IntroductionCardiac 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.ObjectiveTo investigate the effect of inspiratory muscle training on functional capacity submaximal and inspiratory muscle strength in patients undergoing cardiac surgery.MethodsThis 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.Results50 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).ConclusionWe conclude that inspiratory muscle training was effective in improving functional capacity submaximal and inspiratory muscle strength in this sample of patients undergoing cardiac surgery.

Introduction: Surgical major procedures like heart surgeries considerable systemic changes constantly promote direct impact on the lives of individuals who undergo them. These effects are related to various causes such as degree of sedation, time in minutes, cardiopulmonary bypass (CPB), pulmonary and cardiac function preoperatively, which can influence the degree of functionality of these patients. Objective: The objective was to evaluate the variation of the degree of functional independence in patients undergoing cardia surgery from admission until the time of discharge from the intensive care unit. Methods: A quantitative study of the prospective cohort was conducted. The survey was conducted in the Inpatient Unit Noble Institute of Cardiology (INCARDIO). After the criteria for inclusion and exclusion sample comprised 14 patients. Patients underwent assessment of functionality through a FIM scale. This evaluation was performed in the preoperative period and at discharge from the ICU, performed by the same examiner. Results: The research population consisted of 9 men and 5 women with a mean age of 50.0 +-14.02 years. According to the mean duration of mechanical ventilation found 9.5 hours (SD: ± 6.42), mean cardiopulmonary bypass time of 64 minutes or 1 hour and 4 min. (SD: ± 20.65) and the average length of hospital stay was 52,3 hours (SD: ± 14,30). The average MIF pre-surgery was 126 and post-operative 103 ± 17.58 with a p-value of 0.0001. Conclusion: We conclude that a significant reduction in the degree of functional independence. From the foregoing, it is clear that commonly cardiac surgery leads to changes in peripheral muscle function, requiring the application of specific therapy in this patient profile.

Infl uência do tempo de ventilação mecânica sobre a independência funcional em pacientes submetidos à cirurgia cardíaca: uma revisão da literatura [A] André Luiz Cordeiro [a] , Thiago Araújo de Melo [b] , Andriele Medeiros Santos [a] , Gisele Freitas Lopes [a] * [a] Faculdade Nobre de Feira de Santana (FAN), Feira de Santana, BA, Brazil [b] Universidade Salvador (UNIFACS), Salvador, BA, Brazil [R] Abstract Introduction: Patients submitted to cardiovascular surgery present motor and respiratory complications mainly due to high surgery manipulation and the use of mechanical ventilation. Reducing the weaning start time and disconnecting patient's ventilation system prematurely can decrease the pulmonary complications and hospitalization time. Motor complications are the most relevant as they have a direct effect on functional independence provoked by immobility time. Objectives: Identify if mechanical ventilation time has an impact on functional capacity on patients submitted to cardiac surgery in order to contribute to the establishment of reliable evidence to practice through this patient's profile. Materials and methods:

Introduction Coronary artery bypass grafting (CABG) is associated with reduced ventilatory muscle strength and consequent worsening of functional capacity (FC). Inspiratory Muscle Training (IMT) can be indicated, but there is still a lack of knowledge about the use of the anaerobic threshold (AT) as a basis for prescription. The objective of this study is to evaluate if IMT based on AT modifies FC and inspiratory muscle strength of patients submitted to CABG. Methods This is a clinical trial. On the first postoperative day, the patients were divided into two groups: the conventional group (IMT-C), which performed IMT based on 40% of maximal inspiratory pressure (MIP), and the IMT-AT group, which performed IMT based on AT. All patients underwent preoperative and postoperative assessment of MIP and performed a six-minute walk test (6MWT). Results Forty-two patients were evaluated, 21 in each group. Their mean age was 61.4±10 years and 27 (64%) of them were male. There was a reduction of inspiratory muscle strength with a delta of 23±13 cmH2O in the IMT-C group vs . 11±10 cmH2O in the IMT-AT group ( P <0.01) and of the walking distance with a delta of 94±34 meters in the IMT-C group vs . 57±30 meters in the IMT-AT group ( P =0.04). Conclusion IMT based on AT minimized the loss of FC and inspiratory muscle strength of patients submitted to CABG.

