Effects of Structured Manual Hyperinflation for Improving Respiratory Parametrs in Post-Operative Coronary Artery Bypass Graft Patients

Abstract

Purpose: Cardiopulmonary physiotherapy plays a crucial role in cardiac rehabilitation after surgeries. The deterioration of respiratory parameters occurs after coronary artery bypass grafting (CABG) procedure. Manual hyperinflation (MHI) is done according to clinical experiences and there are no specific guidelines for it. The objectives were to determine the effects of structured manual hyperinflation for improving respiratory parameters in post-operative CABG patients.
 Methodology: Duration of study was 6 months (January 2019-June 2019) with a sample size of 76 post-operative CABG patients. Non-probability purposive sampling technique was used. Patients were divided into two groups’ i-e MHI and VHI depending upon the treatment protocol. In protocol, endotracheal tube (ETT) suctioning was done followed by MHI and VHI in assigned group in randomized controlled trial design. Respiratory parameters were measured by ABG’S, equations for static lung compliance and alveolar-arterial oxygen tension difference. Data was recorded pre and post ETT suctioning, immediately, 30 min and 60 min post intervention. Both males and females were included. Inclusion criteria involves patient must be intubated, hemodynamically and vitally stable, and age range 55-77 years. Those were excluded who have past medical history of diagnosed pulmonary pathology and any post-operative complications. Patient was withdrawn from the study if any subject who have unstable cardiovascular status and high levels of respiratory support. Data was analyzed on SPSS 21.
 Findings: All the respiratory parameters showed significant differences (p<0.05) in pre and post values of structured MHI. Significant difference (p<0.05) was observed immediately after intervention in terms of acidity (pH), partial pressure of carbon oxide (PaCO2), partial pressure of oxygen (PaO2), oxygen saturation and arterial oxygen to fraction of inspired oxygen ratio between the groups with scores higher for experimental group. HCO3 showed significant difference (p<0.05) immediately after intervention and 30 min and 60 min post intervention with the scores higher for control group. Static lung compliance showed significant difference (p<0.05) at 30 min and 60 min post intervention with scores higher for control group. Alveolar-arterial oxygen tension showed no significant difference (p>0.05) between the groups at any point. No significant difference (p>0.05) was observed between the groups at any other point of measurement for all respiratory parameters. MHI and VHI are both effective in improving respiratory parameters in post-operative CABG patients but the values were more significant in MHI group. But the difference between the groups was not significant and conclusive.
 Recommendations: This study should be conducted in different patient populations having different pulmonary conditions and other types of cardiac surgeries and in other patients who are intubated and mechanically ventilated. Moreover, the effects of both techniques on different variables must be studied after multiple numbers of sessions during the whole period of intubation.