Avaliação da função pulmonar em pacientes submetidos à cirurgia de revascularização do miocárdio com e sem circulação extracorpórea

The aim of this study is to make a literature review about the different techniques of respiratory physiotherapy used after cardiac surgery and their effectiveness in reverting pulmonary dysfunction. It has been used as reference publications in English and Portuguese using as keywords thoracic surgery, respiratory exercises, physiotherapy modalities, postoperative complications and coronary artery bypass grafting, contained in the following databases -BIREME, SciELO Brazil, LILACS, PUBMED, from 1997 to 2007. A secondary study through list of references of identified articles also was performed. It has been selected eleven randomized trials (997 patients). Among the articles included in this study, incentive spirometry was used in three; deep breathing exercises in six; deep breathing exercises associated with positive expiratory pressure in four and positive expiratory pressure associated with inspiratory resistance in two. Three studies used intermittent positive pressure breathing. Continuous positive airway pressure and bi-level positive airway pressure has been used in three and two studies respectively. The protocols used in the studies were varied and the co-interventions were present in most of them. The different analyzed variables and the time of postoperatory follow-up make a comparative analysis difficult. Pulmonary dysfunction is evident in the postoperatory period of cardiac surgery. The use of non-invasive ventilation has been associated with good results in the first postoperatory days. Despite the known importance of postoperatory respiratory physiotherapy, until now, there is no consensus in the literature about the superiority of one technique over the others. 563RENAULT, JA ET AL -Respiratory physiotherapy in the pulmonary dysfunction after cardiac surgery Bras Cir Cardiovasc 2008; 23(4): 562-569 Rev METHODS Search StrategyUsing a primary and secondary search strategy, we performed a literature review of the different techniques of respiratory physiotherapy used in the PO of heart surgery and their effectiveness in the reversion of pulmonary dysfunction, using as publications in English and Portuguese as references. The descriptors used were thoracic surgery, respiratory exercises, physiotherapy modalities, postoperative complications and CABG, and were searched for in the following data sources: BIREME, SciELO Brazil, LILACS and PUBMED from 1997 until 2007. We avoided an excess of similar studies. A secondary search through the considered articles' list of references was also performed. Criteria for the selection of studiesRandomized clinical studies were selected for analysis if they had more than 20 patients and adults who had undergone HS, and if they compared different techniques of respiratory physiotherapy, or if they compared these techniques to procedures without respiratory physiotherapy in the PO. We also selected articles about HS and its pulmonary repercussions in order to introduce the subject and provide a stronger theoretical base. Variables analyzedThe analyzed v...

Section: Resultsmentioning

confidence: 99%

“…The reduction in lung volume and capacity contributes to changes in gas exchange, resulting in hypoxemia [15,17,28,33,35] and decreasing diffusion capacity [21]. Restrictive presentation often persists over more than 116 days [32,36].…”

Section: Resultsmentioning

confidence: 99%

Fisioterapia respiratória na disfunção pulmonar pós-cirurgia cardíaca

Renault¹,

Costa-Val²,

Rossetti

2008

“…Patients who have undergone surgery without use of CPB show better preservation of pulmonary function and a shorter time of tracheal intubation when compared to those operated with CPB [16]. One of the causes of extended MV time is related to prolonged cardiopulmonary bypass.…”

Section: Changes Resulting From Heart Surgerymentioning

confidence: 99%

“…Patients should be informed about the surgery and the immediate postoperative period, and should receive information about the importance of respiratory exercises and the early ambulation that will be performed [16]. Information such as the previous history of the patient, presence of chronic obstructive pulmonary disease (COPD), smoking, obesity and age are important, because the best recovery of pulmonary function depends on the appropriate preoperative evaluation to determine surgical risk [5].…”

Section: The Preoperativementioning

confidence: 99%

Cuidados pré e pós-operatórios em cirurgia cardiotorácica: uma abordagem fisioterapêutica

