Safety and feasibility of early mobilization in patients submitted to cardiac surgery using subxiphoid drain.

INTRODUCTION: Patients submitted to heart surgery are restricted to the bed of the Intensive Care Units (ICUs), due to this period of immobility the individual is likely to present clinical and functional alterations. These complications can be avoided by early mobilization; however, in some hospitals, this is not feasible due to the use of subxiphoid drain in the immediate postoperative period. OBJECTIVE: To verify the safety and feasibility of mobilizing patients after cardiac surgery using subxiphoid drain. METHODS: This was a prospective cohort study. On the first day the patient was positioned in sedestration in bed, then transferred from sitting to orthostasis, gait training and sedestration in an armchair. On the second postoperative day the same activities were performed, but with walking through the ICU with a progressive increase in distance. At all these moments, the patient was using the subxiphoid and intercostal drain. The patients were seen three times a day, but physical rehabilitation was performed twice. The adverse events considered were drain obstruction, accidental removal or displacement, total atrioventricular block, postoperative low output syndrome, cardiorespiratory arrest, pneumomediastinum, infection, and pericardial or myocardial damage. RESULTS: 176 patients were evaluated. Only 2 (0.4 %) of the patients had complications during or after mobilization, 1 (0.2 %) due to drain obstruction and 1 (0.2 %) due to accidental removal or displacement. CONCLUSION: Based on the data observed in the results, we found that the application of early mobilization in patients using subxiphoid drain after cardiac surgery is a safe and feasible conduct.

Clinical and functional outcomes associated with pulmonary complications after coronary artery bypass grafting.

INTRODUCTION: Coronary artery bypass grafting(CABG) is a surgical treatment for coronary artery disease aiming at improving symptoms and life expectancy. Despite this, there are pulmonary and functional complications that may arise during the postoperative period due to invasive mechanical ventilation(IMV), cardiopulmonary bypass and immobility, leading to longer hospital stays. OBJECTIVE: To evaluate the clinical and functional outcomes related to pulmonary complications in the postoperative period of CABG. METHODS: Prospective cohort. During the ICU stay the patients were divided into: Non Complicated Group(NCG) who did not present complications and Complicated Group(CG) who presented complication. Functional variables were applied as the six-minute walk test(6MWT), gait speed, sit up and stand up test, Timed Up and Go, peripheral muscle strength, ventilatory, pulmonary function and Functional Independence Measure. These tests were applied preoperatively, at ICU discharge, hospital discharge and six months after surgery. RESULTS: The study evaluated 90 patients, 59 in the NCG and 31 CG. In the 6MWT there was a 2%(p = 0.43) decrease in the NCG, while the decrease was 13%(p < 0.01) in the CG. In the MRC the drop was 2%(p = < 0.01) in the CNG, while in the CG the drop was 14%(p = < 0.01). In MIP the NCG had a 6%(p = 0.67) decrease, while the CG had a 16%(p = < 0.01) decrease. CONCLUSION: Patients with postoperative complications of CABG may have reduced functional performance, muscle strength, and pulmonary function at hospital discharge and after six months.

Ventilatory Muscle Strength Six Months After Coronary Artery Bypass Grafting in Patients Submitted to Inspiratory Muscular Training Based on Anaerobioc Threshold: A Clinical Trial

Abstract Introduction Coronary artery bypass grafting (CABG) surgery is associated with a decline in ventilatory muscle strength and lung function. Inspiratory muscle training (IMT) based on anaerobic threshold (AT) has been used to minimize the impact of CABG on these parameters, but the long-term impact is unknown. Objective To test the hypothesis that AT-based IMT improves inspiratory muscle strength and lung function even six months after CABG. Methods This is a randomized controlled clinical trial. In the preoperative period, maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), vital capacity (VC) and peak expiratory flow (PEF) rate were assessed. On the first postoperative day, patients were randomized into two groups: AT-based IMT (IMT-AT) (n=21) where the load was prescribed based on glycemic threshold and conventional IMT (IMT-C) (n=21), with load of 40% of MIP. Patients were trained during hospitalization until the day of discharge and were assessed at discharge and six months later. For within-group comparison, paired Student's t-test or Wilcoxon test was used, and independent Student's t-test or the Mann-Whitney test was used to analyze the different time points. A p<0.05 was considered significant. Results At six months after CABG surgery, statistical difference was found between the IMT-AT and the IMT-C groups in MIP (difference between the means of -5cmH2; 95% CI=- 8.21to-1.79) and VC (difference between the means of -2ml/kg;95%CI=-3.87to-0.13). No difference was found between groups in the other variables analyzed. Conclusion IMT-AT promoted greater recovery of inspiratory muscle strength and VC after six months of CABG when compared to conventional training.

