array:24 [
  "pii" => "S0873215915300283"
  "issn" => "08732159"
  "doi" => "10.1016/S0873-2159(15)30028-3"
  "estado" => "S350"
  "fechaPublicacion" => "2010-03-01"
  "aid" => "8"
  "copyright" => "Sociedade Portuguesa de Pneumologia/SPP"
  "copyrightAnyo" => "2010"
  "documento" => "simple-article"
  "crossmark" => 0
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "rev"
  "cita" => "Rev Port Pneumol. 2010;16:307-14"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 2810
    "formatos" => array:3 [
      "EPUB" => 227
      "HTML" => 1771
      "PDF" => 812
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S0873215915300295"
    "issn" => "08732159"
    "doi" => "10.1016/S0873-2159(15)30029-5"
    "estado" => "S350"
    "fechaPublicacion" => "2010-03-01"
    "aid" => "9"
    "copyright" => "Sociedade Portuguesa de Pneumologia/SPP"
    "documento" => "simple-article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "sco"
    "cita" => "Rev Port Pneumol. 2010;16:315-20"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2470
      "formatos" => array:3 [
        "EPUB" => 243
        "HTML" => 1473
        "PDF" => 754
      ]
    ]
    "pt" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Caso Cl&#237;nico&#47;Case Report</span>"
      "titulo" => "Pertussis ainda mata"
      "tienePdf" => "pt"
      "tieneTextoCompleto" => 0
      "tieneResumen" => array:2 [
        0 => "pt"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "315"
          "paginaFinal" => "320"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Pertussis keeps on killing"
        ]
      ]
      "contieneResumen" => array:2 [
        "pt" => true
        "en" => true
      ]
      "contienePdf" => array:1 [
        "pt" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Joana Freitas, Susana Gama de Sousa, Cristina Miguel, Paula Fonseca"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Joana"
              "apellidos" => "Freitas"
            ]
            1 => array:2 [
              "nombre" => "Susana Gama"
              "apellidos" => "de Sousa"
            ]
            2 => array:2 [
              "nombre" => "Cristina"
              "apellidos" => "Miguel"
            ]
            3 => array:2 [
              "nombre" => "Paula"
              "apellidos" => "Fonseca"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "pt"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215915300295?idApp=UINPBA00004E"
    "url" => "/08732159/0000001600000002/v1_201509151443/S0873215915300295/v1_201509151443/pt/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S0873215915300271"
    "issn" => "08732159"
    "doi" => "10.1016/S0873-2159(15)30027-1"
    "estado" => "S350"
    "fechaPublicacion" => "2010-03-01"
    "aid" => "7"
    "copyright" => "Sociedade Portuguesa de Pneumologia&#47;SPP"
    "documento" => "simple-article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Pneumol. 2010;16:287-305"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2304
      "formatos" => array:3 [
        "EPUB" => 225
        "HTML" => 1408
        "PDF" => 671
      ]
    ]
    "pt" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Artigo Original&#47;Original Article</span>"
      "titulo" => "Estar&#227;o diferentes as pneumonias agudas adquiridas na comunidade com internamento hospitalar em idade pedi&#225;trica na &#250;ltima d&#233;cada&#63;"
      "tienePdf" => "pt"
      "tieneTextoCompleto" => 0
      "tieneResumen" => array:2 [
        0 => "pt"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "287"
          "paginaFinal" => "305"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Are there any differences in the community acquired pneumonias admitted to hospital over the past decade&#63;"
        ]
      ]
      "contieneResumen" => array:2 [
        "pt" => true
        "en" => true
      ]
      "contienePdf" => array:1 [
        "pt" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Cl&#225;udia Calado, Pedro Nunes, Lu&#237;sa Pereira, Teresa Nunes, Celeste Barreto, Teresa Bandeira"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "Cl&#225;udia"
              "apellidos" => "Calado"
            ]
            1 => array:2 [
              "nombre" => "Pedro"
              "apellidos" => "Nunes"
            ]
            2 => array:2 [
              "nombre" => "Lu&#237;sa"
              "apellidos" => "Pereira"
            ]
            3 => array:2 [
              "nombre" => "Teresa"
              "apellidos" => "Nunes"
            ]
            4 => array:2 [
              "nombre" => "Celeste"
              "apellidos" => "Barreto"
            ]
            5 => array:2 [
              "nombre" => "Teresa"
              "apellidos" => "Bandeira"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "pt"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215915300271?idApp=UINPBA00004E"
    "url" => "/08732159/0000001600000002/v1_201509151443/S0873215915300271/v1_201509151443/pt/main.assets"
  ]
  "pt" => array:15 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Artigo de Revis&#227;o&#47;Review Article</span>"
    "titulo" => "Interven&#231;&#227;o da fisioterapia respirat&#243;ria na fun&#231;&#227;o pulmonar de indiv&#237;duos obesos submetidos a cirurgia bari&#225;trica&#46; Uma revis&#227;o"
    "tieneTextoCompleto" => 0
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "307"
        "paginaFinal" => "314"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Lu&#237;s Henrique Sarmento Ten&#243;rio, Anna Myrna Jaguaribe de Lima, Maria do Socorro Brasileiro-Santos"
        "autores" => array:3 [
          0 => array:4 [
            "nombre" => "Lu&#237;s Henrique Sarmento"
            "apellidos" => "Ten&#243;rio"
            "email" => array:1 [
              0 => "tenorio&#64;gmail&#46;com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">1</span>"
                "identificador" => "af0005"
              ]
              1 => array:2 [
                "etiqueta" => "&#42;"
                "identificador" => "cr0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Anna Myrna Jaguaribe"
            "apellidos" => "de Lima"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">2</span>"
                "identificador" => "af0010"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">4</span>"
                "identificador" => "af0020"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Maria do Socorro"
            "apellidos" => "Brasileiro-Santos"
            "referencia" => array:3 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">3</span>"
                "identificador" => "af0015"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">4</span>"
                "identificador" => "af0020"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">5</span>"
                "identificador" => "af0025"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:5 [
          0 => array:3 [
            "entidad" => "P&#243;s-Graduando em Fisioterapia Cardiorrespirat&#243;ria da Universidade Federal de Pernambuco"
            "etiqueta" => "1"
            "identificador" => "af0005"
          ]
          1 => array:3 [
            "entidad" => "Professora da Universidade Federal Rural de Pernambuco e Doutora em Ci&#234;ncias pela Faculdade de Medicina da Universidade de S&#227;o Paulo&#8211; FMUSP"
            "etiqueta" => "2"
            "identificador" => "af0010"
          ]
          2 => array:3 [
            "entidad" => "Professora da Universidade Federal de Pernambuco e Doutora em Ci&#234;ncias pela Universidade Federal de S&#227;o Paulo &#8211; UNIFESP"
            "etiqueta" => "3"
            "identificador" => "af0015"
          ]
          3 => array:3 [
            "entidad" => "Programa de P&#243;s-gradua&#231;&#227;o Associado em Educa&#231;&#227;o F&#237;sica da Universidade de Pernambuco&#47;Universidade Federal da Para&#237;ba &#8211; UPE&#47;UFPB"
            "etiqueta" => "4"
            "identificador" => "af0020"
          ]
          4 => array:3 [
            "entidad" => "Programa de P&#243;s-gradua&#231;&#227;o em Fisioterapia da Universidade Federal de Pernambuco &#8211; UFPE"
            "etiqueta" => "5"
            "identificador" => "af0025"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cr0005"
            "etiqueta" => "&#42;"
            "correspondencia" => "<span class="elsevierStyleBold">Correspond&#234;ncia</span>&#58; Lu&#237;s Henrique Sarmento Ten&#243;rio&#44; Av&#46; Boa Viagem&#44; 4632&#44; apt&#46; 301&#44; Boa Viagem&#44; CEP&#58; 51021-000&#46; Recife-PE&#44; Telefone&#58; &#40;81&#41; 3325-1719"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "en" => array:1 [
        "titulo" => "The role of respiratory physiotherapy in the lung function of obese patients undergoing bariatric surgery&#46; A review"
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2009-07-21"
    "fechaAceptado" => "2009-09-08"
    "PalabrasClave" => array:2 [
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec570134"
          "palabras" => array:4 [
            0 => "Fun&#231;&#227;o pulmonar"
            1 => "cirurgia bari&#225;trica"
            2 => "obesidade"
            3 => "fisioterapia"
          ]
        ]
      ]
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Key-words"
          "identificador" => "xpalclavsec570135"
          "palabras" => array:4 [
            0 => "Lung function"
            1 => "bariatric surgery"
            2 => "obesity"
            3 => "physiotherapy"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "pt" => array:2 [
        "titulo" => "Resumo"
