased sympathetic modulation influence, and a decrease in parasympathetic modulation in long COVID. The intragroup showed normal sympathovagal balance, while the intergroup showed reduced sympathovagal balance. Our findings indicate that long COVID leads to sympathetic excitation influence and parasympathetic reduction. The excitation can increase the heart rate and blood pressure and predispose to cardiovascular complications. Short-term HRV analysis showed good reproducibility to verify the cardiac autonomic involvement.
Effectiveness of Different Physiotherapy Protocols in Children in the Intensive Care Unit: A Randomized Clinical Trial Gabrielle Sousa Barros Souza, Mariana Furtado Marques Novais, Guilherme Euzébio Lemes, Mary Lucy Ferraz Maia Fiuza de Mello, Susan Carolina Diniz de Sales, et al. Pediatric Physical Therapy, 2022 Purpose:This study aimed to investigate the effectiveness of different physical therapy protocols on the autonomic modulation of heart rate, time of invasive mechanical ventilation (IMV), and length of hospital stay.Methods:This was a randomized clinical study with 20 children on IMV in an intensive care unit (ICU), between July 2018 and September 2019. The control group (n = 10) performed the hospital's physical therapy protocol and the experimental group (n = 10) performed the physical therapy protocol based on physical exercise.Results:Higher values of heart rate variability were found in the experimental group, both in individual and intergroup analyses. There was a significant reduction in the time of IMV and ICU stay.Conclusion:There was an improvement in heart rate variability, reduced time on mechanical ventilation and length of stay in the ICU in individuals who performed the study protocol.