ISSN 2415-3060 (print), ISSN 2522-4972 (online)
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УЖМБС 2020, 5(4): 17–25
Medicine. Reviews

The Role of Respiratory Physical Therapy in the Rehabilitation of Patients after Cardiac Surgery

Vitomskyi V. V., Al-Hawamdeh K. M.

. The purpose of the study was to analyze the results of the respiratory physical therapy effectiveness in reducing the frequency of pulmonary complications, restoring the function of external respiration and reducing the duration of staying at hospital after cardiac surgery. Material and methods. This work is the result of analysis and comparison of research results dedicated to studying changes in the frequency of postoperative pulmonary complications, the length of staying at hospital, and the characteristics of the respiratory system recovery under the influence of various respiratory physical therapy programs. Results and discussion. In a number of studies, a beneficial effect was recorded from the inclusion of respiratory modalities of physical therapy in pre- and postoperative programs, namely, on the indicators of the dynamics of the respiratory muscles strength, on the indicators of spirography, on a decrease in the incidence of pneumonia and a decrease in the time spent in hospital. On the other hand, there are studies that indicate the lack of influence of inspiratory muscle training on the duration of hospitalization; of stimulating spirometry to improve arterial blood gas parameters, the duration of hospitalization, as well as the prevalence of pulmonary complications. There are results that do not confirm the beneficial effect on the restoration of the respiratory system, the reduction of complications from the addition of exercises with positive expiratory pressure to the standard program. The beneficial effects of traditional deep breathing exercises are not supported by a number of authors. Comparisons of approaches to respiratory physical therapy quite often state the absence of difference between them. Considering the conflicting results of the named works, additional studies are necessary to assess the effectiveness of the respiratory modalities of physical therapy for cardiac surgery patients. Conclusion. Considering the presence of a wide range of approaches in respiratory physical therapy of cardiosurgical patients and the lack or insufficiency of evidence to recognize a particular one as the best, we can state that there is a need for further studies to address this general issue, as well as to rationalize local physical therapy protocols, since the routine use of breathing simulators or breathing exercises that do not affect clinically relevant criteria are unacceptable. Both physical therapists and their patients must be sure of the appropriateness of their work. The basis for this should be the results of scientific research, and not their own experience or beliefs.

Keywords: cardiac surgery, pulmonary rehabilitation, therapeutic exercises, respiratory system, sternotomy

