Fisioterapia pré-operatória na prevenção das complicações pulmonares em cirurgia cardíaca pediátrica

Abstract

Fisioterapia pré-operatória na prevenção das complicações pulmonares em cirurgia cardíaca pediátricaPreoperative physiotherapy in prevention of pulmonary complications in pediatric cardiac surgery Abstract Objective: To evaluate the occurrence and risk of pulmonary complications in children who underwent preand postoperative physiotherapeutic intervention in cardiac surgeries, as well as to compare these patients to those who underwent only postoperative physiotherapeutic intervention.Methods: A randomized clinical trial was performed with 135 patients from 6 years of age and younger with congenital heart disease who had undergone cardiac surgery. Patients were randomly assigned to the intervention group (G1) in which they underwent pre-and postoperative physiotherapy, or to the control group (G2) in which they underwent only postoperative physiotherapy. Mann-Whitney and the Chisquare tests were used to compare the variables between the groups. The magnitude of the absolute risk was calculated by the number of patients needing treatment. Statistical significance was set at 5% (p<0.05).Results: 17 patients (25%) in G1, and 29 patients (43.3%) in G2 presented pulmonary complications (p= 0.025). Pneumonia was the most frequent complication, and among the 17 patients in G1, seven (10.3%) developed pneumonia, six (8.8%) developed atelectasis, and four (5.9%) presented complications due to both complications. In G2, 13 patients (19.4%) developed pneumonia, eight (11.9%) developed atelectasis, and eight (11.9%) developed pneumonia associated with atelectasis. Absolute risk reduction for the primary outcome was of 18.3% and the number of necessary treatments was 5.5. Conclusion: Preoperative respiratory physiotherapy significantly reduced the risk of pulmonary complications in postoperative pediatric cardiac surgery.Descriptors: Physical therapy modalities. Cardiac surgical procedures. Child. ResumoObjetivo: Avaliar a incidência e o risco de complicações pulmonares em crianças submetidas a intervenção fisioterapêutica pré e pós-operatória nas cirurgias cardíacas, bem como comparar com aquelas submetidas apenas a intervenção fisioterapêutica pós-operatória.Métodos: Ensaio clínico aleatório, que incluiu 135 pacientes de zero a 6 anos com cardiopatias congênitas, submetidos à cirurgia cardíaca. Os pacientes foram aleatorizados para grupo intervenção (G1), que realizou fisioterapia pré e pós-operatória, ou para grupo controle (G2), somente fisioterapia pós-operatória. Rev Bras Cir Cardiovasc 2008; 23(3): 383-388

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

“…Studies by BorghiSilva et al [15] and Guizilini et al [16] also revealed damages to the respiratory mechanics in patients subjected to cardiac surgery with CPB application. Nozawa et al [17], in another study, with 45 patients, found similar results in which the use of CPB delayed weaning from the mechanical ventilator and still considered as CPB high time periods longer than 120 minutes for adults, however Brown et al [18], in a specific survey with children found worsening of pulmonary mechanics in those with CPB time longer than 30 minutes. Although the fact that great part of our sample (70.3%) used CPB, the findings were different from those of the mentioned studies, once only 7.6%, that is, two patients developed respiratory complications.…”

Cirurgia cardíaca pediátrica: o que esperar da intervenção fisioterapêutica?

“…Another important approach is education, which is to guide the parents about the importance of physiotherapy for the prevention and rapid restoration of respiratory function in children [23,24].…”

“…Other possibilities are the technique of expiratory flow increase (EFI), the active cycle of breathing, forced expiration technique as well as encouraging inspiratory exercises and non-invasive ventilation (NIV) [8,10,23]. It is noted that although the combined use of postural drainage and percussion is usual in clinical practice, there are still few comparative studies emphasizing that, especially in heart diseases.…”

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].…”