{"id":20470,"date":"2021-08-19T12:59:30","date_gmt":"2021-08-19T12:59:30","guid":{"rendered":"https:\/\/sbpt.org.br\/portal\/?p=20470"},"modified":"2021-08-19T12:59:30","modified_gmt":"2021-08-19T12:59:30","slug":"funcao-pulmonar-covid-19-sbpt","status":"publish","type":"post","link":"https:\/\/sbpt.org.br\/portal\/funcao-pulmonar-covid-19-sbpt\/","title":{"rendered":"Recomenda\u00e7\u00e3o atualizada sobre Fun\u00e7\u00e3o Pulmonar e COVID-19"},"content":{"rendered":"<p><em>Bras\u00edlia, 18 de agosto de 2021.<\/em><\/p>\n<p style=\"text-align: justify\">Embora muito aprendizado em rela\u00e7\u00e3o \u00e0 COVID-19 j\u00e1 tenha sido alcan\u00e7ado, enquanto a pandemia existir, a execu\u00e7\u00e3o dos testes de fun\u00e7\u00e3o pulmonar ser\u00e1 um desafio. Sempre vai existir a possibilidade de contamina\u00e7\u00e3o cruzada atrav\u00e9s dos equipamentos, salas de teste e \u00e1reas de espera poder resultar na transmiss\u00e3o viral para funcion\u00e1rios e outros pacientes.<\/p>\n<p style=\"text-align: justify\">A vacina\u00e7\u00e3o e os pacientes que j\u00e1 foram contaminados e seguem com alguma imunidade conferida trazem certa tranquilidade, que antes n\u00e3o havia. Em contrapartida, o surgimento de novas variantes do v\u00edrus mais transmiss\u00edveis ainda preocupa muito.<\/p>\n<p style=\"text-align: justify\">Nossa \u00faltima <a href=\"https:\/\/sbpt.org.br\/portal\/\/reabertura-funcao-pulmonar-covid19-sbpt\/\" target=\"_blank\" rel=\"noopener noreferrer\">recomenda\u00e7\u00e3o<\/a> no site, publicada em maio de 2020, ainda n\u00e3o havia sido atualizada porque est\u00e1 condicionada \u00e0s fases que a pandemia pudesse se encontrar no local (cidade ou estado) do laborat\u00f3rio em quest\u00e3o. A partir da\u00ed cada s\u00f3cio e servi\u00e7os especializados em fun\u00e7\u00e3o pulmonar assumiram suas novas rotinas de cuidados e n\u00e3o houve relato de complica\u00e7\u00f5es maiores. Portanto, a presente recomenda\u00e7\u00e3o n\u00e3o exclui a <a href=\"https:\/\/sbpt.org.br\/portal\/\/reabertura-funcao-pulmonar-covid19-sbpt\/\" target=\"_blank\" rel=\"noopener noreferrer\">\u00faltima<\/a>, em detalhamento das orienta\u00e7\u00f5es fundamentais.<\/p>\n<p style=\"text-align: justify\">Resolvemos voltar a nos expressar sobre isso ap\u00f3s uma revis\u00e3o detalhada na literatura e regras das sociedades internacionais para noticiar aos nossos s\u00f3cios que n\u00e3o h\u00e1 novidades relevantes no assunto, mas vale recapitular e refor\u00e7ar algumas considera\u00e7\u00f5es importantes. Sempre lembrando que a estrat\u00e9gia final depender\u00e1 das prefer\u00eancias institucionais, recursos e preval\u00eancia local.<\/p>\n<h6 style=\"text-align: justify\"><em><u>O que considerar antes da indica\u00e7\u00e3o de qualquer teste de fun\u00e7\u00e3o pulmonar?<\/u><\/em><\/h6>\n<p style=\"text-align: justify\">\u00c9 importante identificar riscos <em>versus<\/em> benef\u00edcios para cada paciente, ou seja, qual a import\u00e2ncia do teste de fun\u00e7\u00e3o pulmonar para fazer um diagn\u00f3stico ou tomar uma decis\u00e3o quanto ao risco de exposi\u00e7\u00e3o de pessoal e contamina\u00e7\u00e3o cruzada de equipamentos? E essa quest\u00e3o abrange principalmente pacientes jovens assintom\u00e1ticos (e, em muitas regi\u00f5es, ainda n\u00e3o vacinados) como <em>check-up<\/em> apenas. \u00c9 consenso atual que esses exames ainda n\u00e3o devem ser realizados. J\u00e1 em outros exemplos fica claro o benef\u00edcio que o paciente pode ter em realizar a fun\u00e7\u00e3o pulmonar que se sobrep\u00f5e ao risco como avalia\u00e7\u00e3o de transplante de pulm\u00e3o, pr\u00e9-operat\u00f3rio de ressec\u00e7\u00e3o pulmonar, avalia\u00e7\u00e3o de risco de bronquiolite obliterante em receptores de transplante de pulm\u00e3o ou medula \u00f3ssea, avalia\u00e7\u00e3o diagn\u00f3stica de pacientes com dispneia inexplicada, diagn\u00f3stico e\/ou acompanhamento de pacientes com doen\u00e7as pulmonares cr\u00f4nicas, como: asma, DPOC, fibrose c\u00edstica e doen\u00e7a pulmonar intersticial.<\/p>\n<h6 style=\"text-align: justify\"><em><u>Uma vez que tenha sido bem definida a indica\u00e7\u00e3o da fun\u00e7\u00e3o pulmonar o que deve ser observado de maneira imprescind\u00edvel para a realiza\u00e7\u00e3o?<\/u><\/em><\/h6>\n<p style=\"text-align: justify\">Apesar do conhecimento sobre o v\u00edrus ter aliviado sobre a transmiss\u00e3o atrav\u00e9s das superf\u00edcies, todo o processo de limpeza da sala em que o exame \u00e9 feito, inclusive mobili\u00e1rio (somente o necess\u00e1rio deve ser mantido dentro do laborat\u00f3rio), permanece necess\u00e1rio.