The Effectiveness of Respiratory Physiotherapy in Mitral Valve Surgery

Overview

This trial was conducted to evaluate the effectiveness of the chest physiotherapy techniques to prevent pulmonary collapse based in an score applied in the patients submitted of the mitral valve surgery, after their ICU discharge. Patients were allocated in groups according their pulmonary function (FVC: forced vital capacity), the respiratory muscle performance (MIP: maximal inspiratory pressure; MEP: maximal expiratory pressure), the oxygenation level (SpO2), the pulmonary auscultation; respiratory frequency (f); the ability to expectorate and the functional independence. The group I was allocated those patients which presented decrease of up to 50% of forced vital capacity (FVC) of preoperative period, SpO2>92%, minimal pulmonary auscultation alterations; frequency (f) between 15 and 25 ipm; able to expectorate without assistance; independence to sit; respiratory. In these patients were randomized for two interventions: a) Deep breathing exercises: diaphragmatic exercises; inspiratory sighs; maximal inspiration exercises. Each kind of exercises was repeated 10 times; b) volume-targeted incentive spirometer: used Coach® three sets of 10 repetitions. Patients allocated in the group II presented FVC> 30% <49% of preoperative period, ≥ 88% SpO2 <92%, necessity of oxygen therapy, abnormal pulmonary auscultation, f> 25 <31ipm; dependence to expectorate and to sit.. They were assisted by: a) Intermittent Positive Pressure Breathing (IPPB) with PEEP – through ventilator (Bird Mark 7™) with exhalation valve spring load set at 10 cmH2O. b) CPAP – 10 cmH2O associated with oxygen support to obtain SpO2≥ 95% with electronic device (Sullivan®) Each session consisted of 20 minutes, twice daily, one in the morning and another in the afternoon. All of the patients were conducted in effort to mobilize upper and lower limbs. On the first day, the patients walked at least 50 meters, by increasing the distance to at least 150 meters on the fourth day. Outcome measures were recorded at day 5 of the interventions.

Full Title of Study: “To Analyze the Effectiveness of Respiratory Physiotherapy Techniques in the Post Operative Mitral Valve”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Treatment
    • Masking: Single (Participant)
  • Study Primary Completion Date: January 2014

Detailed Description

The study were conducted with individuals of both gender, aged between 18 and 60 years, candidates for mitral valve surgery, up to a maximum 2nd valve replacement. Patients unable to perform the functional tests were excluded and patients with signs of neurological disorders; hemodynamic instability, respiratory disorders and mechanically ventilated for more than 48 hours .

Interventions

  • Other: breathing exercises
    • 3 sets of 10 repetitions of deep breathing exercises
  • Device: incentive spirometry
    • 3 sets of 10 repetitions of deep breathing exercises with incentive spirometry
  • Device: Intermittent positive pressure breathing
    • 20 minutes breathing with intermittent positive pressure
  • Device: Continuous positive airway pressure
    • 20 minutes breathing with continuous positive airway pressure

Arms, Groups and Cohorts

  • Other: level1
    • Patients classified in level 1 were randomized in the breathing exercises group or incentive spirometry group
  • Other: level2
    • Patients classified in level 2 were randomized in the Intermittent Positive Pressure Breathing group or Continuous Positive Airway Pressure group

Clinical Trial Outcome Measures

Primary Measures

  • incidence of atelectasis
    • Time Frame: Patients were followed for five days

Secondary Measures

  • pulmonary function
    • Time Frame: Patients were followed for five days
    • Forced vital capacity in liters and percentual (FVC; %FVC )
  • pulmonary function
    • Time Frame: Patients were followed for five days
    • Forced expiratory volume in first second in liters and percentual (FEV1; V1)
  • pulmonary function
    • Time Frame: Patients were followed for five days
    • Ratio of forced expiratory volume in first second and forced vital capacity (FEV1/FVC)

Participating in This Clinical Trial

Inclusion Criteria

  • Patients for mitral valve surgery, up to a maximum 2nd valve replacement Exclusion Criteria:

  • Patients unable to perform the functional tests – Patients with signs of neurological disorders; hemodynamic instability, respiratory disorders and mechanically ventilated for more than 48 hours

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: 60 Years

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • University of Sao Paulo General Hospital
  • Provider of Information About this Clinical Study
    • Principal Investigator: Maria Ignez Zanetti Feltrim, Drª Maria Ignez Zanetti Feltrim – University of Sao Paulo General Hospital

References

Matte P, Jacquet L, Van Dyck M, Goenen M. Effects of conventional physiotherapy, continuous positive airway pressure and non-invasive ventilatory support with bilevel positive airway pressure after coronary artery bypass grafting. Acta Anaesthesiol Scand. 2000 Jan;44(1):75-81. doi: 10.1034/j.1399-6576.2000.440114.x.

Citations Reporting on Results

Pasquina P, Tramer MR, Walder B. Prophylactic respiratory physiotherapy after cardiac surgery: systematic review. BMJ. 2003 Dec 13;327(7428):1379. doi: 10.1136/bmj.327.7428.1379.

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