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Lung Function, Respiratory Muscle Strength and Effects of Breathing Exercises in Cardiac Surgery Patients
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Breathing exercises are widely used after cardiac surgery. The duration of exercises in the immediate postoperative period is not fully evaluated and only limited data regarding the effects of home-based breathing exercises after discharge from hospital have been published.

Aim: The overall aim of this thesis was to evaluate the effects of deep breathing exercises with positive expiratory pressure (PEP) and describe lung function and respiratory muscle strength in patients undergoing cardiac surgery.

Participants and settings: Adult participants (n=131) were randomised to perform either 30 or 10 deep breaths with PEP per hour during the first postoperative days (Study I): the main outcome was oxygenation, assessed by arterial blood gases, on the second postoperative day. In Study III, 313 adult participants were randomly assigned to perform home-based deep breathing exercises with PEP for two months after surgery or not to perform breathing exercises with PEP after the fourth to fifth postoperative day. The main outcome was lung function, assessed by spirometry, two months after surgery. Studies II and IV were descriptive and correlative and investigated pre and postoperative lung function, assessed by spirometry, and respiratory muscle strength, assessed by maximal inspiratory pressure, and maximal expiratory pressure.

Results: On the second postoperative day, arterial oxygen tension (PaO2) and arterial oxygen saturation (SaO2) was higher in the group randomised to 30 deep breaths with PEP hourly. There was no improved recovery of lung function in participants performing home-based deep breathing exercises two months after cardiac surgery, compared to a control group. Subjective experience of breathing or improvement in patient perceived quality of recovery or health-related quality of life did not differ between the groups at two months. Lung function and respiratory muscle strength were in accordance with predicted values before surgery. A 50% reduction in lung function was shown on the second postoperative day. High body mass index, male gender and sternal pain were associated with decreased lung function on the second postoperative day. Two months postoperatively, there was decreased lung function, but respiratory muscle strength had almost recovered to preoperative values.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2013. , 58 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 857
Keyword [en]
Breathing exercises, Cardiac surgery, Deep breathing, Lung function, Oxygenation, Physical therapy, Positive expiratory pressure, Spirometry, Respiratory muscle strength
National Category
Physiotherapy
Research subject
Medical Science
Identifiers
URN: urn:nbn:se:uu:diva-192208ISBN: 978-91-554-8580-1 (print)OAI: oai:DiVA.org:uu-192208DiVA: diva2:589175
Public defence
2013-03-01, B:42, BMC, Husargatan 3, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Note

Available from: 2013-02-08 Created: 2013-01-17 Last updated: 2013-02-14
List of papers
1. Deep breathing exercises with positive expiratory pressure at a higher rate improve oxygenation in the early period after cardiac surgery: a randomised controlled trial
Open this publication in new window or tab >>Deep breathing exercises with positive expiratory pressure at a higher rate improve oxygenation in the early period after cardiac surgery: a randomised controlled trial
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2010 (English)In: European Journal of Cardio-Thoracic Surgery, ISSN 1010-7940, E-ISSN 1873-734X, Vol. 40, no 1, 162-167 p.Article in journal (Refereed) Published
Abstract [en]

Objective: In addition to early mobilisation, a variety of breathing exercises are used to prevent postoperative pulmonary complications after cardiac surgery. The optimal duration of the treatment is not well evaluated. The aim of this study was to determine the effect of 30 versus 10 deep breaths hourly, while awake, with positive expiratory pressure on oxygenation and pulmonary function the first days after cardiac surgery.

Methods: A total of 181 patients, undergoing cardiac surgery, were randomised into a treatment group, performing 30 deep breaths hourly the first postoperative days, or into a control group performing 10 deep breaths hourly. The main outcome measurement arterial blood gases and the secondary outcome pulmonary function, evaluated with spirometry, were determined on the second postoperative day.

Results: Preoperatively, both study groups were similar in terms of age, SpO(2), forced expiratory volume in 1s and New York Heart Association classification. On the second postoperative day, arterial oxygen tension (PaO(2)) was 8.9±1.7kPa in the treatment group and 8.1±1.4kPa in the control group (p=0.004). Arterial oxygen saturation (SaO(2)) was 92.7±3.7% in the treatment group and 91.1±3.8% in the control group (p=0.016). There were no differences in measured lung function between the groups or in compliance to the breathing exercises. Compliance was 65% of possible breathing sessions.

Conclusions: A significantly increased oxygenation was found in patients performing 30 deep breaths the first two postoperative days compared with control patients performing 10 deep breaths hourly. These results support the implementation of a higher rate of deep breathing exercises in the initial phase after cardiac surgery.

