Background: Gastroplasty has been increasingly used in the treatment of morbidly obese patients, who typically present pronounced alterations in lung volume and capacity. Objective: To evaluate post-gastroplasty lung volume, lung capacity, respiratory muscle strength and respiratory pattern, as well as any postoperative pulmonary complications. Method: 21 patients (3 of them men), with an average age of 39 ± 9.7 years and an average body mass index of 50.4 kg/m2, all candidates for gastroplasty, were evaluated during the preoperative period and again on the first, third and fifth postoperative days. Tidal volume, vital capacity, minute volume, maximal expiratory pressure and maximal inspiratory pressure, as well as chest and waist circumferences, were measured. Postoperative pulmonary complications and mortality were assessed. Results: On the first and third postoperative days, respectively, there were drops of 47% and 30.5% in vital capacity, 18% and 12.5% in minute volume, 28% and 21% in tidal volume, 47% and 32% in the diaphragmatic index, 51% and 26% in maximal inspiratory pressure, and 39.5% and 26% in maximal expiratory pressure (p < 0.05). On the fifth postoperative day, all variables analyzed were higher than on the first postoperative day, indicating a linear increase, with only tidal volume, minute volume diaphragmatic index returning to preoperative values. The incidence of postoperative pulmonary complications was 4.7%, and there were no deaths. Conclusion: Patients submitted to gastroplasty present reduced pulmonary function, following a pattern quite similar to that previously observed following other types of upper abdominal surgery.

Keywords: Key words: Gastroplasty. Obesity. Respiratory function tests. Postoperative care.

Objective: To determine the intrarater and interrater reliability of cirtometry (measurements of the circumference of the chest and abdomen taken during respiratory movements) as well as its correlation with pulmonary volumes measured by respiratory inductive plethysmography. Methods: A total of 40 healthy individuals were evaluated. The mean age was 28 years. The measurements were taken in the supine position at three different time points: at rest, at maximal inspiration, and at maximal expiration. Two trained investigators, each of whom was blinded as to the results obtained by the other, performed the measurements. The Friedman test was used to determine intrarater reliability, and the Wilcoxon test, together with the intraclass correlation coefficient, were used to determine interrater reliability. The correlation between the cirtometry measurements and the plethysmography results was obtained using Spearman's correlation coefficient. The level of significance was set at 0.05 for all tests. Results: Intrarater reliability was satisfactory. Regarding interrater reliability, statistically significant differences (2.8 cm at the most) were found in all sets of measurements. However, through the analysis of the intraclass correlation coefficient, the investigators were found to be responsible only for a small portion of the variability (1.2-5.08%) found among the measurements. When the cirtometry measurements were compared to the volumes measured by respiratory inductive plethysmography, low correlations (range, r = 0.170-0.343) were found. Conclusions: The findings of this study suggest that, although cirtometry is a reliable measurement, it does not accurately measure pulmonary volumes.

Keywords: Reproducibility of results; Lung volume measurements; Plethysmography; Statistics, nonparametric.

Objective: To analyze the role that low income plays in the development of asthma in children and adolescents. Methods: A case-control study using a questionnaire. Results: A total of 687 participants were studied at a tertiary hospital via the Brazilian Unified Health System. Ages ranged from 5 to 15 years, and 54.7% of the participants were male. Nearly half of the individuals (49.1%) lived in the metropolitan area of the city of Recife, and the remainder lived in the countryside. Most (98.1%) lived in concrete houses or apartments, with a mean of 5.7 rooms and 4.8 occupants per residence. Mean maternal level of education was 6.8 years of schooling. The median monthly per capita income was R$ 103.75 (Brazilian reals). The sample was stratified according to cut-off points related to the national minimum wage (R$ 350.00): <25% of minimum wage = very low income (39% of the sample); <50% of minimum wage = low income (37.3% of the sample); and ≥50% of minimum wage = satisfactory income (23.7% of the sample). There was no association between poverty and development of asthma. Conclusions: Poverty is not protective against asthma in children and adolescents treated via the Brazilian Unified Health System, as we might suppose based on the hygiene hypothesis. However, cohort studies are needed in order to confirm these findings.

Keywords: Asthma; Poverty; National health programs/Brazil; Child; Adolescent; Case-control studies.

Objective: To describe our experience with video-assisted thoracic surgery (VATS) for anatomic pulmonary resection at a referral center for thoracic surgery in Brazil. Methods: All patients who underwent anatomic pulmonary resection by VATS between 2010 and 2015 were included. Clinical and pathological data, as well as postoperative complications, were analyzed. Results: A total of 117 pulmonary resections by VATS were performed, of which 98 were lobectomies and 19 were anatomic segmentectomies. The mean age of the patients was 63.6 years (range, 15-86 years). Females predominated (n = 69; 59%). The mean time to chest tube removal was 2.47 days, and the mean length of ICU stay was 1.88 days. The mean length of hospital stay was 4.48 days. Bleeding ≥ 400 mL occurred in 15 patients. Conversion to thoracotomy was required in 4 patients. Conclusions: Our results are similar to those published in major international studies, indicating that VATS is an important strategy for pulmonary resection. They also show that VATS can be safely performed with adequate training. This technique should be used more often for the treatment of lung diseases in Brazil.

Keywords: Lung neoplasms/therapy; Lung neoplasms/complications; Thoracic surgery, video-assisted.

Objective: This study aimed to describe the outcomes and explore predictors of intubation and mortality in patients with ARDS due to COVID-19 treated with CPAP delivered via a helmet interface and light sedation. Methods: This was a retrospective cohort study involving patients with COVID-19-related ARDS who received CPAP using a helmet developed in Brazil (ELMOT), associated with a light sedation protocol in a pulmonology ward. Demographic, clinical, imaging, and laboratory data, as well as the duration and response to the ELMO-CPAP sessions, were analyzed. Results: The sample comprised 180 patients. The intubation avoidance rate was 72.8%. The lack of necessity for intubation was positively correlated with younger age, > 24-h continuous HELMET-CPAP use in the first session, < 75% pulmonary involvement on CT, and ROX index > 4.88 in the second hour. The overall in-hospital mortality rate was 18.9%, whereas those in the nonintubated and intubated groups were 3.0% and 61.2%, respectively. Advanced age increased the mortality risk by 2.8 times, escalating to 13 times post-intubation. Conclusions: ELMO-CPAP with light sedation in a pulmonology ward was successful in > 70% of patients with moderate to severe ARDS due to COVID-19. Younger age, pulmonary involvement, ROX index, and prolonged first Helmet-CPAP session duration were associated with no need for intubation. Older age and intubation are associated with mortality.

Keywords: Respiratory distress syndrome; COVID-19; Continuous positive airway pressure; helmets ; Dexmedetomidine.