Al Jaaly et al.[1717 Al Jaaly E, Fiorentino F, Reeves BC, Ind PW, Angelini GD, Kemp S, et al. Effect of adding postoperative noninvasive ventilation to usual care to prevent pulmonary complications in patients undergoing coronary artery bypass grafting: a randomized controlled trial. J Thorac Cardiovasc Surg. 2013;146(4):912-8.], 2013 |
BPAP, RVE, VEBH, EM, IS, NBL |
RVE, VEBH, EM, IS, NBL |
66 / 63 |
65.7±10.7 / 69.4±8.86 |
Not reported |
IG: Usual care and BPAP during the first 24 hours after extubation CG: usual care alone twice per day for the first 2 to 3 days after surgery Outcomes: atelectasis, FEV1, ICU days, days of hospitalization, PaCO2
|
Among patients undergoing elective coronary artery bypass grafting, the use of BPAP at extubation reduced the recovery time. Supported by trained staff, more than 75% of all patients allocated to BPAP tolerated it for more than 10 hours |
Barros et al.[1818 Barros GF, Santos CS, Granado FB, Costa PT, Limaco RP, Gardenghi G. Treinamento muscular respiratório na revascularização do miocárdio. Rev Bras Cir Cardiovasc. 2010;25(4):483-90.], 2010 |
IMT, TM, PD, AT |
TM, PD, TS |
23 / 15 |
62.1±8.1 / 67±7.1 |
19 / 6 |
IG: conventional physiotherapy and IMT, with three sets of ten repetitions, once a day, with 40% of the PImax CG: Conventional physiotherapy with four sets of six cycles of vibrocompression associated with postural drainage and aspiration where necessary, twice a day Outcomes: PImax, PEmax, Dyspnea, pain, PEF, CV |
There is loss of respiratory muscle strength in patients undergoing coronary revascularization. The IMT, performed in the postoperative period, was effective in restoring the following parameters: PImax, PEmax, PEF and CV in this population |
Blattner et al.[1919 Blattner C, Guaragna JC, Saadi E. Oxygenation and static compliance is improved immediately after early manual hyperinflation following myocardial revascularisation: a randomised controlled trial. Aust J Physiother. 2008;54(3):173-8.], 2008 |
MH, TS |
TS |
28 / 27 |
55.6±8.7 / 57.6±4.9 |
16 / 17 |
IG: Twenty minutes MH with flow of 15 l/ m and expiratory pressure 10 cmH2O, often 18 to 30 rpm and TS CG: TS Outcomes: atelectasis, pleural effusion, consolidation, PaO2, Cstat, IMV time, days of hospitalization |
The group that received early MH had markedly better oxygenation and static compliance as well as shorter mechanical ventilation times than the control group. The length of hospital stay and incidence of postoperative pulmonary complications were similar in the two groups |
Borges et al[2020 Borges DL, Nina VJ, Costal MA, Baldez TE, Santos NP, Lima IM, et al. Effects of different PEEP levels on respiratory mechanics and oxygenation after coronary artery bypass grafting. Rev Bras Cir Cardiovasc. 2013;28(3):380-5.], 2013 |
WP with PEEP (5 cmH2O) |
WP with PEEP (8 cmH2O) / WP with PEEP (10 cmH2O) |
44 / 47 / 45 |
20<60>24 / 22<60>25 / 19<60>26 |
29 / 32 / 35 |
IG: PEEP 5 cmH2O after ICU admission and extubation when met clinical conditions CG: PEEP 8 cmH2O after ICU admission and extubation when met clinical conditions CG: PEEP 10 cmH2O after ICU admission and extubation when met clinical conditions Outcomes: ventilatory mechanics, pulmonary shunt, oxygenation index |
Higher levels of positive end-expiratory pressure in immediate postoperative period of coronary artery bypass grafting improved pulmonary compliance values and increased oxygenation indexes, resulting in lower frequency of hypoxemia |
Borghi-Silva et al.[2121 Borgui-Silva A, Mendes RG, Costa FS, Di Lorenzo VA, Oliveira CR, Luzzi S. The influences of positive end expiratory pressure (PEEP) associated wth physiotherapy intervention in phase I cardiac rehabilitation. Clinics (Sao Paulo). 2005;60(6):465-72.], 2005 |
PEP, TM, TS,VEBH, RVE, EULL, AM, LA |
TM, TS, VEBH, RVE, EE, EULL, AM, LA |
8 / 16 |
59.9±9.8 / 55.9±11.9 |
Not reported |
IG: two daily sessions of about 40 minutes. TM, TS, VEBH, EE, AM, LA. PEP through facial mask with PEEP 10 cmH2O CG: two daily sessions of about 40 minutes. TM, TS, VEBH, EE, AM, LA Outcomes: VC, FVC, length of stay, PImax, PEmax. |