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  1. Barbosa RAG, Carmona MJC. Avaliação da função pulmonar em pacientes submetidos à cirurgia cardíaca com circulação extracorpórea. Rev Bras Anestesiol. 2002; 52(6): 689-99. .
  2. Guizilini S, Gomes WJ, Faresin SM, Carvalho ACC, Jaramillo JI, Alves FA, et al. Efeitos do local de inserção do dreno pleural na função pulmonar no pós-operatório de cirurgia de revascularização do miocárdio. Rev Bras Cir Cardiovasc. 2004; 19(1): 47-54.
  3. Elias DG, Costa D, Oishi J. Efeitos do treinamento muscular inspiratório no pré e pós-operatório de cirurgia cardíaca. Rev Bras Ter Intens. 2000; 12(1): 9-18.
  4. Oikkonen M, Karjalainen K, Kahara V, Kuosa R, Schavikin L. Comparison of incentive spirometry and intermittent positive pressure breathing after coronary artery bypass graft. Chest. 1991; 99(1): 60-5.
  5. Taşkin H, Telli Atalay O, Yuncu G, Taşpinar B, Yalman A, et al. Postoperative respiratory muscle training in addition to chest physiotherapy after pulmonary resection: A randomized controlled study. Physiotherapy theory and practice. 2018; 36(3): 1-8.
  6. Denehy L, Granger CL, El-Ansary D, Parry SM. Advances in cardiorespiratory physiotherapy and their clinical impact. Expert review of respiratory medicine. 2018; 12(3): 203-15.
  7. Savci S, Degirmenci B, Saglam M, Arikan H, Inal-Ince D, Turan HN, et al. Short-term effects of inspiratory muscle training in coronary artery bypass graft surgery: a randomized controlled trial. Scand Cardiovasc J. 2011; 45(5): 286-93.
  8. Hulzebos EH, Helders PJ, Favie NJ, De Bie RA, de la Brutel Riviere A, Van Meeteren NL. Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery: a randomized clinical trial. JAMA. 2006; 296(15): 1851-7.
  9. Ferreira GM, Haeffner MP, Barreto SS, Dall'Ago P. Incentive spirometry with expiratory positive airway pressure brings benefits after myocardial revascularization. Arq Bras Cardiol. 2010; 94(2): 230-5, 246-51, 233-8.
  10. Taylor BJ, Romer LM: Effect of expiratory resistive loading on inspiratory and expiratory muscle fatigue. Respir Physiol Neurobiol. 2009; 166(3): 164-74.
  11. Yánez-Brage I, Pita-Fernández S, Juffé-Stein A, Martínez-González U, Pértega-Díaz S, Mauleón-García Á. Respiratory physiotherapy and incidence of pulmonary complications in off-pump coronary artery bypass graft surgery: an observational follow-up study. BMC pulmonary medicine. 2009; 9(1): 36.
  12. Barros GF, Santos Cda S, Granado FB, Costa PT, Limaco RP, Gardenghi G. Respiratory muscle training in patients submitted to coronary arterial bypass graft. Rev Bras Cir Cardiovasc. 2010; 25(4): 483-90.
  13. Savci S, Degirmenci B, Saglam M, Arikan H, Inal-Ince D, Turan HN, Demircin M. Short-term effects of inspiratory muscle training in coronary artery bypass graft surgery: a randomized controlled trial. Scandinavian cardiovascular journal. 2011; 45(5); 286-93.
  14. Cahalin LP, Arena R, Guazzi M, Myers J, Cipriano G, Chiappa G, et al. Inspiratory muscle training in heart disease and heart failure: a review of the literature with a focus on method of training and outcomes. Expert review of cardiovascular therapy. 2013; 11(2): 161-77.
  15. Ferreira PE, Rodrigues AJ, Evora PR. Effects of an inspiratory muscle rehabilitation program in the postoperative period of cardiac surgery. Arq Bras Cardiol. 2009; 92(4): 275-82.
  16. Kendall F, Oliveira J, Peleteiro B, Pinho P, Bastos PT. Inspiratory muscle training is effective to reduce postoperative pulmonary complications and length of hospital stay: a systematic review and meta-analysis. Disability and rehabilitation. 2018; 40(8): 864-82.
  17. Rajendran AJ, Pandurangi UM, Murali R, Gomathi S, Vijayan VK, Cherian KM. Pre-operative short-term pulmonary rehabilitation for patients of chronic obstructive pulmonary disease undergoing coronary artery bypass graft surgery. Indian heart journal. 1998; 50(5): 531-4.
  18. Moradian ST, Heydari AA, Mahmoudi H. What is the Role of Preoperative Breathing Exercises in Reducing Postoperative Atelectasis after CABG? Reviews on recent clinical trials. 2019; 14(4): 275-9.
  19. Bersten AD, Holt AW, Vedig AE, Skowronski GA, Baggoley CJ. Treatment of severe cardiogenic pulmonary edema with continuous positive airway pressure delivered by face mask. N Engl J Med. 1991; 325(26): 1825-30.
  20. Herdy AH, Marcchi PL, Vila A, Tavares C, Collaco J, Niebauer J. Pre- and postoperative cardiopulmonary rehabilitation in hospitalized patients undergoing coronary artery bypass surgery: a randomized controlled trial. Am J Phys Med Rehabil. 2008; 87(9): 714-9.
  21. Haeffener MP, Ferreira GM, Barreto SS, Arena R, 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(5): 900 e1-e8.
  22. Cattano D, Altamirano A, Vannucci A, Melnikov V, Cone C, Hagberg CA. Preoperative use of incentive spirometry does not affect postoperative lung function in bariatric surgery. Translational Research. 2010; 156(5): 265-72.
  23. Overend TJ, Anderson CM, Lucy SD, Bhatia C, Jonsson BI, Timmermans C. The effect of incentive spirometry on postoperative pulmonary complications: a systematic review. Chest. 2001; 120(3): 971-8.
  24. El Sayed HM, El-Refay BH, Essa LM. Comparative Study between Different Pulmonary Rehabilitation Programs in Patients Undergoing Coronary Artery Bypass Graft. Med J Cairo Univ. 2014; 82(2): 183-9.
  25. Borghi-Silva A, Mendes RG, Costa Fde S, Di Lorenzo VA, Oliveira CR, Luzzi S. The influences of positive end expiratory pressure (PEEP) associated with physiotherapy intervention in phase I cardiac rehabilitation. Clinics (Sao Paulo). 2005; 60(6): 465-72.