        "resumen" => "<span id="as0005" class="elsevierStyleSection elsevierViewall"><p id="sp0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Introdu&#231;&#227;o</span>&#58; A obesidade&#44; considerada uma nova epidemia mundial&#44; &#233; caracterizada pelo excesso de tecido adiposo contribuindo para diversas doen&#231;as cr&#243;nicas e aumento da mortalidade&#46; A obesidade associada ao procedimento cir&#250;rgico nesses doentes condiciona a fisioterapia respirat&#243;ria essencial na recupera&#231;&#227;o da fun&#231;&#227;o pulmonar e na preven&#231;&#227;o das complica&#231;&#245;es respirat&#243;rias&#46; <span class="elsevierStyleBold">Objectivos</span>&#58; Verificar o efeito das interven&#231;&#245;es fisioterap&#234;uticas sobre a fun&#231;&#227;o pulmonar de doentes obesos submetidos a cirurgia bari&#225;trica&#46; <span class="elsevierStyleBold">M&#233;todo</span>&#58; Uma revis&#227;o de literatura foi conduzida no per&#237;odo de Outubro&#47;2008 a ju-nho&#47;2009&#44; com materiais dispon&#237;veis na base de dados <span class="elsevierStyleItalic">Medline&#44; Pubmed</span> e <span class="elsevierStyleItalic">Scielo</span>&#44; publicados nos &#250;ltimos trinta anos&#46; <span class="elsevierStyleBold">Conclus&#227;o&#58;</span> A fisioterapia respirat&#243;ria realizada no per&#237;odo pr&#233; e p&#243;s-operat&#243;rio &#233; de fundamental import&#226;ncia nos indiv&#237;duos submetidos a cirurgia bari&#225;trica&#44; independente da t&#233;cnica empregada&#44; para prevenir complica&#231;&#245;es pulmonares inerentes ao processo cir&#250;rgico e possibilitar a recupera&#231;&#227;o da fun&#231;&#227;o pulmonar&#46;</p><p id="sp0010" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2010&#59; XVI &#40;2&#41;&#58; 307-314</span></p></span>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="as0010" class="elsevierStyleSection elsevierViewall"><p id="sp0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Introduction&#58;</span> Obesity&#44; considered a new worldwide epidemic&#44; is characterised by excess adipose tissue and contributes to a series of chronic diseases and increased mortality&#46; Obesity associated to surgical procedure in these patients makes respiratory physiotherapy a must to recover lung function and prevent postoperative pulmonary complications&#46; <span class="elsevierStyleBold">Aims&#58;</span> To assess the effects of respiratory physiotherapy on the lung function of obese patients undergoing weight loss surgery&#46; <span class="elsevierStyleBold">Material and methods&#58;</span> We conducted a literature review October 2008-June 2009 of data which had been published over the last thirty years and which was available on the Medline&#44; Pubmed ans Scielo databases&#46; <span class="elsevierStyleBold">Conclusion&#58;</span> Pre- and postoperative respiratory physiotherapy is vital for patients undergoing weight loss surgery irrespective of technique used&#44; as it can prevent pulmonary complications inherent in the surgical procedure and aid lung function recovery&#46;</p><p id="sp0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2010&#59; XVI &#40;2&#41;&#58; 307-314</span></p></span>"
      ]
    ]
    "lecturaRecomendada" => array:1 [
      0 => array:3 [
        "vista" => "all"
        "titulo" => "<span class="elsevierStyleSectionTitle" id="st0025">Bibliografia</span>"
        "seccion" => array:1 [
          0 => array:2 [
            "vista" => "all"
            "bibliografiaReferencia" => array:51 [
              0 => array:3 [
                "identificador" => "bb0005"
                "etiqueta" => "1&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Obesity&#58; overview of prevalence&#44; etiology&#44; and treatment"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:3 [
                              0 => "S&#46;B&#46; Racette"
                              1 => "S&#46;S&#46; Deusinger"
                              2 => "R&#46;H&#46; Deusinger"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:6 [
                          "tituloSerie" => "Phys Ther"
                          "fecha" => "2003"
                          "volumen" => "83"
                          "paginaInicial" => "276"
                          "paginaFinal" => "288"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12620091"
                              "web" => "Medline"
                            ]
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              1 => array:3 [
                "identificador" => "bb0010"
                "etiqueta" => "2&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Surgical treatment of obesity"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:3 [
                              0 => "M&#46;J&#46;F&#46; Bult"
                              1 => "T&#46; van Dalen"
                              2 => "A&#46;F&#46; Muller"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:2 [
                        "doi" => "10.1530/EJE-07-0145"
                        "Revista" => array:6 [
                          "tituloSerie" => "Eur J Endocrinol"
                          "fecha" => "2008"
                          "volumen" => "158"
                          "paginaInicial" => "135"
                          "paginaFinal" => "145"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18230819"
                              "web" => "Medline"
                            ]
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              2 => array:3 [
                "identificador" => "bb0015"
                "etiqueta" => "3&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "An assessment of vertical banded gastroplasty-Roux-en-Y gastric bypass for the treatment of morbid obesity"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:2 [
                              0 => "J&#46;F&#46; Capella"
                              1 => "R&#46;F&#46; Capella"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:7 [
                          "tituloSerie" => "Am J Surg"
                          "fecha" => "2002"
                          "volumen" => "183"
                          "numero" => "2"
                          "paginaInicial" => "1"
                          "paginaFinal" => "10"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11869691"
                              "web" => "Medline"
                            ]
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              3 => array:3 [
                "identificador" => "bb0020"
                "etiqueta" => "4&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "The medical complications of obesity"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:2 [
                              0 => "S&#46;D&#46;H&#46; Malnick"
                              1 => "H&#46; Knobler"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:5 [
                          "tituloSerie" => "Quar J Med"
                          "fecha" => "2006"
                          "volumen" => "99"
                          "paginaInicial" => "565"
                          "paginaFinal" => "579"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              4 => array:3 [
                "identificador" => "bb0025"
                "etiqueta" => "5&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "The effect of body mass on lung volumes"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:2 [
                              0 => "R&#46;L&#46; Jones"
                              1 => "M&#46;U&#46; Nzekwu"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:2 [
                        "doi" => "10.1378/chest.130.3.827"
                        "Revista" => array:7 [
                          "tituloSerie" => "Chest"
                          "fecha" => "2006"
                          "volumen" => "130"
                          "paginaInicial" => "827"
                          "paginaFinal" => "833"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16963682"
                              "web" => "Medline"
                            ]
                          ]
                          "itemHostRev" => array:3 [
                            "pii" => "S0020729210002468"
                            "estado" => "S300"
                            "issn" => "00207292"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              5 => array:3 [
                "identificador" => "bb0030"
                "etiqueta" => "6&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "The effects of body weight on airway caliber"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => true
                            "autores" => array:6 [
                              0 => "G&#46;G&#46; King"
                              1 => "N&#46;J&#46; Brown"
                              2 => "C&#46; Diba"
                              3 => "C&#46;W&#46; Thorpe"
                              4 => "P&#46; Mu&#241;oz"
                              5 => "G&#46;B&#46; Marks"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:5 [
                          "tituloSerie" => "Eur Resp J"
                          "fecha" => "2005"
                          "volumen" => "25"
                          "paginaInicial" => "896"
                          "paginaFinal" => "901"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              6 => array:3 [
                "identificador" => "bb0035"
                "etiqueta" => "7&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Disorders of the respiratory muscles"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:2 [
                              0 => "F&#46; Laghi"
                              1 => "M&#46;J&#46; Tobin"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:2 [
                        "doi" => "10.1164/rccm.2206020"
                        "Revista" => array:6 [
                          "tituloSerie" => "Am J Respir Crit Care Med"
                          "fecha" => "2003"
                          "volumen" => "168"
                          "paginaInicial" => "10"
                          "paginaFinal" => "48"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12826594"
                              "web" => "Medline"
                            ]
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              7 => array:3 [
                "identificador" => "bb0040"
                "etiqueta" => "8&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Strategies to reduce postoperative pulmonary complications after noncardiothoracic surgery&#58; systematic review for the American College of Physicians"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:3 [
                              0 => "V&#46;A&#46; Lawrence"
                              1 => "J&#46;E&#46; Cornell"
                              2 => "G&#46;W&#46; Smetana"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:6 [
                          "tituloSerie" => "Ann Int Med"
                          "fecha" => "2006"
                          "volumen" => "144"
                          "paginaInicial" => "596"
                          "paginaFinal" => "608"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16618957"
                              "web" => "Medline"
                            ]
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              8 => array:3 [
                "identificador" => "bb0045"
                "etiqueta" => "9&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Respiratory physiotherapy to prevent pulmonary complications after abdominal surgery&#58; a systematic review"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:4 [
                              0 => "P&#46; Pasquina"
                              1 => "M&#46;R&#46; Tram&#232;r"
                              2 => "J&#46; Granier"
                              3 => "B&#46; Walder"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:2 [
