Incentive spirometry with expiratory positive airway pressure reduces pulmonary complications, improves pulmonary function and 6-minute walk distance in patients undergoing coronary artery bypass graft surgery

Haeffener, Mauren Porto; Ferreira, Glória Menz; Barreto, Sérgio Saldanha Menna; Arena, Ross; Dall’Ago, Pedro

doi:10.1016/j.ahj.2008.08.006

Cited by 68 publications

(62 citation statements)

References 26 publications

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“…Both techniques were carried out at the same time by the construction of a system that included one IS and one EPAP valve, as already described. 12 . To adequately adjust the pressure of the EPAP valve, a cmH 2 O-calibrated pressure manometer was used.…”

Section: Intervention Protocolmentioning

confidence: 99%

“…Two commonly used resources of respiratory physiotherapy are the incentive spirometry (IS) and the expiratory positive airway pressure (EPAP), which have the main physiological effect of promoting pulmonary reexpansion. Recently, it was demonstrated that the addition use of IS and EPAP in patients who went through CABG is capable of reducing the loss of pulmonary function, of respiratory muscle strength and of functional capacity 30 days after the surgery 12 . However, there are no studies available on the assessment of long-term effects of IS+EPAP yet.…”

Section: Introductionmentioning

confidence: 99%

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Espirometria de incentivo com pressão positiva expiratória é benéfica após revascularização miocardio

Ferreira¹,

Haeffner²,

Barreto³

et al. 2010

Arq. Bras. Cardiol.

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Section: Intervention Protocolmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Espirometria de incentivo com pressão positiva expiratória é benéfica após revascularização miocardio

Ferreira¹,

Haeffner²,

Barreto³

et al. 2010

Arq. Bras. Cardiol.

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“…[31][32][33]35,37,40 Studies comparing incentive spirometry for PPC prevention after cardiac/thoracic surgery also include a trial with no intervention as the control, 48 and studies that compared incentive spirometry to other techniques. 44,45,47,48,51,52,54,55,58,60 The majority of these trials reported no difference between incentive spirometry and the comparator. 44,47,48,51,52,54,58,60 This creates one of the challenges in evaluating the evidence on incentive spirometry in PPC prevention.…”

Section: Incentive Spirometrymentioning

confidence: 99%

“…Two main areas of investigation have been pursued: incentive spirometry for PPC prevention following upper abdominal surgery, [30][31][32][33][34][35][36][37][38][39][40][41][42][43] and incentive spirometry for PPC prevention following cardiac/thoracic surgery. [44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60] Comparison of these studies is difficult, owing to the various study designs (randomized controlled trials and prospective trials), the comparators (none, chest physical therapy [CPT], CPAP, expiratory airway pressure), the frequency of interventions (eg, hourly, every 4 hours), the duration of each intervention (number of maneuvers, minutes of therapy), and the outcomes (radiographic atelectasis, gas exchange, pneumonia, pulmonary function). Of the studies that used PPCs as an outcome, 3 compared incentive spirometry with a control group of no intervention following upper abdominal surgery.…”

Section: Incentive Spirometrymentioning

confidence: 99%

The Scientific Basis for Postoperative Respiratory Care

Branson

2013

Respir Care

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Postoperative pulmonary complications (PPCs) are common and expensive. Costs, morbidity, and mortality are higher with PPCs than with cardiac or thromboembolic complications. Preventing and treating PPCs is a major focus of respiratory therapists, using a wide variety of techniques and devices, including incentive spirometry, CPAP, positive expiratory pressure, intrapulmonary percussive ventilation, and chest physical therapy. The scientific evidence for these techniques is lacking. CPAP has some evidence of benefit in high risk patients with hypoxemia. Incentive spirometry is used frequently, but the evidence suggests that incentive spirometry alone has no impact on PPC. Chest physical therapy, which includes mechanical clapping and postural drainage, appears to worsen atelectasis secondary to pain and splinting. As with many past respiratory therapy techniques, the profession needs to take a hard look at these techniques and work to provide only practices based on good evidence. The idea of a PPC bundle has merit and should be studied in larger, multicenter trials. Additionally, intraoperative ventilation may play a key role in the development of PPCs and should receive greater attention.

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“…Studies have shown that the use of Expiratory Positive Airway Pressure (EPAP) promotes significant improvement of the gas exchange, reduction of dyspnea and of ventilatory work, providing increase of the training threshold through maintenance of the positive pressure in the airway in the expiratory phase [6][7][8] . To verify the EPAP use, the 6-minute walk test (6'WT) is well-tolerated by the patients for measurement of the functional capacity [8][9][10][11] .…”

Section: Introductionmentioning

confidence: 99%

Efeitos da aplicação da EPAP (Expiratory Positive Airway Pressure) sobre a tolerância ao esforço em pacientes portadores de insuficiência cardíaca

Thofehrn

Coutinho

Daros

et al. 2013

Rev Bras Med Esporte

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Introduction: New therapeutic approaches that aim to improve the sensation of dyspnea and fatigue in patients with heart failure, as the application of expiratory positive airway pressure (EPAP) should be tested in an attempt to improve functional capacity and quality of life. Objective: To evaluate the effects of the use of EPAP during exercise in patients with heart failure functional class II and III (NYHA). Methods: Of 390 patients, 28 were selected with LVEF <40%. The six-minute walk test (6'WT) was performed three times with and without the EPAP, reflecting the greater distance in the analysis. The comparison between the data obtained was performed by paired t test or Wilcoxon test as the normality of the data. Results: The use of EPAP increased volume without significant minutes, but the perceived exertion was higher after the walk with the use of the mask when compared in the absence of a mask. There was significant increase in oxygen saturation compared with the group that did not use the mask. There was no improvement in distance walked in 6'WT with the use of EPAP. Conclusion: Use of EPAP mask increases the perception of ventilatory effort and work, but its applicability in routine cardiac rehabilitation programs based on our preliminary data is questionable.

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Incentive spirometry with expiratory positive airway pressure reduces pulmonary complications, improves pulmonary function and 6-minute walk distance in patients undergoing coronary artery bypass graft surgery

Cited by 68 publications

References 26 publications

Espirometria de incentivo com pressão positiva expiratória é benéfica após revascularização miocardio

Espirometria de incentivo com pressão positiva expiratória é benéfica após revascularização miocardio

The Scientific Basis for Postoperative Respiratory Care

Efeitos da aplicação da EPAP (Expiratory Positive Airway Pressure) sobre a tolerância ao esforço em pacientes portadores de insuficiência cardíaca

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