eISSN: 1897-4252
ISSN: 1731-5530
Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery
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2/2020
vol. 17
 
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abstract:
Original paper

The benefit of a preoperative respiratory protocol and musculoskeletal exercise in patients undergoing cardiac surgery

Paolo Nardi
1
,
Calogera Pisano
1
,
Claudia Altieri
1
,
Dario Buioni
1
,
Carlo Pedicelli
2
,
Silvia Saulle
3
,
Romana Dandi
3
,
Alessia Romano
3
,
Annamaria Servadio
4
,
Alessandra Gianlorenzi
,
Katia Emili
5
,
Giovanni Ruvolo
1

  1. Cardiac Surgery Division, Tor Vergata University Hospital, Rome, Italy
  2. Degree of Physiotherapy, Tor Vergata University Hospital, Rome, Italy
  3. Physiotherapy Service, Tor Vergata University Hospital, Rome, Italy
  4. Management Coordinator Rehabilitation Area, Tor Vergata University Hospital, Rome, Italy
  5. Management Coordinator Cardiac Surgery Division, Tor Vergata University Hospital, Rome, Italy
Kardiochir Torakochir Pol 2020; 17 (2): 94-100
DOI: https://doi.org/10.5114/kitp.2020.97267
Online publish date: 2020/07/20
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Introduction
Loss of physical activity and pulmonary dysfunction with its associated complications represent two of the most important causes of morbidity and mortality following cardiac surgery. To evaluate whether a physiotherapy program based on respiratory training with or without musculoskeletal mobilization, started preoperatively, may provide a significant improvement in pulmonary and musculoskeletal recovery postoperatively in a sufficiently large sample of patients undergoing elective cardiac surgery.

Material and methods
One-hundred and two patients with similar baseline and preoperative characteristics were assigned to a preoperative respiratory physiotherapy protocol (group R, n = 34), a preoperative respiratory and motor physiotherapy protocol (group R + M, n = 34), or no preoperative specific physiotherapy protocol but only a simplified perioperative standard physiotherapy protocol (control group, C, n = 34). Data on 6-minute walking test, peak expiratory flow, and from blood gas analysis were retrospectively analyzed.

Results
As compared with group C, a statistically significant improvement was observed in the two preoperatively treated groups in terms of 1) better pre- (+0.7–0.8 Lt/min, p < 0.05) and postoperative (+1 Lt/min, p < 0.01) peak expiratory flow values; 2) longer pre- (+50–100 m, p < 0.01) and postoperative (+65–170 m, p < 0.01) distance traveled in the 6-minute walking test; 3) better PaO2, SaO2, pH value in postoperative blood gas measurements (p < 0.05, for all comparisons); 4) reduction of postoperative length of in-hospital stay (p < 0.05).

Conclusions
A benefit of combined respiratory and motor physiotherapy protocols can be expected in the groups of patients preoperatively treated, especially with the respiratory one, either before or after cardiac surgery with a faster recovery of physical-functional activities. Specifically, the motor protocol is associated with greater autonomy of running before or after cardiac surgery.

keywords:

respiratory protocol, cardiac surgery, musculoskeletal exercise
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