                        "doi" => "10.1378/chest.130.6.1887"
                        "Revista" => array:6 [
                          "tituloSerie" => "Chest"
                          "fecha" => "2006"
                          "volumen" => "130"
                          "paginaInicial" => "1887"
                          "paginaFinal" => "1899"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17167013"
                              "web" => "Medline"
                            ]
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              9 => array:3 [
                "identificador" => "bb0050"
                "etiqueta" => "10&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Volumes&#44; capacidades pulmonares e for&#231;a muscular respirat&#243;ria no p&#243;s-operat&#243;rio de gastroplastia"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:3 [
                              0 => "D&#46;M&#46; Paisani"
                              1 => "L&#46;D&#46; Chiavegato"
                              2 => "S&#46;M&#46; Faresin"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:6 [
                          "tituloSerie" => "J Pneumol"
                          "fecha" => "2005"
                          "volumen" => "31"
                          "numero" => "2"
                          "paginaInicial" => "125"
                          "paginaFinal" => "132"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              10 => array:3 [
                "identificador" => "bb0055"
                "etiqueta" => "11&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Body weight classification"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:1 [
                              0 => "J&#46;D&#46; Douketis"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:2 [
                        "doi" => "10.1503/cmaj.1050005"
                        "Revista" => array:6 [
                          "tituloSerie" => "CMAJ"
                          "fecha" => "2005"
                          "volumen" => "172"
                          "paginaInicial" => "1274"
                          "paginaFinal" => "1275"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15883391"
                              "web" => "Medline"
                            ]
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              11 => array:3 [
                "identificador" => "bb0060"
                "etiqueta" => "12&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Effects of obesity and fat distribution on ventilatory function&#58; the normative aging study"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:3 [
                              0 => "R&#46; Lazarus"
                              1 => "D&#46; Sparrow"
                              2 => "S&#46;T&#46; Weiss"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:6 [
                          "tituloSerie" => "Chest"
                          "fecha" => "1997"
                          "volumen" => "111"
                          "paginaInicial" => "891"
                          "paginaFinal" => "898"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9106566"
                              "web" => "Medline"
                            ]
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              12 => array:3 [
                "identificador" => "bb0065"
                "etiqueta" => "13&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Treatment of obesity&#58; need to focus on high risk abdominally obese patients"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:3 [
                              0 => "J&#46;P&#46; Despr&#233;s"
                              1 => "I&#46; Lemieux"
                              2 => "D&#46; Prud&#8217;homme"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:6 [
                          "tituloSerie" => "BMJ"
                          "fecha" => "2001"
                          "volumen" => "322"
                          "paginaInicial" => "716"
                          "paginaFinal" => "720"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11264213"
                              "web" => "Medline"
                            ]
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              13 => array:3 [
                "identificador" => "bb0070"
                "etiqueta" => "14&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Longitudinal effects of change in body mass on measurements of ventilatory capacity"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:3 [
                              0 => "D&#46;J&#46; Chinn"
                              1 => "J&#46;E&#46; Cotes"
                              2 => "J&#46;W&#46; Reed"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:6 [
                          "tituloSerie" => "Thorax"
                          "fecha" => "1996"
                          "volumen" => "51"
                          "paginaInicial" => "699"
                          "paginaFinal" => "704"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8882076"
                              "web" => "Medline"
                            ]
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              14 => array:3 [
                "identificador" => "bb0075"
                "etiqueta" => "15&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Pulmonary physiologic changes of morbid obesity"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:4 [
                              0 => "M&#46;S&#46; Biring"
                              1 => "M&#46;I&#46; Lewis"
                              2 => "J&#46;T&#46; Liu"
                              3 => "Z&#46; Mohsenifar"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:6 [
                          "tituloSerie" => "Am J Med Sci"
                          "fecha" => "1999"
                          "volumen" => "318"
                          "paginaInicial" => "293"
                          "paginaFinal" => "297"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10555090"
                              "web" => "Medline"
                            ]
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              15 => array:3 [
                "identificador" => "bb0080"
                "etiqueta" => "16&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Abdominal obesity and respiratory function in men and women in the EPIC-Norfolk Study&#44; United Kingdom"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => true
                            "autores" => array:6 [
                              0 => "D&#46; Canoy"
                              1 => "R&#46; Luben"
                              2 => "A&#46; Welch"
                              3 => "S&#46; Bingham"
                              4 => "N&#46; Warenham"
                              5 => "N&#46; Day"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:2 [
                        "doi" => "10.1093/aje/kwh155"
                        "Revista" => array:6 [
                          "tituloSerie" => "Am J Epidemiol"
                          "fecha" => "2004"
                          "volumen" => "159"
                          "paginaInicial" => "1140"
                          "paginaFinal" => "1149"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15191931"
                              "web" => "Medline"
                            ]
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              16 => array:3 [
                "identificador" => "bb0085"
                "etiqueta" => "17&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Obesity is a risk factor for dyspnea but not for airflow obstruction"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:3 [
                              0 => "D&#46;D&#46; Sin"
                              1 => "R&#46;L&#46; Jones"
                              2 => "S&#46;F&#46; Man"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:6 [
                          "tituloSerie" => "Arch Intern Med"
                          "fecha" => "2002"
                          "volumen" => "162"
                          "paginaInicial" => "1477"
                          "paginaFinal" => "1481"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12090884"
                              "web" => "Medline"
                            ]
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              17 => array:3 [
                "identificador" => "bb0090"
                "etiqueta" => "18&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Pulmonary function tests&#44; respiratory muscle strength&#44; and endurance of persons with obesity"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:4 [
                              0 => "S&#46; Sarikaya"
                              1 => "O&#46;B&#46; Simen"
                              2 => "Y&#46; Gokay"
                              3 => "R&#46; Erden"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:5 [
                          "tituloSerie" => "The Endocrinologist"
                          "fecha" => "2003"
                          "volumen" => "13"
                          "paginaInicial" => "136"
                          "paginaFinal" => "141"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              18 => array:3 [
                "identificador" => "bb0095"
                "etiqueta" => "19&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Relationship of dyspnea to respiratory drive and pulmonary function test in obese patients before and after weight loss"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:4 [
                              0 => "H&#46; El-gamal"
                              1 => "A&#46; Khayat"
                              2 => "S&#46; Shikora"
                              3 => "J&#46;N&#46; Unterborn"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:2 [
                        "doi" => "10.1378/chest.128.6.3870"
                        "Revista" => array:6 [
                          "tituloSerie" => "Chest"
                          "fecha" => "2005"
                          "volumen" => "128"
                          "paginaInicial" => "3870"
                          "paginaFinal" => "3874"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16354856"
                              "web" => "Medline"
                            ]
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              19 => array:3 [
                "identificador" => "bb0100"
                "etiqueta" => "20&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "The effect of obesity on chronic respiratory diseases&#58; pathophysiology and therapeutic strategies"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => true
