Physiotherapy Technique Decreases Respiratory Complications After Cardiac Operation

Santa Casa de Votuporanga200 enrolled

Overview

The objective of this study is to assess whether there is a difference between a care protocol with the use of incentive spirometry (Voldyne ®) and another with the application of NIV (non invasive ventilation with single-level pressure) as a form of therapy. The main focus of the study is to determine the incidence of pulmonary complications in each technique.

Coronary artery bypass graft (CABG) can prolong and improve the quality of life of patients with ischemic coronary syndrome but with the advancement of medical intervention to eligible patients for this procedure are those with more comorbidities where conservation and palliative therapies have been tried without success. Patients undergoing CABG often develop pulmonary complications such as atelectasis, restrictive ventilatory defect, decreased lung compliance, increased shunt and changes in gas exchange leading to probable hypoxemia. In an attempt to reduce the harmful effects and pulmonary complications arising from surgical procedures is instituted extensive physiotherapy program that tracks and monitors such patients from the preoperative to the postoperative immediate transfer to the ward and hospital discharge. The objective of this study is to assess whether there is a difference between a care protocol with the use of incentive spirometry (Voldyne ®) and another with the application of NIV (non invasive ventilation with single-level pressure) as a form of therapy. The main focus of the study is to determine the incidence of pulmonary complications in each technique.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

NONE

Enrollment

200

Conditions

Pneumonia Pleural Effusion Atelectasis

Interventions

Continuous Positive Airway Pressure (CPAP) facial maskPROCEDURE

After extubation, starting non-invasive ventilation with face mask (1 hour) followed by assisted cough maneuver. Total of 18 calls in 72 hours distributed as long the patient was extubated.

Assisted deep inspiration techniquePROCEDURE

After extubation, starting early supplemental oxygen with Venturi (FiO2 50%) with gradual weaning, applying assisted deep inspiration technique with Voldyne(R) with four sets of 10 repetitions and assisted cough maneuver. Total of 18 calls in 72 hours distributed as long the patient was extubated.

Eligibility

Sex: ALLMin age: 16 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Patients with indication for elective coronary artery bypass surgery who agreed to participate and signed the informed consent. Exclusion Criteria: * patients with hemodynamic instability during the physiotherapy care * those who fail to complete all visits to the proposed protocol (whatever the reason) * extubation after 12 hours of ICU admission * major intraoperative hemorrhage * major bleeding in ICU requiring return to the operating room * cardiopulmonary arrest * contraindication to positive pressure (undrained pneumothorax, bronchopleural fistula, hemoptysis, vomiting) or intolerance to the method

Locations (1)

Santa Casa Votuporanga

Votuporanga, São Paulo, Brazil

Outcomes

Primary Outcomes

Pulmonary complications

Occurrence of pulmonary complications such as pneumonia, atelectasis or pleural effusion diagnosed with chest X-rays by ICU doctor.

Time frame: 72 hours

Secondary Outcomes

Exams

Assessment of (Sat O2) capillary saturation, (ABG) arterial blood gases.

Time frame: 72 hours

Data from ClinicalTrials.gov

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