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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

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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

Valores de Referência; Força Muscular; Testes de Função Respiratória; Músculos Respiratórios.

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

Reference values; Muscle strength; Respiratory function tests; Respiratory muscle.

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