Inspiratory muscle training and functional capacity following coronary artery bypass grafting in high-risk patients: A pilot randomized and controlled trial.

Background: Coronary artery bypass graft (CABG) surgery is associated with worsened functional capacity, pulmonary complications, and increased length of hospital stay. These negative effects are exacerbated in patients who are at high risk of post-operative (PO) pulmonary complications before CABG. Inspiratory muscle training (IMT) has been shown to benefit CABG patients in their recovery process. However, in high-risk patients, there is little evidence to support the post-operative implementation of IMT for purposes of faster recovery. Aim: The aim of the study was to test the hypothesis that IMT improves the functional capacity, pulmonary complications, and length of hospital stay in patients prone to pulmonary complications who had undergone CABG. Methods: This is a pilot clinical trial carried out with patients at high risk for pulmonary complications in the PO phase. In the pre-operative period, maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and 6-min walk test (6MWT) were determined and administered. On the first PO day, patients were divided into two groups: A control group (CG) that received routine intervention and an IMT group that, in addition to routine care, was subjected to an IMT protocol until hospital discharge. On the day of discharge, the patients were reassessed with respect to ventilatory muscle strength, functional capacity, PO complications, and length of stay. Results: Twenty-nine patients were evaluated, 15 in the CG and 14 in the IMT group. No significant differences were observed in relation to MIP (difference between the mean of -7 cmH2O; 95% CI = -16.52-2.52), MEP (difference between the mean of -7cm H2O; 95% CI = -15.39-1.39), and in the 6MWT (difference between the mean of -9 m; 95% CI = -43.71-25.71). There was a decrease in the length of stay in the IMT group compared to the CG (9 ± 3 vs. 12 ± 4 days; P = 0.04). The IMT group had a lower rate of atelectasis and pneumonia. Conclusion: IMT does not minimize the loss of functional capacity, but it reduces pulmonary complications and the length of stay of patients undergoing CABG who are preoperatively at a high risk of pulmonary complications. Relevance for Patients: The increase in ventilatory muscle strength, associated with IMT, can reduce PO pulmonary complications, resulting in shorter hospital stays, and improved quality of life.

Impact of early mobilization on clinical and functional outcomes in patients submitted to coronary artery bypass grafting.

INTRODUCTION: Heart surgery is a feature that has grown a lot in recent years. Due to the complications that can be generated, the importance of prevention emerges, thus seeking effective protocols that generate improvement in clinical and functional outcomes to promote a shorter hospital stay and readmission. OBJECTIVE: To evaluate the impact of early mobilization on clinical and functional outcomes in patients undergoing coronary artery bypass grafting. METHODOLOGY: This was a prospective cohort study. Patients were evaluated preoperatively through the Medical Research Council (MRC), Functional Independence Measurement (FIM), Six-Minute Walk Test (6MWT). After the surgery they were divided into two groups: the mobilized group (MG) where patients performed bed transfer to armchair on the 1st postoperative day and ambulated on the 2nd day, and the non-mobilized group (NMG) who underwent passive kinesiotherapy in bed. At ICU discharge, mechanical ventilation (MV) time, intensive care unit stay (ICU) and mortality were compared. At hospital discharge, preoperative tests were repeated to compare with admission. RESULTS: A total of 103 patients were admitted, 59 (57.3%) males, mean age 64 ± 8 years. Time of MV it was 6 ± 2 (MG) vs 10 ± 3 (NMG) hours, P = 0.02, ICU stay it was 2 ± 2 (MG) vs 4 ± 3 (NMG) days (P ≤ 0.001), length of stay hospital was 8 ± 4 (MG) vs 14 ± 5 (NMG) days (P ≤ 0.001), FIM -4 ± 2 (MG) vs -11 ± 4 (NMG) points (P ≤ 0.001) and distance traveled 37 ± 10 (MG) vs 78 ± 11 (NMG) meters (P < 0.001). CONCLUSION: Early mobilization is associated with improvement in clinical outcomes such as MV time, ICU stay, hospital and functional outcomes, on the FIM scale and distance traveled.

