Shehab Mahmoud ABD EL-KADER

5271

Blood gases response to different breathing modalities in phase I of cardiac rehabilitation program after coronary artery bypass graft

Amaç: Postoperatif solunumsal komplikasyonların önemli bir nedeni pulmoner atelaktezidir. Atelektazi ve fonkisyonel alveolar birimin eşlik eden kaybı koroner arter bypass grefti (KABG) sonrası postoperatif hipoksemiden sorumlu önemli bir patofizyolojik mekanizma olarak kabul edilmiştir. Bu çalışmanın amacı postoperatif pulmoner fizyoterapiye ek olarak CPAP, IS ve IPPB terapötik solunum yöntemlerinden hangisinden KABG sonrası kardiyak rehabilitasyon programının faz I’indeki kan gazında en iyi düzelmeyi sağladığını tespit etmekti. Metod: Her iki cinsiyetten KABG cerrahisi yapılan 36 hasta üç gruba bölündü. Grup (A)’ya CABG sonrası hastalar için göğüs fizyoterapi programına ek olarak IS ile solunum egzersizi (günde 5 kez 5 dakika) uygulandı. Grup (B)’ye CABG sonrası hastalar için göğüs fizyoterapi programına ek olarak CPAP ile solunum egzersizi (günde 1 kez 10 cm H2O, 15 dakika), ve Grup (C)’ye CABG sonrası hastalar için göğüs fizyoterapi programına ek olarak IPPB ile solunum egzersizi (günde 1 kez maksimum 15 cm H2O, 15 dakika) uygulandı. Kan gazı ölçümleri ilk post op günde çalışma öncesi yapıldı ve çalışma sonunda 10. Post op günde tekrarlandı. Bulgular: Kan gazları bütün gruplarda IS ve CPAP, ve IS ve IPPB grupları arasında anlamlı olmak üzere düzeldi. Ancak CPAP ve IPPB grupları arasında belirgin fark saptanmadı. Sonuç: KABG sonrası kardiyak rehabilitasyon programının faz I’indeki hastalar için genel solunumsal fizik tedaviye ek olarak insentif spirometre de önerilir.

Koroner arter bypass grafti sonrası kardiyak rehabilitasyon programının faz I’inde değişik solunum yöntemlerine kan gazı cevabı