These data suggest that cardiac surgery produces a reduction in inspiratory muscle strength, pulmonary volume, and flow. The association of positive expiratory pressure with physiotherapy intervention was more efficient in minimizing these changes, in comparison to the physiotherapy intervention alone. However, in both groups, the pulmonary volumes were not completely reestablished by the fifth postoperative day, and it was necessary to continue the treatment after hospital convalescence |
Castellana et al.[2222 Castellana FB, Malbouisson LMS, Carmona MJC, Lopes CR, Auler Júnior JOC. Comparação entre ventilação controlada a volume e a pressão no tratamento da hipoxemia no período pós-operatório de cirurgia de revascularização do miocárdio. Rev Bras Anestesiol. 2003;53(4):440-8.], 2003 |
WP with VC-CMV |
WP with PC-CMV |
32 / 29 |
65±7 / 64±11 |
Not reported |
IG: IMV in the VC-CMV mode with volume of 7 ml/kg respiratory rate of 12 and PEEP 5 cmH2O, inspiratory time of 33% and 60% FiO2 CG: IMV in the PC-CMV mode with volume of 7 ml / kg respiratory rate of 12 and PEEP 5 cmH2O, inspiratory time of 33% and 60% FiO2 Outcomes: shunt, oxygenation index |
Ventilatory modes controlled the volume and pressure were equally effective in treating hypoxemia observed in patients in the postoperative immediate coronary artery bypass surgery, showing that the pattern of administration of inspiratory flow. It is of little relevance for the treatment of postoperative hypoxemia |
Celebi et al.[2323 Celebi S, Köner O, Menda F, Omay O, Günay I, Suzer K, et al. Pulmonary effects of noninvasive ventilation combined with the recruitment maneuver after cardiac surgery. Anesth Analg. 2008;107(2):614-9.], 2008 |
AR, NIV, VEBH, EM, IS |
NIV, VEBH, EM, IS / AR, VEBH, EM, IS / VEBH, EM, IS |
25 / 25 / 25 / 25 |
52±9 / 57±8 / 58±6 / 57±7 |
20 / 18 / 21 / 22 |
IG: NIV through facial mask for periods of one hour, starting 6h after extubation in the first 24 hours, in the SP mode around 10 cmH2O, PEEP 5 cmH2O and FiO2 40%. VEBH, EM and IS after extubation IG: AR in CPAP mode with peak pressure 40 cmH2O (20 cm H2O inspiratory pressure and 20 cmH2O PEEP) sustained for 30 seconds and FiO2 by 40%. VEBH, EM and IS after extubation. IG: application of NIV and AR as the two previously described protocols. VEBH, EM and IS after extubation CG: maintenance of 5 cmH2O PEEP during the IMV and VEBH, EM and IS after extubationOutcomes: pleural effusion, atelectasis, VC, FEV1 |
NIV associated with AR provided better oxygenation both during and after the mechanical ventilation period. NIV either alone or in combination with AR provided lower atelectasis scores and better early pulmonary function tests compared to the control group, without a significant difference regarding the duration of mechanical ventilation, intensive care unit stay, and the length of hospitalization. NIV combined with AR is recommended after open heart surgery to prevent postoperative atelectasis and hypoxemia |
Crowe and Bradley[2424 Crowe JM, Bradley CA. The effectiveness of incentive spirometry with physical therapy for high-risk patients after coronary artery bypass surgery. Phys Ther. 1997;77(3):260-8.], 1997 |
IS, RVE, VEBH, TM, EM, TS, EULL, AM, PE |
RVE, VEBH, TM, EM, TS, EULL, AM, PE |
90 / 95 |
64±8.9 / 64.8±8.6 |
74 / 79 |
IG: PE, RVE, TM, VEBH and TS once or twice a day. After extubation, EULL and AM. Spirometry incentive driven volume used every hour by the patient CG: PE, RVE, TM, VEBH and TS once or twice a day. After extubation, EULL and AM Outcomes: atelectasis, pulmonary congestion, pneumothorax, pleural effusion, FEV1, FVC, respiratory infection, SpO2, days of hospitalization |
Incentive spirometry combined with physical therapy is no more effective than postoperative physical therapy alone in reducing atelectasis for this population. Use of the spirometer, however, was not monitored, and although the study mimicked practice as it often occurs, the effectiveness of the spirometer cannot be fully evaluated |
