JULIANA ARAUJO NASCIMENTO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina
9 resultados
Resultados de Busca
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bookPart Fisioterapia nas Disfunções Cardiovasculares(2015) NASCIMENTO, Juliana Araújo; KAWAUCHI, Tatiana Satie; NAKAO, Mayumi; AIKAWA, Priscila; NAKAGAWA, Naomi Kondo- Humidification and mucus transport in critical patients: Clinical and therapeutic implications(2012) NAKAGAWA, N. K.; NASCIMENTO, J. A.; NICOLA, M. L.; SALDIVA, P. H. N.An adult man inhales more than 12,000 l of air per day, which may contain particles and microorganisms. The epithelium of the conducting airways, from the nose to the bronchioli, are anatomically and physiologically designed to protect the alveoli by providing clean, warmed and fully saturated air at this level, where an efficient gas exchange must occur, and by providing specific defense mechanisms, such as trapping particles and microorganisms in the mucus and mucociliary transport of these agents in the direction of the oropharynx, where they will be swallowed or expectorated. Mucociliary transport (MCT) is an important respiratory defense mechanism, which efficiency depends on the equilibrium among three major components: ciliary beating, airway surface liquid (the periciliary liquid and mucus), and the interaction between cilia and mucus. In the intensive care unit (ICU) and emergency department, many factors can increase the risks of mucus transport dysfunction. Among them, artificial inspired air conditioning is a basic factor with physiological and clinical impact in critically ill patients. © Springer-Verlag Berlin Heidelberg 2012.
- Predictors of oronasal breathing among obstructive sleep apnea patients and controls(2019) NASCIMENTO, Juliana A.; GENTA, Pedro R.; FERNANDES, Paulo H. S.; BARROSO, Lucia P.; CARVALHO, Tomas S.; MORIYA, Henrique T.; MADEIRO, Fernanda; LORENZI-FILHO, Geraldo; NAKAGAWA, Naomi KondoOronasal breathing may adversely impact obstructive sleep apnea (OSA) patients either by increasing upper airway collapsibility or by influencing continuous positive airway pressure (CPAP) treatment outcomes. Predicting a preferential breathing route would be helpful to guide CPAP interface prescription. We hypothesized that anthropometric measurements but not self-reported oronasal breathing are predictors of objectively measured oronasal breathing. Seventeen OSA patients and nine healthy subjects underwent overnight polysomnography with an oronasal mask with two sealed compartments attached to independent pneumotacographs. Subjects answered questionnaires about nasal symptoms and perceived breathing route. Oronasal breathing was more common (P = <0.001) among OSA patients than controls while awake (62 +/- 44 vs. 5 +/- 6%) and during sleep (59 +/- 39 vs. 25 +/- 21%, respectively). Oronasal breathing was associated with OSA severity (P = 0.009), age (P = 0.005), body mass index (P = 0.044), and neck circumference (P = 0.004). There was no agreement between objective measurement and self-reported breathing route among OSA patients while awake (kappa = -0.12) and asleep (kappa = -0.02). The breathing route remained unchanged after 92% of obstructive apneas. These results suggest that oronasal breathing is more common among OSA patients than controls during both wakefulness and sleep and is associated with OSA severity and anthropometric measures. Self-reporting is not a reliable predictor of oronasal breathing and should not be considered an indication for oronasal CPAP. NEW & NOTEWORTHY Continuous positive airway pressure (CPAP) interface choice for obstructive sleep apnea (OSA) patients is often guided by nasal symptoms and self-reported breathing route. We showed that oronasal breathing can be predicted by anthropometric measurements and OSA severity but not by self-reported oronasal breathing. Self-reported breathing and nasal symptoms should not be considered for CPAP interface choice.