Pressão positiva expiratória das vias aéreas sobre a oxigenação e hemodinâmica em pacientes submetidos a revascularização do miocárdio / Expiratory positive airway pressure on oxygenation and hemodynamics in patients submitted to coronary artery bypass grafting

)Introdução: A pressão positiva expiratória nas vias aéreas (EPAP) é a aplicação de uma resistência expiratória para manter a pressão positiva nas vias aéreas e também tem sido amplamente utilizada para prevenir possíveis complicações no pós-operatório de cirurgia cardíaca. Objetivo: Descrever o comportamento da oxigenação e hemodinâmica durante o uso de EPAP em pacientes submetidos à cirurgia de revascularização do miocárdio (RM). Métodos: Estudo transversal que avaliou saturação periférica de oxigênio (SpO2), frequência cardíaca (FC), frequência respiratória (FR), pressão arterial sistólica (PAS), diastólica (PAD) e média (PAM), pressão arterial de oxigênio (PaO2), pressão arterial de dióxido de carbono (PaCO2) e índice de oxigenação calculado dividindo a PaO2 pela fração inspirada de oxigênio (FiO2), os pacientes foram avaliados em repouso, no primeiro dia de pós-operatório. A EPAP foi realizada com o paciente em sedestação na poltrona e uma gasometria arterial foi coletada e analisada para verificar os valores de PaO2, PaCO2, SaO2 e PaO2/FiO2. Foi aplicada uma resistência expiratória de 12 cmH2O por dez minutos. Imediatamente após a aplicação do EPAP, os pacientes tiveram nova análise gasométrica e a hemodinâmica analisada. Resultados: 58 pacientes, 41 (71%) do sexo masculino e com idade média de 54 ± 8 anos foram avaliados. O uso de EPAP no pós-operatório levou à melhora de todas as variáveis gasométricas, exceto PaCO2. Houve uma melhora na SaO2 (%) pré-EPAP 94 ± 3 e pós-EPAP 98 ± 2, PaO2/FiO2 pré-EPAP 279 ± 10 e pós-EPAP 346 ± 8, PaO2 (mmHg) pré-EPAP 78 ± 8 e pós-EPAP 97 ± 7. Conclusão: Concluiu-se que a aplicação do EPAP teve um impacto positivo na oxigenação em pacientes submetidos à RM sem gerar efeitos adversos na hemodinâmica. (AU)

Clinical and Surgical Characteristics of Patients Undergoing Valve Replacement / Características Clínicas e Cirúrgicas de Pacientes Submetidos a Troca Valvar

Abstract Cardiovascular diseases have been the leading the causes of hospital admissions, being one of the main public health problems in Brazil, and one of the forms of treatment is cardiac surgery, being more prevalent in older people who have several other comorbidities associated. This study aimed to describe the clinical and surgical profile of patients undergoing valve replacement. Thus, an ambispective study was carried out with patients admitted to the Intensive Care Unit of Instituto Nobre de Cardiologia. An analysis was carried out in the patients' medical records in search of data related to their clinical and surgical profile. During the research period, 55 patients underwent valve replacement, 10 of which were excluded. Thus, 45 patients were evaluated, with 28 (62%) male participants with a mean age of 43 ± 6 years, hypertension and sedentary lifestyle were the most common comorbidities (49% and 56% respectively) and 60% with the Body Mass Index within the normal range. Regarding the surgical characteristics, the extracorporeal circulation time was 211 ± 22 minutes and the Mechanical Ventilation time was 6 ± 2 hours. Based on the findings, it can be characterized that patients undergoing cardiac valve replacement surgery are over 40 years old, male, sedentary, hypertensive. (AU)