Dongelmans et al.[2525 Dongelmans DA, Veelo DP, Paulus F, de Mol BA, Korevaar JC, Kudoga A, et al. Weaning automation with adaptive support ventilation: a randomized controlled trial in cardiothoracic surgery patients. Anesth Analg. 2009;108(2):565-71.], 2009 |
WP with SA |
WP with PC-CMV and SP |
64 / 64 |
65±9 / 67±8 |
56 / 51 |
IG: ventilation adapted support, minute volume of 100% of the predicted weight, FiO2 50%, PEEP 10 cmH2O, trigger the 2 L/s CG: PC-CMV, CV 6-8 ml/kg, respiratory rate of 12-15 rpm, FiO2 50%, PEEP 10 cmH2O, 2 L/s trigger. After spontaneous ventilation with SP 10 cmH2O, trigger 2 L/s, expiratory sensitivity 25% and rise time 50 ms. Outcomes: days of ICU, length of stay, PaO2, PaCO2, IMV Time |
Weaning automation with SA is feasible and safe in non-fast-track coronary artery bypass grafting patients. Time until tracheal extubation with SA equals time until tracheal extubation with standard weaning and allows for frequent (automatic) switches between controlled and assisted ventilation |
El-Kader[2626 El-Kader SMA. Blood gases response to different breathing modalities in phase I of cardiac rehabilitation program after coronary artery bypass graft. Eur J Gen Med. 2011;8(2):85-9.], 2011 |
RVE, VEBH, TM, IS |
RVE, VEBH, TM, CPAP / RVE, VEBH, TM, RPPI |
12 / 12 / 12 |
48.7±6.8 / 47.4±6 / 49.6±7.1 |
Not reported |
IG: 3-5 RVE followed 2-3 VEBH at least 10 times in 15 minutes. If necessary, positioning and thoracic maneuvers. IS volume for five minutes, five times a day IG: 3-5 RVE followed 2-3 VEBH at least 10 times in 15 minutes. If necessary, positioning and thoracic maneuvers. CPAP 10 cmH2O for 15 minutes daily CG: 3-5 RVE followed 2-3 VEBH at least 10 times in 15 minutes. If necessary, positioning and thoracic maneuvers. RPPI with inspiratory phase of 20%, peak inspiratory pressure of 15 cmH2O for 15 minutesOutcomes: PaCO2, PaO2
|
Incentive spirometry in addition to the usual respiratory physical therapy is recommended for patients in phase I of cardiac rehabilitation program after CABG |
Ferreira et al.[2727 Ferreira GM, Haeddner MP, Barreto SSM, Dall'ago P. Espirometria de incentivo com pressão positiva expiratória é benéfica após revascularização miocárdio. Arq Bras Cardiol. 2010;94(2):246-51.], 2010 |
IS, PEP |
RVE, VEBH, EM |
8 / 8 |
61±2 / 60±3 |
6 / 6 |
IG: IS volume coupled to a PEP valve after extubation, with increased expiratory pressure progressively to 5 cmH2O to 15 cmH2O twice a day with supervision and twice a day without supervision, lasting 15 minutes CG: guidance on VEBH, EM and RVE Outcomes: FVC, FEV1, PEF, PImax, PEmax, 6MWD, Evaluation level of physical activity, evaluation of quality of life |
Patients undergoing IS + PEP presented less dyspnea and lower sensation of effort after SMWT and also better quality of life 18 months after CABG |
Franco et al.[2828 Franco AM, Torres FCC, Simon ISL, Morales D, Rodrigues AJ. Avaliação da ventilação não-invasiva com dois níveis de pressão positiva nas vias aéreas após cirurgia cardíaca. Rev Bras Cir Cardiovasc. 2011;26(4):582-90.], 2011 |
BPAP, RVE, VEBH, TM, EULL, PE |
RVE, VEBH, TM, EULL, PE |
13 / 13 |
Not reported |
10 / 7 |
IG: RVE, VEBH, TM, EULL, PE for two days after surgery. BPAP in the spontaneous mode with inspiratory pressure of 8-12 cmH2O and expiratory of 6 cmH2O, twice daily for 30 minutes CG: RVE, VEBH, TM, EULL, PE for two days after surgery Outcomes: CV, MV, VC, PImax, PEmax, PEF |
Coronary artery bypass surgery leads to deterioration of respiratory function postoperatively, and the application the BPAP may be beneficial to restore lung function more quickly, especially vital capacity, safely, and well accepted by patients due to greater comfort with the feeling of pain during the execution of respiratory therapy |
Garcia and Costa[2929 Garcia RCP, Costa D. Treinamento muscular respiratório em pós-operatório de cirurgia cardíaca eletiva. Rev Bras Fisioter. 2002;6(3):139-46.], 2002 |
IMT (twice a day) |
