Respiratory function after cardiac surgery

Johnson, David H.; Hurst, Tom; Thomson, Dorothy; Mycyk, Taras; Burbridge, Brent; To, Teresa; Mayers, Irvin

doi:10.1016/s1053-0770(96)80130-3

Cited by 64 publications

(45 citation statements)

References 23 publications

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“…Likewise, transoperatory factors, such as general anesthesia, pulmonary modifications after extracorporeal circulation (ECC), utilization of internal mammary artery as well as postoperative pain, are factors that contribute with the occurrence of PC [4][5][6][7][8] . Follow-up studies on pulmonary function and capacity after cardiac surgeries demonstrated that the volumes did not recover the preoperative values eight weeks after the surgery 9 . The pulmonary function remains 25 to 30% lower even 3.5 months after surgery 10,11 .…”

Section: Introductionmentioning

confidence: 89%

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: Introductionmentioning

confidence: 89%

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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“…7,8 In spite of modernization of procedures, cardiac surgery can damage pulmonary function, with decreases of respiratory muscle strength and spirometric measurements occurring postoperatively, in addition to the occurrence of atelectasis in more than 90% of the patients. 9 Reduction in oxygenation, 10 pulmonary function, 11,12,13,14 and respiratory muscle strength, 4,5,9,12 as well as radiological changes such as atelectasis 8,12,15 have been cited as common alterations in postoperative cardiac surgery. The reduction of respiratory muscle strength, resulting from direct or indirect lesion of respiratory muscles during surgery and the secondary diaphragmatic dysfunction due to phrenic nerve lesion, has also been related to reduced pulmonary function tests, worsened gas exchange, and increase in the rate of pulmonary complications.…”

mentioning

confidence: 99%

“…The reduction of respiratory muscle strength, resulting from direct or indirect lesion of respiratory muscles during surgery and the secondary diaphragmatic dysfunction due to phrenic nerve lesion, has also been related to reduced pulmonary function tests, worsened gas exchange, and increase in the rate of pulmonary complications. 4,5,9,12 Considering this, some authors 8,[15][16][17][18][19] have investigated the application of different physiotherapeutic treatment techniques in an attempt to minimize the alterations in the respiratory and cardiovascular system and thereby reduce the incidence of complications.…”

mentioning

confidence: 99%

The Influences of Positive End Expiratory Pressure (Peep) Associated With Physiotherapy Intervention in Phase I Cardiac Rehabilitation

Borghi‐Silva

Mendes

Costa

et al. 2005

Clinics

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PURPOSE:To evaluate the effects of positive end expiratory pressure and physiotherapy intervention during Phase I of cardiac rehabilitation on the behavior of pulmonary function and inspiratory muscle strength in postoperative cardiac surgery. METHODS: A prospective randomized study, in which 24 patients were divided in 2 groups: a group that performed respiratory exercises with positive airway expiratory pressure associated with physiotherapy intervention (GEP, n = 8) and a group that received only the physiotherapy intervention (GPI, n = 16). Pulmonary function was evaluated by spirometry on the preoperative and on the fifth postoperative days; inspiratory muscle strength was measured by maximal inspiratory pressure on the same days. RESULTS: Spirometric variables were significantly reduced from the preoperative to the fifth postoperative day for the GPI, while the GEP had a significant reduction only for vital capacity (P < .05). When the treatments were compared, smaller values were observed in the GPI for peak flow on the fifth postoperative day. Significant reductions of maximal inspiratory pressure from preoperative to the first postoperative day were found in both groups. However, the reduction in maximal inspiratory pressure from the preoperative to the fifth postoperative day was significant only in the GPI (P < .05). CONCLUSIONS: These data suggest that cardiac surgery produces a reduction in inspiratory muscle strength, pulmonary volume, and flow. The association of positive expiratory pressure with physiotherapy intervention was more efficient in minimizing these changes, in comparison to the physiotherapy intervention alone. However, in both groups, the pulmonary volumes were not completely reestablished by the fifth postoperative day, and it was necessary to continue the treatment after hospital convalescence. Cardiac surgery reverts symptoms for individuals with specific cardiopathologies and measurably increases their chances of survival and quality of life.1-3 However, pulmonary complications are quite frequent and represent an important cause of morbidity and mortality for patients undergoing cardiac surgery with cardiopulmonary bypass. 2,[4][5][6] These patients can develop various degrees of a systemic inflammatory response syndrome due to factors such as surgical trauma, contact of blood with nonendothelial surfaces of the bypass circuit, and alterations known as reperfusion post-cardiopulmonary bypass lesions, mainly affecting the cardiac and pulmonary regions. 2,[4][5][6] In the pulmonary region, there is an increase in extravascular water with alveolar filling caused by inflammatory cells, which leads to the inactivation of the pulmonary surfactant and collapse of some areas, modifying the pulmonary ventilation/perfusion relationship, with resultant

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“…Johnson et al study 17 included 138 patients undergoing cardiac surgery, who had their maximal inspiratory and expiratory pressures and pulmonary function assessed in two periods: at the day of hospital discharge, which occurred on the fifth postoperative day, on average, and on the eighth postoperative week. In the first analysis, pain, as assessed subjectively, was described as mild to moderate.…”

Section: Discussionmentioning

confidence: 99%

“…Lock et al 18 , in turn, demonstrated that respiratory pressures and pulmonary function remained reduced even in the second analysis carried Changes in lung volumes and capacity of patients undergoing cardiac surgery account, to a great extent, for the morbidity of these patients 6 . Atelectases are the most frequent complications 4,20,21 , resulting from decreased functional residual capacity that leads to hypercapnia and hypoxia 5,22 , from rib cage changes 17 , and from the cephalad displacement of the diaphragm. Changes in the respiratory mechanics 23 may also occur due to increased airway resistance, postoperative pain 24 , paresis of the phrenic nerve 25 , and others.…”

Section: Discussionmentioning

confidence: 99%

Estimulação elétrica nervosa transcutânea de curta duração no pós-operatório de cirurgia cardíaca

Gregorini

Cipriano

Aquino

et al. 2010

Arq. Bras. Cardiol.

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Background: Respiratory muscle strength has been related to the postoperative outcome of cardiac surgeries. The main documented therapeutic purpose of transcutaneous electrical nerve stimulation (TENS) is the reduction of pain, which could bring secondary benefits to the respiratory muscles and, consequently, to lung capacities and volumes.Objectives: The objective of the present study was to evaluate the effectiveness of short-duration transcutaneous electrical nerve stimulation (TENS) in the reduction of pain and its possible influence on respiratory muscle strength and lung capacity and volumes of patients in the postoperative period of cardiac surgery.Methods: Twenty five patients with mean age of 59.9 ± 10.3 years, of whom 72% were men, and homogeneous as regards weight and height, were randomly assigned to two groups. One group received therapeutic TENS (n = 13) and the other, placebo TENS (n = 12), for four hours on the third postoperative day of cardiac surgery. Pain was analyzed by means of a visual analogue scale, and of respiratory muscle strength as measured by maximum respiratory pressures and lung capacity and volumes before and after application of TENS. Results

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Respiratory function after cardiac surgery

Cited by 64 publications

References 23 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 Influences of Positive End Expiratory Pressure (Peep) Associated With Physiotherapy Intervention in Phase I Cardiac Rehabilitation

Estimulação elétrica nervosa transcutânea de curta duração no pós-operatório de cirurgia cardíaca

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