                            "autores" => array:6 [
                              0 => "M&#46; Poulain"
                              1 => "M&#46; Doucet"
                              2 => "G&#46;C&#46; Major"
                              3 => "V&#46; Drapeau"
                              4 => "F&#46; S&#233;ri&#232;s"
                              5 => "L&#46;P&#46; Boulet"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:2 [
                        "doi" => "10.1503/cmaj.051299"
                        "Revista" => array:7 [
                          "tituloSerie" => "CMAJ"
                          "fecha" => "2006"
                          "volumen" => "174"
                          "numero" => "9"
                          "paginaInicial" => "1293"
                          "paginaFinal" => "1299"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16636330"
                              "web" => "Medline"
                            ]
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              20 => array:3 [
                "identificador" => "bb0105"
                "etiqueta" => "21&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Influence of excessive weight after gastroplasty for morbid obesity on respiratory muscle performance"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:6 [
                              0 => "P&#46; Weiner"
                              1 => "J&#46; Waizman"
                              2 => "M&#46; Weiner"
                              3 => "M&#46; Rabner"
                              4 => "R&#46; Magadle"
                              5 => "D&#46; Zamir"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:6 [
                          "tituloSerie" => "Thorax"
                          "fecha" => "1998"
                          "volumen" => "53"
                          "paginaInicial" => "39"
                          "paginaFinal" => "42"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9577520"
                              "web" => "Medline"
                            ]
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              21 => array:3 [
                "identificador" => "bb0110"
                "etiqueta" => "22&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Noninvasive assessment of the tension&#8211; time index of inspiratory muscles at rest in obese male subjects"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:5 [
                              0 => "M&#46; Chlif"
                              1 => "D&#46; Keochkerian"
                              2 => "C&#46; Mourlhon"
                              3 => "D&#46; Choquet"
                              4 => "S&#46; Ahmaidi"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:5 [
                          "tituloSerie" => "Int J Obes &#40;Lond&#41;"
                          "fecha" => "2005"
                          "volumen" => "29"
                          "paginaInicial" => "1478"
                          "paginaFinal" => "1483"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              22 => array:3 [
                "identificador" => "bb0115"
                "etiqueta" => "23&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Influence of excess adiposity on exercise fitness and performance in overweight children and adolescents"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:6 [
                              0 => "A&#46;C&#46; Norman"
                              1 => "B&#46; Drinkard"
                              2 => "Mcduffie Jr"
                              3 => "S&#46; Ghorbani"
                              4 => "L&#46;B&#46; Yanoff"
                              5 => "J&#46;A&#46; Yanovski"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:2 [
                        "doi" => "10.1542/peds.2004-1543"
                        "Revista" => array:6 [
                          "tituloSerie" => "Pediatrics"
                          "fecha" => "2005"
                          "volumen" => "115"
                          "paginaInicial" => "e690"
                          "paginaFinal" => "e696"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15930197"
                              "web" => "Medline"
                            ]
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              23 => array:3 [
                "identificador" => "bb0120"
                "etiqueta" => "24&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Obesity and asthma&#58; directions for research"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:2 [
                              0 => "S&#46;T&#46; Weiss"
                              1 => "S&#46; Shore"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:5 [
                          "tituloSerie" => "Am J Respir Care Med"
                          "fecha" => "2004"
                          "volumen" => "169"
                          "paginaInicial" => "963"
                          "paginaFinal" => "968"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              24 => array:3 [
                "identificador" => "bb0125"
                "etiqueta" => "25&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Obesity"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:1 [
                              0 => "N&#46; Finer"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:7 [
                          "tituloSerie" => "Clin Med"
                          "fecha" => "2003"
                          "volumen" => "3"
                          "numero" => "1"
                          "paginaInicial" => "23"
                          "paginaFinal" => "27"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12617409"
                              "web" => "Medline"
                            ]
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              25 => array:3 [
                "identificador" => "bb0130"
                "etiqueta" => "26&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Meta-analysis&#58; surgical treatment of obesity"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => true
                            "autores" => array:6 [
                              0 => "M&#46;A&#46; Maggard"
                              1 => "L&#46;R&#46; Shugarman"
                              2 => "M&#46; Suttorp"
                              3 => "M&#46; Maglione"
                              4 => "H&#46;J&#46; Sugerman"
                              5 => "E&#46;H&#46; Livingston"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:6 [
                          "tituloSerie" => "Ann Intern Med"
                          "fecha" => "2005"
                          "volumen" => "142"
                          "paginaInicial" => "547"
                          "paginaFinal" => "559"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15809466"
                              "web" => "Medline"
                            ]
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              26 => array:3 [
                "identificador" => "bb0135"
                "etiqueta" => "27&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Pulmonary complications of obesity"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:1 [
                              0 => "S&#46;M&#46; Koenig"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:7 [
                          "tituloSerie" => "Am J Med Sci"
                          "fecha" => "2001"
                          "volumen" => "321"
                          "numero" => "4"
                          "paginaInicial" => "249"
                          "paginaFinal" => "279"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11307867"
                              "web" => "Medline"
                            ]
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              27 => array:3 [
                "identificador" => "bb0140"
                "etiqueta" => "28&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "The effects on abdominal opening on respiratory mechanics during general anesthesia in normal and morbidly obese patients&#58; a comparative study"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:6 [
                              0 => "J&#46;O&#46;C&#46; Auler"
                              1 => "E&#46; Myoshi"
                              2 => "C&#46;R&#46; Fernandes"
                              3 => "F&#46;R&#46; Bense&#241;or"
                              4 => "L&#46; Elias"
                              5 => "J&#46; Bonassa"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:6 [
                          "tituloSerie" => "Anesth Analg"
                          "fecha" => "2002"
                          "volumen" => "94"
                          "paginaInicial" => "741"
                          "paginaFinal" => "748"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11867409"
                              "web" => "Medline"
                            ]
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              28 => array:3 [
                "identificador" => "bb0145"
                "etiqueta" => "29&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Preoperative pulmonary evaluation"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:1 [
                              0 => "G&#46;W&#46; Smetana"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:4 [
                          "tituloSerie" => "Cleav Clin J Med"
                          "fecha" => "2006"
                          "volumen" => "73"
                          "numero" => "1"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              29 => array:3 [
                "identificador" => "bb0150"
                "etiqueta" => "30&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Postural changes in lung volumes and respiratory resistance in subjects with obesity"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:2 [
                              0 => "R&#46;A&#46; Watson"
                              1 => "N&#46;B&#46; Pride"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:2 [
                        "doi" => "10.1152/japplphysiol.00430.2004"
                        "Revista" => array:6 [
                          "tituloSerie" => "J Appl Physiol"
                          "fecha" => "2005"
                          "volumen" => "98"
                          "paginaInicial" => "512"
                          "paginaFinal" => "517"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15475605"
                              "web" => "Medline"
                            ]
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              30 => array:3 [
                "identificador" => "bb0155"
