Prophylactic respiratory physiotherapy after cardiac surgery: systematic review

Pasquina, Patrick

doi:10.1136/bmj.327.7428.1379

Cited by 187 publications

(136 citation statements)

References 39 publications

(56 reference statements)

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“…However, systematic review of the literature shows that there are controversies about the aforementioned subject, making it difficult to decide which resource would be more useful and less expensive in the management of these patients [42]. The techniques used in respiratory physiotherapy vary by country and practice.…”

Section: Resultsmentioning

confidence: 99%

Fisioterapia respiratória na disfunção pulmonar pós-cirurgia cardíaca

Renault¹,

Costa-Val²,

Rossetti

2008

Rev Bras Cir Cardiovasc

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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...

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Section: Resultsmentioning

confidence: 99%

Fisioterapia respiratória na disfunção pulmonar pós-cirurgia cardíaca

Renault¹,

Costa-Val²,

Rossetti

2008

Rev Bras Cir Cardiovasc

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“…In order to verify whether respiratory physiotherapy helps to prevent pulmonary complications after heart surgery, Pasquina et al [4] performed a meta-analysis using the following databases: Medline, Embase, CINAHL, and the Cochrane Library. Based on data from 18 trials (1457 patients), they concluded that no physiotherapeutic intervention showed superiority in the adopted parameters.…”

Section: Contradictory Evidence On the Real Usefulness Of Respiratorymentioning

confidence: 99%

“…After surgery, patients are more susceptible to developing respiratory complications. About 65% of patients develop atelectasis and 3% catch pneumonia 3% [4]. For this reason, the physiotherapist has an important role in the treatment of these patients, aiming to prevent or reduce such complications [3].…”

Section: Introductionmentioning

confidence: 99%

“…Particularly in patients who underwent surgery with cardiopulmonary bypass (CPB), inflammatory reactions may be triggered by this procedure, causing deterioration of lung function in the postoperative period [3]. These complications are responsible for extended hospital stays and increased hospital costs [4], and is also an important cause of morbidity and mortality [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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Cuidados pré e pós-operatórios em cirurgia cardiotorácica: uma abordagem fisioterapêutica

Arcêncio¹,

Souza²,

Bortolin³

et al. 2008

Rev Bras Cir Cardiovasc

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It is well known that anesthesia and certain surgeries predispose patients to changes in respiratory function, pulmonary volumes, and gas exchange. Cardiac surgery, which is considered a major surgery, may trigger respiratory complications in the postoperative period. These complications have various causes, such as heart and lung functions in the pre-operative, the use of cardiopulmonary bypass (CPB), and the level of sedation. In these extensive thoracic procedures, respiratory dysfunction may be significant, persisting in the postoperative period. Physiotherapy is offered to patients in the ICU as part of a multidisciplinary treatment plan. It is a time-consuming treatment, and is possible at various times during the patient's stay in the ICU. However, it is particularly valuable in postoperative recovery in order to avoid respiratory and motor complications. Thus, a literature review was performed, aiming to arrange current and relevant information on available resources for respiratory monitoring, as well as its importance in evaluating and treating lung function impairment, as this complication is a frequent cause of death in surgical patients. Bras Cir Cardiovasc 2008; 23(3): 400-410 For acquisition data in this study, scientific articles and an electronic research strategy was used for bibliographic reviews, mainly aiming to identify studies and guidelines that relate to physiotherapeutic performance and cardiothoracic surgery. The study was carried out based on articles that were published in the last 20 years, were available in the MEDLINE database, and used the terms "Physiotherapy", "cardiac surgery", "respiratory monitoring" and/or "respiratory complications". Relevant studies from Brazilian authors were also considered, particularly those published by the Brazilian Journal of Cardiovascular Surgery and the Brazilian Archives of Cardiology (official journals of dissemination of Brazilian cardiology) if the articles contained the key words "physiotherapy" and "monitoring". In addition to this research, additional data from postgraduate studies was found at the Division of Thoracic and Cardiovascular Surgery, FMRP-USP.ARCÊNCIO, L ET AL -Pre-and postoperative care in cardiothoracic surgery: a physiotherapeutic approach RevThe findings included randomized clinical trials, metaanalysis, review articles and consensus guidelines, and were related to physiotherapy, respiratory monitoring, and cardiac surgery and its complications. As the diagram of Figure 1 shows, 623 potentially relevant publications in MEDLINE were found, of which 55 fulfilled all of the scientific criteria.

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“…Non‐pharmacological prevention of pulmonary diseases has included invasive (endotracheal intubation) and noninvasive (mask, helmet) mechanical ventilatory support for respiratory deficient hypoxic patients 37. Effects are documented on morbidity and survival compared with endotracheal mechanical ventilation 38 and conventional oxygen delivery 39, 40; however conflicting results exist 41, 42, 43, 44. An RCT among hematological patients admitted to the ICU, showed that comprehensive 45‐minute noninvasive ventilation every 3 hr with face mask connected to a ventilator (CPAP/PEEP), in addition to oxygen therapy, can reduce the number of intubation cases and increase survival compared to initial oxygen therapy alone 45.…”

Section: Discussionmentioning

confidence: 99%

Early warning and prevention of pneumonia in acute leukemia by patient education, spirometry, and positive expiratory pressure: A randomized controlled trial

et al. 2016

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Long‐lasting neutropenia associated with acute myeloid leukemia (AML) and its treatment gives rise to a high risk of pneumonia. The use of broad‐spectrum antibiotic prophylaxis during outpatient management has not completely protected patients against admission due to infections and neutropenic fever, emphasizing the need to approach infection protection with complementary efforts. In a randomized controlled design, we examined the applicability of patient‐performed daily spirometry [forced expiratory volume in one second (FEV1)] as an early warning tool and explored the effectiveness of positive expiratory pressure (PEP) in preventing pneumonia among 80 AML patients. Twenty‐five incidences of pneumonia were detected among 23 patients (6 interventions, 17 controls), giving a prevalence of 28.75% during 5420 days of observation. We found a significant difference in incidence between intervention versus control group (2.17 per 1000 days vs. 6.52 per 1000 days, P = 0.021, respectively). A cross point at 80‐76% of the personal FEV1 reference value showed high sensitivity and specificity on pneumonia development. Our data demonstrate the feasibility of educating AML patients in their continuous daily measurement of FEV1 and use of PEP. Daily measures of FEV1 may be an important early warning tool for assessment of pulmonary deterioration during critical phases of neutropenia. We suggest that strategic patient education in the use of spirometry and PEP should be part of standard of care for AML patients undergoing induction chemotherapy. Am. J. Hematol. 91:271–276, 2016. © 2015 The Authors. American Journal of Hematology Published by Wiley Periodicals, Inc.

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Prophylactic respiratory physiotherapy after cardiac surgery: systematic review

Cited by 187 publications

References 39 publications

Fisioterapia respiratória na disfunção pulmonar pós-cirurgia cardíaca

Fisioterapia respiratória na disfunção pulmonar pós-cirurgia cardíaca

Cuidados pré e pós-operatórios em cirurgia cardiotorácica: uma abordagem fisioterapêutica

Early warning and prevention of pneumonia in acute leukemia by patient education, spirometry, and positive expiratory pressure: A randomized controlled trial

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