Efeito agudo da pressão positiva expiratória versus técnica de Breath Stacking no pós-operatório de cirurgia cardíaca: ensaio randomizado cruzado
Autor(a) principal: | |
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Data de Publicação: | 2019 |
Tipo de documento: | Dissertação |
Idioma: | por |
Título da fonte: | Manancial - Repositório Digital da UFSM |
dARK ID: | ark:/26339/001300000nt97 |
Texto Completo: | http://repositorio.ufsm.br/handle/1/21600 |
Resumo: | Patients submitted to cardiac surgery may develop postoperative pulmonary complications. Physical therapy uses techniques and equipment that reduce these complications. The Breath Stacking (BS) technique and Expiratory Positive Airway Pressure (EPAP) are used to achieve greater lung expansion and to improve clinical and functional outcomes in the postoperative period of cardiothoracic surgery. The aim of this study was to compare the acute effects of EPAP and BS on cardiopulmonary and physiological variables of postoperative eletive cardiac surgery patients during hospitalization and to analyze interventions safety aspects. This randomized crossover clinical trial was conducted at the Intensive Cardiology Unit, Medical Clinic I and Medical Clinic II of the University Hospital of Santa Maria, with a sample of 24 individuals undergoing cardiac surgery. Patients received EPAP with 10 cmH20 for 5 minutes and BS in 3 series of 5 applications, with sustained inspiration for 20 seconds, both using a siliconized face mask, in randomized order, with a 24-hour interval between each intervention. Preoperative screening and analysis of medical records were carried and spirometry, ventilometry, thoracoabdominal mobility, maximal respiratory pressures, vital signs and peripheral oxygen saturation were evaluated. In the postoperative period (before and after the interventions) all the above evaluations were performed again. Before, after and 10 min after the interventions, the following patient safety variables were recorded: degree of dyspnea, painful perception in the surgical incision, signs of respiratory distress, hemodynamic and respiratory responses. The evaluator was blinded as to the type of intervention. The study showed that EPAP increased FVC (P <0.003), FEV1 (P <0.024), and axillary (P = 0.030) and xiphoid (P = 0.002) amplitude coefficients. BS improved the abdominal amplitude coefficient (P <0.003). Both techniques increase RR similarly (EPAP: 3.0 bpm, 95% CI 0.98 to 5.01; BS: 2.2 bpm, 95% CI 0.19 to 4.21), which decreased after 10 min (EPAP: -1.8 bpm, 95% CI -3.30 to -0.33; BS: -2.3 bpm, 95% CI -3.83 to -0.83). EPAP reduced MAP (-4.1 mmHg, 95% CI -8.03 to -0.21), which remained lower after 10 min (-5.0 mmHg, 95% CI -8.95 to -1.13). In the other variables there were no changes in response to interventions. It concludes that a single application of EPAP improved FVC, FEV1 and axillary and xiphoid expansibility, which suggests broader effects compared to BS. The techniques proved to be safe in the respiratory and hemodynamic aspects, making these findings as auxiliaries in the physiotherapeutic decision making after cardiac surgery. |
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Efeito agudo da pressão positiva expiratória versus técnica de Breath Stacking no pós-operatório de cirurgia cardíaca: ensaio randomizado cruzadoAcute effect of positive expiratory pressure versus Breath Stacking technique after cardiac surgery: a randomized crossover trialCirurgia cardíacaCuidados pós-operatóriosTécnicas de fisioterapiaTerapia respiratóriaCardiac surgeryPostoperative carePhysical therapy modalitiesRespiratory therapyCNPQ::CIENCIAS DA SAUDEPatients submitted to cardiac surgery may develop postoperative pulmonary complications. Physical therapy uses techniques and equipment that reduce these complications. The Breath Stacking (BS) technique and Expiratory Positive Airway Pressure (EPAP) are used to achieve greater lung expansion and to improve clinical and functional outcomes in the postoperative period of cardiothoracic surgery. The aim of this study was to compare the acute effects of EPAP and BS on cardiopulmonary and physiological variables of postoperative eletive cardiac surgery patients during hospitalization