Physical Exercise Combined With CPAP in Subjects Who Underwent Surgical Myocardial Revascularization: A Randomized Clinical Trial.

BACKGROUND: Aerobic exercise and CPAP benefit patients in the postoperative period of cardiac surgery. To our knowledge, the association of aerobic exercise on an exercise bicycle with CPAP has not yet been demonstrated. Therefore, we aimed to evaluate the effectiveness of physical exercise on a cycle ergometer combined with CPAP in the postoperative period after coronary artery bypass graft surgery. METHODS: This was a randomized clinical trial, with recruitment from May 2017 to December 2017 (registered in the Brazilian Clinical Trials Registry: RBR-69CDYF). The step group (n = 16 subjects) started rehabilitation in the immediate postoperative period with breathing exercises and passive mobilization in the sitting position, progressing to active exercises, ambulation, and stair training. For the intervention group (n = 15 subjects), dynamic exercises on a cycle ergometer combined with CPAP were added to the step program from the second to the fourth postoperative day in a single daily session. RESULTS: Functional capacity decreased in both groups, but this reduction was not significant in the intervention group (P = .11). The length of stay in ICU was lower in the intervention group (P = .050). In both groups there was a decrease in maximum inspiratory and expiratory pressure, as well as in the 1-min sit-to-stand test on the fourth postoperative day compared to the preoperative period. CONCLUSIONS: Physical exercise combined with CPAP promoted the maintenance of functional capacity and reduced the length of stay in the ICU.

Preoperative therapy restores ventilatory parameters and reduces length of stay in patients undergoing myocardial revascularization.

INTRODUCTION: The frequency of surgical procedures has increased steadily in recent decades, including the myocardial revascularization. OBJECTIVES: To demonstrate the importance of physiotherapy in the preoperative period of cardiac surgery in relation to the reduction of hospital stay, changes in lung volumes and respiratory muscle strength. METHODS: We conducted a prospective study with patients undergoing myocardial revascularization, the Hospital das Clínicas da Universidade Estadual Paulista (UNESP)/Botucatu - SP. We evaluated 70 patients of both genders, aged between 40 and 75 years, subdivided into two groups: group I - 35 patients of both genders, who received a written protocol guidance, breathing exercises and respiratory muscle training in the preoperative period and group II - 35 patients of both genders, who received only orientation of the ward on the day of surgery. This study was approved by the Ethics Committee of UNESP / Botucatu - SP. RESULTS: Maximal inspiratory pressure in third postoperative day and fifth postoperative day and significant difference between groups, being better for the intervention group. Expiratory pressure was significant in fifth postoperative day in the intervention group compared to controls. The difference of length of hospital stay in the postoperative was found between the groups with shorter hospital stay in the group receiving preoperative therapy. CONCLUSION: Physical therapy plays an important role in the preoperative period, so that individuals in the intervention group more readily restored the parameters evaluated before surgery, in addition, there was a decrease in the time of the postoperative hospital stay. Thus, it is thought the cost-effectiveness of a program of preoperative physiotherapy.

Análise das variáveis hemodinâmicas em idosos revascularizados após mobilização precoce no leito / Analysis of Hemodynamic Variables among Elderly Revascularized Patients after Early In-Bed Mobilization

Fundamentos: Durante o pós-operatório da cirurgia de revascularização do miocárdio (CRM), o repouso prolongado no leito aumenta a possibilidade de ocorrer complicações sistêmicas decorrentes do imobilismo. Objetivo: Verificar o comportamento das variáveis hemodinâmicas e no pico de fluxo expiratório (peack flow) em pacientes idosos, em pós-operatório de CRM submetidos a três tipos diferentes de intervenção fisioterapêutica. Métodos: Estudados 30 idosos estratificados em três grupos: Grupo A - mobilização com cicloergômetro; Grupo B - mobilização sem uso do cicloergômetro, mas com fisioterapia e Grupo C - sem qualquer mobilização, mas com ventilação não invasiva (VNI), sendo analisados o comportamento da frequência cardíaca (FC), frequência respiratória (FR), pressão arterial (PA), saturação periférica de oxigênio (SpO2) e pico de fluxo expiratório (peack flow). Para a variação dos resultados intragrupos, nas fases pré e pós-teste utilizou-se o teste de Wilcoxon; para a comparação intergrupos nas fases pré e pós-teste utilizou-se o teste de Kruskal-Wallis. Considerou-se significância estatística p<0,05.Resultados: Observou-se aumento significativo para os valores peack flow em todos os grupos (pré e pós-teste); redução significativa da PAS no grupo A, aumento da FC e da FR no grupo B (pré e pós-teste). Na análise intergrupos, observou-se redução da PAD no grupo C, com significado estatístico.

