Randomized controlled trial of prophylactic chest physiotherapy in major abdominal surgery

Olsén, Monika Fagevik; Hahn, I.; Nordgren, Svante; Lönroth, Hans; Lundholm, Kent

doi:10.1111/j.1365-2168.1997.02828.x

Cited by 145 publications

(105 citation statements)

References 23 publications

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“…Segundo Tzani, Chetta e Olivieri 14 , as intervenções preventivas, incluindo o controle da dor, fisioterapia respiratória e pressão positiva contínua nas vias, pode efetivamente reduzir a ocorrência de complicações pulmonares. Os principais objetivos da fisioterapia respiratória incluem promover a reexpansão pulmonar, restaurar volumes e capacidades pulmonares, facilitar a expectoração de secreções traqueobrônquicas e melhorar a condição de imobilidade funcional acarretada pelo repouso no leito, minimizando assim as complicações que facilmente acometem pacientes obesos e cirúrgicos 6,[15][16][17][18][19][20] . Considerando que a aplicação de pressão positiva contínua nas vias aéreas (CPAP) apresenta efeito bené-fico para resolução das complicações pulmonares 14 por restaurar volumes e capacidades pulmonares, aumentar a oxigenação e melhorar a mecânica muscular respirató-ria 15 , a hipótese do presente estudo foi que a utilização da pressão positiva associada à fisioterapia respiratória convencional durante o período pré-operatório poderia trazer benefícios adicionais à restauração do volume corrente (VC) da frequência respiratória (FR) e do volume minuto (VM) quase sempre alterados dentro das primeiras 24 horas do pós-operatório de cirurgias bariátricas.…”

Section: Pesquisa Originalunclassified

Fisioterapia respiratória associada à pressão positiva nas vias aéreas na evolução pós-operatória da cirurgia bariátrica

et al. 2012

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RESUMO | Analisar volume corrente (VC), volume minuto (VM) e frequência respiratória (FR) de obesas mórbidas no pós-operatório de cirurgia bariátrica (CB), após a fisioterapia respiratória convencional (FRC) associada ou não à pressão positiva contí-nua nas vias aéreas (CPAP) no pré-operatório. Foram estudadas 36 mulheres, com idade de 40, 1±8, 41 anos, que seriam submetidas à CB por laparotomia e que realizaram FRC (exercícios respiratórios diafragmáticos, de inspirações profundas, fracionadas e associados a movimentos de membros superiores, 1 série de 10 repetições de cada exercício) por 30 dias antes da cirurgia. Após internação, 18 delas foram submetidas a 20 minutos de CPAP, 1 hora antes da indução anestésica e compuseram o grupo FRC+CPAP. As outras 18 não receberam o CPAP e compuseram o grupo FRC. Foram avaliados VM, VC e FR por meio do ventilômetro, no momento da internação e 24 horas após a realização da cirurgia. Constatou-se que as medidas de VC, VM e FR não apresentaram significância estatística quando comparados os resultados do pré e pós-operatório em ambos os grupos, bem como quando comparados os dois grupos entre si tanto no pré como no pós-operatório. Os resultados sugerem que a tanto a aplicação da FRC como a aplicação da FRC+CPAP no período pré-operatório contribui para a manutenção das variá-veis respiratórias no pós-operatório. A aplicação do CPAP antes da indução anestésica não promoveu benefícios adicionais no pós-operatório de CB no que se refere aos volumes pulmonares.Descritores | cirurgia bariátrica; pressão positiva contínua nas vias aéreas; medidas de volume pulmonar; fisioterapia.ABSTRACT | To assess the tidal volume (VT), minute volume (MV) and respiratory rate (RR) of morbidly obese women in postoperative bariatric surgery (BS), after the conventional respiratory physiotherapy (CRP) with or without preoperatively continuous positive airway pressure (CPAP). Thirty-six women, aged 40. 1±8. 41 years, that would be submitted to BS by laparotomy were studied. All of them underwent preoperative outpatient conventional respiratory physiotherapy (CRP) (diaphragmatic breathing exercises, deep breathing, fractionated breathing and breathing associated to movements of the upper limbs, a series of 10 repetitions of each exercise) by 30 days. Once admitted, 18 were subjected to 20 minutes of CPAP, an hour before induction of anesthesia and composed group CRP+CPAP. The other 18 did not receive CPAP and composed group CRP. VT, MV, and RR were performed through the ventilometer, at admission and 24 hours after surgery. It was found that measures of TV, VM and RR were not statistically significant when comparing pre and postoperative in both groups and as well as when the two groups were compared between them in both pre and postoperative. The results suggest that both the application and the implementation of FRC and FRC+CPAP in the preoperative period contribute to the maintenance of respiratory variables in the postoperative period. The use of CPAP before induction of anesthesia, did not provide...

