Background:
Bariatric surgery can trigger postoperative pulmonary complications due to
factors inherent to the procedure, mainly due to diaphragmatic dysfunction.
Aim:
To evaluate and compare the effects of two levels of positive pressure and
exercises with inspiratory load on lung function, inspiratory muscle
strength and respiratory muscle resistance, and the prevalence of
atelectasis after gastroplasty.
Methods:
Clinical, randomized and blind trial, with subjects submitted to bariatric
surgery, allocated to two groups: positive pressure group, who received
positive pressure at two levels during one hour and conventional respiratory
physiotherapy and inspiratory load group, who performed exercises with load
linear inspiratory pressure, six sets of 15 repetitions, in addition to
conventional respiratory physiotherapy, both of which were applied twice in
the immediate postoperative period and three times a day on the first
postoperative day. Spirometry was performed for pulmonary function analysis,
nasal inspiratory pressure for inspiratory muscle strength and incremental
test of respiratory muscle resistance for sustained maximal inspiratory
pressure, both preoperatively and on hospital discharge on the second
postoperative day.
Results:
There was no significant difference (p> 0.05) in the expiratory reserve
volume and in the tidal volume in the pre and postoperative periods when
compared intra and intergroup. There was no significant difference
(p>0.05) in the nasal inspiratory pressure and the maximal inspiratory
pressure maintained in the inspiratory load group in the intragroup
evaluation, but with a significant difference (p<0.05) compared to the
positive pressure group. The prevalence of atelectasis was 5% in both groups
with no significant difference (p>0.05) between them.
Conclusion:
Both groups, associated with conventional respiratory physiotherapy,
preserved expiratory reserve volume and tidal volume and had a low
atelectasis rate. The inspiratory loading group still maintained inspiratory
muscle strength and resistance of respiratory muscles.
SUMMARY OBJECTIVE To investigate the use of Bilevel Positive Airway Pressure (BiPAP) in morbidly obese individuals in two moments following bariatric surgery (Roux-en-Y gastric bypass): post-anesthetic recovery (PAR) and first postoperative day (1PO). DESIGN Randomized and blinded clinical trial. METHODS We studied 40 morbidly obese individuals aged between 25 and 55 years who underwent pulmonary function test and chest X-ray preoperatively, and on the day of discharge (2nd day after surgery). They were randomly allocated into two groups: PAR-G (BiPAP in PAR for one hour), and 1PO-G (BIPAP for one hour on the 1PO). RESULTS In the PAR-G and 1PO-G, respectively there were significant reductions in slow vital capacity (SVC) (p=0.0007 vs. p<0.0001), inspiratory reserve volume (IRV) (p=0.0016 vs. p=0.0026), and forced vital capacity (FVC) (p=0.0013 vs. p<0.0001) and expiratory reserve volume (ERV) was maintained only for the PAR-G (p=0.4446 vs. p=0.0191). Comparing the groups, the SVC (p=0.0027) and FVC (p=0.0028) showed a significant difference between the treatments, while the PAR-G showed smaller declines in these capacities. The prevalence of atelectasis was 10% for the PAR-G and 30% for the 1PO-G (p=0.0027). CONCLUSION Thus, the use of BiPAP in PAR can promote restoration of ERV and contribute to the reduction of atelectasis.
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