<\/p>\n<p style=\"text-align: justify\">Toda a equipe deve usar EPI adequado (m\u00e1scara N95, \u00f3culos, gorro e avental descart\u00e1vel).<\/p>\n<p style=\"text-align: justify\">Todos os exames devem ser realizados com filtros antimicrobianos descart\u00e1veis. A efic\u00e1cia desses filtros, bem estabelecida por cada fabricante, deve ser inclusive real\u00e7ada para os pacientes e os mesmos descartados na frente deles.<\/p>\n<h6 style=\"text-align: justify\"><em><u>Quais exames podem ser realizados na atualidade?<\/u><\/em><\/h6>\n<p style=\"text-align: justify\">Podem ser realizados na rotina espirometria, difus\u00e3o de mon\u00f3xido de carbono e medida de volumes por dilui\u00e7\u00e3o de gases. Na espirometria, se necess\u00e1ria a realiza\u00e7\u00e3o de broncodilatador, o mesmo deve ser fornecido na forma de<em> spray<\/em>.<\/p>\n<p style=\"text-align: justify\">A pletismografia tamb\u00e9m pode ser realizada com limpeza da caixa em seguida com produto especificado pelo fabricante.<\/p>\n<p style=\"text-align: justify\">Teste de caminhada de seis minutos \u00e9 o teste de esfor\u00e7o que pode ser realizado sem maiores preocupa\u00e7\u00f5es.<\/p>\n<p style=\"text-align: justify\">Teste de broncoprovoca\u00e7\u00e3o com metacolina, se indicado como realmente necess\u00e1rio para complemento da proped\u00eautica, deve ser realizado como o \u00faltimo exame da agenda, de forma que a sala demore o maior tempo poss\u00edvel para ser reutilizada e o efeito da aerossoliza\u00e7\u00e3o provocada pelo nebulizador seja minimizado.<\/p>\n<p style=\"text-align: justify\">No Teste de esfor\u00e7o Cardiopulmonar (TECP) n\u00e3o \u00e9 recomendado uso de filtro, porque pode resultar em um aumento da resist\u00eancia ao fluxo de ar \u00e0 medida que a demanda ventilat\u00f3ria do exerc\u00edcio aumenta e levar a um resultado de teste n\u00e3o confi\u00e1vel. Por n\u00e3o ser poss\u00edvel usar filtro e com o risco de contamina\u00e7\u00e3o ambiental pela hiperventila\u00e7\u00e3o, a recomenda\u00e7\u00e3o \u00e9 de realizar TCPE em salas com press\u00e3o negativa.<\/p>\n<p style=\"text-align: justify\">Se n\u00e3o dispon\u00edvel press\u00e3o negativa, e teste realmente necess\u00e1rio, realizar em sala \u00fanica e exclusiva com m\u00e9dico e t\u00e9cnico com EPI completo (j\u00e1 que n\u00e3o \u00e9 poss\u00edvel dist\u00e2ncia segura do paciente) e desinfec\u00e7\u00e3o completa de sala ap\u00f3s realiza\u00e7\u00e3o. Tempo entre testes deve ser calculado ap\u00f3s essa limpeza completa e troca tamb\u00e9m de todos os remov\u00edveis e limpezas de superf\u00edcies (m\u00ednimo uma hora).<\/p>\n<p style=\"text-align: justify\">O uso concomitante de um filtro de ar particulado de alta efici\u00eancia (HEPA) ou descontamina\u00e7\u00e3o por luz ultravioleta pode reduzir o tempo entre testes.<\/p>\n<p style=\"text-align: right\"><em>SBPT \u2013 Departamento de Fun\u00e7\u00e3o Pulmonar.<\/em><\/p>\n<p style=\"text-align: center\"><a href=\"https:\/\/d1xe7tfg0uwul9.cloudfront.net\/sbpt.org.br\/portal\/wp-content\/uploads\/2021\/08\/Fun\u00e7\u00e3o-Pulmonar-e-Covid-19-18-08-2021.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Clique aqui para fazer download da nota.<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"Bras\u00edlia, 18 de agosto de 2021. Embora muito aprendizado em rela\u00e7\u00e3o \u00e0 COVID-19 j\u00e1 tenha sido alcan\u00e7ado, enquanto a pandemia existir, a execu\u00e7\u00e3o dos testes de fun\u00e7\u00e3o pulmonar ser\u00e1 um desafio. Sempre vai existir a possibilidade de contamina\u00e7\u00e3o cruzada atrav\u00e9s dos equipamentos, salas de teste e \u00e1reas de espera poder resultar na transmiss\u00e3o viral para [\u2026]","protected":false},"author":3,"featured_media":20471,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"ngg_post_thumbnail":0,"footnotes":""},"categories":[68],"tags":[118,30,34],"class_list":["post-20470","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-noticias","tag-covid-19","tag-espirometria","tag-sbpt"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.7 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Recomenda\u00e7\u00e3o atualizada sobre Fun\u00e7\u00e3o Pulmonar e COVID-19<\/title>\n<meta name=\"description\" content=\"A SBPT divulga informa\u00e7\u00f5es sobre a realiza\u00e7\u00e3o de testes de fun\u00e7\u00e3o pulmonar no per\u00edodo da COVID-19. 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