Atendimento fisioterapêutico no pós-operatório imediato de pacientes submetidos à cirurgia abdominal

Abstract

In order to minimize postoperative complications of abdominal surgery, early initiation of postoperative treatment is necessary. The objective of the present study was to evaluate patients submitted to abdominal surgery in terms of the effect of physical therapy in the immediate postoperative period in the recovery room.This was a randomized clinical trial, in which patients who underwent open abdominal surgery and remained in the recovery room wereThe incidence of clinically relevant pulmonary complications in the postoperative period after abdominal surgery ranges from 5% to 30%. Such complications are the leading causes of morbidity and mortality, increasing hospital stays, medication use and hospital costs.(1) Respiratory therapy has been shown to be effective in the postoperative period, reducing the incidence of pulmonary complications in patients submitted to abdominal surgery. AbstractA series of pulmonary complications can occur after abdominal surgery. Therefore, it is necessary to introduce appropriate treatment early in order to minimize postoperative complications. The objective of the present study was to evaluate patients submitted to abdominal surgery in terms of the effect of physical therapy in the immediate postoperative period. This was a randomized clinical trial, in which one group of patients was submitted to physical therapy in the postoperative recovery room and, subsequently, in the infirmary, whereas another group was submitted to physical therapy in the infirmary exclusively. We conclude that physical therapy performed in the immediate postoperative period minimizes losses in lung function and respiratory muscle strength, as well as shortening recovery room stays.Keywords: Physical therapy (specialty); Postoperative period; Surgery/abdomen. ResumoA cirurgia abdominal causa uma série de complicações pulmonares após o processo cirúrgico. Assim, faz-se necessário um tratamento precoce adequado objetivando minimizar as complicações no período pós-operatório. Objetivamos avaliar o efeito do atendimento fisioterapêutico no pós-operatório imediato de pacientes submetidos à cirurgia abdominal. Este foi um ensaio clínico randomizado, no qual um grupo recebeu atendimento fisioterapêu-tico na sala de recuperação e, posteriormente, nas enfermarias, e outro grupo o recebeu somente nas enfermarias. Concluímos que a fisioterapia realizada no pós-operatório imediato reduziu a perda da função pulmonar, a perda da força muscular ventilatória e o tempo de internação na sala de recuperação.Descritores: Fisioterapia (especialidade); Período pós-operatório; Cirurgia/abdome.

Application of positive airway pressure in restoring pulmonary function and thoracic mobility in the postoperative period of bariatric surgery: a randomized clinical trial

“…The decreased chest wall compliance due to increased abdominal pressure, administration of anesthetics and postoperative pain may cause a prolonged reduction in lung volumes and capacities. The BIPAP therapy is believed to reverse these phenomena through the combined positive PEEP effects and inspiratory support pressure, allowing the recruitment of collapsed alveoli zones, increasing pulmonary ventilation and improving gas exchange, in addition to increasing chest expansion 9 , 23 , 42 , 43 . However, in this study, BIPAP was not able to restore lung function postoperatively, and its effectiveness was only observed in the restoration of the thoracic mobility when compared to the other positive the therapy exerted a dose and time dependent pressure techniques used.…”

“…The absence of significant positive effects when using the positive pressure techniques in this study can also be explained by the time that the techniques were applied, as they were only begun approximately four hours after the end of surgery. Forgiarini Junior et al 43 demonstrated that physical therapy, when initiated in the post-anesthetic recovery room, might be beneficial for patients who underwent abdominal surgery because the pulmonary function values in patients who received physical therapy earlier had lower variation in postoperative spirometry values compared to the preoperative values than the group that started physical therapy on the ward.…”

Effects of Diaphragmatic Breathing on Health: A Narrative Review

“…Grams et al [ 74 ] examined the effects of breathing exercises on the prevention of postoperative pulmonary complications and recovery of pulmonary function in patients who had upper abdominal surgery. A total of six RCTs or quasi-RCTs were included in this systematic review [ 36 , 37 , 38 , 39 , 40 , 75 ], four of which were conducted in Brazil. The meta-analysis showed that the maximal expiratory pressure and maximal inspiratory pressure increased by 12.8 (95% CI, 7.6–18.1) and 5.6 (95% CI, 0.6–10.5) mmH 2 O, respectively, on Day 1 postop [ 38 , 39 , 40 ].…”

“…DB has a potential to be a non-pharmacological treatment for patients with stress disorder as well as chronic respiratory disease. Although a number of studies have investigated the efficacy of breathing exercises in treating chronic obstructive pulmonary disease (COPD) [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ], asthma [ 30 , 31 , 32 , 33 , 34 , 35 ], postoperative pulmonary function [ 36 , 37 , 38 , 39 , 40 ], and cardiorespiratory performance in post-Fontan patients [ 41 ], the effect of DB on other disorders, for example, cancer, heart failure, and anxiety, still needs to be further investigated. As a martial arts practitioner, the author uses DB in daily mind–body exercises ( Figure 1 ) and feels the necessity to assess whether DB has a favorable impact on the overall health.…”

Laparotomia exploratória e colecistectomia: análise da frequência respiratória e saturação de oxigênio de pacientes no pós-operatório imediato

“…En ese contexto, la terapéutica al paciente quirúrgico en post-operatorio para equilibrio de los sistemas orgánicos y prevención de complicaciones consiste principalmente en el control del dolor mediante administración de analgésicos para promover bienestar y menor dificultad para respirar, prevención de infección a partir de la antibióticoprofilaxia, utilización de técnica aséptica en el cambio de apósitos y en procedimientos invasivos, medición periódica de los signos vitales y evaluación de la respiración y demás sistemas para detección precoz de alteraciones, evaluación de las condiciones de hidratación y balance hídrico, evaluación del sitio quirúrgico y de los dispositivos de drenaje, posicionamiento en la camilla con cabecera elevada entre 15º y 30º, excepto cuando sea contraindicado, proporcionando confort y expansión pulmonar, variación de decúbito periódica para prevenir acumulación de secreciones y atelectasia, así como incentivo de respiración profunda la instrucción y realización de ejercicios respiratorios para reclutamiento alveolar y mejora en la ventilación/perfusión (4,11) .…”