and to analyze interventions safety aspects. This randomized crossover clinical trial was conducted at the Intensive Cardiology Unit, Medical Clinic I and Medical Clinic II of the University Hospital of Santa Maria, with a sample of 24 individuals undergoing cardiac surgery. Patients received EPAP with 10 cmH20 for 5 minutes and BS in 3 series of 5 applications, with sustained inspiration for 20 seconds, both using a siliconized face mask, in randomized order, with a 24-hour interval between each intervention. Preoperative screening and analysis of medical records were carried and spirometry, ventilometry, thoracoabdominal mobility, maximal respiratory pressures, vital signs and peripheral oxygen saturation were evaluated. In the postoperative period (before and after the interventions) all the above evaluations were performed again. Before, after and 10 min after the interventions, the following patient safety variables were recorded: degree of dyspnea, painful perception in the surgical incision, signs of respiratory distress, hemodynamic and respiratory responses. The evaluator was blinded as to the type of intervention. The study showed that EPAP increased FVC (P <0.003), FEV1 (P <0.024), and axillary (P = 0.030) and xiphoid (P = 0.002) amplitude coefficients. BS improved the abdominal amplitude coefficient (P <0.003). Both techniques increase RR similarly (EPAP: 3.0 bpm, 95% CI 0.98 to 5.01; BS: 2.2 bpm, 95% CI 0.19 to 4.21), which decreased after 10 min (EPAP: -1.8 bpm, 95% CI -3.30 to -0.33; BS: -2.3 bpm, 95% CI -3.83 to -0.83). EPAP reduced MAP (-4.1 mmHg, 95% CI -8.03 to -0.21), which remained lower after 10 min (-5.0 mmHg, 95% CI -8.95 to -1.13). In the other variables there were no changes in response to interventions. It concludes that a single application of EPAP improved FVC, FEV1 and axillary and xiphoid expansibility, which suggests broader effects compared to BS. The techniques proved to be safe in the respiratory and hemodynamic aspects, making these findings as auxiliaries in the physiotherapeutic decision making after cardiac surgery.Pacientes submetidos à cirurgia cardíaca podem desenvolver complicações pulmonares pós-operatórias. A fisioterapia utiliza-se de técnicas e equipamentos que comprovadamente diminuem essas complicações. A Expiratory Positive Airway Pressure (EPAP) e a técnica denominada Breath Stacking (BS) podem aumentar a expansão pulmonar e melhorar desfechos clínicos e funcionais no pós-operatório de cirurgias cardiotorácicas. O objetivo deste estudo foi comparar os efeitos agudos da EPAP e da BS sobre variáveis cardiopulmonares e fisiológicas de pacientes em pós-operatório de cirurgia cardíaca eletiva, durante a internação hospitalar e analisar aspectos de segurança das intervenções. Este ensaio clínico randomizado cruzado foi realizado na Unidade Cardiológica Intensiva, Clínica Médica I e Clínica Médica II do Hospital Universitário de Santa Maria, com amostra de 24 indivíduos submetidos à cirurgia cardíaca. Os pacientes receberam a aplicação da EPAP a 10cmH20 por 5 min e da BS em 3 séries de 5 aplicações, com inspiração sustentada por 20 s, ambas através de máscara facial siliconizada, em ordem definida por randomização, com intervalo de 24 horas entre cada intervenção. No pré-operatório ocorreu a triagem e análise do prontuário e foram avaliadas espirometria, ventilometria, expansibilidade tóraco-abdominal, pressões respiratórias máximas, sinais vitais e saturação periférica de oxigênio (SpO2). No período pós-operatório (antes e após as intervenções) foram realizadas novamente todas as avaliações supracitadas. Antes, após e 10 min após as intervenções foram registradas as seguintes variáveis de segurança do paciente: grau de dispneia, percepção dolorosa na incisão cirúrgica, sinais de desconforto respiratório, respostas hemodinâmicas e respiratórias. O avaliador foi cegado quanto ao tipo de intervenção. O estudo mostrou que EPAP aumentou a capacidade vital forçada (CVF; P<0,003), o volume expiratório forçado no primeiro segundo (VEF1; P<0,024) e os coeficientes de amplitude axilar (P=0,030) e xifoide (P=0,002). A BS melhorou o coeficiente de amplitude abdominal (P<0,003). Ambas as técnicas aumentaram a FR, similarmente (EPAP: 