Resumo As doenças cardiovasculares têm liderado as causas de internação hospitalar, sendo um dos principais problemas de saúde publica no Brasil, sendo que umas das formas de tratamento é a cirurgia cardíaca, sendo mais prevalente em pessoas com idade mais avançada, e que possuem várias outras comorbidades associadas. O presente estudo teve como objetivo descrever o perfil clínico e cirúrgico de pacientes submetidos à troca valvar. Para isso foi realizado um estudo ambispectivo com os pacientes internados na Unidade de Terapia Intensiva do Instituto Nobre de Cardiologia. Foi feita uma análise no prontuário dos pacientes na busca de dados relacionados ao seu perfil clinico e cirúrgico. Durante o período da pesquisa foram submetidos a troca valvar 55 pacientes sendo que 10 foram excluídos. Desse modo foram avaliados 45 pacientes, com 28 (62%) participantes do sexo masculino com idade média de 43 ± 6 anos, hipertensão e sedentarismo as comorbidades mais encontradas (49% e 56% respectivamente) e 60% com o Índice de Massa Corpórea dentro da normalidade. Em relação às características cirúrgicas o tempo da circulação extracorpórea 211 ± 22 minutos e o tempo de Ventilação Mecânica 6 ± 2 horas. Com base nos achados podese caracterizar que os pacientes submetidos à cirurgia cardíaca de troca de válvulas têm mais de 40 anos, do gênero masculino, sedentários, hipertensos. (AU)

Pilates method on pulmonary function and range of motion after coronary artery bypass grafting: A clinical trial.

INTRODUCTION: Coronary artery bypass grafting (CABG) can compromise pulmonary function and range of motion (ROM) of the shoulder and knee joints due to median sternotomy and saphenectomy, the Pilates method being a strategy for reducing loss. OBJECTIVE: To evaluate the effect of applying the Pilates method on pulmonary function and ROM in patients undergoing CABG. METHOD: ology: This is a clinical trial. Patients were evaluated preoperatively at discharge from the hospital for shoulder flexion and abduction and knee flexion-extension. In addition, vital capacity(VC), maximum inspiratory pressure(MIP), expiratory pressure(MEP) and peak expiratory flow(PEF) were evaluated. Upon discharge from the Intensive Care Unit (ICU), they were divided into a control group(CG) that received conventional assistance and Pilates(PG) was increased with Pilates method techniques. RESULTS: 40 patients were analyzed, 25 were men(61%), with a mean age of 66 ± 7 years. At the end, the left shoulder abduction in the CG was 105±9vs115 ± 8 in the PG(p = 0.03), the right shoulder abduction in the CG 104 ± 11vs116 ± 10 in the PG(p < 0.001) and right knee flexion in the CG 78 ± 13vs92 ± 9 in the PG(0.002). In relation to MIP, the CG had a loss of 32 ± 8 while the PG 18 ± 10cmH2O(p < 0.001), the worsening MEP was 31 ± 9(CG)vs29 ± 11cmH2O(PG)(p = 0.53), the VC in the CG reduced 8±9vs6±8 in the PG(p = 0.23) and the PEF reduced 107 ± 5 in the GCvs83 ± 88 in the PG(p = 0.09). CONCLUSION: It is concluded that the Pilates method decreased the loss of ROM and maximum inspiratory pressure in patients undergoing coronary artery bypass grafting.

Factors associated with pulmonary complacence in patients submitted to coronary artery bypass grafting: cross-sectional study.

BACKGROUND: Coronary artery bypass grafting (CABG) is one of the most studied surgical procedures worldwide and is associated with deleterious effects on respiratory function in the postoperative period, corroborating the incidence of factors that can cause a decrease in lung compliance, generating possible respiratory complications. OBJECTIVE: To identify factors associated with low pulmonary compliance in patients submitted to coronary artery bypass grafting. METHODS: This is a cross-sectional study. After admission to the Intensive Care Unit (ICU), the static compliance calculation was performed and the patients were divided into two groups: Low Compliance Group (LCG) and Normal Compliance Group (NCG), to verify which factors were associated with low compliance. RESULTS: The final sample consisted of 62 patients, with male prevalence, with a mean age of 60 ± 9.5 years. Clinical variables body mass index (BMI) (P=0.04), smoking (P=0.05), chronic obstructive pulmonary disease (P < 0.001) and ejection fraction (P=0.03) were associated with reduced static pulmonary compliance. CONCLUSION: It is concluded that factors such as age, COPD, smoking, BMI and ejection fraction may be associated with worsening pulmonary compliance after CABG.