Keyword
Cardiac surgery, Chest physiotherapy, Deep breathing, Intensive care, Positive expiratory pressure
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-140137 (URN)10.1016/j.ejcts.2010.10.018 (DOI)000291483100042 ()21146420 (PubMedID)
Available from: 2011-01-04 Created: 2011-01-04 Last updated: 2017-12-11Bibliographically approved
2. Lung Function Before and Two Days After Open-Heart Surgery
Open this publication in new window or tab >>Lung Function Before and Two Days After Open-Heart Surgery
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2012 (English)In: Critical Care Research and Practice, ISSN 2090-1313, Article ID:-291628 p.Article in journal (Refereed) Published
Abstract [en]

Reduced lung volumes and atelectasis are common after open-heart surgery, and pronounced restrictive lung volume impairmenthas been found. The aim of this study was to investigate factors influencing lung volumes on the second postoperative day. Open-heart surgery patients (n = 107, 68 yrs, 80% male) performed spirometry both before surgery and on the second postoperative day. The factors influencing postoperative lung volumes and decrease in lung volumes were investigated with univariate and multivariate analyses. Associations between pain (measured by numeric rating scale) and decrease in postoperative lung volumes were calculated with Spearman rank correlation test. Lung volumes decreased by 50% and were less than 40% of the predictive values postoperatively. Patients with BMI > 25 had lower postoperative inspiratory capacity (IC) (33% ± 14% pred.) than normalweight patients (39% ± 15% pred.), (P = 0.04).More pain during mobilisation was associated with higher decreases in postoperative lung volumes (VC: r = 0.33, P = 0.001; FEV1: r = 0.35, P ≤ 0.0001; IC: r = 0.25, P = 0.01). Patients with high BMI are a risk group for decreased postoperative lung volumes and should therefore receive extra attention during postoperative care. As pain is related to a larger decrease in postoperative lung volumes, optimal pain relief for the patients should be identified.

National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-187856 (URN)10.1155/2012/291628 (DOI)
Available from: 2012-12-11 Created: 2012-12-11 Last updated: 2013-02-14Bibliographically approved
3. Deep Breathing Exercises Performed 2 Months Following Cardiac Surgery: A Randomized Controlled Trial
Open this publication in new window or tab >>Deep Breathing Exercises Performed 2 Months Following Cardiac Surgery: A Randomized Controlled Trial
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2014 (English)In: JOURNAL OF CARDIOPULMONARY REHABILITATION AND PREVENTION, ISSN 1932-7501, Vol. 34, no 1, 34-42 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Postoperative breathing exercises are recommended to cardiac surgery patients. Instructions concerning how long patients should continue exercises after discharge vary, and the significance of treatment needs to be determined. Our aim was to assess the effects of home-based deep breathing exercises performed with a positive expiratory pressure device for 2 months following cardiac surgery. METHODS: The study design was a prospective, single-blinded, parallel-group, randomized trial. Patients performing breathing exercises 2 months after cardiac surgery (n = 159) were compared with a control group (n = 154) performing no breathing exercises after discharge. The intervention consisted of 30 slow deep breaths performed with a positive expiratory pressure device (10-15 cm H2O), 5 times a day, during the first 2 months after surgery. The outcomes were lung function measurements, oxygen saturation, thoracic excursion mobility, subjective perception of breathing and pain, patient-perceived quality of recovery (40-Item Quality of Recovery score), health-related quality of life (36-Item Short Form Health Survey), and self-reported respiratory tract infection/pneumonia and antibiotic treatment. RESULTS: Two months postoperatively, the patients had significantly reduced lung function, with a mean decrease in forced expiratory volume in 1 second to 93 +/- 12% (P< .001) of preoperative values. Oxygenation had returned to preoperative values, and 5 of 8 aspects in the 36-Item Short Form Health Survey were improved compared with preoperative values (P< .01). There were no significant differences between the groups in any of the measured outcomes. CONCLUSION: No significant differences in lung function, subjective perceptions, or quality of life were found between patients performing home-based deep breathing exercises and control patients 2 months after cardiac surgery.

National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
urn:nbn:se:uu:diva-190789 (URN)10.1097/HCR.0000000000000020 (DOI)000335569100005 ()
Available from: 2013-01-17 Created: 2013-01-08 Last updated: 2014-07-02Bibliographically approved
4. Respiratory Muscle Strength in Cardiac Surgery Patients
Open this publication in new window or tab >>Respiratory Muscle Strength in Cardiac Surgery Patients
(English)Article in journal (Refereed) Submitted
National Category
Physiotherapy
Research subject
Physiotherapy
Identifiers
urn:nbn:se:uu:diva-190790 (URN)
Available from: 2013-01-17 Created: 2013-01-08 Last updated: 2013-02-14

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