Effects of Inspiratory Muscle Training Using an Electronic Device on Patients Undergoing Cardiac Surgery: A Randomized Controlled Trial

Abstract Background Cardiac surgery causes pathophysiological changes that favor the occurrence of pulmonary and functional complications. Objective To investigate the effects of inspiratory muscle training (IMT) with an electronic device on patients undergoing cardiac surgery. Methods A randomized controlled trial was conducted with 30 adult patients undergoing elective cardiac surgery. A control group (CG) received conventional physical therapy care, and an intervention group (IG) received IMT using the POWERbreathe K5® electronic device. Two daily sessions of physical therapy were performed at the intensive care unit and one daily session at the ward until the sixth postoperative day. The following variables were measured preoperatively and on the sixth postoperative day, in both groups: inspiratory muscle strength, dynamic inspiratory muscle strength, and peak inspiratory flow. Data distribution was evaluated by the Shapiro-Wilk test. Analysis of variance was used, and the results were considered statistically significant when p < 0.05. Results Maximal inspiratory pressure (71.7 ± 17.1 cmH2O vs 63.3 ± 21.3 cmH2O; p = 0.11], S-index (52.61 ± 18.61 vs 51.08 ± 20.71), and peak inspiratory flow [(2.94 ± 1.09 vs 2.79 ± 1.26)] were maintained in the IG but had a significant reduction in the CG. Conclusion IMT performed with an electronic device was effective at maintaining inspiratory muscle strength, dynamic inspiratory muscle strength, and peak inspiratory flow when compared to conventional physical therapy. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0

Cuidados pré e pós-operatórios em cirurgia cardiotorácica: uma abordagem fisioterapêutica: revisão / Pre-and postoperative care in cardiothoracic surgery: a physiotherapeutic approach: review

Sabe-se que a anestesia e determinadas cirurgias predispõem a alterações na mecânica respiratória, volumes pulmonares e trocas gasosas. A cirurgia cardíaca, considerada de grande porte, pode desencadear alterações respiratórias no pós-operatório, sendo estas relacionadas a causas diversas, como funções pulmonar e cardíaca no pré-operatório, utilização de circulação extracorpórea (CEC) e grau de sedação. Nestes procedimentos torácicos extensos, a disfunção respiratória pode ser importante, persistindo no período pós-operatório. A Fisioterapia faz parte do atendimento multidisciplinar oferecido aos pacientes em Unidade de Terapia Intensiva, sendo sua atuação extensa, presente em várias etapas do tratamento intensivo, principalmente na recuperação pós-cirúrgica, com o objetivo de evitar complicações respiratórias e motoras. Sendo assim, realizou-se uma revisão bibliográfica com o objetivo de reunir informações atuais e relevantes sobre recursos disponíveis para a monitorização respiratória, bem como a sua importância para avaliação e atuação diante de alterações na função pulmonar, uma vez que tal complicação é causa freqüente de óbito em pacientes operados.

It is well known that anesthesia and certain surgeries predispose patients to changes in respiratory function, pulmonary volumes, and gas exchange. Cardiac surgery, which is considered a major surgery, may trigger respiratory complications in the postoperative period. These complications have various causes, such as heart and lung functions in the pre-operative, the use of cardiopulmonary bypass (CPB), and the level of sedation. In these extensive thoracic procedures, respiratory dysfunction may be significant, persisting in the postoperative period. Physiotherapy is offered to patients in the ICU as part of a multidisciplinary treatment plan. It is a time-consuming treatment, and is possible at various times during the patient's stay in the ICU. However, it is particularly valuable in postoperative recovery in order to avoid respiratory and motor complications. Thus, a literature review was performed, aiming to arrange current and relevant information on available resources for respiratory monitoring, as well as its importance in evaluating and treating lung function impairment, as this complication is a frequent cause of death in surgical patients.