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Section: Pesquisa Originalunclassified

Fisioterapia respiratória associada à pressão positiva nas vias aéreas na evolução pós-operatória da cirurgia bariátrica

et al. 2012

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“…Obese subjects have been reported to have up to twice the normal total respiratory work values [19]. In the post-operative period, the decreased ventilation in overweight persons implies a higher risk of development of PPC compared to persons of a normal weight [13,20,21].…”

Section: Obesitymentioning

confidence: 99%

“…Over a period of 13 years, a series of trials including different types of surgery have been performed at Sahlgrenska University Hospital (Gothenburg, Sweden including gastrectomies, whipples and different kinds of pancreas surgery [20]. Subsequently, studies concerning open and laparoscopic hysterectomy [29], laparoscopic fundoplication [30], laparoscopic gastroplasty, as vertical banded gastroplasty [30] and gastric bypass [31], open heart surgery and thoracoabdominal oesophagus surgery [32] have been performed.…”

Section: Respiratory Changes and Risk Of Ppcmentioning

confidence: 99%

Chest physical therapy in surgery: a theoretical model about who to treat

Olsén¹

2005

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Key pointThe major high-risk factors for developing PPC include: Advanced age Smoking Obesity Obstructive pulmonary diseaseEducational aimsTo highlight high- and low-risk factors for PPC.To present overview data showing how the respiratory system is affected by different surgical interventions.To present a model to determine which treatment is most suitable for each individual patient.SummaryChest physiotherapy is common for patients undergoing different types of surgery in order to avoid PPC. However, do all patients require treatment, is it possible to predict those patients at risk and is it possible to select the optimal treatment for each patient? This paper aims to address these questions and to propose a model that can be utilised for determining how much physical therapy is needed.

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“…13 On the other hand, preoperative chest physiotherapy reduced the incidence of postoperative pulmonary complications and improved mobilization and oxygen-hemoglobin saturation after major abdominal surgery. 14 The hypothesis of this study was that chest physiotherapy during the immediate postoperative period among patients who had undergone upper abdominal surgery would improve the postoperative results or prevent postoperative pulmonary complications.…”

Section: Introductionmentioning

confidence: 99%

Chest physiotherapy during immediate postoperative period among patients undergoing upper abdominal surgery: randomized clinical trial

et al. 2008

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CONTEXT AND OBJECTIVE: Abdominal surgical procedures increase pulmonary complication risks. The aim of this study was to evaluate the effectiveness of chest physiotherapy during the immediate postoperative period among patients undergoing elective upper abdominal surgery. DESIGN AND SETTING:This randomized clinical trial was performed in the post-anesthesia care unit of a public university hospital.METHODS: Thirty-one adults were randomly assigned to control (n = 16) and chest physiotherapy (n = 15) groups. Spirometry, pulse oximetry and anamneses were performed preoperatively and on the second postoperative day. A visual pain scale was applied on the second postoperative day, before and after chest physiotherapy. The chest physiotherapy group received treatment at the post-anesthesia care unit, while the controls did not. Surgery duration, length of hospital stay and postoperative pulmonary complications were gathered from patients' medical records. RESULTS:The control and chest physiotherapy groups presented decreased spirometry values after surgery but without any difference between them (forced vital capacity from 83.5 ± 17.1% to 62.7 ± 16.9% and from 95.7 ± 18.9% to 79.0 ± 26.9%, respectively). In contrast, the chest physiotherapy group presented improved oxygen-hemoglobin saturation after chest physiotherapy during the immediate postoperative period (p < 0.03) that did not last until the second postoperative day. The medical record data were similar between groups.

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Randomized controlled trial of prophylactic chest physiotherapy in major abdominal surgery

Abstract: Preoperative chest physiotherapy reduced the incidence of postoperative pulmonary complications and improved mobilization and oxygen saturation after major abdominal surgery.

Cited by 145 publications

References 23 publications

Fisioterapia respiratória associada à pressão positiva nas vias aéreas na evolução pós-operatória da cirurgia bariátrica

Fisioterapia respiratória associada à pressão positiva nas vias aéreas na evolução pós-operatória da cirurgia bariátrica

Chest physical therapy in surgery: a theoretical model about who to treat

Chest physiotherapy during immediate postoperative period among patients undergoing upper abdominal surgery: randomized clinical trial

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