Evaluation of breathing exercise in hormonal and immunological responses in patients undergoing abdominal surgery

PURPOSE: To evaluate the effects of sustained deep inspiration in the prevention of postoperative pulmonary complications, the hormonal and immunological responses in patients submitted to abdominal surgery. METHODS: This randomized clinical trial study included 75 patients submitted to abdominal surgery, of which 36 were randomly allocated in the experimental group and underwent sustained deep inspiration during five seconds, in three sets of ten repetitions per day. The others 39 patients were allocated in the control group and were not submitted to any breathing exercise. The following parameters were measured preoperatively, 24h and 48h postoperatively: chest x-ray, serum ACTH, cortisol, IL-4, IL-10, TNF-α, forced expiratory volume in first second (FEV1), forced expiratory flow 25-75% (FEF 25-75), forced vital capacity (FVC), paO2 and paCO2. RESULTS: Mean serum cortisol in patients of the experimental and control groups before surgery were 12.8 mcg/dl (4.6-50) and 10.48 mcg/dl (1-29.1), respectively (p=0.414). The experimental group had significantly increase in serum cortisol levels, 23.6 mcg/dl (9.3-45.8), especially 24h postoperatively (p=0.049). CONCLUSION: Sustained deep inspiration in patients submitted to abdominal surgery determined important changes in serum cortisol, however, without significantly influence the postoperative pulmonary complications and the endocrine and immune responses.

Tabagismo não limita o incremento da força muscular respiratória em pacientes submetidos ao treinamento muscular inspiratório pré-esofagectomia / Smoking doesn't limit the increase in respiratory muscle strength in patients undergoing pre-inspiratory muscle training esophagectomy

Um programa de treinamento muscular respiratório (TMR) para pacientes tabagistas no pré-operatório ambulatorial pode melhorar a força muscular e a capacidade funcional respiratória, evitando complicações que aumentem a permanência do paciente no hospital. O objetivo deste trabalho foi avaliar a eficácia do treinamento muscular inspiratório (TMI) em pacientes tabagistas e não tabagistas que seriam submetidos à cirurgia do megaesôfago. Foram estudados 17 pessoas, divididas em dois grupos: o tabagista (GT), composto por 10 pacientes (58,82%), e o não tabagista (GNT), com 7 pacientes (41,18%). A análise dos dados relacionando os dois foi expressa da seguinte forma: os valores de idade e as medidas antropométricas foram comparadas pelo teste t de Student e os valores da pressão inspiratória máxima (PImáx) e da pressão expiratória máxima (PEmáx) pelo teste t de Student pareado. Os dados foram expressos em média±desvio-padrão quando verificada a normalidade. Consideraram-se diferenças estatisticamente significativas se p<0,05. Na análise comparativa, observou-se aumento significativo da PImáx após as 4 semanas do TMI, como se segue: PImáx no GT de -57,20±18,76 para -79,00±15,38 e no GNT de -52,00±18,76 para -72,66±19,33. A fisioterapia profilática no pré-operatório ambulatorial proporcionou aumento significativo na força dos músculos inspiratórios em ambos os grupos, evidenciada pelo acréscimo na PImáx com consequente melhora da capacidade ventilatória.

A program of muscular respiratory training to smoker patients in pre-operatory ambulatory can improve the muscle strength and the functional respiratory capacity, avoiding complications which increase the hospitalization period of the patient. The aim of this work was to evaluate the effectiveness of the inspiratory muscle training in smoker and non-smoker patients who would be submitted to a megaesophagus surgery. Seventeen patients were studied, divided into two groups: smoker (GT), composed of 10 patients (58.82%), and the non-smoker (GNT), with 7 patients (41.18%). Data analysis comparing the two groups was expressed as follows: the values of age and anthropometric measurements were compared by Student's t-test and the values of Maximal Inspiratory Pressure (MIP) and Maximal Expiratory Pressure (MEP) were compared by the paired Student's t-test. Data were expressed as mean±standard deviation when checked to normal. Differences were considered statistically significant if p<0.05. Level of significance adopted was p=0.05. Considering the comparative analysis, it was observed a significant increase of Maximal Inspiratory Pressure MIP after the 4 weeks of inspiratory muscle training (IMT), as follows: MIP in GT from -57.20±18.76 to -79.00±15.38 and in GNT from -52.00±18.76 to -72.66±19.33. The prophylactic therapy in the preoperative outpatient provides a significant increase in inspiratory muscle strength in both groups, as evidenced by the increase in MIP with consequent improvement in ventilatory capacity.