Aim: One major cause of postoperative respiratory complications is pulmonary atelectasis. Atelectasis and the associated loss of functional alveolar units has been recognized as a major pathophysiological mechanism responsible for postoperative hypoxemia after coronary artery bypass graft (CABG). The aim of this study was to determine which therapeutic breathing method from incentive spirometry (IS), non-invasive intermittent positive pressure breathing (IPPB) and continuous positive airway pressure breathing (CPAP) in addition to postoperative pulmonary physiotherapy obtain the best improvement in blood gases in phase I of cardiac rehabilitation program after CABG. Method: Thirty six patients of both sexes who underwent CABG divided into three groups. Group (A) received breathing training with IS (5 minutes 5 times per day) in addition the chest physiotherapy program for patients after CABG and Group (B) received breathing training with CPAP (10 cmH2O for 15 minutes once daily) in addition to the chest physiotherapy program for patients after CABG., where Group(C) received breathing training with IPPB (maximum 15 cmH2O for 15 minutes once daily) in addition to the chest physiotherapy program for patients after CABG. Measurements of blood gases were done before the study in the first post operative day and repeated at the end of the study in the tenth postoperative day. Result: Blood gases were improved in all groups in addition to a significant difference between IS & CPAP and IS & IPPB groups. Where there was no significant difference between CPAP & IPPB groups. Conclusion: Incentive spirometry in addition to the usual respiratory physical therapy is recommended for patients in phase I of cardiac rehabilitation program after CABG.
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  • 1. Haeffener M, Ferreira G, Barreto S, Ross A, Dall'Ago P. 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. Am Heart J 2008;156:900-8.
  • 2. Harkness K, Smith K, Taraba L, MacKenzie C, Gunn E, Arthur H. Effect of a postoperative telephone intervention on attendance at intake for cardiac rehabilitation after coronary artery bypass graft surgery.Heart & Lung: J Acute Crit Care 2005;34:179-86.
  • 3. Agostini P, Singh S. Incentive spirometry following thoracic surgery: what should we be doing? Physiotherapy 2009;95:76-82.
  • 4. Gosselink R, Katleen S, Philippe C, et al. Incentive spirometry does not enhance recovery after thoracic surgery. Crit Care Med 2000;28:679-83.
  • 5. Weindler J, Kiefer R. The efficacy of postoperative incentive spirometry is influenced by the device specific imposed work of breathing. Chest 2001;119:1858-64.
  • 6. Cordova F. Using non-invasive intermittent positive pressure breathing to manage respiratory failure. J Respir Dis 2000;21:366-9.
  • 7. Moore M. Keys to effective non-invasive ventilation. Crit Illness 2001;16:118-24.
  • 8. Zarbock A, Mueller E, Netzer S, Gabriel A, Feint P, Kindgen-Milles D. Prophylactic Nasal Continuous Positive Airway Pressure Following Cardiac Surgery Protects From Postoperative Pulmonary Complications.A Prospective, Randomized, Controlled Trial in 500 Patients. Chest 2009; 135:1252-9.
  • 9. Pasquina P, Tramer M, Walder B. Prophylactic respiratory physiotherapy after cardiac surgery: systematic review. BMJ 2003;327:1379.
  • 10. Freitas E, Soares B, Cardoso J. Incentive spirometry for preventing pulmonary complications after coronary artery bypass graft. Cochrane Database Syst Rev 2007: CD004466.
  • 11. Muller A, Olandoski M, Macedo R, Costantini C, Guarita– Souza L. Comparative study between intermittent (Müller Reanimator) and continuous positive airway pressure in the postoperative period of coronary artery bypass grafting. Arq Bas Cardiol 2006;86:232-9.
  • 12. Yende S, Wunderink R. Causes of prolonged mechanical ventilation after coronary artery bypass surgery. Chest 2002;122:245-52.
  • 13. Robert W, Johon L. Clinical assessment in respiratory care, 4th ed, Philadelphia company 2000:71-80.
  • 14. Ayad E, Hamed H. Continuous positive air way pressures during cardio pulmonary bypass attenuate postoperative pulmonary Dysfunction and complication. Eg J Anaesth 2003;19:345-51.
  • 15. Antonelli M, Conti G, Rocco M, Acrangeli A, Cavaliere F, Meduri G. Non invasive positive pressure ventilation vs conventional oxygen supplementation in hypoxemic patients under going diagnostic bronchoscopy. Chest 2002; 121:1149-54.
  • 16. Overend T, Anderson C, Lucy D, Buatia C. The effect of incentive spirometry on postoperative pulmonary complications. Chest 2001;120:971-8.
  • 17. Agostini P, Singh S. Incentive spirometry following thoracic surgery: what should we be doing? Physiotherapy 2009;95:76-82.
  • 18. Schonhofer B, Wallstein S, Wiese C, Kohler D. Noninvasive mechanical ventilation improves endurance performance in patients with chronic respiratory failure due to thoracic restriction. Chest 2001;119:1371-8.
  • 19. Schuppisser J, Brändli O, Meili U. Postoperative intermittent positive pressure breathing versus physiotherapy. Am J Surg 1980;140:682-6.
  • 20. Oikkonen M, Karjalainen K, Kähärä V, Kuosa R, Schavikin L. Comparison of incentive spirometry and intermittent positive pressure breathing after coronary artery bypass graft. Chest 1991;99:60-5.
  • 21. Romanini W, Muller A, Carvalho K, et al. The effects of intermittent positive pressure and incentive spirometry in the postoperative of myocardial revascularization. Arg Bras Cardiol 2007;89:94-9.
  • 22. Masouyé P, Morel D, Neidhart P. Effect of continuous positive airway pressure applied by face mask on right ventricular function after cardiac surgery. J Cardiothorac Vasc Anesth 1993;7:551-4.
  • 23. Yan A, Bradley D, Liu P. The role of continuous positive airway pressure in the treatment of congestive heart failure. Chest 2001;120:1675-85.
  • 24. Thomas A, Ryan J, Doran B, Pollard B. Nasal CPAP after coronary artery surgery. Anaesthesia 1992;47:316-9.
  • 25. Altmay E, Karaca P, Yurtseven N, et al. Continuous positive airway pressure does not improve lung function after cardiac surgery. Can J Anaesth 2006;53:919-25.
  • 26. Figueiredo L, Araújo S, Abdala R, Abdala A, Guedes C. CPAP at 10 cm H2O during cardiopulmonary bypass does not improve postoperative gas exchange. Rev Bras Cir Cardiovasc 2008;23:209-15.
  • 27. Celli B, Katharine S, Rodrigue Z and Snider G. A controlled trial of intermittent positive pressure breathing, incentive spirometry, and deep breathing exercises in preventing pulmonary complications after abdominal surgeries. Am Rev Resp Dis 2000;130:12-5.
  • 28. Wattie J. Incentive Spirometry following Coronary Artery Bypass Surgery. Physiotherapy 1998;84:508-14.
European Journal of General Medicine-Cover
  • Yayın Aralığı: 4
  • Başlangıç: 2015
  • Yayıncı: Sağlık Bilimleri Araştırmaları Derneği
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Blood gases response to different breathing modalities in phase I of cardiac rehabilitation program after coronary artery bypass graft

Shehab Mahmoud ABD EL-KADER