                "etiqueta" => "31&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Critical care of patients with obesity"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:2 [
                              0 => "D&#46; Charlebois"
                              1 => "D&#46; Wilmoth"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:7 [
                          "tituloSerie" => "Crit Care Nurse"
                          "fecha" => "2004"
                          "volumen" => "24"
                          "numero" => "4"
                          "paginaInicial" => "19"
                          "paginaFinal" => "27"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15526488"
                              "web" => "Medline"
                            ]
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              31 => array:3 [
                "identificador" => "bb0160"
                "etiqueta" => "32&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Preval&#234;ncia&#44; riscos e solu&#231;&#245;es na obesidade e sobrepeso&#58; Here&#44; there&#44; and everywhere"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:3 [
                              0 => "G&#46; Repetto"
                              1 => "J&#46; Rizzolli"
                              2 => "C&#46; Bonatto"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:6 [
                          "tituloSerie" => "Arq Bras Endocrinol Metab"
                          "fecha" => "2003"
                          "volumen" => "47"
                          "numero" => "6"
                          "paginaInicial" => "633"
                          "paginaFinal" => "635"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              32 => array:3 [
                "identificador" => "bb0165"
                "etiqueta" => "33&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Chest mechanics in morbidly obese non-hypoventilated patients"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:3 [
                              0 => "W&#46; Ladosky"
                              1 => "M&#46;A&#46;M&#46; Botelho"
                              2 => "J&#46;P&#46; Albuquerque Jr&#46;"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:5 [
                          "tituloSerie" => "Resp Med"
                          "fecha" => "2001"
                          "volumen" => "95"
                          "paginaInicial" => "281"
                          "paginaFinal" => "286"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              33 => array:3 [
                "identificador" => "bb0170"
                "etiqueta" => "34&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Pulmonary atelectasis&#58; A pathogenic perioperative entity"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:2 [
                              0 => "M&#46; Duggan"
                              1 => "B&#46;P&#46; Kavanagh"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:5 [
                          "tituloSerie" => "Anaesth"
                          "fecha" => "2005"
                          "volumen" => "102"
                          "paginaInicial" => "838"
                          "paginaFinal" => "854"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              34 => array:3 [
                "identificador" => "bb0175"
                "etiqueta" => "35&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Changes in pulmonary mechanics during laparoscopic gastroplasty in morbidly obese patients"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:6 [
                              0 => "L&#46; Dumont"
                              1 => "M&#46; Mattys"
                              2 => "C&#46; Mardirosoff"
                              3 => "N&#46; Vervloesem"
                              4 => "J&#46;L&#46; All&#233;"
                              5 => "J&#46; Massaut"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:6 [
                          "tituloSerie" => "Acta Anaesth Scan"
                          "fecha" => "1997"
                          "volumen" => "41"
                          "paginaInicial" => "408"
                          "paginaFinal" => "413"
                          "itemHostRev" => array:3 [
                            "pii" => "S0168822713000314"
                            "estado" => "S300"
                            "issn" => "01688227"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              35 => array:3 [
                "identificador" => "bb0180"
                "etiqueta" => "36&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "The effect of gender on the relationship between body fat distribution and lung function"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:3 [
                              0 => "H&#46; Raida"
                              1 => "R&#46;A&#46; Wise"
                              2 => "J&#46;L&#46; Fleg"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:5 [
                          "tituloSerie" => "J Clin Epidemiol"
                          "fecha" => "2001"
                          "volumen" => "54"
                          "paginaInicial" => "306"
                          "paginaFinal" => "399"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              36 => array:3 [
                "identificador" => "bb0185"
                "etiqueta" => "37&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Obesity and cardiovascular disease&#58; pathophysiology&#44; evaluation&#44; and effect of weight loss"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => true
                            "autores" => array:1 [
                              0 => "P&#46; Poirier"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:2 [
                        "doi" => "10.1161/01.ATV.0000216787.85457.f3"
                        "Revista" => array:6 [
                          "tituloSerie" => "Arterioscler Thromb Vasc Biol"
                          "fecha" => "2006"
                          "volumen" => "26"
                          "paginaInicial" => "968"
                          "paginaFinal" => "976"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16627822"
                              "web" => "Medline"
                            ]
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              37 => array:3 [
                "identificador" => "bb0190"
                "etiqueta" => "38&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Effects of obesity on respiratory resistance"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:6 [
                              0 => "F&#46; Zerah"
                              1 => "A&#46; Harf"
                              2 => "L&#46; Perlemuter"
                              3 => "H&#46; Lorino"
                              4 => "A&#46;M&#46; Lorino"
                              5 => "G&#46; Atlan"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:6 [
                          "tituloSerie" => "Chest"
                          "fecha" => "1993"
                          "volumen" => "103"
                          "paginaInicial" => "1470"
                          "paginaFinal" => "1476"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8486029"
                              "web" => "Medline"
                            ]
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              38 => array:3 [
                "identificador" => "bb0195"
                "etiqueta" => "39&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Respiratory system mechanics in sedated&#44; paralyzed&#44; morbidly obese patients"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => true
                            "autores" => array:6 [
                              0 => "P&#46; Pelosi"
                              1 => "M&#46; Croci"
                              2 => "I&#46; Ravagnan"
                              3 => "M&#46; Cerisara"
                              4 => "P&#46; Vicardi"
                              5 => "A&#46; Lissoni"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:6 [
                          "tituloSerie" => "J Appl Physiol"
                          "fecha" => "1997"
                          "volumen" => "82"
                          "paginaInicial" => "811"
                          "paginaFinal" => "818"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9074968"
                              "web" => "Medline"
                            ]
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              39 => array:3 [
                "identificador" => "bb0200"
                "etiqueta" => "40&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "The effects of obesity on pulmonary function"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:6 [
                              0 => "A&#46;M&#46; Li"
                              1 => "D&#46; Chan"
                              2 => "E&#46; Wong"
                              3 => "J&#46; Yin"
                              4 => "E&#46;A&#46; Nelson"
                              5 => "T&#46;F&#46; Fok"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:6 [
                          "tituloSerie" => "Arch Dis Child"
                          "fecha" => "2003"
                          "volumen" => "88"
                          "paginaInicial" => "361"
                          "paginaFinal" => "363"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12651773"
                              "web" => "Medline"
                            ]
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              40 => array:3 [
                "identificador" => "bb0205"
                "etiqueta" => "41&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Obesity in anesthesia and intensive care"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:2 [
                              0 => "J&#46;P&#46; Adams"
                              1 => "P&#46;G&#46; Murphy"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:6 [
                          "tituloSerie" => "Br J Anaesth"
                          "fecha" => "2000"
                          "volumen" => "85"
                          "paginaInicial" => "91"
                          "paginaFinal" => "108"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10927998"
                              "web" => "Medline"
                            ]
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              41 => array:3 [
                "identificador" => "bb0210"
                "etiqueta" => "42&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Respiratory muscle strength in obese individuals and influence of upper body fat distribution"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:2 [