IMT (once a day) / VEBH |
20 / 20 / 20 |
56±11 / 58±7.5 / 63±9 |
13 / 16 / 11 |
IG: three sets of 10 repetitions, twice a day. Efforts inspiratory in a free load manometer for at least five seconds IG: three sets of 10 repetitions daily. Efforts inspiratory in a free load manometer for at least five seconds CG: conventional treatment, especially VEBH Outcomes: PImax, PEmax, PEF, cytometry |
It was found that through a specific IMT was increased respiratory muscle strength both the group that trained two as in trained once a day, compared to the control group which had no change |
Gust et al.[3030 Gust R, Gottschalk A, Schmidt H, Böttiger BW, Böhrer H, Martin E. Effects of continuous (CPAP) and bi-level positive airway pressure (BiPAP) on extravascular lung water after extubation of the trachea in patients following coronary artery bypass grafting. Intensive Care Med. 1996;22(12):1345-50.], 1996 |
RCP |
CPAP / BPAP |
25 / 25 / 25 |
60.5±7.5 / 63±7 / 62.6±7.5 |
23 / 21 / 23 |
IG: oxygen therapy by NC 6l m and RCP IG: CPAP with 7.5 cmH2O and FiO2 of 50% CG: BPAP with 10 cmH2O and PEEP 5 cmH2O, getting oxygen to 10 l/ m Outcomes: cardiac index, pulmonary blood volume index, extravascular water content |
Mask CPAP and nasal BPAP after extubation of the trachea prevent the increase in extravascular lung water during weaning from mechanical ventilation. This effect is seen for at least 1 h after the discontinuation of CPAP or BPAP treatment |
Haefener et al.[3131 Haeffener MP, Ferreira GM, Barreto SS, Arena R, Dall'Ago P. 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. Am Heart J. 2008;156(5):900.], 2008 |
IS, PEP |
RVE, VEBH, EM |
17 / 17 |
62±6 / 60±7 |
14 / 14 |
IG: IS volume associated with PEP twice a day 15-20 minutes with expiratory pressure increased progressively 2.5 cmH2O the 15 cmH2O CG: patients were educated about VEBH, EM and RVE Outcomes: plethysmography, 6MWD, atelectasis, pleural effusion, consolidation, FVC, FEV1, IMV time |
In patients undergoing CABG, IS + PEP results in improved pulmonary function and 6-minute walk distance as well as a reduction in postoperative pulmonary complications |
Hendrix et al.[3232 Hendrix H, Kaiser ME, Yusen RD, Merk J. A randomized trial of automated versus conventional protocol-driven weaning from mechanical ventilation following coronary artery bypass surgery. Eur J Cardiothorac Surg. 2006;29(6):957-63.], 2006 |
WP with PRVC, VS |
WP with PRVC, SIMV, CPAP |
10 / 10 |
54±9 / 66±4 |
10 / 10 |
IG: WP with PRVC and activated automatic mode function triggered when the patient's ventilatory cycle the mode automatically changed to VSV CG: WP with PRVC when the patient triggered a ventilation cycle, the team modified to SIMV mode with frequency of 5 and PS 10 cmH2O. When patients become fully alert, they were changed to the mode CPAP 10 cmH2O Outcomes: VC, FEV1, PaO2, PaCO2, IMV time |
Automode ventilator weaning trended toward more rapid extubation than did conventional protocol driven ventilation in conjunction with a standardized weaning protocol. Physiologic and hemodynamic factors were better in patients using automode ventilation compared to patients using conventional ventilation. Automode ventilation was well tolerated and did not induce significant adverse effects. |
Herdy et al.[3333 Herdy AH, Marcchi PL, Vila A, Tavares C, Collaço J, Niebauer J, et al. Pre- and postoperative cardiopulmonary rehabilitation in hospitalized patients undergoing coronary artery bypass surgery: a randomized controlled trial. Am J Phys Med Rehabil. 2008;87(9):714-9.], 2008 |
RPPI, RVE, IS, AM, LA |
NPI |
29 / 27 |
61±10 58±9 |
20 / 20 |
IG: RPPI, RVE, IS, AM, LA five days before surgery and continuing after extubation to discharge. Energy expenditure was 2 METS, progressing up to 4 METS CG: NIP Outcomes: pleural effusion, atelectasis, ICU days, hospital days, PEF, IMV time, 6MWD |
Pre- and postoperative cardiopulmonary rehabilitation in patients who await CABG in the hospital is superior to standard care and leads to a reduced rate of postoperative complications and shorter hospital stay |
