Manobra expiratÃria forÃada em crianÃas prÃ-escolares: aplicaÃÃo de critÃrios de aceitaÃÃo e reprodutibilidade

AUTOR(ES)
DATA DE PUBLICAÇÃO

2006

RESUMO

Objectives: Through of the literature review, to evaluate the general characteristics of the forced expiratory maneuver (FEM), in preschool children and the application of the acceptance criteria and reproduticility, tested in this studies. For original search, to evaluate the acceptance of FEM in healthy preschool children in relation to the current standardized criteria (American Thoracic Society and European Respiratory Society -ATS/ERS, updating 2005) and to verify the effect of modifications in these criteria, being accepted curves with incomplete expiration; to evaluate the reproducibility of the forced vital capacity (FVC), of the forced expiratory volume in the first second of FVC (FEV1) and of the forced expiratory volume in the half first second of FVC (FEV0,5), to the criterion once evaluate in others studies, of the difference ≤ 10% e ≤ 0,1 L, and the new criteria suggested for this authors , of the difference ≤ 8%. Methods: Revision of the literature in the bases of data Medline, Lilacs, Scielo and Cockrane Library , of 1996 to March of 2006. Descriptors: spirometry, tests of lung function, forced vital capacity, reference values. Researches for word: maneuvers, expiratory, forced, spirometry. Transversal study with die prospectively collected and sample calculated of the 225 children. Accomplishment of FEM in 240 prÃ-school children (three to five years) of schools and day cares of the city of Recife, Brazil, for simple aleatory sampling. The criteria of acceptance of the maneuvers were divided in three groups: ATS/ERS - conform the standardized current criteria. Type I Partial - group with incomplete expiration, with end of the expiration when the flow was ≤ 0,3 L/s or ≤ 10% of peak expiratory flow (PEF), what goes larger. Type II Partial - group with incomplete expiration, with end of the expiration when the flow was >0,3 L/s or >10% of that it goes larger; in this, went judged just measured of PEF and of forced expiratory volume in the half of the first second (FEV 0,5). Utilized the test of the Duncan for comparison between the group and the tests kappa for evaluate the concordance between the different criterion tested. Results: The acceptability of FEM varied, in the several studies, of 40-92%, directilly proportional with the strip etÃria and, inverselly with the severity of the acceptance criteria adopted; the reproducibility criterion for FVC and FEV1, of ≤ 0,1 L, the most appropriate was considered. It was demonstrated the reproducibility of FEV0,5 and of FEV0,75 and proven the usefulness of FEV0,5 in the answer evaluation to the broncodilatador. In the original search with 240 preschool, the distribution for groups was: ATS/ERS (37,1%), Type I Partial (13,7%) and Type II Partial (30,8%). The modification applied at the Type I Partial group were valid for measure of the PEF, FEV1, FEV0,5 and forced expiratory flow mean between 25-75% of the FVC (FEF25-75), but no for measures of the FVC. The reproducibility for FVC, FEV1 and FEV0,5 the criteria ≤ 0,1 L, ≤ 10% or ≤ 8% was more than 89%. Donât have significant estatistic diffence between the groups, in report on the aceitabilility and reproducibility. Conclusion: The revision did evidence the need of modifications in the current acceptance criteria in relation to the retro-extrapolated volume and to the criteria of test end, as well as of the one definition of reproducibility criteria for the preschool. The original search did demonstrate the necessity of the adaptations in the criterion of the acceptance (accepting curves expired partly) and reproducibility of the spirometry program and incentives visual program directed for the preschool. Conform with the kappa test, are necessary adaptations of the acceptance criteria and reproducibility of the espirometria programs and of the programs of incentive visual to the preschool. We recommended the criterion ≤ 0,1 L or ≤ 8%, what goes larger for FVC and FEV1, and the criterion of ≤ 10% for FEV0,5

ASSUNTO(S)

forced vital capacity prÃ-escolar manobra expiratÃria forÃada capacidade vital forÃada testes de funÃÃo pulmonar valores de referÃncia spirometry reference values espirometria preschool tests of lung function forced expiratory maneuvers pediatria

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