Pulmonary physiotherapy effect on patients undergoing open cardiac surgery

Abstract

Backgrounds and Objectives -Respiratory complications after open heart surgeries are common problems which can lead to death if not properly managed. The aim of this study was to evaluate the role of pulmonary rehabilitation before and after surgery for reducing the risk of pulmonary complications after surgery also correlations of the six-minute walk test and respiratory following open heart surgery. Material and Methods -In a randomized clinical trial, 60 patients undergoing heart surgery were divided into two groups randomly (groups A and B). In group A it was performed physiotherapy before and after chest physiotherapy surgery, but on patients in group B were done only chest physiotherapy after surgery. Effects of preoperative pulmonary rehabilitation were compared between two groups, using spirometry and six-minute walk test. Results -Thirty nine of males (65%) and 21 females (35%) with a mean age of 8.10±9.56 was been analyzed. The mean difference in predicted forced vital capacity (CI95%: 1.3 to 8.7) and predicted peak flow indices (CI95%: 1.9 to 9.4) of spirometery indicator was significant, also evaluation of six-minute walk test showed, mean difference in walking distant (CI95%: 8.8 to 21.0) and mean oxyhemoglobin saturation (CI95%: 0.59 to 1.67) in group A was more than group B. Inverse correlation of heart rate with forced vital capacity showed that patients with more restriction had more heart rate during the walking test. Conclusion -Pulmonary rehabilitation program before surgery is recommended to reduce complications of heart surgery. Further evaluations are necessary in relation to the sensitivity and specificity of six-minute walk test parameters alone in the evaluation of respiratory performance.

Prevention of postoperative pulmonary complications through preoperative physiotherapy interventions in patients undergoing coronary artery bypass graft: literature review

“…Among the trials, one study 28 ) was conducted according to the principles of CONSORT statement 2001. Other studies stand out because the outcomes were clearly described 30 ) , stated the clinical relevance of the study in terms of Relative and Absolute Risk Reduction 31 ) and all data entry and analysis were blind to group allocation 32 ) .…”

“…Regarding the timing of training on respiratory techniques, other studies outline two different options: it may be carried out 15 days before the operation (15 sessions) 30 ) or the same day of hospital admittance 31 ) . In both studies, the respiratory exercises consisted in a set of 10 repetitions of deep and diaphragmatic breaths 30 , 31 ) with puckered lips (pursed lip breathing) 30 ) , pulmonary expansion with three tactile stimulation levels 31 ) and instructions for training in use of the Respiflow ® 30 , 31 ) (slowly with a passive expiration, 5 series of deep inspirations with 30–60 seconds of rest in between) 31 ) . Furthermore, techniques of assisted coughing 30 , 31 ) , how to sit and turn in the bed, early mobilization exercises, and the adherence to the treatment were explained.…”

“…In both studies, the respiratory exercises consisted in a set of 10 repetitions of deep and diaphragmatic breaths 30 , 31 ) with puckered lips (pursed lip breathing) 30 ) , pulmonary expansion with three tactile stimulation levels 31 ) and instructions for training in use of the Respiflow ® 30 , 31 ) (slowly with a passive expiration, 5 series of deep inspirations with 30–60 seconds of rest in between) 31 ) . Furthermore, techniques of assisted coughing 30 , 31 ) , how to sit and turn in the bed, early mobilization exercises, and the adherence to the treatment were explained. Among the effects of regarding PPC, a positive effect was reported on the respiratory efficiency with an increase of the FVC (Forced Vital Capacity), as well as an increase in walking distance 30 ) and a decrease in the atelectasis incidence 31 ) .…”

“…Furthermore, techniques of assisted coughing 30 , 31 ) , how to sit and turn in the bed, early mobilization exercises, and the adherence to the treatment were explained. Among the effects of regarding PPC, a positive effect was reported on the respiratory efficiency with an increase of the FVC (Forced Vital Capacity), as well as an increase in walking distance 30 ) and a decrease in the atelectasis incidence 31 ) .…”

Comparison of impact of medical therapy and surgical treatment on overall mortality in patients with severe chronic heart failure: a meta-analysis

“…It is out of the question that clinical decision making and personal risk evaluation for surgical management of severe CHF should be done with consideration of other risk factors, already well studied for cardiosurgical patients [76][77][78][79][80].…”