Hirschhorn et al.[3434 Hirschhorn AD, Richards D, Mungovan SF, Morris NR, Adams L. Supervised moderate intensity exercise improves distance walked at hospital discharge following coronary artery bypass graft surgery: a randomised controlled trial. Heart Lung Circ. 2008;17(2):129-38.], 2008 |
VEBH, PD, AM, LA, PE |
PWC / IS, EULL, AM |
31 / 31 / 30 |
63.6±8.5 / 63.2±10.8 / 61.8±7.2 |
26 / 27 / 27 |
IG: five sets of 4 repetitions of IS during the service and guidance to perform every hour. RVE and EMSI IG: PWC CG: PE, PD, RVE, VEBH, LA. AM starting at 10 m up to 30 m in the morning and night Outcomes: 6MWD, VC, quality of life, atelectasis, injury, failure or pulmonary consolidation |
A physiotherapy-supervised, moderate intensity walking program in the inpatient phase following CABG improves walking capacity at discharge from hospital. The performance of respiratory and musculoskeletal exercises confers no additional benefit to the measured outcomes |
Jenkins et al.[3535 Jenkins SC, Soutar SA, Loukota JM, Johnson LC, Moxham J. Physiotherapy after coronary artery surgery: are breathing exercises necessary? Thorax. 1989;44(8):634-9.], 1989 |
RVE, VEBH, EULL, AM, LA, PE, TM |
VEBH, EULL, AM, LA, PE / VEBH, EULL, AM, LA, PE, IS |
35 / 38 / 37 |
55±8.5 / 56±6.9 /54±7.6 |
35 / 38 / 37 |
IG: Guidance on VEBH, EULL, AM, LA, PE. Three to five repetitions of RVE and if necessary were carried TM. At least 10 RVE every hour until the fifth day after surgery IG: Guidance on VEBH, EULL, AM, LA, PE. Three to five repetitions of IS. At least 10 reps every hour until the fifth day after surgery CG: Guidance on VEBH, EULL, AM, LA, PE Outcomes: FEV1, PEF, FVC, consolidation, PaCO2, PaO2, pain |
It is concluded that the addition of breathing exercises or incentive spirometry to a regimen of early mobilization and huffing and coughing confers no extra benefit after uncomplicated coronary artery bypass grafting |
Johnson et al.[3636 Johnson D, Kelm C, To T, Hurst T, Naik C, Gulka I, et al. Postoperative physical therapy after coronary artery bypass surgery. Am J Respir Crit Care Med. 1995;152(3):953-8.], 1995 |
RVE, EM |
RVE, SMI, EM (group with minimal atelectasis) / RVE, SMI, EM (group marked atelectasis) / RVE, SMI, TM, EM |
48 / 49 / 64 / 63 |
60±10 / 64±11 / 66±8 / 64±11 |
39 / 40 / 52 / 53 |
IG: EM and five repetitions of RVE every hour IG: group with minimal atelectasis. EM and five repetitions of SMI starting from the residual functional capacity to total lung capacity IG: group marked atelectasis. EM and five repetitions of SMI starting from the residual functional capacity to total lung capacity CG: During the operation of SMI, application TM with frequency of 1-2 per second and EM. Three daily sessions. Outcomes: atelectasis, VC, FVC, FEV1, days of hospitalization, PImax, PEmax, pain |
We concluded that postoperative respiratory dysfunction is common but does not commonly cause significant morbidity or prolong hospital stay. Adding SMI to patients with minimal atelectasis at extubation does not improve clinical outcomes. Similarly, adding TM to patients with marked atelectasis does not improve outcomes over those obtained with SMI and early ambulation |
Marvel et al.[3737 Marvel SL, Elliott CG, Tocino I, Greenway LW, Metcalf SM, Chapman RH. Positive end-expiratory pressure following coronary artery bypass grafting. Chest. 1986;90(4):537-41.], 1986 |
WPwith ambient pressure |
WP with PEEP of 5 cmH2O, CPAP of 5 cmH2O / WP with PEEP 10 cmH2O |
17 / 15 / 12 |
62.7±1.7 / 60.9±2.9 / 55.8±2.7 |
Not reported |
IG: WP pressure environment IG: WP with 5 cmH2O and CPAP 5 cmH2O for an hour and a half before extubation CG: WP with 10 cmH2O and CPAP 5 cmH2O for half an hour before extubation Outcomes: atelectasis, days of hospitalization, PaO2
|
We conclude that routine PEEP improves pulmonary oxygen transfer but, once discontinued, PEEP offers no sustained beneficial effect upon impaired oxygen transfer or roentgenographic evidence of atelectasis following CABG |
