Benefícios da cinesioterapia respiratória no pós-operatório de colecistectomia laparoscópica

Abstract

Introduction: Pulmonary function changes following abdominal surgery lead to reduced pulmonary volume, thus compromising gas exchanges. Objective: To evaluate the effects of respiratory kinesiotherapy on pulmonary function and respiratory muscle strength in patients who underwent laparoscopic cholecystectomy. Methods: Twenty women and 16 men (age 48.4 ± 9.55 years) who underwent laparoscopic cholecystectomy were prospectively studied. They were randomly divided as follows: 17 subjects performed breathing exercises (diaphragmatic respiration, maximum sustained inspiration and fractional inspiration) and 19 participated as a Control Group. All of them underwent evaluations of maximal inspiratory and expiratory pressures (MIP and MEP), peak expiratory fl ow (PEF) and spirometry, with measurements of vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in the fi rst second (FEV 1) and the FEV 1 /FVC ratio before the operation and daily until the sixth postoperative day (POD). Results: The preoperative parameters were not statistically different between the two groups. Both groups presented decreases in all variables on the fi rst POD (p< 0.05). The Exercise Group continued to present decreased values until the second POD for VC, FVC, and FEV1 (p< 0.05), until the third POD for MIP and PEF (p< 0.05) and the fourth POD for MEP (p< 0.05). For the Control Group, the values of all the variables began to normalize on the fi fth POD. The MIP and MEP values in the Exercise Group were higher than those in the controls, from the third and second POD onwards, respectively. Conclusions: Respiratory kinesiotherapy contributed towards early recovery of pulmonary function and muscle strength among patients who had undergone laparoscopic cholecystectomy.

Comparative study of respiratory muscle strength in women undergoing conventional and single-port laparoscopic cholecystectomy

“…Gastaldi et al 23 observed a reduction in respiratory muscle strength on the first postoperative day after laparoscopic cholecystectomy similar to the findings of other studies. However, PImax (p<0.05) and PEmax (p<0.05) showed an early return to normal levels by the third or fourth postoperative day.…”

Breathing exercises in upper abdominal surgery: a systematic review and meta-analysis

“…Of the six included studies, one had a final PEDro score of 1, one had a final score of 3, two had a final score of 5, one had a final score of 6, and one had a final score of 7 ( Table 2). The overall quality of the included studies was low, with the exception of the studies by Forgiarini et al 25 (score 7) and Gastaldi et al 24 (score 6; Table 2). Among the included studies, the one by Hallböök et al 20 divided the participants into three intervention groups: mobilization, thoracic physical therapy, and thoracic physical therapy plus bronchodilator.…”

“…Based on the abstracts, 22 articles were eligible for a full review, and a total of six articles [20][21][22][23][24][25] that fulfilled all of the inclusion criteria were selected ( Table 1).…”

“…• 20 Manzano et al 21 Roukema et al 22 Ribeiro et al 23 Gastaldi et al 24 Forgiarini Junior et al final score as it relates to external validity. Of the six included studies, one had a final PEDro score of 1, one had a final score of 3, two had a final score of 5, one had a final score of 6, and one had a final score of 7 ( Table 2).…”

“…Ribeiro, Gastaldi and Fernandes 23 and Gastaldi et al 24 assessed the MEP and MIP (mmH 2 O) on day 1 postoperative (PO), and the meta-analysis of these two studies (Figure 2A and 2C 25 also assessed the MEP and MIP (mmH 2 O) on day 1 PO, however in their study, the treatment group started the treatment in the recovery room and the control group in the hospital room. Because it was unclear whether the control group received any treatment prior to the assessment at day 1 PO, we decided to present a subsequent meta-analysis that includes data from the study by Forgiarini Junior et al 25 ( Figure 2B and 2D).…”