3,0 rpm, IC 95% 0,98 a 5,01; BS: 2,2 rpm, IC 95% 0,19 a 4,21), que reduziu após 10 min (EPAP: -1,8 rpm, IC 95% -3,30 a -0,33; BS: -2,3 rpm, IC 95% -3,83 a -0,83). EPAP reduziu a PAM (-4,1 mmHg, IC 95% -8,03 a -0,21), que permaneceu menor após 10 min (-5,0 mmHg, IC 95% -8,95 a -1,13). Nas demais variáveis não houve mudanças em resposta às intervenções. Conclui-se que uma única aplicação da EPAP melhorou a CVF, o VEF1 e a expansibilidade ao nível axilar e xifoidiano, o que sugere efeitos mais amplos na comparação com a BS. As técnicas se mostraram seguras quanto aos aspectos respiratórios e hemodinâmicos, tornando esses achados como auxiliares na tomada de decisão fisioterapêutica no pós-operatório de cirurgia cardíaca.Universidade Federal de Santa MariaBrasilCiências da SaúdeUFSMPrograma de Pós-Graduação em Ciências da SaúdeCentro de Ciências da SaúdeSilva, Antônio Marcos Vargas dahttp://lattes.cnpq.br/9981854873337898Silva, Andréa Lúcia Gonçalves daSignori, Luis UlissesNichele, Lidiane de Fátima Ilha2021-07-24T22:36:32Z2021-07-24T22:36:32Z2019-08-29info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisapplication/pdfhttp://repositorio.ufsm.br/handle/1/21600ark:/26339/001300000nt97porAttribution-NonCommercial-NoDerivatives 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessreponame:Manancial - Repositório Digital da UFSMinstname:Universidade Federal de Santa Maria (UFSM)instacron:UFSM2022-01-17T17:05:46Zoai:repositorio.ufsm.br:1/21600Biblioteca Digital de Teses e Dissertaçõeshttps://repositorio.ufsm.br/ONGhttps://repositorio.ufsm.br/oai/requestatendimento.sib@ufsm.br||tedebc@gmail.comopendoar:2022-01-17T17:05:46Manancial - Repositório Digital da UFSM - Universidade Federal de Santa Maria (UFSM)false |
dc.title.none.fl_str_mv |
Efeito agudo da pressão positiva expiratória versus técnica de Breath Stacking no pós-operatório de cirurgia cardíaca: ensaio randomizado cruzado Acute effect of positive expiratory pressure versus Breath Stacking technique after cardiac surgery: a randomized crossover trial |
title |
Efeito agudo da pressão positiva expiratória versus técnica de Breath Stacking no pós-operatório de cirurgia cardíaca: ensaio randomizado cruzado |
spellingShingle |
Efeito agudo da pressão positiva expiratória versus técnica de Breath Stacking no pós-operatório de cirurgia cardíaca: ensaio randomizado cruzado Nichele, Lidiane de Fátima Ilha Cirurgia cardíaca Cuidados pós-operatórios Técnicas de fisioterapia Terapia respiratória Cardiac surgery Postoperative care Physical therapy modalities Respiratory therapy CNPQ::CIENCIAS DA SAUDE |
title_short |
Efeito agudo da pressão positiva expiratória versus técnica de Breath Stacking no pós-operatório de cirurgia cardíaca: ensaio randomizado cruzado |
title_full |
Efeito agudo da pressão positiva expiratória versus técnica de Breath Stacking no pós-operatório de cirurgia cardíaca: ensaio randomizado cruzado |
title_fullStr |
Efeito agudo da pressão positiva expiratória versus técnica de Breath Stacking no pós-operatório de cirurgia cardíaca: ensaio randomizado cruzado |
title_full_unstemmed |
Efeito agudo da pressão positiva expiratória versus técnica de Breath Stacking no pós-operatório de cirurgia cardíaca: ensaio randomizado cruzado |
title_sort |
Efeito agudo da pressão positiva expiratória versus técnica de Breath Stacking no pós-operatório de cirurgia cardíaca: ensaio randomizado cruzado |
author |
Nichele, Lidiane de Fátima Ilha |
author_facet |
Nichele, Lidiane de Fátima Ilha |
author_role |
author |
dc.contributor.none.fl_str_mv |
Silva, Antônio Marcos Vargas da http://lattes.cnpq.br/9981854873337898 Silva, Andréa Lúcia Gonçalves da Signori, Luis Ulisses |
dc.contributor.author.fl_str_mv |
Nichele, Lidiane de Fátima Ilha |
dc.subject.por.fl_str_mv |
Cirurgia cardíaca Cuidados pós-operatórios Técnicas de fisioterapia Terapia respiratória Cardiac surgery Postoperative care Physical therapy modalities Respiratory therapy CNPQ::CIENCIAS DA SAUDE |
topic |
Cirurgia cardíaca Cuidados pós-operatórios Técnicas de fisioterapia Terapia respiratória Cardiac surgery Postoperative care Physical therapy modalities Respiratory therapy CNPQ::CIENCIAS DA SAUDE |
description |