                              0 => "K&#46;L&#46; Magnani"
                              1 => "A&#46;J&#46;M&#46; Cataneo"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:7 [
                          "tituloSerie" => "Sao Paulo Med J"
                          "fecha" => "2007"
                          "volumen" => "125"
                          "numero" => "4"
                          "paginaInicial" => "215"
                          "paginaFinal" => "219"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17992391"
                              "web" => "Medline"
                            ]
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              42 => array:3 [
                "identificador" => "bb0215"
                "etiqueta" => "43&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "The effect of bilevel positive airway pressure on postoperative pulmonary function following gastric surgery for obesity"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:3 [
                              0 => "C&#46;T&#46; Ebeo"
                              1 => "P&#46;N&#46; Benotti"
                              2 => "R&#46;A&#46; Byrd"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:6 [
                          "tituloSerie" => "Respir Med"
                          "fecha" => "2002"
                          "volumen" => "96"
                          "paginaInicial" => "672"
                          "paginaFinal" => "676"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12243311"
                              "web" => "Medline"
                            ]
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              43 => array:3 [
                "identificador" => "bb0220"
                "etiqueta" => "44&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Tratamento farmacol&#243;gico da obesidade"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:2 [
                              0 => "M&#46; Mancini"
                              1 => "A&#46; Halpern"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:4 [
                          "tituloSerie" => "Arq Bras Endocrinol Metab"
                          "fecha" => "2002"
                          "volumen" => "46"
                          "numero" => "5"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              44 => array:3 [
                "identificador" => "bb0225"
                "etiqueta" => "45&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Preoperative evaluation for postoperative pulmonary complications"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:3 [
                              0 => "A&#46;M&#46; Arozullah"
                              1 => "M&#46;V&#46; Conde"
                              2 => "V&#46;A&#46; Lawrence"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:6 [
                          "tituloSerie" => "Med Clinics North Am"
                          "fecha" => "2003"
                          "volumen" => "87"
                          "paginaInicial" => "153"
                          "paginaFinal" => "173"
                          "itemHostRev" => array:3 [
                            "pii" => "S0168822714000175"
                            "estado" => "S300"
                            "issn" => "01688227"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              45 => array:3 [
                "identificador" => "bb0230"
                "etiqueta" => "46&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Are incentive spirometry&#44; intermittent positive pressure breathing&#44; and deep breathing exercises effective in the prevention of postoperative pulmonary complications after upper abdominal surgery&#63;&#58; a systematic overview and meta-analysis"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:2 [
                              0 => "J&#46;A&#46; Thomas"
                              1 => "J&#46;M&#46; Mcintosh"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:6 [
                          "tituloSerie" => "Phys Ther"
                          "fecha" => "1994"
                          "volumen" => "74"
                          "paginaInicial" => "3"
                          "paginaFinal" => "10"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8265725"
                              "web" => "Medline"
                            ]
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              46 => array:3 [
                "identificador" => "bb0235"
                "etiqueta" => "47&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "The effect of incentive spirometry on postoperative pulmonary complications&#58; a systematic review"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:6 [
                              0 => "T&#46;J&#46; Overend"
                              1 => "C&#46;M&#46; Anderson"
                              2 => "S&#46;D&#46; Lucy"
                              3 => "C&#46; Bhatia"
                              4 => "B&#46;I&#46; Jonsson"
                              5 => "C&#46; Timmermans"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:6 [
                          "tituloSerie" => "Chest"
                          "fecha" => "2001"
                          "volumen" => "120"
                          "paginaInicial" => "971"
                          "paginaFinal" => "978"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11555536"
                              "web" => "Medline"
                            ]
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              47 => array:3 [
                "identificador" => "bb0240"
                "etiqueta" => "48&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Effect of periodic positive airway pressure by mask on postoperative pulmonary function"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:5 [
                              0 => "S&#46;E&#46; Ricksten"
                              1 => "A&#46; Bengtsson"
                              2 => "C&#46; Soderberg"
                              3 => "M&#46; Thorden"
                              4 => "H&#46; Kvist"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:6 [
                          "tituloSerie" => "Chest"
                          "fecha" => "1986"
                          "volumen" => "89"
                          "paginaInicial" => "774"
                          "paginaFinal" => "781"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3519107"
                              "web" => "Medline"
                            ]
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              48 => array:3 [
                "identificador" => "bb0245"
                "etiqueta" => "49&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Postoperative pulmonary complications and lung function in high-risk patients&#58; a comparison of three physiotherapy regimens after upper abdominal surgery in general anesthesia"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => true
                            "autores" => array:6 [
                              0 => "E&#46;F&#46; Christensen"
                              1 => "P&#46; Schultz"
                              2 => "O&#46;V&#46; Jensen"
                              3 => "K&#46; Egebo"
                              4 => "M&#46; Engberg"
                              5 => "I&#46; Gr&#248;n"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:6 [
                          "tituloSerie" => "Acta Anaesthesiol Scand"
                          "fecha" => "1991"
                          "volumen" => "35"
                          "paginaInicial" => "97"
                          "paginaFinal" => "104"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2024569"
                              "web" => "Medline"
                            ]
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              49 => array:3 [
                "identificador" => "bb0250"
                "etiqueta" => "50&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Effect of bi-level positive airway pressure &#40;BiPAP&#41; nasal ventilation on the postoperative pulmonary restrictive syndrome in obese patients undergoing gastroplasty"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:5 [
                              0 => "J&#46;L&#46; Joris"
                              1 => "T&#46;M&#46; Sottiaux"
                              2 => "J&#46;D&#46; Chiche"
                              3 => "C&#46;J&#46; Desaive"
                              4 => "M&#46;L&#46; Lamy"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:6 [
                          "tituloSerie" => "Chest"
                          "fecha" => "1997"
                          "volumen" => "111"
                          "paginaInicial" => "665"
                          "paginaFinal" => "670"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9118706"
                              "web" => "Medline"
                            ]
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              50 => array:3 [
                "identificador" => "bb0255"
                "etiqueta" => "51&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Randomized controlled trial of prophylactic chest physiotherapy in major abdominal surgery"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => false
                            "autores" => array:5 [
                              0 => "M&#46; Fagevik Olse&#180;n"
                              1 => "I&#46; Hanh"
                              2 => "S&#46; Nordgren"
                              3 => "H&#46; L&#246;nroth"
                              4 => "K&#46; Lundholm"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:6 [
                          "tituloSerie" => "Brit J Surg"
                          "fecha" => "1997"
                          "volumen" => "84"
                          "paginaInicial" => "1535"
                          "paginaFinal" => "1538"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9393272"
                              "web" => "Medline"
                            ]
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "pt"
  "url" => "/08732159/0000001600000002/v1_201509151443/S0873215915300283/v1_201509151443/pt/main.assets"
  "Apartado" => array:4 [
    "identificador" => "43356"
    "tipo" => "SECCION"
    "pt" => array:2 [
      "titulo" => "Artigos de revis&#227;o"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "pt"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/08732159/0000001600000002/v1_201509151443/S0873215915300283/v1_201509151443/pt/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215915300283?idApp=UINPBA00004E"
]
Share
Journal Information
Vol. 16. Issue 2.