  26. Campbell T, Fergunson N, McKinlay RGC. The use of a simple self-administered method of positive expiratory pressure (PEP) in chest physiotherapy after abdominal surgery. Physiotherapy. 1986; 72: 198-200.
  27. Larsen RK, Ingwersen U, Thode S, Jakobsen S. Mask physiotherapy in patients after heart surgery: a controlled study. Intensive Care Med. 1995; 21(6): 469-74.
  28. Frolund L, Madsen F. Self-administered prophylactic postoperative positive expiratory pressure in thoracic surgery. Acta Anaesthesiol Scand. 1986; 30: 381-5.
  29. Stock MC, Downs JB, Cooper RB, Lebenson IM, Cleveland J, Weaver DE, et al. Comparison of continuous positive airway pressure, incentive spirometry, and conservative therapy after cardiac operations. Crit Care Med. 1984; 12(11): 969-72.
  30. Manapunsopee S, Thanakiatpinyo T, Wongkornrat W, Chuaychoo B, Thirapatarapong W. Effectiveness of Incentive Spirometry on Inspiratory Muscle Strength After Coronary Artery Bypass Graft Surgery. Heart, Lung and Circulation. 2019.
  31. Jenkins SC, Soutar SA, Loukota JM, Johnson LC, Moxham J. Physiotherapy after Coronary artery surgery: are breathing exercises necessary? Thorax. 1989; 44(8): 634-9.
  32. Jenkins SC, Soutar SA, Loukota JM, Johnson LC, Moxham J. A comparison of breathing exercises, incentive spirometry and mobilisation after coronary artery surgery. Physiother Theory Pract. 1990; 6: 117-26.
  33. Dull JL, Dull WL. Are maximal inspiratory breathing exercises or incentive spirometry better than early mobilisation after cardiopulmonary bypass? Phys Ther. 1983; 63: 655-9.
  34. Jenkins S, Akinkugbe Y, Corry G, Johnson L. Physiotherapy management following coronary artery surgery. Physiotherapy Theory and Practice. 1994; 10(1): 3-8.
  35. Vraciu JK, Vraciu RA. Effectiveness of breathing exercises in preventing pulmonary complications following open heart surgery. Phys Ther. 1977; 57: 1367-71.
  36. Crowe JM, Bradley CA. The effectiveness of incentive spirometry with physical therapy for high-risk patients after coronary artery bypass surgery. Phys Ther. 1997; 77: 260-8.
  37. Renault JA, Costa-Val R, Rosseti MB, Houri Neto M. Comparison between deep breathing exercises and incentive spirometry after CABG surgery. Rev Bras Cir Cardiovasc. 2009; 24: 165-72.
  38. Westerdahl E, Lindmark B, Almgren SO, Tenling A. Chest physiotherapy after coronary artery bypass graft surgery - a comparison of three different deep breathing techniques. J Rehabil Med. 2001; 33(2): 79-84.
  39. Westerdahl E, Lindmark B, Eriksson T, Hedenstierna G, Tenling A. Deep-breathing exercises reduce atelectasis and improve pulmonary function after coronary artery bypass surgery. Chest. 2005; 128(5): 3482-8.
  40. Ingwersen UM, Larsen KR, Bertelsen MT, Kiil-Nielsen K, Laub M, Sandermann J, et al. Three different mask physiotherapy regimens for prevention of post-operative pulmonary complications after heart and pulmonary surgery. Intensive Care Med. 1993; 19: 294-8.
  41. Iverson LIG, Ecker RR, Fox HE, May IA. A comparative study of IPPB, the incentive spirometer, and blow bottles: the prevention of atelectasis following cardiac surgery. Ann Thorac Surg. 1978; 25: 197-200.
  42. Westerdahl E, Lindmark B, Eriksson T, Hedenstierna G., Tenling A. The immediate effects of deep breathing exercises on atelectasis and oxygenation after cardiac surgery. Scandinavian Cardiovascular Journal. 2003; 37(6): 363-7.
  43. Carlsson M, Berthelsen O, Fagevik Olsén M. Effects of a prolonged intervention of breathing exercises after cardiac surgery-a randomised controlled trial. European Journal of Physiotherapy. 2019; 21(4): 233-9.
  44. Lunardi AC, Paisani DM, da Silva CCM, Cano DP, Tanaka C, Carvalho CR. Comparison of lung expansion techniques on thoracoabdominal mechanics and incidence of pulmonary complications after upper abdominal surgery: a randomized and controlled trial. Chest. 2015; 148(4): 1003-10.
  45. Stiller K, Montarello J, Wallace M, Dajf M, Grant R, Jenkins S, et al. Efficacy of breathing and coughing exercises in the prevention of pulmonary complications after coronary artery surgery. Chest. 1994; 105(3): 741-7.
  46. Brasher PA, McClelland KH, Denehy L, Story I. Does removal of deep breathing exercises from a physiotherapy program including pre-operative education and early mobilisation after cardiac surgery alter patient outcomes? Australian journal of physiotherapy. 2003; 49(3): 165-73.
  47. Pasquina P, Walder B. Prophylactic respiratory physiotherapy after cardiac surgery: systematic review. BMJ. 2003; 327(7428): 1379.
  48. Renault J, Costa-Val R, Rossetti M. Respiratory physiotherapy in the pulmonary dysfunction after cardiac surgery. Brazilian Journal of Cardiovascular Surgery. 2008; 23(4): 562-9.
  49. Shakouri SK, Salekzamani Y, Taghizadieh A, Sabbagh-Jadid H, Soleymani J, Sahebi L, et al. Effect of respiratory rehabilitation before open cardiac surgery on respiratory function: a randomized clinical trial. Journal of cardiovascular and thoracic research. 2015; 7(1): 13-7.
  50. Shakuri SK, Salekzamani Y, Taghizadieh A, Jadid HS. Effects of Rehabilitation on Pulmonary Function in Patients Undergoing Coronary Artery Bypass Graft: A Clinical Trial Study. Journal of cardiovascular and thoracic research. 2015; 7(1): 13.
  51. Westerdahl E, Olsén MF. Chest physiotherapy and breathing exercises for cardiac surgery patients in Sweden-a national survey of practice. Monaldi Archives for Chest Disease. 2011; 75(2): 112-9.