Effects of Long Intubation Period on Respiratory Functions following Open Heart Surgery.

Abstract

SUMMARYThe objective of the present study was to compare pre-and postoperative pulmonary function tests in adult patients who had intubation periods greater and less than 24 hours following elective open heart surgery.Group l consisted of 91 patients (18 females and 73 males) gr, whose intubation periods were more than 24 hours (mean: 8.1±18.6 hours); and group 2 75 patients (13 females and 62 males) who had intubation periods less than 24 hours (mean: 13.25±3.60 hours). The pulmonary function test measurements were obtained from a vitalograph before and after the operation (just before being discharged from the hospital), All patients underwent cardiopulmonary physiotherapy and a rehabilitation programme during their hospital stay.The patients were similar in height and weight. The duration of hospitalization of the patients who had a prolonged intubation period was 17.26±9.7 days, while that of the control group was 10.64±2.04 days (P<0.0001).When the preoperative pulmonary function test values of each patient were compared with the expected values, the percent values of forced expiratory volume for one second, flow velocity of the mid-forced expiration and forced expiratory flow which were achieved by group 2 were significantly high compared to those of group 1 (P=0.014, P= 0.03 and P<0.0001, respectively). However, the percent values of forced vital capacity were similar.When the percent variations of the differences between the pre-and postoperative pulmonary function test values of the groups were compared, all values except the flow velocity of the mid-forced expiration, and forced vital capacity, were found to be significantly lower statistically in the group having a prolonged intubation period.As a result, it was determined that the patients whose preoperative pulmonary function test values were poor, had longer intubation periods and similarly, they continued to be worse after the operation. We believe that it is advantageous to apply more intensive pulmonary rehabilitation for prolonged periods to these patients in the postoperative period. (Jpn Heart J 2002; 43: 523-530)

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

“…One of the causes of extended MV time is related to prolonged cardiopulmonary bypass. Akdur et al [17] observed that, among the patients who underwent cardiac surgery with obstructive and restrictive respiratory alterations, those who remained intubated for more than 24 hours needed for a longer period of hospital stay and recovery when compared to patients who had MV interrupted within 24 hours.…”

“…Pneumonia and atelectasis are also respiratory complications associated with dependence on mechanical ventilatory assistance [10]. For these reasons, those patients who remain intubated for a long period in postoperative cardiac surgery with impaired lung function should undergo long and intense physiotherapy [17].…”

A efetividade de uma proposta fisioterapêutica pré-operatória para cirurgia de revascularização do miocárdio

“…Postoperative pulmonary complications are an important cause of mortality and morbidity [1]. Thus, by identifying patients at risk of postoperative pulmonary complications [2][3][4] and optimizing the therapeutic treatment [1][2][3][4][5] mortality rates can be reduced.…”

O papel da fisioterapia respiratória precoce na evolução de pacientes submetidos í cirurgia cardí­aca com circulação extracorpórea

“…Embora o uso de técnicas de fi sioterapia respiratória no tratamento de pacientes submetidos à cirurgia cardíaca seja amplo, existem poucas avaliações científi cas detalhadas. Em um estudo, realizado por Akdur et al [23], foram avaliados 269 pacientes a fi m de avaliar o teste de função pulmonar pré e pós-operatório e comparar os efeitos do longo período de intubação. Todos os pacientes submetidos a esse estudo realizaram um programa de reabilitação cardiopulmonar, incluindo exercícios pulmonares diafragmáticos, educação de tosse, técnicas de drenagem postural e exercícios de mobilização geral durante sua internação, iniciando no primeiro dia de extubação.…”