Pages 307-314 (March - April 2010)
Share
Share
Download PDF
More article options
Vol. 16. Issue 2.
Pages 307-314 (March - April 2010)
Artigo de Revisão/Review Article
Open Access
Intervenção da fisioterapia respiratória na função pulmonar de indivíduos obesos submetidos a cirurgia bariátrica. Uma revisão
The role of respiratory physiotherapy in the lung function of obese patients undergoing bariatric surgery. A review
Visits
5915
Luís Henrique Sarmento Tenório1,
Corresponding author
tenorio@gmail.com

Correspondência: Luís Henrique Sarmento Tenório, Av. Boa Viagem, 4632, apt. 301, Boa Viagem, CEP: 51021-000. Recife-PE, Telefone: (81) 3325-1719
, Anna Myrna Jaguaribe de Lima2,4, Maria do Socorro Brasileiro-Santos3,4,5
1 Pós-Graduando em Fisioterapia Cardiorrespiratória da Universidade Federal de Pernambuco
2 Professora da Universidade Federal Rural de Pernambuco e Doutora em Ciências pela Faculdade de Medicina da Universidade de São Paulo– FMUSP
3 Professora da Universidade Federal de Pernambuco e Doutora em Ciências pela Universidade Federal de São Paulo – UNIFESP
4 Programa de Pós-graduação Associado em Educação Física da Universidade de Pernambuco/Universidade Federal da Paraíba – UPE/UFPB
5 Programa de Pós-graduação em Fisioterapia da Universidade Federal de Pernambuco – UFPE
This item has received

Under a Creative Commons license
Article information
Resumo

Introdução: A obesidade, considerada uma nova epidemia mundial, é caracterizada pelo excesso de tecido adiposo contribuindo para diversas doenças crónicas e aumento da mortalidade. A obesidade associada ao procedimento cirúrgico nesses doentes condiciona a fisioterapia respiratória essencial na recuperação da função pulmonar e na prevenção das complicações respiratórias. Objectivos: Verificar o efeito das intervenções fisioterapêuticas sobre a função pulmonar de doentes obesos submetidos a cirurgia bariátrica. Método: Uma revisão de literatura foi conduzida no período de Outubro/2008 a ju-nho/2009, com materiais disponíveis na base de dados Medline, Pubmed e Scielo, publicados nos últimos trinta anos. Conclusão: A fisioterapia respiratória realizada no período pré e pós-operatório é de fundamental importância nos indivíduos submetidos a cirurgia bariátrica, independente da técnica empregada, para prevenir complicações pulmonares inerentes ao processo cirúrgico e possibilitar a recuperação da função pulmonar.

Rev Port Pneumol 2010; XVI (2): 307-314

Palavras-chave:
Função pulmonar
cirurgia bariátrica
obesidade
fisioterapia
Abstract

Introduction: Obesity, considered a new worldwide epidemic, is characterised by excess adipose tissue and contributes to a series of chronic diseases and increased mortality. Obesity associated to surgical procedure in these patients makes respiratory physiotherapy a must to recover lung function and prevent postoperative pulmonary complications. Aims: To assess the effects of respiratory physiotherapy on the lung function of obese patients undergoing weight loss surgery. Material and methods: We conducted a literature review October 2008-June 2009 of data which had been published over the last thirty years and which was available on the Medline, Pubmed ans Scielo databases. Conclusion: Pre- and postoperative respiratory physiotherapy is vital for patients undergoing weight loss surgery irrespective of technique used, as it can prevent pulmonary complications inherent in the surgical procedure and aid lung function recovery.

Rev Port Pneumol 2010; XVI (2): 307-314

Key-words:
Lung function
bariatric surgery
obesity
physiotherapy
Full text is only aviable in PDF
Bibliografia
[1.]
S.B. Racette, S.S. Deusinger, R.H. Deusinger.
Obesity: overview of prevalence, etiology, and treatment.
Phys Ther, 83 (2003), pp. 276-288
[2.]
M.J.F. Bult, T. van Dalen, A.F. Muller.
Surgical treatment of obesity.
Eur J Endocrinol, 158 (2008), pp. 135-145
[3.]
J.F. Capella, R.F. Capella.
An assessment of vertical banded gastroplasty-Roux-en-Y gastric bypass for the treatment of morbid obesity.
Am J Surg, 183 (2002), pp. 1-10
[4.]
S.D.H. Malnick, H. Knobler.
The medical complications of obesity.
Quar J Med, 99 (2006), pp. 565-579
[5.]
R.L. Jones, M.U. Nzekwu.
The effect of body mass on lung volumes.
Chest, 130 (2006), pp. 827-833
[6.]
G.G. King, N.J. Brown, C. Diba, C.W. Thorpe, P. Muñoz, G.B. Marks, et al.
The effects of body weight on airway caliber.
Eur Resp J, 25 (2005), pp. 896-901
[7.]
F. Laghi, M.J. Tobin.
Disorders of the respiratory muscles.
Am J Respir Crit Care Med, 168 (2003), pp. 10-48
[8.]
V.A. Lawrence, J.E. Cornell, G.W. Smetana.
Strategies to reduce postoperative pulmonary complications after noncardiothoracic surgery: systematic review for the American College of Physicians.
Ann Int Med, 144 (2006), pp. 596-608
[9.]
P. Pasquina, M.R. Tramèr, J. Granier, B. Walder.
Respiratory physiotherapy to prevent pulmonary complications after abdominal surgery: a systematic review.
Chest, 130 (2006), pp. 1887-1899
[10.]
D.M. Paisani, L.D. Chiavegato, S.M. Faresin.
Volumes, capacidades pulmonares e força muscular respiratória no pós-operatório de gastroplastia.
J Pneumol, 31 (2005), pp. 125-132
[11.]
J.D. Douketis.
Body weight classification.
CMAJ, 172 (2005), pp. 1274-1275
[12.]
R. Lazarus, D. Sparrow, S.T. Weiss.
Effects of obesity and fat distribution on ventilatory function: the normative aging study.
Chest, 111 (1997), pp. 891-898
[13.]
J.P. Després, I. Lemieux, D. Prud’homme.
Treatment of obesity: need to focus on high risk abdominally obese patients.
BMJ, 322 (2001), pp. 716-720
[14.]
D.J. Chinn, J.E. Cotes, J.W. Reed.
Longitudinal effects of change in body mass on measurements of ventilatory capacity.
Thorax, 51 (1996), pp. 699-704
[15.]
M.S. Biring, M.I. Lewis, J.T. Liu, Z. Mohsenifar.
Pulmonary physiologic changes of morbid obesity.
Am J Med Sci, 318 (1999), pp. 293-297
[16.]
D. Canoy, R. Luben, A. Welch, S. Bingham, N. Warenham, N. Day, et al.
Abdominal obesity and respiratory function in men and women in the EPIC-Norfolk Study, United Kingdom.
Am J Epidemiol, 159 (2004), pp. 1140-1149
[17.]
D.D. Sin, R.L. Jones, S.F. Man.
Obesity is a risk factor for dyspnea but not for airflow obstruction.
Arch Intern Med, 162 (2002), pp. 1477-1481
[18.]
S. Sarikaya, O.B. Simen, Y. Gokay, R. Erden.
Pulmonary function tests, respiratory muscle strength, and endurance of persons with obesity.
The Endocrinologist, 13 (2003), pp. 136-141
[19.]