- Risk Factors for Inspiratory Muscle Weakness in Chronic Heart Failure(2020) NAKAGAWA, Naomi Kondo; DIZ, Mariana Abreu; KAWAUCHI, Tatiana Satie; ANDRADE, Geisa Nascimento de; UMEDA, Iracema Ioco Kikuchi; MURAKAMI, Fernanda Murata; OLIVEIRA-MAUL, Janaina Proenca; NASCIMENTO, Juliana Araujo; NUNES, Newton; TAKADA, Julio Yoshio; MANSUR, Antonio de Padua; CAHALIN, Lawrence PatrickBACKGROUND: Chronic heart failure is commonly associated with inspiratory muscle weakness. However, few studies have investigated the risk factors for inspiratory muscle weakness in individuals with chronic heart failure and systolic dysfunction (left-ventricular ejection fraction [LVEF] <40%). METHODS: Seventy subjects were recruited in a cardiac center. We assessed clinical parameters, smoking history, peripheral muscle strength, pulmonary function, echocardiographic variables, and brain natriuretic peptide. The subjects were classified with inspiratory muscle weakness when the maximum inspiratory pressure was <70% of predicted values. RESULTS: Thirty-six subjects (51%) had inspiratory muscle weakness. The subjects with inspiratory muscle weakness and the subjects with no inspiratory muscle weakness were similar in age, sex, body mass index, medication use, and physical activity. However, the subjects with inspiratory muscle weakness had lower LVEF (P = .003), systolic blood pressure (P = .01), diastolic blood pressure (P = .042), quadriceps muscle strength (P = .02), lung function (P = .035), increased brain natriuretic peptide (P = .02), smoking history (P = .01), and pulmonary hypertension incidence (P = .03). Multivariate logistic regression analysis found a lower LVEF, increased smoking history, and lower systolic blood pressure as significant independent predictors for inspiratory muscle weakness. CONCLUSIONS: The combination of lower LVEF, lower systolic blood pressure, and smoking history predicted inspiratory muscle weakness. Patients with suspected inspiratory muscle weakness should be examined and, if inspiratory muscle weakness exists, then inspiratory muscle training should be provided. Reducing inspiratory muscle weakness has the potential to improve many of the deleterious effects of chronic heart failure.
- Prolonged heart rate recovery time after 6-minute walk test is an independent risk factor for cardiac events in heart failure: A prospective cohort study(2022) ANDRADE, G. N.; RODRIGUES, T.; TAKADA, J. Y.; BRAGA, L. M.; UMEDA, I. I. K.; NASCIMENTO, J. A.; PEREIRA-FILHO, H. G.; GRUPI, C. J.; SALEMI, V. M. C.; JACOB-FILHO, W.; CAHALIN, L. P.; MANSUR, A. P.; BOCCHI, E. A.; NAKAGAWA, N. K.Objectives To determine whether the time for peak exercise heart rate to return to resting heart rate after the 6-minute walk test (6MWT) can predict cardiac events in patients with heart failure (HF) within 2 years.& nbsp;Design Prospective cohort study.& nbsp;Setting HF outpatient facility at a tertiary teaching hospital.& nbsp;Participants Seventy-six patients with HF, New York Heart Association functional classification II and III, and left ventricular ejection fraction < 50%.& nbsp;Main outcome measures Patients used a heart rate monitor to measure the time for peak exercise heart rate to return to resting heart rate after the 6MWT. Data were analysed using Polar Pro-Trainer 5 software (Kempele, Finland). Patients were followed for > 2 years for cardiac events (hospitalisations and death).& nbsp;Results Thirty-four patients had cardiac events during the 2-year follow-up period. However, there was a significant difference in the time to return to resting heart rate between the groups with and without cardiac events {with 3.6 (SD 1.1) vs without 2.8 (SD 1.1) minutes; mean difference of 0.79 (95% confidence interval (CI) of the difference 0.28 to 1.28; P = 0.003}. No significant differences between patients with and without cardiac events were found for mean walking distance, mean heart rate recovery at 1 minute and mean heart rate recovery at 2 minutes. The receiver operating curve discriminated between patients with and without cardiac events (area under the curve 0.71, 95% CI 0.61 to 0.81; P < 0.001). Using logistic regression analysis, prolonged time to return to resting heart rate (>= 3 minutes) independently increased the risk for cardiac events 6.9-fold (95% CI 2.34 to 20.12; P < 0.001). The Kaplan-Meier curve showed more cardiac events in patients with prolonged time to return to resting heart rate (P = 0.028).& nbsp;Conclusions Prolonged time to return to resting heart rate (>= 3 minutes) after the 6MWT was an independent predictor of cardiac events in patients with HF. (C)& nbsp;2021 Chartered Society of Physiotherapy.
- Validation of the Portuguese Version of the Kansas City Cardiomyopathy Questionnaire-12(2023) REIS, Mariane Cecilia dos; NASCIMENTO, Juliana Araujo; ANDRADE, Geisa Nascimento de; COSTA, Ana Claudia de Souza; TAKADA, Julio Yoshio; MANSUR, Antonio de Padua; BOCCHI, Edimar Alcides; SANTOS, Gianni Mara Silva dos; SPERTUS, John A.; NAKAGAWA, Naomi KondoThe Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) is a simple, feasible, and sensitive questionnaire developed in English for assessing the health status (symptoms, function, and quality of life) of patients with heart failure (HF). We aimed to assess the internal consistency and construct validity of the Portuguese version of KCCQ-12. We administered the KCCQ-12, the Minnesota Living Heart Failure (MLHFQ), and the New York Heart Association (NYHA) classification by telephone. Internal consistency was assessed with Cronbach's Alpha (alpha-Cronbach) and construct validity with correlations to the MLHFQ and NYHA. Internal consistency was high (alpha-Cronbach = 0.92 for the Overall Summary score and 0.77-0.85 for the subdomains). Construct validity was supported by finding high correlations between the KCCQ-12 Physical Limitation and the Symptom Frequency domains with the physical domain of the MLHFQ (r = -0.70 and r = -0.76, p < 0.001 for both) and the Overall Summary scale with NYHA classifications (r = -0.72, p < 0.001). The Portuguese version of KCCQ-12 has high internal consistency and shows a convergent construct validity with other measures quantifying the health status of patients with chronic HF and can be used confidently in Brazil for research and clinical care.