Matheus et al.[3838 Matheus GB, Dragosavac D, Trevisan P, Costa CE, Lopes MM, Ribeiro GCA. Treinamento muscular melhora o volume corrente e a capacidade vital no pós-operatório de revascularização do miocárdio. Rev Bras Cir Cardiovasc. 2012;27(3):362-9.], 2012 |
IMT, RVE, IS, AM, PE |
RVE, IS, AM, PE |
23 / 24 |
61.8±13.5 / 63.3±10.2 |
18 / 16 |
IG: RVE, IS, AM, PE and IMT twice a day with three sets of 10 repetitions with 40% of MIP CG: RVE, IS, AM, PE Outcomes: PImax, PEmax, CV, VC, PEF, pleural effusion, atelectasis, ICU days, hospital days, IMV time |
Patients undergoing cardiac surgery suffer reduction of VC and respiratory muscle strength after the surgery. The muscle training performed was effective in recovering the CV and VC in PO3, the trained group |
Matte et al.[3939 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;44(1):75-81.], 2000 |
VEBH, EM, IS, NBL |
RVE, EM, IS, NBL, CPAP / VEBH, EM, IS, NBL, BPAP |
30 / 33 / 33 |
63±8 / 65±8 / 64±9 |
25 / 30 / 30 |
IG: Routine physiotherapy (VEBH, NBL, EM and IS)IG: Routine physiotherapy, CPAP 5 cmH2O CG: Routine physiotherapy, BPAP with the inspiratory pressure 12 cmH2O and expiratory pressure 5 cmH2O
Outcomes: VC, FEV1, PaO2, PaCO2, atelectasis, days of ICU |
We conclude that preventive use of NIV can be considered as an effective means to decrease the negative effect of coronary surgery on pulmonary function |
Mendes et al.[4040 Mendes RG, Simões RP, De Souza Melo Costa F, Pantoni CB, Di Thommazo L, Luzzi S, et al. Short-term supervised inpatient physiotherapy exercise protocol improves cardiac autonomic function after coronary artery bypass graft surgery: a randomised controlled trial. Disabil Rehabil. 2010;32(16):1320-7.], 2010 |
RVE, VEBH, PD, TM, EM, PE, EE, EULL, AM, LA |
RVE, VEBH, PD, TM, EM, PE |
24 / 23 |
60±8 / 58±9 |
16 / 20 |
IG: Four sets of 10 repetitions of RVE and VEBH once daily. If necessary, PD and TM CG: Four sets of 10 repetitions of RVE and VEBH once daily. If necessary, PD and TM. EE with five sets of 10 repetitions, EULL with two sets of 15 reps, 10 minutes AM, LA-four steps Outcomes: ICU days, hospital days, IMV time, heart rate and RR interval |
Short-term supervised physiotherapy exercise protocol during inpatient cardiac rehabilitation improves cardiac autonomous regulation at the time of discharge. Thus, exercise-based inpatient cardiac rehabilitation might be an effective non-pharmacological tool to improve autonomic cardiac tone in patient's post-CABG |
Michalopoulos et al.[4141 Michalopoulos A, Anthi A, Rellos K, Geroulanos S. Effects of positive end-expiratory pressure (PEEP) in cardiac surgery patients. Respir Med. 1998;92(6):858-62.], 1998 |
WP with ZEEP |
WP with PEEP of 5 cmH2O / WP with PEEP of 10 cmH2O |
22 / 24 / 21 |
61.1±6.1 / 60.9±6.2 / 61.9±6.6 |
18 / 20 / 16 |
IG: ZEEP during IMV postoperatively until extubation IG: PEEP 5 cmH2O during IMV postoperatively until extubation CG: PEEP 10 cmH2O during IMV postoperatively until extubation Outcomes: atelectasis, IMV time, oxygenation index, cardiac index |
We concluded that low levels of PEEP have no advantage over zero PEEP in improving gas exchange in the early postoperative course of patients following open heart surgery |
Muller et al.[4242 Müller AP, Olandoski M, Macedo R, Costantini C, Guarita-Souza LC. Estudo comparativo entre a pressão positiva intermitente (reanimador de Müller) e contínua no pós-operatório de cirurgia de revascularização do miocárdio. Arq Bras Cardiol. 2006;86(3):232-9.], 2006 |
CPAP |
RPPI |
20 / 20 |
61±5.8 / 62.1±7.3 |
16 / 17 |
IG: CPAP to 5 cmH2O and 3 l/m oxygen within 3 hours for 15 minutes every hour, on the 24th and 48thpostoperative for 30 minutes in two 15-minute sets CG: RPPI 20 cmH2O the 30 cmH2O with serum as diluent in the micronebulizer. Within 3 hours for 15 minutes every hour, on the 24th and 48th postoperative for 30 minutes in two 15-minute sets Outcomes: PaO2, PaCO2, dyspnea, ventilometry |