Background: During the post-operative phase after coronary artery bypass (CAB) surgery, prolonged bed rest increases the possibility of systemic complications resulting from immobilization. Objective: To ascertain the behavior of peak expiratory flow and hemodynamic variables among elderly patients during the CAB postoperative period undergoing three types of physiotherapy interventions. Methods: Thirty elderly patients were studied, divided into three groups: Group A - mobilization with an ergometric bicycle; Group B - mobilization without an ergometric bicycle but with physiotherapy; and Group C - no mobilization but with non-invasive ventilation, analyzing the heart rate (HR), respiration rate (RR), blood pressure (BP), peripheral oxygen saturation (SpO2)and expiratory peak flow. The Wilcoxon test was used for variations in the intra-group results for the pre- and post-test phases, using the Kruskal-Wallis test for the inter-group comparison of the pre and post-test phases, with a statistical significance of p<0.05.Results: A significant increase was observed in the peak flow values for the three groups (pre- and post-test);with a significant reduction in the systolic blood pressure for group A and higher heart rates and respiration rates in group B. The inter-group analysis presented a statistically significant reduction in the diastolic blood pressure for group C.

Preoperative therapy restores ventilatory parameters and reduces length of stay in patients undergoing myocardial revascularization / Fisioterapia pré-operatória restabelece parâmetros ventilatórios e reduz tempo de internação após revascularização do miocárdio

Introduction: The frequency of surgical procedures has increased steadily in recent decades, including the myocardial revascularization. Objectives: To demonstrate the importance of physiotherapy in the preoperative period of cardiac surgery in relation to the reduction of hospital stay, changes in lung volumes and respiratory muscle strength. Methods: We conducted a prospective study with patients undergoing myocardial revascularization, the Hospital das Clínicas da Universidade Estadual Paulista (UNESP)/Botucatu - SP. We evaluated 70 patients of both genders, aged between 40 and 75 years, subdivided into two groups: group I - 35 patients of both genders, who received a written protocol guidance, breathing exercises and respiratory muscle training in the preoperative period and group II - 35 patients of both genders, who received only orientation of the ward on the day of surgery. This study was approved by the Ethics Committee of UNESP / Botucatu - SP. Results: Maximal inspiratory pressure in third postoperative day and fifth postoperative day and significant difference between groups, being better for the intervention group. Expiratory pressure was significant in fifth postoperative day in the intervention group compared to controls. The difference of length of hospital stay in the postoperative was found between the groups with shorter hospital stay in the group receiving preoperative therapy. Conclusion: Physical therapy plays an important role in the preoperative period, so that individuals in the intervention group more readily restored the parameters evaluated before surgery, in addition, there was a decrease in the time of the postoperative hospital stay. Thus, it is thought the cost-effectiveness of a program of preoperative physiotherapy. .

Introdução: Procedimentos cirúrgicos aumentaram progressivamente nas últimas décadas, inclusive a revascularização do miocárdio(RM). Objetivos: Demonstrar a importância da fisioterapia no préoperatório de cirurgia cardíaca, em relação à redução do tempo de internação hospitalar, alteração de volumes pulmonares e força muscular respiratória. Métodos: Foi realizado estudo clínico prospectivo, com pacientes submetidos à revascularização do miocárdio, no Hospital das Clínicas da Universidade Estadual PaulistaUNESP / Botucatu - SP. Foram avaliados 70 pacientes de ambos os gêneros, com faixa etária entre 40 a 75 anos, randomizados por meio programa computadorizado em dois grupos: Grupo I - 35 pacientes de ambos os sexos, que receberam um protocolo de orientação por escrito, exercícios respiratórios e treinamento muscular respiratório no pré-operatório e Grupo II - 35 pacientes de ambos os gêneros, que receberam apenas orientação de rotina da enfermaria no dia da cirurgia. Trabalho foi aprovado pelo Comitê de Ética da Universidade Estadual PaulistaUNESP / Botucatu - SP. Resultados: A avaliação das pressões inspiratórias máximas evidenciou aumento significativo no terceiro dia pós-operatório e quinto dia pós-operatório para o grupo de intervenção e análise das pressões expiratórias máximas apresentou valores significativos apenas no quinto dia pós-operatório para o grupo intervenção em relação ao grupo controle, observando-se ainda que o grupo submetido ao protocolo de tratamento fisioterapêutico pré-operatório apresentou menor tempo de internação hospitalar. Conclusão: A fisioterapia ...

