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

Abstract

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.

Perfil ventilatório dos pacientes submetidos a cirurgia de revascularização do miocárdio

“…These changes are related to various causes such as heart and lung function preoperatively, duration of CPB and the degree of sedation [7], intensity of surgical manipulation and the number of pleural drains, and the intraoperative factors were the main responsible for change on respiratory mechanics in the immediate postoperative period [2,6].…”

“…The median sternotomy, the most used approach to the procedure of CABG surgery, promotes significant changes in pulmonary function by the consequent instability of the upper chest and leads to changes in mechanical ventilation and ineffective coughing [7]. The use of CPB and absence of pulmonary ventilation during this period are also determining factors in the development of pulmonary complications after heart surgery, probably by changes in mechanical properties of the respiratory system resulting from changes in pulmonary compliance and resistance [8,9].…”

Recrutamento alveolar em pacientes no pós-operatório imediato de cirurgia cardíaca

“…Physiotherapy contributes to adequate ventilation and leads to successful extubation in the postoperative period, after the patient's arrival in the intensive care unit. [5,[7][8][9].…”

Influência da atuação fisioterapêutica no processo de ventilação mecânica de pacientes admitidos em UTI no período noturno após cirurgia cardíaca não complicada

“…Physiotherapeutic care encompasses a variety of techniques, including breathing pattern exercises, early ambulation, kinesiotherapy, positioning, and stimulus to cough. Respiratory physiotherapy, following the arrival in the ICU, contributes a lot to the proper ventilation and to the success of the extubation 4 .…”