- Nasal vs Oronasal CPAP for OSA Treatment A Meta-Analysis(2018) ANDRADE, Rafaela G. S.; VIANA, Fernanda M.; NASCIMENTO, Juliana A.; DRAGER, Luciano F.; MOFFA, Adriano; BRUNONI, Andre R.; GENTA, Pedro R.; LORENZI-FILHO, GeraldoBACKGROUND: Nasal CPAP is the ""gold standard"" treatment for OSA. However, oronasal masks are frequently used in clinical practice. The aim of this study was to perform a meta-analysis of all randomized and nonrandomized trials that compared nasal vs oronasal masks on CPAP level, residual apnea-hypopnea index (AHI), and CPAP adherence to treat OSA. METHODS: The Cochrane Central Register of Controlled Trials, Medline, and Web of Science were searched for relevant studies in any language with the following terms: ""sleep apnea"" and ""CPAP"" or ""sleep apnea"" and ""oronasal mask"" or ""OSA"" and ""oronasal CPAP"" or ""oronasal mask"" and ""adherence."" Studies on CPAP treatment for OSA were included, based on the following criteria: (1) original article; (2) randomized or nonrandomized trials; and (3) comparison between nasal and oronasal CPAP including pressure level, and/or residual AHI, and/or CPAP adherence. RESULTS: We identified five randomized and eight nonrandomized trials (4,563 patients) that reported CPAP level and/or residual AHI and/or CPAP adherence. Overall, the random-effects meta-analysis revealed that as compared with nasal, oronasal masks were associated with a significantly higher CPAP level (Hedges' g, -0.59; 95% CI, -0.82 to -0.37; P < .001) (on average, +1.5 cm H2O), higher residual AHI (Hedges' g, -0.34; 95% CI, -0.52 to -0.17; P < .001) (+2.8 events/h), and a poorer adherence (Hedges' g, 0.50; 95% CI, 0.21-0.79; P = .001) (-48 min/night). CONCLUSIONS: Oronasal masks are associated with a higher CPAP level, higher residual AHI, and poorer adherence than nasal masks.
- Body Position May Influence Oronasal CPAP Effectiveness to Treat OSA(2016) NASCIMENTO, Juliana Araujo; CARVALHO, Tomas de Santana; MORIYA, Henrique Takachi; FERNANDES, Henrique Sousa; ANDRADE, Rafaela Garcia Santos de; GENTA, Pedro Rodrigues; LORENZI-FILHO, Geraldo; NAKAGAWA, Naomi KondoCPAP applied by a nasal mask is the gold standard treatment of obstructive sleep apnea. Oronasal masks are an alternative interface that can be used, especially in subjects with predominant oral breathing. However, oronasal masks have higher costs, are associated with larger leaks and higher residual apnea-hypopnea index, and in some cases may be ineffective.
- O impacto do tipo de máscara na eficácia e na adesão ao tratamento com pressão positiva contínua nas vias aéreas da apneia obstrutiva do sono(2014) ANDRADE, Rafaela Garcia Santos de; PICCIN, Vivien Schmeling; NASCIMENTO, Juliana Araujo; VIANA, Fernanda Vladeiro Leite; GENTA, Pedro Rodrigues; LORENZI-FILHO, GeraldoContinuous positive airway pressure (CPAP) is the gold standard for the treatment of obstructive sleep apnea (USA). Although CPAP was originally applied with a nasal mask, various interfaces are currently available. This study reviews theoretical concepts and questions the premise that all types of interfaces produce similar results. We revised the evidence in the literature about the impact that the type of CPAP interface has on the effectiveness of and adherence to USA treatment. We searched the PubMed database using the search terms ""CPAP"", ""mask"", and ""obstructive sleep apnea"". Although we identified 91 studies, only 12 described the impact of the type of CPAP interface on treatment effectiveness (n = 6) or adherence (n = 6). Despite conflicting results, we found no consistent evidence that nasal pillows and oral masks alter USA treatment effectiveness or adherence, in contrast, most studies showed that oronasal masks are less effective and are more often associated with lower adherence and higher CPAP abandonment than are nasal masks. We concluded that oronasal masks can compromise CPAP USA treatment adherence and effectiveness. Further studies are needed in order to understand the exact mechanisms involved in this effect.