Multidisciplinary outpatient rehabilitation following cardiac revascularization or valve surgery: patient-related factors for uptake.

BACKGROUND: There are concerns in Europe regarding the service provision and accessibility of multidisciplinary cardiac rehabilitation (MDCR) in general, and particularly in ambulatory settings. This paper analyses the utilization of outpatient MDCR and its determinants after cardiac revascularization or valve surgery in Belgium. METHODS: Claims rehabilitation data for all patients discharged in 2007 after a percutaneous cardiac intervention or cardiac surgery were available from the Belgian Common Sickness Funds Agency. Logistic regressions were performed to identify patients demographic and socioeconomic characteristics associated with the uptake of outpatient MDCR during the year following the hospital discharge. RESULTS: A total of 29,021 patients were included. During the hospitalization for the cardiac procedure, 44% were offered inpatient MDCR. After discharge, only 15.6% followed at least one session of outpatient MDCR. The chance of attending outpatient MDCR was lower for female, disabled, and older patients, as well as unemployed patients. The absence of an authorized MDCR centre in the neighbourhood of the patient's residence decreased the chance of attending outpatient MDCR, while living in a neighbourhood with a high education and income level increased this probability. CONCLUSION: These results confirm the low rates of MDCR attendance found in a previous study performed by the European Association of Cardiovascular Prevention and Rehabilitation. The study shows specific patient groups that should be targeted in priority, i.e. women, elderly, unemployed patients, disabled persons, and patients with a low socioeconomic status.

Influência da força muscular respiratória pré-operatória na evolução clínica após cirurgia de revascularização do miocárdio / Influence preoperative respiratory muscle strength on clinical evolution after myocardial revascularization surgery

O objetivo foi avaliar se diferenças na força muscular respiratória pré-operatória: a) se relacionam com outros fatores de risco pré-operatórios; e b) influenciam o risco de surgimento de complicações pulmonares pós-operatórias (CPP), os tempos de permanência em ventilação mecânica (VM) e em unidade de terapia intensiva (UTI) e hospitalar após cirurgia de revascularização do miocárdio. O estudo foi observacional, prospectivo, tipo coorte. Vinte e quatro indivíduos concluíram o estudo e, após análise dos valores da manovacuometria pré-operatória, foram alocados em: G1, com pressão inspiratória máxima (PImáx) >70% do previsto (n=13, 54%); e G2, PImáx <70% do previsto (n=11, 46%). Na análise estatística adotou-se o nível de significância de 5% (p≤0,05); também foi calculado o risco relativo (RR). Os grupos foram homogêneos (p0,05) quanto à maioria das variáveis obtidas no pré-operatório (exceto PImáx e PEmáx) e aos dados cirúrgicos. Quase metade dos pacientes do G2, com PImáx inferior, também apresentaram pressão expiratória máxima (PEmáx) inferior à prevista. Os tempos de VM, de internação em UTI e hospitalar pós-operatória, e a presença de CPP não diferiram estatisticamente entre os grupos. Quando comparados aos do G1, os indivíduos do grupo que apresentava fraqueza muscular respiratória (G2) antes da cirurgia revelaram maior risco relativo para o desenvolvimento de complicações pulmonares pós-operatórias...

The aim of this study was to assess whether preoperative respiratory muscle strength: a) is related to other preoperative risk factors and b) represents a higher risk to postoperative pulmonary complications (PPC), higher time under mechanical ventilation (MV), intensive care unit (ICU) and hospitalization, after myocardial revascularization surgery. Twenty-four patients were studied and, after the analysis of preoperative measures taken, divided into two groups: G1, with maximum inspiratory pressure (MIP) over 70% predicted value (n=13, 54%); and G2, with MIP below 70% predicted value (n=11, 46%). At the statistical analysis, significance level was set at 5% (p0.05); relative risk (RR) was also estimated. The groups were homogeneous as to most variables measured both in preoperative exams (to the exception of MIP and MEP) and as to surgical data (p0.05). Almost half of G2 patients, who had lower MIP, also presented maximum expiratory pressure (MEP) below predicted value. As for time under MV, postoperative ICU and in-hospital times, besides number of PPC, no statistical differences were found between the groups. When compared to G1, G2 patients showed higher relative risk to developing postoperative pulmonary complications...