Effect of cardiac surgery on respiratory muscle strength.

OBJECTIVES: Pulmonary complications, such as atelectasis, pulmonary oedema, pleural effusion, bronchospasm, and pneumonia, have been reported following cardiac surgery. Shallow breathing leading to impaired lung function is the major cause of respiratory complications. Decreases in respiratory muscle strength can be measured using the maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) produced in the oral cavity. This study aimed to determine the decrease in respiratory muscle strength 8 weeks following cardiac surgery. Moreover, the relationship between lung function and respiratory muscle strength was studied. METHODS: In this observational study, 42 adult cardiac surgery patients (10 women, 32 men; mean age 65 ± 7 years) were investigated. Lung function and respiratory muscle strength were measured preoperatively and at 2 months postoperatively. RESULTS: The pre- and postoperative respiratory muscle strengths were in accordance with the predicted values. The MIP was 81.75 ± 22.04 cmH2O preoperatively and 74.56 ± 18.86 cmH2O at the 2-month follow-up (p = 0.146). The MEP was 98.55 ± 22.24 cmH2O preoperatively and 88.86 ± 18.14 cmH2O at the 2-month follow-up (p = 0.19). The preoperative lung function was in accordance with the predicted values; however, lung function significantly decreased postoperatively. At the 2-month follow-up, there was a moderate correlation between the MIP and forced expiratory volume (r = 0.59, p = 0 .0078). CONCLUSIONS: The respiratory muscle strength was not impeded either before or 2 months after cardiac surgery. However, the exact mechanism for the alteration in lung function remains unclear. Measures to re-establish the ideal postoperative lung capacity should concentrate on different perioperative pulmonary exercises.

Effect of a short term pulmonary rehabilitation programme on exercise capacity, pulmonary function and health related quality of life in patients with COPD.

OBJECTIVES: Patients with chronic obstructive pulmonary disease (COPD) have been shown to benefit from pulmonary rehabilitation programmes. The purpose of this study was to ascertain the effects of a short-term pulmonary rehabilitation programme (PRP) on exercise capacity, pulmonary function and quality of life in patients with COPD. METHODS: A pre-test and post-test experimental design was conducted on patients from the outpatient physical therapy department. Thirty stable COPD patients with mild to severe airflow obstruction, (mean age 54.1 ± 5.22, FEV1, between 0.80 and 0.30 predicted; FEV1/FVC < 0.70) were recruited for a 6-week comprehensive pulmonary rehabilitation programme (PRP) that included education and exercise training. Exclusion criteria included the following: cardiovascular conditions likely to be aggravated by exercise, locomotor impairment, haemoptysis, cognitive impairment, severe pulmonary hypertension, and metastatic cancer. The patients were randomly divided into experimental and control groups. RESULTS: Six-minute walk distance (6MWD), pulmonary function (FEV1, FVC, FEV1/FVC), and St. George's Respiratory Questionnaire (SGRQ) scores were measured at baseline, at the end of the 3rd week and at the end of the 6th week. The results showed significant improvements in 6MWD and SGRQ (p < 0.05). CONCLUSION: A 6-week outpatient-based PRP significantly improves exercise capacity and quality of life, irrespective of the degree of airflow obstruction.