Postoperatory Recovery in Thoracic Surgical Procedure, Fast-track Protocol vs. Conventional Care

Instituto do Coracao40 enrolled

Overview

The aim of this study was to compare the functional capacity of exercise by six-minute walk test before and after thoracic surgical procedure in subjects who have undergone the Fast-track protocol with those who were under conventional care. Researchers want to find out if Fast-track is a strategy to enhance functional capacity after thoracic surgery.

Fast track programs represents a new approach to the management of patients undergoing surgery. It is perioperative care pathway designed to achieve early recovery and helps to minimize postoperative morbidity and mortality. These multimodal approaches focuses on enhancing recovery and reducing of surgical stress by minimal invasive surgery, optimized pain relief, early nutrition and ambulation. In postoperative, the bed rest leads to the increase in muscle loss and weakness, impairs pulmonary function, predisposes to venous stasis and thromboembolism, increases infection complications and reduces functional capacity. However, information on the results of Fast-track protocols in functional capacity of exercise during hospital stay is sparse. The six-minute walk test is use to measure of functional capacity of exercise in different populations and to detect changes after interventions. The distances traveled in two six-minute walk test (preoperative and postoperative) will be compared between the two groups (Fast-track and Conventional). In this trial the investigators will consider Fast-track protocol to be feasible to enhance functional capacity of exercise after thoracic surgery.

Study Type

INTERVENTIONAL

Allocation

NON_RANDOMIZED

Masking

NONE

Enrollment

Conditions

Thoracic Surgery

Interventions

Fast-track protocolOTHER

Preoperatory management, epidural anesthetic management, avoiding the need opioid in postoperatory analgesia and use of an standardized postoperatory management protocol to an early oral intake and early mobilization. At the postoperative recovery room, after extubation and fully awake, patients started physiotherapy exercises, as physical exercises of moving up upper and lower extremities accompanied by deep breathing exercises. After than, the patients standed up beside the bed and if there was no complications, patients performed ambulation. The physiotherapist aided the patients during all period.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 80 Years

Medical Language ↔ Plain English

Inclusion Criteria: * patients who are scheduled to undergo a thoracic surgical procedure * sign the informed consent form * independent ambulation * ability to understand and follow instructions Exclusion Criteria: * contraindications for epidural catheter placement * refusal to do physical exercises on postoperative

Outcomes

Primary Outcomes

Functional capacity of exercise ( six-minute walk test)

Change from baseline in distance walking on hospital discharge

Time frame: participants will be followed for the duration of hospital stay, an expected average of 6 days

Secondary Outcomes

Time to first postoperative ambulation

Time from end of surgical procedure until first postoperative ambulation

Time frame: up 2 hour after surgery

The length of hospital stay

Time to achieve standardized hospital discharge criteria (tolerance of oral intake, recovery of lower gastrointestinal function, adequate pain control on oral analgesia, ability to mobilize and self care and no evidence of complications or untreated medical problems).

Time frame: expected average of 6 days

Surgical complications

Pneumonia, atelectasis, pneumothorax and air leak in the chest drainage

Time frame: up 6 days after surgery

Data from ClinicalTrials.gov

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