Both devices were shown to be able to keep pO2, pCO2, and SPO2 values within normal limits. However, when the objective was pulmonary reexpansion with less imposed workload, the Müller resuscitator was more effective because of its prompter action and consequently lower levels of dyspnea, respiratory rate (RR) and use of accessory muscle were observed |
Oikkonen et al.[4343 Oikkonen M, Karjalainen K, Kähärä V, Kuosa R, Schavikin L. Comparison of incentive spirometry and intermittent positive pressure breathing after coronary artery bypass graft. Chest. 1991;99(1):60-5.], 1991 |
IS, PE |
RPPI, PE |
26 / 26 |
55±1 / 55±1 |
22 / 22 |
IG: PE with guidance on RVE, VEBH. IS volume with 3 seconds support at least 5 times per training CG: PE with guidance on RVE, VEBH. RPPI with a peak pressure of 10 to 15 cmH2O pressure for not less than 4 daily sessions Outcomes: atelectasis, congestion, pleural effusion, diaphragm elevation, VC, PEF, PaO2, PaCO2
|
Based on the three variables studied, we consider both devices equal in efficiency after coronary surgery |
Renault et al.[4444 Renault JA, Costa-Val R, Rossetti MB, Neto MH. Comparação entre exercícios de respiração profunda e espirometria de incentivo no pós-operatório de cirurgia de revascularização do miocárdio. Rev Bras Cir Cardiovasc. 2009;24(2):165-72.], 2009 |
RVE, VEBH, EM, NIV |
VEBH, EM, IS, NIV |
18 / 18 |
54.8±7.4 / 58.7±9.2 |
13 / 16 |
IG: EM, VEBH, NIV with two pressure levels for 30 minutes twice a day in the ICU and once in the inpatient unit. RVE three sets of ten repetitions CG: EM, VEBH, NIV with two pressure levels for 30 minutes twice a day in the ICU and once in the inpatient unit. IS three sets of ten repetitions with the position of the adjustment ring 0-2, prioritizing slow flows Outcomes: PImax, PEmax, FVC, FEV1, IMV time |
No significant differences were observed in maximal respiratory pressures, spirometric variables and oxygen saturation in patients undergoing deep breathing exercises and incentive spirometry in postoperative coronary artery bypass surgery |
Richter Larsen et al.[4545 Richter Larsen K, Ingwersen U, Thode S, Jakobsen S. Mask physiotherapy in patients after heart surgery: a controlled study. Intensive Care Med. 1995;21(6):469-74.], 1995 |
RVE, VEBH, EM, AM, PE, PEP |
RVE, VEBH, EM, AM, PE, IR, PEP / RVE, VEBH, EM, AM, PE |
Not reported |
Not reported |
Not reported |
IG: Twice a day RVE, VEBH and EM. PEP with 10-15 cmH2O IG: Twice a day RVE, VEBH and EM. IR around 20 cmH2O and PEP of 10-15 cmH2O CG: twice a day RVE, VEBH and EM Outcomes: Atelectasis, FVC, PaO2
|
We did not find any significant difference among the three groups; however, a tendency to decreased risk of having post operative complications was observed in the groups having positive expiratory pressure and inspiratory resistance-positive expiratory pressure |
Romanini et al.[4646 Romanini W, Muller AP, Carvalho KAT, Olandoski M, Faria-Neto JR, Mendes FL, et al. Os efeitos da pressão positiva intermitente e do incentivador respiratório no pós-operatório de revascularização miocárdica. Arq Bras Cardiol. 2007; 89(2):105-10.], 2007 |
RPPI |
IS |
20 / 20 |
56.4±8.8 / 57.1±9.8 |
12 / 16 |
IG: RPPI for ten minutes, five minutes interval and again applied for ten minutes CG: IS volume for ten minutes, five minutes interval and again applied for ten minutes Outcomes: FEV1, Tiffenau index, PImax, PEmax, ventilometry |
In order to reverse hypoxemia earlier, the RPPI was more efficient compared to IS; however, to improve the strength of respiratory muscles, it was more effective |
Savci et al.[4747 Savci S, Degirmenci B, Saglam M, Arikan H, Inal-Ince D, Turan HN, et al. Short-term effects of inspiratory muscle training in coronary artery bypass graft surgery: a randomized controlled trial. Scand Cardiovasc J. 2011;45(5):286-93.], 2011 |
IMT, RVE, VEBH, EM, EULL, AM, LA |
RVE, VEBH, EM, EULL, AM, LA |
22 / 21 |
62.8±8.6 / 57.4±1.4 |
19 / 19 |
IG: IMT twice a day for ten days (five before and five postoperatively), EM, EULL, RVE, VEBH, AM, LA CG: EM, EULL, RVE, VEBH, AM, LA Outcomes: atelectasis, pleural effusion, consolidation, FVC, FEV1, Tifennau index, PImax, PEmax, 6MWD, quality of life |