Two types of inspiratory muscle training on muscle strength in patients submitted to coronary artery bypass grafting: clinical trial / Dois tipos de treinamento muscular inspiratório sobre a força muscular de pacientes após revascularização do miocárdio: ensaio clínico

Introduction: Coronary artery bypass grafting (CABG) causes changes in the respiratory musculature that affects functional capacity and postoperative complications (POC). Inspiratory muscle training (IMT) is a tool used for these patients, but it is not known what the best form is to increase strength. Objective: To investigate whether IMT with a linear pressure load device is superior to the inspiratory incentive on functional capacity and muscle strength of patients undergoing CABG. Methods: This is a clinical trial. Patients were assessed preoperatively for inspiratory muscle pressure (MIP), expiratory pressure (MEP), peak expiratory flow (PEF), six-minute walk test (6MWT) and functional independence measure (FIM). After surgery, they were divided into three groups: control group (CG), training group with linear pressure load (IMT) and inspiratory incentive group (IG). On the day of discharge, all patients had their previous variables reassessed. Results: The study included 56 patients, 31 (55.4%) were male and an average age of 55 ± 12 years. There was a significant reduction in all variables, in relation to MIP, the IMT showed a higher value in the postoperative period 83 ± 19 cmH2O, against 70 ± 15 cmH2O in the CG and 80 ± 15 cmH2O in the IG (p < 0.001). The same behavior was observed in MEP, 77 ± 12 cm H2O in IMT, 67 ± 14 cmH2O in CG and 75 ± 10 cmH2O in IG (p < 0.001). Regarding the 6 MWT, there was a lesser loss in the IMT from 434 ± 15 m to 398 ± 20 m in IG (p < 0.001). Conclusion: It is concluded that muscle training with a linear pressure load device is superior to training with incentive on functional capacity and muscle strength in patients undergoing CABG. (AU)

Introdução: A cirurgia de revascularização do miocárdio (CRM) causa alterações na musculatura respiratória que afetam a capacidade funcional e complicações pós-operatórias (DCP). O treinamento muscular inspiratório (TMI) é uma ferramenta utilizada por esses pacientes, mas não se sabe qual é a melhor forma de aumentar a força. Objetivo: Investigar se o TMI com dispositivo de carga de pressão linear é superior ao incentivo inspiratório na capacidade funcional e força muscular de pacientes submetidos à CRM. Métodos: Este é um ensaio clínico. Os pacientes foram avaliados no pré-operatório para pressão muscular inspiratória (PImáx), pressão expiratória (PEF), pico de fluxo expiratório (PFE), teste de caminhada de seis minutos (TC6) e medida de independência funcional (MIF). Após a cirurgia, eles foram divididos em três grupos: grupo controle (GC), grupo treinamento com carga linear de pressão (IMT) e grupo incentivo inspiratório (GI). No dia da alta, todos os pacientes tiveram suas variáveis anteriores reavaliadas. Resultados: O estudo incluiu 56 pacientes, 31 (55,4%) eram do sexo masculino e idade média de 55 ± 12 anos. Houve redução significativa em todas as variáveis, em relação à PImáx, o IMT apresentou valor maior no pós-operatório 83 ± 19 cmH2O, contra 70 ± 15 cmH2O no GC e 80 ± 15 cmH2O no GI (p < 0,001). O mesmo comportamento foi observado na PEmáx, 77 ± 12 cmH2O no IMT, 67 ± 14 cmH2O no GC e 75 ± 10 cmH2O no GI (p < 0,001). Em relação ao TC6, houve menor perda no TMI de 434 ± 15 metros para 398 ± 20 metros no GI (p < 0,001). Conclusão: Conclui-se que o treinamento muscular com dispositivo de carga pressórica linear é superior ao treinamento com incentivo inspiratório na capacidade funcional e da força muscular em pacientes submetidos à CRM. (AU)

