Los ejercicios respiratorios postoperatorios reducen el riesgo de complicaciones pulmonares en pacientes sometidos a lobectomía / Postoperative Respiratory Exercises Reduce the Risk of Developing Pulmonary Complications in Patients Undergoing Lobectomy

Objetivo: Evaluar los efectos de un programa intensivo de fisioterapia postoperatoria basado en ejercicios respiratorios dirigido a pacientes lobectomizados mediante toracotomía abierta. Diseño : Estudio cuasiexperimental. Emplazamiento: Hospital universitario terciario. Participantes: Doscientos ocho (208) pacientes lobectomizados mediante toracotomía abierta. Intervención: Los pacientes del grupo control (n=102) recibieron atención médica/de enfermería estándar y los pacientes del grupo experimental (n=106), además de la atención clínica estándar, se sometieron a un programa de fisioterapia diaria basada en ejercicios respiratorios hasta el momento del alta hospitalaria. Variables de resultado: Las variables de resultado estudiadas incluyeron la frecuencia de complicaciones pulmonares postoperatorias (CPP) más susceptibles de tratamiento fisioterapéutico (neumonía, atelectasias e insuficiencia respiratoria) y la duración de la estancia hospitalaria (DEH). Resultados: Las características preoperatorias y quirúrgicas de ambos grupos fueron comparables. La incidencia de CPP registrada fue de un 20,6% en el grupo control y un 6,6% en el grupo experimental (p = 0,003). La mediana y el RIC de la DEH fue de 14 y 7días, respectivamente (estimador M de Huber 14,21) en el grupo control y de 12 y 6días (estimador M de Huber 12,81) en el grupo experimental. El modelo de regresión logística creado identificó al programa de fisioterapia evaluado (p = 0,017; EXP (B) [IC 95% 0,081-0,780]) y al porcentaje del FEV1 (p = 0,042; EXP (B) [IC 95% 0,941-0,999]) como factores protectores frente al desarrollo de CPP en los pacientes intervenidos de lobectomía. Conclusiones: La implementación de un programa intensivo de fisioterapia postoperatoria basado en ejercicios respiratorios reduce el riesgo de desarrollar CPP y la DEH en pacientes lobectomizados

Objective: To evaluate the effects of an intensive postoperative physiotherapy program focused on respiratory exercises in patients undergoing lobectomy by open thoracotomy. Design: Quasi-experimental study. Setting: Tertiary referral academic hospital. Participants: 208 patients undergoing lobectomy by open thoracotomy. Interventions: Control group patients (n = 102) received standard medical/nursing care, and experimental group patients (n=106) added to the standard clinical pathway a daily physiotherapy program focused on respiratory exercises until discharge. Outcomes: Analyzed outcomes were the frequency of postoperative pulmonary complications (PPCs) more amenable to physiotherapy (pneumonia, atelectasis and respiratory insufficiency) and length of hospital stay (LOS). Results: Both groups were comparable regarding preoperative and surgical characteristics. Incidence of PPCs was 20.6% in control and 6.6% in experimental group (P = .003). Median (IQR) LOS in control group was 14 (7) days (Huber M estimator 14.21) and 12 (6) days (Huber M estimator 12.81) in experimental. Logistic regression model identified the evaluated physiotherapy program (P = .017; EXP [B] 95% CI 0.081-0.780) and % FEV1 (P = .042; EXP [B] 95% CI 0.941-0.999) as protective factors for the development of PPCs in patients undergoing lobectomy. Conclusions: Implementing a postoperative intensive physiotherapy program focused on respiratory exercises reduces the risk of PPCs and resultant LOS on patients undergoing lobectomy

Postoperative Respiratory Exercises Reduce the Risk of Developing Pulmonary Complications in Patients Undergoing Lobectomy. / Los ejercicios respiratorios postoperatorios reducen el riesgo de complicaciones pulmonares en pacientes sometidos a lobectomía.

OBJECTIVE: To evaluate the effects of an intensive postoperative physiotherapy program focused on respiratory exercises in patients undergoing lobectomy by open thoracotomy. DESIGN: Quasi-experimental study. SETTING: Tertiary referral academic hospital. PARTICIPANTS: 208 patients undergoing lobectomy by open thoracotomy. INTERVENTIONS: Control group patients (n=102) received standard medical/nursing care, and experimental group patients (n=106) added to the standard clinical pathway a daily physiotherapy program focused on respiratory exercises until discharge. OUTCOMES: Analyzed outcomes were the frequency of postoperative pulmonary complications (PPCs) more amenable to physiotherapy (pneumonia, atelectasis and respiratory insufficiency) and length of hospital stay (LOS). RESULTS: Both groups were comparable regarding preoperative and surgical characteristics. Incidence of PPCs was 20.6% in control and 6.6% in experimental group (P=.003). Median (IQR) LOS in control group was 14 (7) days (Huber M estimator 14.21) and 12 (6) days (Huber M estimator 12.81) in experimental. Logistic regression model identified the evaluated physiotherapy program (P=.017; EXP [B] 95% CI 0.081-0.780) and % FEV1 (P=.042; EXP [B] 95% CI 0.941-0.999) as protective factors for the development of PPCs in patients undergoing lobectomy. CONCLUSIONS: Implementing a postoperative intensive physiotherapy program focused on respiratory exercises reduces the risk of PPCs and resultant LOS on patients undergoing lobectomy.