Two types of inspiratory muscle training on muscle strength in patients submitted to coronary artery bypass grafting: clinical trial
DOI:
https://doi.org/10.33233/fb.v22i3.4796Keywords:
physical therapy, myocardial revascularization, muscle strengthAbstract
Introduction: Coronary artery bypass grafting (CABG) causes changes in the respiratory musculature that affects functional capacity and postoperative complications (POC). Inspiratory muscle training (IMT) is a tool used for these patients, but it is not known what the best form is to increase strength. Objective: To investigate whether IMT with a linear pressure load device is superior to the inspiratory incentive on functional capacity and muscle strength of patients undergoing CABG. Methods: This is a clinical trial. Patients were assessed preoperatively for inspiratory muscle pressure (MIP), expiratory pressure (MEP), peak expiratory flow (PEF), six-minute walk test (6MWT) and functional independence measure (FIM). After surgery, they were divided into three groups: control group (CG), training group with linear pressure load (IMT) and inspiratory incentive group (IG). On the day of discharge, all patients had their previous variables reassessed. Results: The study included 56 patients, 31 (55.4%) were male and an average age of 55 ± 12 years. There was a significant reduction in all variables, in relation to MIP, the IMT showed a higher value in the postoperative period 83 ± 19 cmH2O, against 70 ± 15 cmH2O in the CG and 80 ± 15 cmH2O in the IG (p < 0.001). The same behavior was observed in MEP, 77 ± 12 cm H2O in IMT, 67 ± 14 cmH2O in CG and 75 ± 10 cmH2O in IG (p < 0.001). Regarding the 6 MWT, there was a lesser loss in the IMT from 434 ± 15 m to 398 ± 20 m in IG (p < 0.001). Conclusion: It is concluded that muscle training with a linear pressure load device is superior to training with incentive on functional capacity and muscle strength in patients undergoing CABG.
References
Chen X, Hou L, Zhang Y, Liu X, Shao B, Yuan B, et al. The effects of five days of intensive preoperative inspiratory muscle training on postoperative complications and outcome in patients having cardiac surgery: a randomized controlled trial. Clin Rehabil 2019;00(0):1-10. doi: 10.1177/0269215519828212
Santos TD, Pereira SN, Portela LOC, Cardoso DM, Lago PD, Guarda NS. Moderate-to-high intensity inspiratory muscle training improves the effects of combined training on exercise capacity in patients after coronary artery bypass graft surgery: A randomized clinical trial. Int J Cardiol 2019;279:40-6. doi: 10.1016/j.ijcard.2018.12.013
Apostolakis E, Filos KS, Koletsis E, Dougenis D. Lung dysfunction following cardiopulmonary bypass. J Card Surg 2010;25(1):47-55. doi: 10.1111/j.1540-8191.2009.00823.x
Cordeiro ALL, Silva LGR, Pinto MO, Araújo JS, Guimarães AR, et al. Behavior of pulmonary function after hospital discharge in patients submitted to myocardial revascularization. Int J Cardiovasc Sci 2019;32(2)104-9. doi: 10.5935/2359-4802.20180092
Oh HC, Han JW, Choj JW, Kim YH, Hwang HY, Kim KB. Concomitant off-pump coronary artery bypass and non-cardiovascular surgery. J Thorac Dis 2016;20(8):2115-20. doi: 10.21037/jtd.2016.07.80
Mathis MR, Duggal NM, Likosky DS, Haft JW, Douville NJ, Vaughn MT, et al. Intraoperative mechanical ventilation and postoperative pulmonary complications following cardiac surgery. Anesthesiology 2019;131(5):1046–62. 10.1097/ALN.0000000000002909
Zochios V, Klein AA, Gao F. Protective invasive ventilation in cardiac surgery: a systematic review with a focus on acute lung injury in adult cardiac surgical patients. J Cardiothorac Vasc Anesth 2018;32(4):1922-36. doi: 10.1053/j.jvca.2017.10.031
Pessoa IMBS, Neto MH, Montemezzo D, Silva LAM, Andrade AD, Parreira VF. Predictive equations for respiratory muscle strength according to international and Brazilian guidelines. Braz J Phys Ther 2014;18(5):410-11. doi: 10.1590/bjpt-rbf.2014.0044
Leiner GC, Abramowits S, Small MJ, Stenby VB, Lewis WA. Expiratory peak flow rate. Standard values for normal subjects. Use as a clinical test of ventilatory function. Am Rev Respir Dis 1963;88:644-51. doi: 10.1164/arrd.1963.88.5.644
American Thoracic Society (ATS). Committee on proficiency standards for clinical pulmonary function laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2004;166(1):111-7. doi: 10.1164/ajrccm.166.1.at1102
Riberto M, Miyazaki MH, Jucá SSH, Sakamoto H, Pinto PPN. Validation of the Brazilian version of functional independence measure. Acta Fisiatr 2004;11(2):72-6.
