Airway Positive Pressure vs. Exercises With Inspiratory Loading Focused on Pulmonary and Respiratory Muscular Functions in the Postoperative Period of Bariatric Surgery

Abstract

Background: Bariatric surgery can trigger postoperative pulmonary complications due to factors inherent to the procedure, mainly due to diaphragmatic dysfunction. Aim: To evaluate and compare the effects of two levels of positive pressure and exercises with inspiratory load on lung function, inspiratory muscle strength and respiratory muscle resistance, and the prevalence of atelectasis after gastroplasty. Methods: Clinical, randomized and blind trial, with subjects submitted to bariatric surgery, allocated to two groups: positive pressure group, who received positive pressure at two levels during one hour and conventional respiratory physiotherapy and inspiratory load group, who performed exercises with load linear inspiratory pressure, six sets of 15 repetitions, in addition to conventional respiratory physiotherapy, both of which were applied twice in the immediate postoperative period and three times a day on the first postoperative day. Spirometry was performed for pulmonary function analysis, nasal inspiratory pressure for inspiratory muscle strength and incremental test of respiratory muscle resistance for sustained maximal inspiratory pressure, both preoperatively and on hospital discharge on the second postoperative day. Results: There was no significant difference (p> 0.05) in the expiratory reserve volume and in the tidal volume in the pre and postoperative periods when compared intra and intergroup. There was no significant difference (p>0.05) in the nasal inspiratory pressure and the maximal inspiratory pressure maintained in the inspiratory load group in the intragroup evaluation, but with a significant difference (p<0.05) compared to the positive pressure group. The prevalence of atelectasis was 5% in both groups with no significant difference (p>0.05) between them. Conclusion: Both groups, associated with conventional respiratory physiotherapy, preserved expiratory reserve volume and tidal volume and had a low atelectasis rate. The inspiratory loading group still maintained inspiratory muscle strength and resistance of respiratory muscles.

Adding autogenic drainage to chest physiotherapy after upper abdominal surgery: effect on blood gases and pulmonary complications prevention. Randomized controlled trial

“…niques as part of the physiotherapeutic management of ineffective cough in the postoperative period after abdominal surgery. 11,20,21 However, only limited studies using the AD technique in the postoperative period are available.…”

“…Also, Rocha et al found that conventional chest physiotherapy after bariatric surgery led to improvement of tidal volume and decreased the frequency of atelectasis. 20 To the best of our knowledge, only limited clinical trials involving use of AD postoperatively are available in the literature. The results from the present study are supported by those of a study by Shingavi et al, 26 who compared the active cycles of a breathing technique versus the AD technique after abdominal surgery.…”

“…28 In addition, abdominal surgery and obesity cause restrictive breathing patterns. 20 Reductions in lung volume cause secretion accumulations in the airways, which are considered to be a risk factor for developing pneumonia and atelectasis. Reductions in vital capacity can also lead to atelectasis, with reduction of the partial pressure of oxygen and facilitation of alveolar collapse.…”

Physiotherapeutic Approaches and the Effects on Inspiratory Muscle Force in Patients With Chronic Obstructive Pulmonary Disease in the Pre-Operative Preparation for Abdominal Surgical Procedures

“…Physiotherapy works in the treatment of acute or chronicle pulmonary disturbances. It has preventive indication of respiratory complications especially in patients submitted to abdominal surgical procedures 18 .…”

Efeitos Da Mamoplastia Redutora Na Função Pulmonar E Qualidade De Vida De Mulheres Submetidas À Gigantoplastia

“…Estudos revelam o quanto a gigantomastia concorre para alterar o componente funcional, com transtornos de ordem circulatória, respiratória e postural. Entre os transtornos respiratórios, a disfunção pulmonar é uma complicação associada à gigantomastia, ainda pouco estudada e documentada na literatura, cujas alterações estão relacionadas à função pulmonar, afetando suas capacidades e volumes, que podem ser avaliadas por meio dos testes de função pulmonar: espirometria e medida dos gases sanguíneos arteriais (4)(5)(6) .…”