QUE FAZ CRESCER O PULMÃO?

Dr. Paulo Gurgel Fortaleza - Brasil

Espirometria do mês Caso 2
• • • • • • NPL, sexo feminino, 15 anos Tosse + expectoração purulenta, crônicas Não fumante Diagnóstico: bronquiectasia multissegmentar 2003: lingulectomia (LSE) + piramidectomia (LIE) 2004: lobectomia (LMD) + segmentectomia anterior (LSD) + segmentectomias medial e anterior (LID) • Indicação da espirometria: avaliação pós-operatória

Radiografia de tórax em 2005
(após ressecção de 10 segmentos pulmonares)

10 – 5 = 5

8–5=3

18 – 10 = 8

ESPIROMETRIA FORÇADA
16/02/05
Parâmetro CVF (L) VEF1 (L) VEF1/CVF FEF25-75/CVF Previsto 3,75 3,38 0,90 1,06 LIN 3,26 2,94 (90%) (60%) Pré-BD (% Previsto) 2,53 (67%) 2,20 (65%) 0,87 (96%) 0,95 (89%) Pós-BD (% Previsto) 2,51 (67%) 2,34 (69%) 0,93 (103%) 1,17 (110%) Pré-BD – Pós-BD -0,02 0,14 (4%)

Laudo – Distúrbio ventilatório restritivo em grau leve. Sem variação significativa após BD, demonstrável no momento do exame.

ESPIROMETRIAS FORÇADAS
22/05/03 e 16/02/05

Parâmetro CVF (L) VEF1 (L) VEF1/CVF FEF25-75/CVF PFE (L)

Inicial (2003) 2,62 2,37 0,90 1,38 5,13

Atual (2005) 2,53 2,20 0,87 0,95 4,98

Why Doesn't Exercise Grow the Lungs When Other Factors Do?

Peter D. Wagner [Exerc Sport Sci Rev 33(1):3-8, 2004. © 2004 American College of Sports Medicine]

Abstract
Exercise training enhances every component of the O2 transport and metabolic system— except the lungs. Consequently, the lungs can contribute to the limitation of VO2max. Only hypoxia early in life and substantial lung resection reproducibly stimulate growth in normal lungs across species. Possible pathways involve genes activated by hypoxia or mechanical strain, or both, including growth factors, hormones, nitric oxide, and retinoids.

Conceptual diagram to show O2 pumped from the lungs by the heart through the circulation to the muscles. This is an in-series system (arrows) in which each component has a characteristic conductance for O2 indicated by the diameter of the "tube" in each case. The figure shows that muscle training improves the conductance of all components except the lungs (changes not to scale). This makes the lungs a potentially significant contributor to exercise limitation.

Postpneumonectomy Lung Growth
1. 2. 3. 4. Growth does not measurably occur until approximately 50% or more of the lung has been removed. Growth is reflected by structural as well as functional enhancement in the remaining lungs (slide 9) Growth occurs at the alveolar level, and not at the conducting airway or blood vessel level. If compensatory hyperinflation in the remaining lung is prevented by replacing the removed lobes by an inert gas-filled balloon, growth does not occur to nearly the same degree (slide 10)

Effects of pneumonectomy on exercise performance and arterial oxygenation in dogs. Two months after surgery ), limitation is severe ; 10 months later, oxygenation and exercise capacity are improved , to within 85% of normal , reflecting regenerative lung growth. (Reprinted from Hsia, C.C.W., L.F. Herazo, M. Ramanathan, R.L. Johnson, Jr., and P.D. Wagner.Cardiopulmonary adaptations to pneumonectomy in dogs II. VA/Q relationships and microvascular recruitment. J. Appl. Physiol. 74:1299 –1309, 1993. Copyright © 1993 American Physiological Society. Used with permission.)

Prevention of lung expansion (and subsequent regenerative lung growth after pneumonectomy) in foxhounds causes impaired arterial oxygenation and exercise capacity . Pneumonectomized animals in which lung growth was permitted show partial recovery (both data approximately 7 months after surgery). (Reprinted from Hsia, C.C.W., R.L. Johnson, E.Y. Wu, A.S. Estrera, H. Wagner, and P.D. Wagner. Reducing lung strain after pneumonectomy impairs oxygen diffusing capacity but not ventilation-perfusion matching. J. Appl. Physiol. 95:1370 –1378, 2003. Copyright © 2003 American Physiological Society. Used with permission

O PENSADOR (Auguste Rodin)

Respiração basal sexo masculino, 30 anos, 175 cm
CV = 5 L VEF1 = 4,2 L Volume minuto = volume corrente x freqüência = 0,5 L x 15 = 7,5 L/min

Respiração em esforço máximo segundo a espirometria
VVM = VEF1 x 37,5 + 15,8 = 4,2 L x 37,5 + 15,8 = 173,3 L/min (23 x) LIN = VVM - 26 = 147,3 L/min (19 x)

Respiração em esforço máximo segundo o TECP
50 – 60% CV x 50 – 60 ciclos 3,0 x 60 = 180 L/min 2,5 x 50 = 125 L/min = 180 – 125 L/min (24 – 17 x)

Comparando...
Débito cardíaco = volume de ejeção sistólica x frequência = 5 – 6 L/min em repouso

= 20 – 25 L/min em esforço máximo (4x)

GRATO PELA ATENÇÃO
pgcs@ig.com.br http://blogdopg.blogspot.com