Cordeiro ALL, Melo TA, Neves D, Luna J, Esquivel MS, Guimarães ARF, et al. Inspiratory muscle training and functional capacity in patients undergoing cardiac surgery. Braz J Cardiovasc Surg 2016;31(2):140-4. doi: 10.5935/1678-9741.20160035
Paiva DN, Assmannb LB, Bordinb DF, Gassb R, Jostc RT, Bernardo-Filho M, et al. Inspiratory muscle training with threshold or incentive spirometry: Which is the most effective? Rev Port Pneumol 2015;21(2):76-81. doi: 10.1016/j.rppnen.2014.05.005
Sarmento GJV. Fisioterapia respiratória de A a Z. Barueri: Manole; 2016.
Barbas CS, Ísola AM, Farias AM, Cavalcanti AB, Gama AM, Duarte AC, et al. Brazilian recommendations of mechanical ventilation 2013. Part I. Rev Bras Ter Intensiva 2014;26(2):89-121. doi: 10.5935/0103-507X.20140017
Stephens RS, Whitman GJR. Postoperative critical care of the adult cardiac surgical patient: part II: procedure-specific considerations, management of complications, and quality improvement. Crit Care Med 2015:43(9);1-20. doi: 10.1097/CCM.0000000000001171
Stephens RS, Whitman GJR. Postoperative critical care of the adult cardiac surgical patient: part i: routine postoperative care. Crit Care Med 2015:43(7):1-21. doi: 10.1097/CCM.0000000000001059
Mashaqi B, Iamail I, Siemeni TT, Ruemke S, Fleissner F, Zhang R, et al. Local anesthetics delivered through pleural drainages improve pain and lung function after cardiac surgery. Thorac Cardiovasc Surg 66(2):198-202. doi: 10.1055/s-0035-1558994
Katsura M, Kuriyama A, Takeshima T, Fukuhara S, Furukawa TA. Preoperative inspiratory muscle training for postoperative pulmonary complications in adults undergoing cardiac and major abdominal surgery (Review). Cochrane Database of Systematic Reviews 2015:1-87. doi: 10.1002/14651858.CD010356.pub2
Naseer BA, Al-Shengiti AM, Rahman AHAli, Aljeraisi T. Effect of cardiac surgery on respiratory muscle strength. J Taibah Univ Med Sci 2019:14(4);337-42. doi: 10.1016/j.jtumed.2019.06.002
Mans CM, Reeve JC, Elkins MR. Postoperative outcomes following preoperative inspiratory muscle training in patients undergoing cardiothoracic or upper abdominal surgery: a systematic review and meta analysis. Clin Rehabil 2014;1-13. doi: 10.1177/0269215514545350
Canet J, Gallart L, Gomar C, Paluzie G, Vallès J, Castillo J, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology 2010;113:1338-50. doi: 10.1097/ALN.0b013e3181fc6e0a
Guizilinia S, Alvesa DF, Bolzana DW, Cancia ASA, Regengaa MM, Moreira RSL, et al. Sub-xyphoid pleural drain as a determinant of functional capacity and clinical results after off-pump coronary artery bypass surgery: a randomized clinical trial. Interac Cardiovasc Thorac Surg 2014;382-7. doi: 10.1093/icvts/ivu138
Bissett B, Leditschke IA, Green M, Marzano V, Collins S, Haren FV. Inspiratory muscle training for intensive care patients: A multidisciplinary practical guide for clinicians. Aust Crit Care 2019:249-255. doi: 10.1016/j.aucc.2018.06.001
Walterspachera S, Pietschc F, Walkera DJ, Rockerd K, Kabitza Hans-Joachim. Activation of respiratory muscles during respiratory muscle training. Resp Phys Neurobiol 2018:126-32. doi: 10.1016/j.resp.2017.10.004
Elkins M, Dentice R. Inspiratory muscle training facilitates weaning from mechanical ventilation among patients in the intensive care unit: A systematic review. J Physiother 2015;61(3):125-34. doi: 10.1016/j.jphys.2015.05.016
Silva PE, Almeida KMG, Dias VS, Andrade FMD, Almeida MLO. Does inspiratory muscle training with the flow-oriented incentive spirometer Respiron® on late postoperative cardiac surgery improve functional outcomes? A double-blind, randomized, sham-controlled study. Assobrafir Ciência 2015;6(2):43-54.
Santos TD, Pereira SN, Portela LOC, Cardoso DM, Lago PD, Guarda NS, et al. Moderate-to-high intensity inspiratory muscle training improves the effects of combined training on exercise capacity in patients after coronary artery bypass graft surgery: A randomized clinical trial. Int J Cardiol 2019;(279):40-6. doi: 10.1016/j.ijcard.2018.12.013
Ge X, Wang W, Hou L, Yang K, Fa X. Inspiratory muscle training is associated with decreased postoperative pulmonary complications: Evidence from randomized trials. The Journal of Thoracic and Cardiovascular Surgery 2018;(156)5:1-48. doi: 10.1016/j.jtcvs.2018.02.105
Gomes Neto M, Martinez BP, Reis HFC, Carvalho VO. Pre- and postoperative inspiratory muscle training in patients undergoing cardiac surgery: Systematic review and meta-analysis. Clin Rehabil 2016;1(1):1-11. doi: 10.1177/0269215516648754
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