Avaliação muscular respiratória nas toracotomias e laparotomias superiores eletivas

Abstract

Objective: To identify any possible relation between lower than predicted preoperative respiratory muscle function and the incidence of postoperative respiratory complications and death in elective thoracotomies and laparotomies of the upper abdomen. Methods: A prospective cohort study was conducted, in which 70 patients over the age of 18 were monitored in two similar hospitals. In the preoperative evaluation performed at admission, patients were classified as presenting respiratory muscle function (as determined by measurement of maximal respiratory pressures) > 75% of the predicted value (n = 50) or < 75% of the predicted value (n = 20). Patients were monitored until discharge. In both groups, the incidence of pneumonia was determined, as was that of acute respiratory failure, bronchospasm, prolonged mechanical ventilation, atelectasis, pleural effusion, pneumothorax and death. A comparative analysis was made between the groups, and relative risk was calculated. Results: In the study sample, the overall incidence of postoperative complications was 22.86% (16/70): 55% (11/20) in the group of patients presenting < 75% of the predicted value; and 10% (5/50) in the group of patients presenting > 75% of the predicted value. Patients in the < 75% of the predicted value group presented a relative risk of 5.5 (95% confidence interval between 2.19 and 13.82). Conclusion:Respiratory muscle function below the predicted value was found to be related with higher relative risk of postoperative complications in the surgical procedures studied.

Surgical risk tests related to cardiopulmonary postoperative complications: comparison between upper abdominal and thoracic surgery

“…Another difference concerning the study methodology is that some authors 32,33 used fixed reference values, regardless age and gender, while Bellinetti's 35 and the present study used the predict values in percentage.…”

“…Bellinetti et al 35 concluded more recently that the abnormal respiratory muscle strength during preoperative period of thoracic surgery and elective upper abdominal surgery was associated to a higher incidence of POC or death and when abnormal can be considered a risk factor. However, an association between the respiratory pressures and POC was not found in TS…”

Incidência de complicações pulmonares na cirurgia de revascularização do miocárdio

“…The sample size was based on data from literature with an approximate 30% incidence of complications following MRV [5][6][7] , a confidence interval amplitude of 10, alpha 0.05, and statistical power of 80%.…”

Dor, função pulmonar e força muscular respiratória no pré e pós-operatório de mulher mastectomizada

“…A utilização da espirometria só é eficaz naqueles pacientes que realizarão ressecção pulmonar ou que tenham algum problema respiratório 15 .…”

“…Nosso estudo discorda de Bellinetti e Thomson 15 , uma vez que a espirometria pode ser muito útil nas cirurgias de mama, pois nos fornece informações dos valores basais da função pulmonar e de como pode ocorrer alteração da função pulmonar após o ato cirúrgico. A opção de tratamento fisioterapêutico precoce proposto neste trabalho pode ter contribuído para retorno da função pulmonar aos valores previstos.…”