Inspiratory muscle training for diaphragm dysfunction after cardiac surgery

Kodric, Metka; Trevisan, Roberto; Torregiani, Chiara; Cifaldi, Rossella; Longo, Carlos Alberto; Cantarutti, Fabiana; Confalonieri, Marco

doi:10.1016/j.jtcvs.2012.07.087

Cited by 65 publications

(52 citation statements)

References 25 publications

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“…In fact, inspiratory muscle training (IMT) may increase diaphragm strength and tone in different clinical settings (2,16). There is some evidence that prolonged inspiratory effort can improve gastroesophageal reflux.…”

mentioning

confidence: 99%

Inspiratory muscle training improves antireflux barrier in GERD patients

Souza

Lima

Martins

et al. 2013

American Journal of Physiology-Gastrointestinal and Liver Physi

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Nobre e Souza MÂ, Lima MJ, Martins GB, Nobre RA, Souza MH, de Oliveira RB, dos Santos AA. Inspiratory muscle training improves antireflux barrier in GERD patients. Am J Physiol Gastrointest Liver Physiol 305: G862-G867, 2013. First published October 10, 2013 doi:10.1152/ajpgi.00054.2013.-The crural diaphragm (CD) is an essential component of the esophagogastric junction (EGJ), and inspiratory exercises may modify its function. This study's goal is to verify if inspiratory muscle training (IMT) improves EGJ motility and gastroesophageal reflux (GER). Twelve GER disease [GERD; 7 males, 20 -47 yr, 9 esophagitis, and 3 nonerosive reflex disease (NERD)] and 7 healthy volunteers (3 males, 20 -41 yr) performed esophageal pH monitoring, manometry, and heart rate variability (HRV) studies. A 6-cm sleeve catheter measured average EGJ pressure during resting, peak inspiratory EGJ pressures during sinus arrhythmia maneuver (SAM) and inhalations under 17-, 35-, and 70-cmH2O loads (TH maneuvers), and along 1 h after a meal. GERD patients entered a 5-days-a-week IMT program. One author scored heartburn and regurgitation before and after IMT. IMT increased average EGJ pressure (19.7 Ϯ 2.4 vs. 29.5 Ϯ 2.1 mmHg; P Ͻ 0.001) and inspiratory EGJ pressure during SAM (89.6 Ϯ 7.6 vs. 125.6 Ϯ 13.3 mmHg; P ϭ 0.001) and during TH maneuvers. The EGJ-pressure gain across 35-and 70-cmH2O loads was lower for GERD volunteers. The number and cumulative duration of the transient lower esophageal sphincter relaxations decreased after IMT. Proximal progression of GER decreased after IMT but not the distal acid exposure. Low-frequency power increased after IMT and the higher its increment the lower the increment of supine acid exposure. IMT decreased heartburn and regurgitation scores. In conclusion, IMT improved EGJ pressure, reduced GER proximal progression, and reduced GERD symptoms. Some GERD patients have a CD failure, and IMT may prove beneficial as a GERD add-on treatment. crural diaphragm; GERD; lower esophageal sphincter; muscle training

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confidence: 99%

Inspiratory muscle training improves antireflux barrier in GERD patients

Souza

Lima

Martins

et al. 2013

American Journal of Physiology-Gastrointestinal and Liver Physi

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“…These complications increase morbidity and mortality rates, slowing down the recovery process in patients [2]. In the 20 years of our clinic practice of cardiology, we have frequently encountered a plegia of the phrenic nerve, that may be transient, partially permanent or permanent, as found in published literature [2,3]. The lesion of the phrenic nerve may occur in 60% -85% of the population undergoing thoracic cardiac surgery, in particular the left nerve [3,4].…”

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confidence: 99%

The Five Diaphragms in Patients Following Cardiac Surgery in Sternotomy: An Observational Study

Bordoni¹

2017

IJCAM

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The recovery and rehabilitation process of patients following heart surgery in sternotomy is lengthy and requires significant time. This observational study on five diaphragms in patients undergoing a sternotomy is the first of its kind.Objectives: Evaluate the position of the 5 bodily diaphragms, creating a platform of useful information for the practice of manual therapy. Understand if the diaphragm position coincides with the clinical status of the patient.Setting: Department for Cardiac Rehabilitation, Foundation Don Carlo Gnocchi IRCCS. Materials and methods:From January 2012 to July 2016, 300 cardiac patients underwent evaluation following a cardiothoracic intervention. In a supine position, palpation was conducted on the pelvic floor, the respiratory diaphragm, the thoracic outlet, the buccal floor and the cerebellar tentorium. The evaluation was undertaken on the first day of recovery in the ward. Rating scales were conducted such as the VAS, the walking test and the air life, an instrument for measuring the volume of air inhaled.Results: Eleven different positional organisation structures of the 5 diaphragms have been highlighted which do not correspond to the patient's clinical status. Conclusions:The data collected from the study allows us to obtain important information to guide the work of the manual therapist, but does not have a direct relationship with the patient's functional status.

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“…[5] Respiratory muscles are affected after cardiac surgeries. It has been shown that domiciliary program of inspiratory muscle training was safe and improved the forced vital capacity and the maximum voluntary ventilation, although the clinical benefits of this program were not clearly [8][9][10]2017 demonstrable. [6] Postoperative pulmonary complications (PPCs) after coronary artery bypass graft (CABG) surgery are a major source of morbidity and mortality, and increase length of hospital stay and resource utilization.…”

Section: Introductionmentioning

confidence: 99%

“…Inspiratory muscle training may improve inspiratory muscle strength and increases paralyzed diaphragm mobility. [10] Most patients are readily liberated from mechanical ventilation (MV) support, however, 10% -15% of patients experience failure to wean (FTW). FTW patients account for approximately 40% of all MV days and have significantly worse clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

Preoperative Respiratory Physiotherapy and Postoperative Pulmonary Complications in CABG

2017

Sept. 8-10, 2017 Istanbul (Turkey) ESTIA-2017, HEFBS-2017, UTAEE-17, BLECSR-17 &Amp; LEHSS-17

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Abstract:It has been shown that Preoperative inspiratory muscle training is able to affect on surgical trauma, the respiratory muscle strength, the lung volumes, and diaphragmatic excursion in patients undergoing surgery. The aim of this short review is to introduce preoperative respiratory physiotherapy as a mean to reduce the postoperative pulmonary complications after coronary artery bypass graft surgery .

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Inspiratory muscle training for diaphragm dysfunction after cardiac surgery

Abstract: Inspiratory muscle training may improve inspiratory muscle strength and increases paralyzed diaphragm mobility.

Cited by 65 publications

References 25 publications

Inspiratory muscle training improves antireflux barrier in GERD patients

Inspiratory muscle training improves antireflux barrier in GERD patients

The Five Diaphragms in Patients Following Cardiac Surgery in Sternotomy: An Observational Study

Preoperative Respiratory Physiotherapy and Postoperative Pulmonary Complications in CABG

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