Fisioterapia respiratória na disfunção pulmonar pós-cirurgia cardíaca

Abstract

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...

Condições Físico-Funcionais E Qualidade De Vida De Pacientes No Pré E Pós-Operatório De Cirurgia Cardíaca

“…Pacientes submetidos à cirurgia cardíaca também desenvolvem, em sua maioria, disfunção pulmonar pós-operatória com redução importante dos volumes pulmonares 7 , prejuízos na mecânica respiratória, diminuição na complacência pulmonar e aumento do trabalho respiratório. sofre pelo medo constante da morte, sobretudo pelas mudanças de hábitos necessárias para a prevenção de novo episódio da doença 27 .…”

“…Estudos evidenciam que a intervenção da cirurgia cardíaca leva redução da independência funcional 4 , força muscular respiratória 5,6 , além de redução dos volumes pulmonares 7 formação de atelectasia 8 .…”

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

“…The technique involves the application of CPAP with pressure levels ranging from 30 to 45 cmH2O pulmonary complications after cardiac surgery [5,6]. When approaching these cases, respiratory physiotherapy has been increasingly requested, since it uses techniques that can improve respiratory mechanics, reexpansion pulmonary and bronchial hygiene.…”

“…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

“…The postoperative pain and the presence of drains imply low lung volumes. Considering that this case of pulmonary dysfunction is related to cardiac surgery and its possible repercussions, physiotherapy has been required as an attempt to reverse or reduce such conditions, avoiding pulmonary complications 2 .…”