Correlation between Surgical Risk Scales with Respiratory Muscle Strength and Functional Independence in Patients Submitted to Coronary Artery Bypass Grafting

Abstract Background The European Heart Surgery Risk Assessment System (EuroSCORE) and InsCor have been used to predict complications of cardiac surgery. However, their application to predict lung function and functionality is still uncertain. Objective To correlate surgical risk scales with functional independence and pulmonary function in patients undergoing coronary artery bypass grafting. Methods This was a prospective cohort study. In the preoperative period, the two surgical scales were applied, the maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and peak expiratory flow (PEF) were measured, and functionality was assessed using the functional independence measure (FIM). On the seventh postoperative day, the pulmonary function and functionality variables were reevaluated, compared with the preoperative values (delta) and correlated with the risk scales. Correlations of pulmonary function, functional independence and muscle strength variables with the surgical scales were made by Pearson correlation test. The significance level adopted was 5%. Results Thirty-one patients were studied; most were male (77%), with a mean age of 56±8 years. Mean EuroSCORE was 2.3±0.5 and mean InsCOR was 1.2±0.5. MIP, MEP, and PEF reduced 30% (p<0.001), 33% (p<0.001) and 10% (p=0.23), respectively. The EuroSCORE correlated with MIP (r-0.78; p = 0.02) and FIM (r-0.79; p <0.01), and the InsCor correlated with MIP (r-0.77), MEP (r-0.73) and MIF (r-0.89; p=0.02). Conclusion The EuroSCORE showed a strong negative correlation with MIP and FIM, while InsCor had a strong negative correlation with MIP, MEP and FIM. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0)

Virtual reality on pulmonary function and functional independence after coronary artery bypass grafting: clinical trial.

INTRODUCTION: Coronary artery bypass grafing (CABG) is responsible for the decrease in pulmonary function and functionality. In this case the virtual reality is an alternative to reduce the impact of the surgical procedure. OBJECTIVE: To evaluate the effect of virtual reality on pulmonary function and functional independence in patients undergoing CABG. METHODOLOGY: This is a clinical trial. In the preoperative period, pulmonary function was assessed using maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), vital capacity (VC), peak expiratory flow (PEF) and functionality through the measurement of functional independence (FIM) and time up and go (TUG). On the first postoperative day, patients were randomized into two groups: the control group (CG), submitted to conventional physiotherapy, and the virtual rehabilitation group (VRG), increased through virtual reality. On the day of hospital discharge, patients were reassessed. RESULTS: 56 patients were analyzed, 25 in the CG, with a mean age of 51 ± 10 years, male prevalence 17 (68%), 31 in the VRG aged 54 ± 8 years, 21 (68%) men. All variables showed an intragroup reduction. At the end, the MIP of the CG was 74 ± 15 vs 92 ± 12 cmH2O of the VRG (P < 0.001), the MEP of the GC was 54 ± 14 vs 75 ± 16 cmH2O of the VRG (P < 0.001), the VC was 1.9 ± 0.6 ml/Kg in GC vs 2.4 ± 0.7 ml/Kg in VRG (P = 0.22), PEF in GC was 231 ± 28 vs 311 ± 26 L/min in VRG (P < 0.001), TUG of CG 22 ± 9.1 seconds vs 10 ± 1.6 seconds in the VRG (P < 0.001), the CG's FIM was 112 ± 5 vs 120 ± 3 in the GRV (P < 0.001). CONCLUSION: Based on the results obtained, it was found that the intervention with virtual reality was effective in reducing the loss of pulmonary function and functional independence after CABG.

Inspiratory Muscle Training and Functional Capacity in Patients Undergoing Cardiac Surgery.

