Introduction:Cardiac anxiety(CA) is a common finding in patients in the pre- and postoperative period of coronary artery bypass graft(CABG) surgery. Ventilatory restriction generated by pain and reduced muscle strength is associated with increased CA level. Inspiratory muscle training(IMT) for generating increased muscle strength can cause a decrease in CA in the postoperative period. Objective:To evaluate the impact of IMT on inspiratory muscle strength and its relationship with cardiac anxiety in patients undergoing CABG. Methodology:This is a randomized controlled clinical trial. In the preoperative moment, all patients answered a cardiac anxiety questionnaire, composed of two domains: fear and vigilance and avoidance. In addition, their maximum inspiratory pressure(MIP) was assessed. After the surgical procedure, the patients were divided into a control group(CG) that received routine hospital care and a training group(TG) who underwent an IMT protocol until the moment of hospital discharge. Results:80 patients were evaluated,40 in each group. The IMT group showed a 17% decrease in MIP while the CG decreased 43%(p <0.01). The fear and vigilance domain had a decrease of -16±3 in the CG while in the TG the reduction was -8±3(p <0.01). The avoidance domain reduced -17±4 in the CG vs -10±4 in the TG(p <0.01). In addition, there was a strong correlation between the MIP of the TG with the domains of fear/vigilance(r -0.77) and avoidance(r -0.72). Conclusion:IMT is associated with a reduction in the loss of inspiratory muscle strength, resulting in a reduced level of cardiac anxiety in patients undergoing CABG.
Introduction: The application of non-invasive ventilation(NIV) after coronary artery bypass grafting(CABG) brings the possibility of reducing loss of functional capacity and complications in the patient. However, the evidence is controversial about immediate or conventional use. Objective: Assess the impact of immediate NIV after extubation on oxygenation and functional capacity of patients undergoing to CABG. Methods: Randomized clinical trial. Patients were assessed before and after surgery using the Functional Independence Measure(FIM), six-minute walk test(6MWT) and peripheral muscle strength(MRC). On the first day after the surgery, two groups formed immediate NIV(NIVI) and conventional NIV(NIVC). Hemogasometry was collected before and after NIV. Complication rates were also assessed. NIVI performed ventilation after one hour of orotracheal extubation, at NIVC performed NIV on the first postoperative day, 24 hours after extubation. After discharge, the above variables were reevaluated. Results: 79 patients were evaluated, 46(58.22%) men, mean age 65±9 years. NIVI reduced the reintubation rate, only 1 (3%) compared to NIVC with 5 (12%) patients, p=0.01. In the post-Intervention the inspired oxygen fraction (FiO2) was 0.43±0.07 in the conventional group and 0.30±0.10 in the intervention group, p=0.01. The post-intervention PaO2/FiO2 ratio was 191±45 and NIVI 266±29(p <0.001) and one day later in the NIVC it was 210±39 and NIVI 279±37(p <0.001). VNII lost 51±36 meters in the 6MWT compared to the NIVC that lost 95±40 meters(p <0.01). Conclusion: NIVI after extubation of patients undergoing to CABG, reduced the loss of functional capacity, improved blood gases and decreased the rate of reintubation.
Introduction: Gait speed can be applied, predicting outcomes associated with hospital stay such as length of stay and/or discharge. Despite these studies that correlate gait speed with the aforementioned outcomes, when we deal with cardiac surgery there is a gap. Objective: Verify whether gait speed is associated with the risk of hospital readmission in the postoperative period of coronary artery bypass grafting. Methodology: This is a prospective cohort study. In the preoperative period, all patients underwent a 10-meter gait speed test and repeated at hospital discharge. After the repetition of the gait speed test, patients were divided into two groups: slow and non-slow. Those who were not discharged walked less than 1.0 m/s occupied the slow group and those who were above 1.0 m/s were classified as not slow. Patients were followed for six months to observe the primary outcome, which was the need for hospital readmission. Results: The 6 months rate of readmission was 58%(14/24;95%CI49%to80%) among slow walkers and 17% (6/36;95%CI13%to46%) among non-slow walkers(p=0.002).In univariate analysis, gait speed, treated as a continuous variable, was associated with the primary outcome (HR0.6;95%CI0.2to0.9), while age, gender, BMI, MV and CPB time were not. In the multivariate model including age, gender, BMI, MV and CPB time, gait speed remained the only variable associated with readmission (multivariate HR:0.5,95%CI0.1to0.7p=0.02). Conclusion: Our data suggest that gait speed is associated with hospital readmission in patients undergoing to coronary artery bypass grafting.
Objective: To assess the impact of IMT on the functional capacity of patients undergoing CABG with a high risk of PPC. Design: This is a randomized clinical trial. Setting: Instituto Nobre de Cardiologia (INCARDIO), Feira de Santana – Bahia. Subjects: In total, 29 patients were selected at high risk of pulmonary complications. Intervention: Patients were divided into two groups at risk of CPP: intervention group (IM) submitted to IMT and control group (CG) who received standard care. Considered a high risk patient, age over 60 years, diabetic, smoker and body mass index above 27 kg / m2. All were submitted to preoperative evaluation and hospital discharge for maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP) and six-minute walk test (6MWT). Results: 29 individuals were evaluated, 19 of whom were female (65%) and the mean age was 67±4 years. The IG showed MIP before of 103±15 and the CG 105±17cmH2O (p=0.35), at discharge the IG had 80±14 and the CG 75±15cmH2O (p=0.12). The 6MWT in the pre was 386±43 in the IG and 398±56 meters (p = 0.65). In the CG, at discharge they covered 285±51 meters in the IG and 288±45 in the CG (p=0.34). There were no differences between the variables of the groups. Conclusion: It is concluded that the IMT performed in the postoperative period did not show significance on the variables muscle strength and functional capacity in patients who were at high risk of pulmonary complications.
Objective: To evaluate the impact of early ambulation on the functionality of patients undergoing cardiac valve replacement surgery. Methods: Prospective cohort study in patients undergoing cardiac valve replacement surgery. Patients had their functionality assessed preoperatively using the Functional Independence Measurement (FIM) and Perme Intensive Care Unit Mobility Score scales. At ICU discharge, they were divided into two groups: walking group (WG) and, non-walking group (NWG). At discharge, the two functional scales were reapplied in these patients. Results: 170 patients were evaluated, 110 (65%) male, with a mean age of 48 ± 2 years. In relation to Perme Score, the WG had a decrease of 11 ± 2 and in the NWG the decrease was 13 ± 2 (p=0.34). Regarding FIM, those who walked had a decrease of 27 ± 3 against those who did not walk, which reduced 36 ± 5, with a significance level of p<0.001. Conclusion: Based in the FIM data found, patients undergoing cardiac valve replacement surgery who underwent early mobilization had less decrease of functionality compared to patients who did not ambulate.