Evaluation of respiratory conditions in early phase of hematopoietic stem cell transplantation

Abstract

ObjectivesTo investigate the effectiveness of respiratory physiotherapy based on clinical evidence and analyze the improvement in respiratory parameters.MethodsA prospective study was carried out in the Bone Marrow Transplant Unit of the Universidade Estadual de Campinas (UNICAMP). Two different previously established respiratory physiotherapy protocols were applied from days D-1 to D+7 that aimed to improve airway clearance, pulmonary re-expansion and the strengthening of respiratory muscles. Group A were subjected to diaphragmatic proprioceptive stimulation, breathing exercises, incentive spirometry with Respiron®, inspiratory muscle training with the Threshold® Inspiratory Muscle Training device, bronchial hygienization with Shaker® and cough stimulation. Group B performed a protocol that only used incentive spirometry. The parameters analyzed were: tidal volume, minute volume, maximal inspiratory pressure, maximal expiratory pressure, oxygen saturation, heart rate and respiratory frequency.ResultsSixty-seven patients submitted to myeloablative hematopoietic stem cell transplantation were included in this study. Among these, thirty-nine were evaluated and randomized in the two groups. There were significant differences between the groups for tidal volume at D+2 (p-value = 0.007) and maximal inspiratory pressure (p-value = 0.03), maximal expiratory pressure (p-value = 0.03) and tidal volume (p-value = 0.004) at D+7.ConclusionsOn comparing Group A with Group B, the authors concluded that the protocol of respiratory physiotherapy applied in this study resulted in an improvement in ventilation and in respiratory muscle strength of patients submitted to hematopoietic stem cell transplantation.

Bleeding frequency during physiotherapy in thrombocytopenic patients undergoing hematopoietic stem cell transplantation

“…During the pre-and post-HSCT period, the recipients are susceptible to the toxicities of conditioning with myeloablative chemotherapy, radiotherapy, and complications resulting from HSCT, which have deleterious effects on the cardiorespiratory and musculoskeletal system. Also, the time of prolonged inactivity causes the decline of physical and functional capacity, affecting the quality of life of the patient [5,6]. Additionally, these patients develop severe thrombocytopenia, increasing their predisposition to bleeding [7,8].…”

“…For a long time, absolute rest has been indicated for thrombocytopenic patients; however, studies indicate a strong correlation between immobility and a vicious cycle of physical dysfunction, which results in a rapid and irreversible loss of function, increased morbidity, and mortality [9,10]. In this context, studies have demonstrated the positive effect of early physiotherapy interventions in HSCT recipients [11,12] showing that physical exercise can reduce the decline in physical performance, cytopenia, and hospital stay [13,14]. However, safety levels of platelet counts and erythrocytes for physical exercise are not fully established in the literature [15].…”

Comparação De Dois Protocolos De Espirometria De Incentivo No Pós-Operatório De Cirurgia De Revascularização Do Miocárdio: Estudo Piloto

“…A justificativa para a elevação nestas medidas, segundos os autores, ocorreu devido ao maior recrutamento das unidades motoras dos músculos inspiratórios e em função da redução da dor. Dessa forma, houve uma maior expansibilidade torácica, com consequente aumento da complacência pulmonar 31,32 . As variáveis analisadas nesse estudo se diferenciaram somente na comparação intragrupo (efeito tempo), sem diferença entre os grupos (efeito grupo e interação).…”

Evaluation of respiratory conditions in early phase of hematopoietic stem cell transplantation

“…In this issue of the Revista Brasileira de Hematologia e Hemoterapia , Bom et al (2) demonstrate the benefits of RT in patients submitted to myeloablative hematopoietic stem cell transplantation (HSCT).…”

“…The scientific foundation of respiratory therapy (RT) has increased over the last decade in patients with respiratory diseases ( 1 ) ; however, its effect in patients with other diseases remains poorly understood. In this issue of the Revista Brasileira de Hematologia e Hemoterapia , Bom et al ( 2 ) demonstrate the benefits of RT in patients submitted to myeloablative hematopoietic stem cell transplantation (HSCT).…”