Patients submitted to cardiac surgery may develop postoperative pulmonary complications. Physical therapy uses techniques and equipment that reduce these complications. The Breath Stacking (BS) technique and Expiratory Positive Airway Pressure (EPAP) are used to achieve greater lung expansion and to improve clinical and functional outcomes in the postoperative period of cardiothoracic surgery. The aim of this study was to compare the acute effects of EPAP and BS on cardiopulmonary and physiological variables of postoperative eletive cardiac surgery patients during hospitalization and to analyze interventions safety aspects. This randomized crossover clinical trial was conducted at the Intensive Cardiology Unit, Medical Clinic I and Medical Clinic II of the University Hospital of Santa Maria, with a sample of 24 individuals undergoing cardiac surgery. Patients received EPAP with 10 cmH20 for 5 minutes and BS in 3 series of 5 applications, with sustained inspiration for 20 seconds, both using a siliconized face mask, in randomized order, with a 24-hour interval between each intervention. Preoperative screening and analysis of medical records were carried and spirometry, ventilometry, thoracoabdominal mobility, maximal respiratory pressures, vital signs and peripheral oxygen saturation were evaluated. In the postoperative period (before and after the interventions) all the above evaluations were performed again. Before, after and 10 min after the interventions, the following patient safety variables were recorded: degree of dyspnea, painful perception in the surgical incision, signs of respiratory distress, hemodynamic and respiratory responses. The evaluator was blinded as to the type of intervention. The study showed that EPAP increased FVC (P <0.003), FEV1 (P <0.024), and axillary (P = 0.030) and xiphoid (P = 0.002) amplitude coefficients. BS improved the abdominal amplitude coefficient (P <0.003). Both techniques increase RR similarly (EPAP: 3.0 bpm, 95% CI 0.98 to 5.01; BS: 2.2 bpm, 95% CI 0.19 to 4.21), which decreased after 10 min (EPAP: -1.8 bpm, 95% CI -3.30 to -0.33; BS: -2.3 bpm, 95% CI -3.83 to -0.83). EPAP reduced MAP (-4.1 mmHg, 95% CI -8.03 to -0.21), which remained lower after 10 min (-5.0 mmHg, 95% CI -8.95 to -1.13). In the other variables there were no changes in response to interventions. It concludes that a single application of EPAP improved FVC, FEV1 and axillary and xiphoid expansibility, which suggests broader effects compared to BS. The techniques proved to be safe in the respiratory and hemodynamic aspects, making these findings as auxiliaries in the physiotherapeutic decision making after cardiac surgery. |
publishDate |
2019 |
dc.date.none.fl_str_mv |
2019-08-29 2021-07-24T22:36:32Z 2021-07-24T22:36:32Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/masterThesis |
format |
masterThesis |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://repositorio.ufsm.br/handle/1/21600 |
dc.identifier.dark.fl_str_mv |
ark:/26339/001300000nt97 |
url |
http://repositorio.ufsm.br/handle/1/21600 |
identifier_str_mv |
ark:/26339/001300000nt97 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.rights.driver.fl_str_mv |
Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/ info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/ |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Universidade Federal de Santa Maria Brasil Ciências da Saúde UFSM Programa de Pós-Graduação em Ciências da Saúde Centro de Ciências da Saúde |
publisher.none.fl_str_mv |
Universidade Federal de Santa Maria Brasil Ciências da Saúde UFSM Programa de Pós-Graduação em Ciências da Saúde Centro de Ciências da Saúde |
dc.source.none.fl_str_mv |
reponame:Manancial - Repositório Digital da UFSM instname:Universidade Federal de Santa Maria (UFSM) instacron:UFSM |
instname_str |
Universidade Federal de Santa Maria (UFSM) |
instacron_str |
UFSM |
institution |
UFSM |
reponame_str |
Manancial - Repositório Digital da UFSM |
collection |
Manancial - Repositório Digital da UFSM |
repository.name.fl_str_mv |
Manancial - Repositório Digital da UFSM - Universidade Federal de Santa Maria (UFSM) |
repository.mail.fl_str_mv |
atendimento.sib@ufsm.br||tedebc@gmail.com |
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1821325996697059328 |