IntroductionDuring and after coronary artery bypass grafting, a decline in multifactor lung function is observed. Due to this fact, some patients may benefit from non-invasive ventilation after extubation targeting lung expansion and consequently improved oxygenation.ObjectiveTo test the hypothesis that higher levels of positive end expiration pressure during non-invasive ventilation improves oxygenation in patients undergoing coronary artery bypass grafting.MethodsA randomized clinical trial was conducted at Instituto Nobre de Cardiologia in Feira de Santana. On the first day after surgery, the patients were randomized: Group PEEP 10, Group PEEP 12 and Group PEEP 15 who underwent non-invasive ventilation with positive end expiration pressure level. All patients were submitted to analysis blood pressure oxygen (PaO2), arterial oxygen saturation (SaO2) and oxygenation index (PaO2/FiO2).ResultsThirty patients were analyzed, 10 in each group, with 63.3% men with a mean age of 61.1±12.2 years. Mean pulmonary expansion pre-therapy PaO2 was generally 121.9±21.6 to 136.1±17.6 without statistical significance in the evaluation among the groups. This was also present in PaO2/FiO2 and SaO2. Statistical significance was only present in pre and post PEEP 15 when assessing the PaO2 and SaO2 (P=0.02). ConclusionBased on the findings of this study, non-invasive ventilation with PEEP 15 represented an improvement in oxygenation levels of patients undergoing coronary artery bypass grafting.

ObjectiveTo evaluate the impact of different levels of positive end-expiratory pressure (PEEP) on gas exchange in patients undergoing coronary artery bypass grafting (CABG).MethodsA randomized clinical trial was conducted with patients undergoing CABG surgery. Patients were randomized into three groups: Group 10, PEEP of 10 cmH2O; Group 12, PEEP of 12 cmH2O; and Group 15, PEEP of 15 cmH2O. After the randomization, all patients underwent gas analysis at three moments: (1) before lung expansion therapy (LET); (2) 30 minutes after LET; and (3) one hour after extubation.ResultsSixty-six patients were studied, of which 61.7% were men, with mean age of 64 ± 8.9 years. Patients allocated to Group 15 showed a significant improvement in gas exchange comparing pre- and post-expansion values (239±21 vs. 301±19, P<0,001) and the increase was maintained after extubation (278±26). Despite the use of high levels of PEEP, no significant hemodynamic change was evidenced.ConclusionIt is concluded that high levels of PEEP (15 cmH2O) are beneficial for the improvement of gas exchange in patients undergoing CABG.

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| Introduction:Life expectancy has increased in recent decades and associated with this there is also an increased incidence of cardiovascular disease. One form of treatment for these diseases is the heart surgery, which is very prevalent in the elderly. Objective: To characterize the clinical and surgical profile of elderly patients undergoing cardiac surgery. Methods: A retrospective observational study of patients admitted to the Intensive Care Unit of the Nobre Cardiology Institute, in Feira de Santana, Bahia, Brazil. On the first postoperative day, all patients were evaluated in search of data related to their clinical and surgical profile. Results: During the study period 51 patients were operated on, 39 men (77%), with an average of more prevalent age above 75 years (30%), hypertension and diabetes mellitus being the most frequent comorbidities (67 and 58%, respectively) and 53% with the body mass index within the normal range. Regarding the surgical characteristics 90% of patients underwent coronary artery bypass surgery, requiring in 72% of cases three bridges, extracorporeal circulation time of 74 ± 22 minutes and time of mechanical ventilation 8 ± 4 hours. Conclusion: Based on these findings, the subjects to myocardial revascularization can be characterized as hypertense, sedentary males over 75 years old.