H. El-gamal, A. Khayat, S. Shikora, J.N. Unterborn.
Relationship of dyspnea to respiratory drive and pulmonary function test in obese patients before and after weight loss.
Chest, 128 (2005), pp. 3870-3874
[20.]
M. Poulain, M. Doucet, G.C. Major, V. Drapeau, F. Sériès, L.P. Boulet, et al.
The effect of obesity on chronic respiratory diseases: pathophysiology and therapeutic strategies.
CMAJ, 174 (2006), pp. 1293-1299
[21.]
P. Weiner, J. Waizman, M. Weiner, M. Rabner, R. Magadle, D. Zamir.
Influence of excessive weight after gastroplasty for morbid obesity on respiratory muscle performance.
Thorax, 53 (1998), pp. 39-42
[22.]
M. Chlif, D. Keochkerian, C. Mourlhon, D. Choquet, S. Ahmaidi.
Noninvasive assessment of the tension– time index of inspiratory muscles at rest in obese male subjects.
Int J Obes (Lond), 29 (2005), pp. 1478-1483
[23.]
A.C. Norman, B. Drinkard, Mcduffie Jr, S. Ghorbani, L.B. Yanoff, J.A. Yanovski.
Influence of excess adiposity on exercise fitness and performance in overweight children and adolescents.
Pediatrics, 115 (2005), pp. e690-e696
[24.]
S.T. Weiss, S. Shore.
Obesity and asthma: directions for research.
Am J Respir Care Med, 169 (2004), pp. 963-968
[25.]
N. Finer.
Obesity.
Clin Med, 3 (2003), pp. 23-27
[26.]
M.A. Maggard, L.R. Shugarman, M. Suttorp, M. Maglione, H.J. Sugerman, E.H. Livingston, et al.
Meta-analysis: surgical treatment of obesity.
Ann Intern Med, 142 (2005), pp. 547-559
[27.]
S.M. Koenig.
Pulmonary complications of obesity.
Am J Med Sci, 321 (2001), pp. 249-279
[28.]
J.O.C. Auler, E. Myoshi, C.R. Fernandes, F.R. Benseñor, L. Elias, J. Bonassa.
The effects on abdominal opening on respiratory mechanics during general anesthesia in normal and morbidly obese patients: a comparative study.
Anesth Analg, 94 (2002), pp. 741-748
[29.]
G.W. Smetana.
Preoperative pulmonary evaluation.
Cleav Clin J Med, 73 (2006),
[30.]
R.A. Watson, N.B. Pride.
Postural changes in lung volumes and respiratory resistance in subjects with obesity.
J Appl Physiol, 98 (2005), pp. 512-517
[31.]
D. Charlebois, D. Wilmoth.
Critical care of patients with obesity.
Crit Care Nurse, 24 (2004), pp. 19-27
[32.]
G. Repetto, J. Rizzolli, C. Bonatto.
Prevalência, riscos e soluções na obesidade e sobrepeso: Here, there, and everywhere.
Arq Bras Endocrinol Metab, 47 (2003), pp. 633-635
[33.]
W. Ladosky, M.A.M. Botelho, J.P. Albuquerque Jr..
Chest mechanics in morbidly obese non-hypoventilated patients.
Resp Med, 95 (2001), pp. 281-286
[34.]
M. Duggan, B.P. Kavanagh.
Pulmonary atelectasis: A pathogenic perioperative entity.
Anaesth, 102 (2005), pp. 838-854
[35.]
L. Dumont, M. Mattys, C. Mardirosoff, N. Vervloesem, J.L. Allé, J. Massaut.
Changes in pulmonary mechanics during laparoscopic gastroplasty in morbidly obese patients.
Acta Anaesth Scan, 41 (1997), pp. 408-413
[36.]
H. Raida, R.A. Wise, J.L. Fleg.
The effect of gender on the relationship between body fat distribution and lung function.
J Clin Epidemiol, 54 (2001), pp. 306-399
[37.]
P. Poirier, et al.
Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss.
Arterioscler Thromb Vasc Biol, 26 (2006), pp. 968-976
[38.]
F. Zerah, A. Harf, L. Perlemuter, H. Lorino, A.M. Lorino, G. Atlan.
Effects of obesity on respiratory resistance.
Chest, 103 (1993), pp. 1470-1476
[39.]
P. Pelosi, M. Croci, I. Ravagnan, M. Cerisara, P. Vicardi, A. Lissoni, et al.
Respiratory system mechanics in sedated, paralyzed, morbidly obese patients.
J Appl Physiol, 82 (1997), pp. 811-818
[40.]
A.M. Li, D. Chan, E. Wong, J. Yin, E.A. Nelson, T.F. Fok.
The effects of obesity on pulmonary function.
Arch Dis Child, 88 (2003), pp. 361-363
[41.]
J.P. Adams, P.G. Murphy.
Obesity in anesthesia and intensive care.
Br J Anaesth, 85 (2000), pp. 91-108
[42.]
K.L. Magnani, A.J.M. Cataneo.
Respiratory muscle strength in obese individuals and influence of upper body fat distribution.
Sao Paulo Med J, 125 (2007), pp. 215-219
[43.]
C.T. Ebeo, P.N. Benotti, R.A. Byrd.
The effect of bilevel positive airway pressure on postoperative pulmonary function following gastric surgery for obesity.
Respir Med, 96 (2002), pp. 672-676
[44.]
M. Mancini, A. Halpern.
Tratamento farmacológico da obesidade.
Arq Bras Endocrinol Metab, 46 (2002),
[45.]
A.M. Arozullah, M.V. Conde, V.A. Lawrence.
Preoperative evaluation for postoperative pulmonary complications.
Med Clinics North Am, 87 (2003), pp. 153-173
[46.]
J.A. Thomas, J.M. Mcintosh.
Are incentive spirometry, intermittent positive pressure breathing, and deep breathing exercises effective in the prevention of postoperative pulmonary complications after upper abdominal surgery?: a systematic overview and meta-analysis.
Phys Ther, 74 (1994), pp. 3-10
[47.]
T.J. Overend, C.M. Anderson, S.D. Lucy, C. Bhatia, B.I. Jonsson, C. Timmermans.
The effect of incentive spirometry on postoperative pulmonary complications: a systematic review.
Chest, 120 (2001), pp. 971-978
[48.]
S.E. Ricksten, A. Bengtsson, C. Soderberg, M. Thorden, H. Kvist.
Effect of periodic positive airway pressure by mask on postoperative pulmonary function.
Chest, 89 (1986), pp. 774-781
[49.]
E.F. Christensen, P. Schultz, O.V. Jensen, K. Egebo, M. Engberg, I. Grøn, et al.
Postoperative pulmonary complications and lung function in high-risk patients: a comparison of three physiotherapy regimens after upper abdominal surgery in general anesthesia.
Acta Anaesthesiol Scand, 35 (1991), pp. 97-104
[50.]
J.L. Joris, T.M. Sottiaux, J.D. Chiche, C.J. Desaive, M.L. Lamy.
Effect of bi-level positive airway pressure (BiPAP) nasal ventilation on the postoperative pulmonary restrictive syndrome in obese patients undergoing gastroplasty.
Chest, 111 (1997), pp. 665-670
[51.]
M. Fagevik Olse´n, I. Hanh, S. Nordgren, H. Lönroth, K. Lundholm.
Randomized controlled trial of prophylactic chest physiotherapy in major abdominal surgery.
Brit J Surg, 84 (1997), pp. 1535-1538
Copyright © 2010. Sociedade Portuguesa de Pneumologia/SPP
Download PDF
Pulmonology
Article options
Tools

Are you a health professional able to prescribe or dispense drugs?