INTRODUCTION: Cardiac surgery is a highly complex procedure which generates worsening of lung function and decreased inspiratory muscle strength. The inspiratory muscle training becomes effective for muscle strengthening and can improve functional capacity. OBJECTIVE: To investigate the effect of inspiratory muscle training on functional capacity submaximal and inspiratory muscle strength in patients undergoing cardiac surgery. METHODS: This is a clinical randomized controlled trial with patients undergoing cardiac surgery at Instituto Nobre de Cardiologia. Patients were divided into two groups: control group and training. Preoperatively, were assessed the maximum inspiratory pressure and the distance covered in a 6-minute walk test. From the third postoperative day, the control group was managed according to the routine of the unit while the training group underwent daily protocol of respiratory muscle training until the day of discharge. RESULTS: 50 patients, 27 (54%) males were included, with a mean age of 56.7±13.9 years. After the analysis, the training group had significant increase in maximum inspiratory pressure (69.5±14.9 vs. 83.1±19.1 cmH2O, P=0.0073) and 6-minute walk test (422.4±102.8 vs. 502.4±112.8 m, P=0.0031). CONCLUSION: We conclude that inspiratory muscle training was effective in improving functional capacity submaximal and inspiratory muscle strength in this sample of patients undergoing cardiac surgery.

Inspiratory muscle training and functional capacity in patients undergoing cardiac surgery

Abstract Introduction: Cardiac surgery is a highly complex procedure which generates worsening of lung function and decreased inspiratory muscle strength. The inspiratory muscle training becomes effective for muscle strengthening and can improve functional capacity. Objective: To investigate the effect of inspiratory muscle training on functional capacity submaximal and inspiratory muscle strength in patients undergoing cardiac surgery. Methods: This is a clinical randomized controlled trial with patients undergoing cardiac surgery at Instituto Nobre de Cardiologia. Patients were divided into two groups: control group and training. Preoperatively, were assessed the maximum inspiratory pressure and the distance covered in a 6-minute walk test. From the third postoperative day, the control group was managed according to the routine of the unit while the training group underwent daily protocol of respiratory muscle training until the day of discharge. Results: 50 patients, 27 (54%) males were included, with a mean age of 56.7±13.9 years. After the analysis, the training group had significant increase in maximum inspiratory pressure (69.5±14.9 vs. 83.1±19.1 cmH2O, P=0.0073) and 6-minute walk test (422.4±102.8 vs. 502.4±112.8 m, P=0.0031). Conclusion: We conclude that inspiratory muscle training was effective in improving functional capacity submaximal and inspiratory muscle strength in this sample of patients undergoing cardiac surgery.

Influência da deambulação precoce no tempo de internação hospitalar no pós-operatório de cirurgia cardíaca / Influence of early ambulation in postoperative hospitalization following cardiac surgery

Fundamentos: Apesar do avanço tecnológico que visa a prolongar a qualidade de vida de pacientes submetidos acirurgia cardíaca, esse procedimento ainda é considerado de alta complexidade. A deambulação precoce é uma alternativa para melhorar a capacidade pulmonar, o condicionamento cardiovascular e o aumento do desempenho funcional. Objetivos: Avaliar o impacto da deambulação precoce sobre o tempo de internação na Unidade de Terapia Intensiva (UTI) e hospitalar em pacientes submetidos a cirurgia cardíaca. Métodos: Estudo transversal, realizado com 49 pacientes submetidos à cirurgia cardíaca e admitidos na UTI, no período de outubro de 2014 a abril de 2015. Os pacientes foram estratificados em dois grupos: com e semdeambulação precoce. Deambulação precoce definida como o ato de caminhar até o terceiro dia de internação na UTI. Análise estatística realizada para verificar a existência de modificações no tempo de permanência hospitalare UTI entre os dois grupos de deambulação.Resultados: Foram estudados 49 pacientes, dos quais 55,1% homens, média de idade 55,2±13,9 anos, internados na UTI em decorrência de cirurgia cardíaca no período do estudo. Não se observou correlação estatística entre o ato de deambular precocemente com o tempo de permanência na UTI cardíaca (3,0±1,5 dias vs. 2,8±1,1 dias, p=0,819) e hospitalar (5,4±3,3 dias vs. 5,3±2,6 dias, p=0,903).Conclusão: A deambulação precoce não se associou a um menor tempo de permanência na UTI ou hospitalar.

