Abstract
1) To demonstrate the impaired ventilatory capacity during the post operatory period, in patients submitted to coronary arterial bypass graft surgery (CABG). 2) To test the hypothesis that the respiratory muscle training (RMT), performed after the surgery, may increase the ventilatory capacity in this population. Thirty-eight patients (age: 65 ± 7 years, 29 male), whose underwent CABG with extra-corporeal circulation. Patients were randomized in two groups: 23 patients in the RMT group and 15 in the control group (CO). RMT group received conventional physiotherapy plus RMT. The CO group received the conventional physiotherapy. Evaluated parameters: maximum inspiratory and expiratory pressures (MIP) (MEP), dyspnea (Borg), peak expiratory flow (PEF), pain, tidal volume and hospitalization days. Measures were performed at pre, first post operatory day and also at the patients discharge from the hospital). MIP and MEP in the RMT group were higher when compared with CO at the patients discharge (MIP: 90 ± 26 vs. 55 ± 38 cmH2O, P = 0.01) (MEP: 99 ± 30 vs. 53 ± 26 cmH2O, P = 0.02). The PEF was higher after hospitalization in the RMT group (237 ± 93 vs. 157 ± 102 lpm, P=0.02). Tidal volume was also higher in the RMT group at discharge (0.71 ± 0.21 vs. 0.44 ± 0.12 liters, P = 0,00). No differences were observed among the groups in the aspects: admission days, dyspnea and pain. Patients submitted to CABG presents an impaired respiratory muscle strength in their post operatory. RMT performed in this phase was effective to restore the ventilatory capacity in the following parameters: MIP, MEP, PEF and tidal volume, in this group of patients.
Highlights
In recent decades, the procedures related to myocardial revascularization, to peri-operative, have improved considerably, resulting in fewer complications related to it
It can be assumed that such patients after CABG, become prone to develop pulmonary complications resulting from intraoperative interventions, such as anesthesia, cardiopulmonary bypass (CPB), thoracotomy or sternotomy, the patient’s hemodynamic status, type and duration of surgery, pain and placement of chest tubes, resulting in reduced lung volume and capacity, changes in values of blood oxygenation, and especially the reduction in lung expansion, which facilitates the installation of atelectasis and pneumonia
With regard to the anthropometric characteristics of the sample, after randomization, the respiratory muscle training group (RMT) group had a mean age of 62.13 ± 8.10 years, while the CO group had a mean of 67.08 ± 7.11 years, P = 0
Summary
The procedures related to myocardial revascularization, to peri-operative, have improved considerably, resulting in fewer complications related to it. Respiratory dysfunction in cardiac postoperative are usually multifactorial and may be present, possibly because currently the CABG surgeries are performed in more vulnerable patients (high risk), with a higher tendency to limited functional reserve and often associated with older age [1,3]. It can be assumed that such patients after CABG, become prone to develop pulmonary complications resulting from intraoperative interventions, such as anesthesia, cardiopulmonary bypass (CPB), thoracotomy or sternotomy, the patient’s hemodynamic status, type and duration of surgery, pain and placement of chest tubes, resulting in reduced lung volume and capacity, changes in values of blood oxygenation, and especially the reduction in lung expansion, which facilitates the installation of atelectasis and pneumonia
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