Arcêncio¹,

Souza²,

Bortolin³

et al. 2008

It is well known that anesthesia and certain surgeries predispose patients to changes in respiratory function, pulmonary volumes, and gas exchange. Cardiac surgery, which is considered a major surgery, may trigger respiratory complications in the postoperative period. These complications have various causes, such as heart and lung functions in the pre-operative, the use of cardiopulmonary bypass (CPB), and the level of sedation. In these extensive thoracic procedures, respiratory dysfunction may be significant, persisting in the postoperative period. Physiotherapy is offered to patients in the ICU as part of a multidisciplinary treatment plan. It is a time-consuming treatment, and is possible at various times during the patient's stay in the ICU. However, it is particularly valuable in postoperative recovery in order to avoid respiratory and motor complications. Thus, a literature review was performed, aiming to arrange current and relevant information on available resources for respiratory monitoring, as well as its importance in evaluating and treating lung function impairment, as this complication is a frequent cause of death in surgical patients. Bras Cir Cardiovasc 2008; 23(3): 400-410 For acquisition data in this study, scientific articles and an electronic research strategy was used for bibliographic reviews, mainly aiming to identify studies and guidelines that relate to physiotherapeutic performance and cardiothoracic surgery. The study was carried out based on articles that were published in the last 20 years, were available in the MEDLINE database, and used the terms "Physiotherapy", "cardiac surgery", "respiratory monitoring" and/or "respiratory complications". Relevant studies from Brazilian authors were also considered, particularly those published by the Brazilian Journal of Cardiovascular Surgery and the Brazilian Archives of Cardiology (official journals of dissemination of Brazilian cardiology) if the articles contained the key words "physiotherapy" and "monitoring". In addition to this research, additional data from postgraduate studies was found at the Division of Thoracic and Cardiovascular Surgery, FMRP-USP.ARCÊNCIO, L ET AL -Pre-and postoperative care in cardiothoracic surgery: a physiotherapeutic approach RevThe findings included randomized clinical trials, metaanalysis, review articles and consensus guidelines, and were related to physiotherapy, respiratory monitoring, and cardiac surgery and its complications. As the diagram of Figure 1 shows, 623 potentially relevant publications in MEDLINE were found, of which 55 fulfilled all of the scientific criteria.

“…It is believed that factors such as general anesthesia, surgical incision, cardiopulmonary bypass (CPB), ischemia time, intensity of surgical manipulation and number of drains may predispose patients to pulmonary function changes, which are highly relevant on the onset of respiratory complications in cardiac surgery postoperative [3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Complicações pulmonares em crianças submetidas à cirurgia cardíaca em um hospital universitário

Borges

Sousa²,

Silva³

et al. 2010

Complicações pulmonares em crianças submetidas à cirurgia cardíaca em um hospital universitárioPulmonary complications in pediatric cardiac surgery at a university hospital Federal Abstract Objective: To identify the prevalence of pulmonary complications in children subjected to cardiac surgery, as well as demographic and clinical characteristics of the studied population.Methods: The sample comprised 37 children of both genders, subjected to cardiac surgery at the Hospital Universitário Presidente Dutra, São Luis (MA), during the year of 2007. Patients who had pre-operative pulmonary disease, patients with neurological disorders, intra-operative death besides lack of data in medical records were not included. The data were obtained from data collection of medical and nursing developments of the respective medical records.Results: The population of the study was predominantly composed by female children, from the countryside and at school age. Pathologies considered as low risk were the majority, highlighting the patent ductus arteriosus, ventricular septal defect and interatrial septal defect. It was observed that most children used cardiopulmonary bypass for over 30 minutes, with a median of 80 minutes, suffered a median sternotomy, using only the mediastinal drain and made use of postoperative mechanical ventilation, with the median of about 6.6 hours. Only 8.1%, in other words, three patients developed pulmonary complications, and of those, two died.Conclusion: Most of the sample children was female, school aged and from the countryside. The low time of cardiopulmonary bypass and mechanical ventilation, in addition to congenital heart diseases with low risk, may have been factors that contributed to the low rate of postoperative pulmonary complications.Descriptors: Congenital Heart Diseases. Surgery. Postoperative Complications.