Determination of the Effectiveness of Physiotherapy Techniques after Coronary Artery Bypass Graft Surgery

Objective: The aim of this study was to investigate the effects of incentive spirometer on respiratory muscle strength, exercise capacity and hemodynamic responses after CABG surgery. Methods: Between June 2017 and December 2018, a total of 35 patients underwent CABG surgery were included this prospective randomized controlled study. Patients divided into incentive spirometer (IS) group and physiotherapy (PT) group. All patients received standard physiotherapy postoperatively. In addition, IS group received volume-oriented incentive spirometer. Respiratory muscle strength (mouth pressure device) on 2nd and 5th postoperative day, exercise capacity (6-min.walking test (6-MWT)) on 3rd postoperative day, before and immediately after physiotherapy on the first post-operative day blood gases were assessed. Results: Demographic characteristics of the groups were similar in both groups. Statistically significant increases in maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), %MIP and %MEP values were observed in both two groups (p<0.05) but there was no statistically significant difference between the groups (p > 0.05). There were no significant differences in 6 MWT parameters between PT and IS group (p > 0.05). No significant difference was found in arterial blood gas values on first postoperative day in both groups (p > 0.05). Conclusion: Respiratory muscle strength improved and blood gas values maintained in both groups. There was no superiority of IS combined with PT in increasing respiratory muscle strength and in maintaining arterial blood gas results after CABG surgery. IS combined with physiotherapy could be used safely from the early period after cardiac surgery.

[1]  Adam E M Eltorai,et al.  Effect of an Incentive Spirometer Patient Reminder After Coronary Artery Bypass Grafting: A Randomized Clinical Trial. , 2019, JAMA surgery.

[2]  M. Polkey,et al.  ERS statement on respiratory muscle testing at rest and during exercise , 2019, European Respiratory Journal.

[3]  H. Ghavami,et al.  Effect of self-care interventions on sleep quality in post-coronary artery bypass grafting patients: A single-center, randomized-controlled study. , 2018, Turk gogus kalp damar cerrahisi dergisi.

[4]  J. Alison,et al.  Physiotherapy mobility and walking management of uncomplicated coronary artery bypass graft (CABG) surgery patients: a survey of clinicians’ perspectives in Australia and New Zealand , 2018, Physiotherapy theory and practice.

[5]  S. Patman,et al.  Physiotherapy in upper abdominal surgery – what is current practice in Australia? , 2017, Archives of Physiotherapy.

[6]  R. Elizondo-Omaña,et al.  Conduits Used in Coronary Artery Bypass Grafting: A Review of Morphological Studies. , 2017, Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia.

[7]  Thierry Troosters,et al.  An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease , 2014, European Respiratory Journal.

[8]  Vitor Oliveira Carvalho,et al.  Determinants of distance walked during the six-minute walk test in patients undergoing cardiac surgery at hospital discharge , 2014, Journal of Cardiothoracic Surgery.

[9]  A. Holland,et al.  Physiotherapy for patients following coronary artery bypass graft (CABG) surgery: Limited uptake of evidence into practice , 2012, Physiotherapy theory and practice.

[10]  Ruben D. Restrepo,et al.  Incentive Spirometry: 2011 , 2011, Respiratory Care.

[11]  Handan Inönü The effects of heart surgery on early and late pulmonary functions: the results of three-year follow-up , 2011 .

[12]  R. Arena,et al.  Incentive spirometry with expiratory positive airway pressure reduces pulmonary complications, improves pulmonary function and 6-minute walk distance in patients undergoing coronary artery bypass graft surgery. , 2008, American heart journal.

[13]  L. Dei Cas,et al.  The 6-min walking test early after cardiac surgery. Reference values and the effects of rehabilitation programme. , 2007, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[14]  G. Hedenstierna,et al.  Deep‐Breathing Exercises Reduce Atelectasis And Improve Pulmonary Function After Coronary Artery Bypass Surgery. , 2005, Chest.

[15]  D. Bouros,et al.  Surgery and the respiratory muscles , 1999, Thorax.

[16]  D L Sherrill,et al.  Reference equations for the six-minute walk in healthy adults. , 1998, American journal of respiratory and critical care medicine.

[17]  L. Chiavegato,et al.  Effects of early mobilisation in patients after cardiac surgery: a systematic review. , 2017, Physiotherapy.

[18]  U. Demirkılıç,et al.  Is physiotherapy effective on the occurrence of postoperative pulmonary complications in patients undergoing coronary artery bypass graft surgery ? A randomized controlled trial , 2015 .

[19]  P. Dagnelie,et al.  Prediction of postoperative pulmonary complications on the basis of preoperative risk factors in patients who had undergone coronary artery bypass graft surgery. , 2003, Physical therapy.