Background: Despite the technological advances aimed to extend the quality of life of patients undergoing cardiac surgery, such procedure is still deemed a highly complex intervention. Early ambulation is an alternative to improve lung capacity, cardiovascular fitness and increased functional performance. Objective: Assess the impact of early ambulation on the length of stay in intensive care unit (ICU) and in hospital, for patients undergoing cardiac surgery. Methods: Cross-sectional study of 49 patients undergoing cardiac surgery and admitted to the ICU from October 2014 to April 2015. Patients were stratified into two groups: with and without early ambulation. Early ambulation is the act of walking up to the third day of ICU admission. Statistical analysis performed to check for changes in the length of stay in ICU and in hospital between the two groups of ambulation. Results: The study observed 49 patients (55.1% men) with mean age of 55.2±13.9 years, admitted to the ICU due to cardiac surgery carried out during the study period. No statistical correlation was found between early ambulation and the length of stay in cardiac ICU (3.0±1.5 days vs. 2.8±1.1 days, p=0.819) and in hospital (5.4±3.3 days vs. 5.3±2.6 days, p=0.903).Conclusion: Early ambulation is not related to a shorter length of stay in ICU or in hospital.

Comparação da função pulmonar no pré e pósoperatóriode pacientes submetidos à cirurgia cardíaca aberta de revascularização do miocárdio de um hospital filantrópico de Feira de Santana/BA / Comparison of lung function in pre and postoperative in patients after open heart surgery for myocardial revascularization in a philanthropic hospital at Feira de Santana/BA

Introdução: A cirurgia cardíaca aberta de revascularização domiocárdio (RM) por ser um procedimento muito invasivo e degrande porte, predispõe o paciente a muitas complicações pulmonaresas quais causam impacto na função pulmonar. Objetivo:Avaliar e comparar a função pulmonar no pré e pós-operatório depacientes submetidos à cirurgia cardíaca aberta de revascularizaçãodo miocárdio de um hospital filantrópico de Feira de Santana/Bahia. Material e métodos: Foi realizado um estudo de caráter coorteprospectivo na Unidade de Terapia Intensiva e no ambulatório deum hospital filantrópico de Feira de Santana. Foram avaliados 9pacientes com média de idade 62,44 ± 10,69 anos, peso 62,55 ±12,5 kg, altura 161,4 ± 1,075 cm, IMC 23,41 ± 3,55, no períodopré-operatório e no 1º DPO. Foi realizada avaliação clínica e funcionalcom anamnese e testes espirométricos, de ventilometria e deforça muscular. Resultados: Os resultados demonstraram que houveperda significativa, com redução do VEF1, da CVF e da CV (p <0,0005) quando comparados os valores pré-operatórios com os do1º DPO, enquanto que as demais variáveis de força muscular, VEe VT não apresentaram diferença estatística significativa no períodoavaliado. Conclusão: A cirurgia de RM associa-se a um decréscimona função pulmonar em todos os pacientes, apresentando reduçãoimportante nos valores de VEF1, da CVF e da CV.

Introduction: Open heart surgery and myocardial revascularization(MR) is a very invasive procedure that predisposes patients tomany pulmonary complications and causes impact on lung function.Objective: To evaluate and compare the pre and postsurgicalpulmonary function in patients undergoing open heart surgery ofmyocardial revascularization in a philanthropic hospital in Feira deSantana/BA. Methods: Was performed a prospective cohort study inthe Intensive Care Unit and ambulatory of a philanthropic hospitalin Feira de Santana. We evaluated 9 patients with mean age 62.44 ±10.69 years, weight 12.5 ± 62.55 kg, height 161.4 ± 1.075 cm, BMI23.41 ± 3.55 kg/m2 in the preoperative period and the 1st DPO.Clinical and functional evaluation was performed with anamneseand spirometry tests (pulmonary and muscle strength). Results: Theresults showed that there was significant loss, with reduced FEV1,FVC and VC (p < 0.0005) when compared to preoperative valueswith the 1st POD, while the other variables of muscle strength, VEand VT showed no statistically significant difference in the studyperiod. Conclusion: MR surgery is associated with decrease in lungfunction in all patients, showing significant reduction in FEV1,FVC and VC.