IMT results in faster recovery of inspiratory muscle strength, functional capacity, intensive care unit stay, quality of life and psychosocial status after CABG |
Savci et al.[4848 Savci S, Sakinç S, Inal-Ince DI, Kuralay E. Active cycle of breathing techniques and incentive spirometer in coronary artery bypass graft surgery. Fizyoterapi Rehabilitasyon. 2006;17(2):61-9.], 2006 |
RVE, VEBH, EM, EULL, AM, CAR |
RVE, VEBH, EM, EULL, AM, IS |
30 / 30 |
55.2±8.5 / 57.2±8.9 |
30 / 30 |
IG: RVE, VEBH, EM, EULL. AM 30 and 80m in the morning and afternoon on the first postoperative day. On the second day, AM for five minutes. On the third day, the walk was free in the hallway. CAR consisted of 1-2 controlled breaths, followed 3 RVE inspiratory pause of 3 seconds, controlled breaths 1-2 VEBH CG: RVE, VEBH, EM, EULL. AM 30 and 80 m in the morning and afternoon on the first postoperative day. On the second day, AM for five minutes. On the third day, the walk was free in the hallway. IS was applied followed by 3 repetitions inspiratory pause of 3 seconds. VEBH 1-2 controlled breaths. By the second day after surgery, two daily sessions and after, once a day, 15 minutes session Outcomes: VC, FVC, FEV1, PEF, 6MWD, atelectasis, congestion, infiltration, pneumothorax, pleural effusion, pulmonary edema, pain |
Both treatments improved arterial oxygenation from the first day of the postoperative period. After a 5-day treatment, functional capacity was well preserved with the usage of CAR or IS Both physiotherapy methods had similar effects on the rate of atelectasis, pulmonary function, and pain perception |
Stein et al.[4949 Stein R, Maia CP, Silveira AD, Chiappa GR, Myers J, Ribeiro JP. Inspiratory muscle strength as a determinant of functional capacity early after coronary artery bypass graft surgery. Arch Phys Med Rehabil. 2009;90(10):1685-91.], 2009 |
Medical consultation and nursing , RVE, VEBH, EE, EULL, AM, LA, PE, PEP |
PE, medical consultation and nursing |
10 / 10 |
64±7 / 63±6 |
6 / 5 |
IG: Medical consultation and nursing, PE, VEBH, RVE, EE, EULL, AM, LA, PEP with progressive pressure 3-8 cmH2O for 3-12 minutes CG: PE, medical visits and nursing Outcomes: FVC, FEV1, PImax, PEmax, SMWT, dyspnea, IMV time |
A 6-day rehabilitation program attenuated the postoperative reduction in respiratory muscle strength and also improved the recovery of functional capacity after CABG. The correlation between PImax and VO2 peak during the late postoperative period suggests that inspiratory muscle strength is an important determinant of functional capacity after CABG |
Stiller et al.[5050 Stiller K, Montarello J, Wallace M, Daff M, Grant R, Jenkins S, et al. Efficacy of breathing and coughing exercises in the prevention of pulmonary complications after coronary artery surgery. Chest. 1994;105(3):741-7.], 1994 |
PE and RVE, VEBH, TM, PD (twice a day) |
PE and RVE, VEBH, TM, PD (four times a day) / NPI |
40 / 40 / 40 |
61±9 / 63±8 / 62±11 |
33 / 32 / 33 |
IG: PE, RVE, VEBH (2x / day for the first two days of PO and e 1x / day 3 and 4 PO. 3-5 EVR followed 2-3 HB (also independently every hour). If necessary TM and PD IG: PE, RVE, VEBH (4x / day for the first 2 days of PO and 2x / day 3 and 4 PO. 3-5 RVE followed 2-3 VEBH (also independently every hour) if necessary TM and PD CG: No physical therapy intervention in the pre- or postoperative period Outcomes: FVC, days of hospitalization, IMV time, PaO2, PaCO2, oxygenation index |
The necessity for prophylactic chest physiotherapy after routine coronary artery surgery should be reviewed |
Sulzer et al.[5151 Sulzer CF, Chioléro R, Chassot PG, Mueller XM, Revelly JP. Adaptive support ventilation for fast tracheal extubation after cardiac surgery: a randomized controlled study. Anesthesiology. 2001;95(6):1339-45.], 2001 |
WP with SA |
WP with SIMV |
16 / 20 |
59.2±8.7 / 59.7±8.1 |
12 / 14 |
IG: WP with SA 100% of minute ventilation, 100% FiO2, 4 cmH2O PEEP, peak pressure 25 cmH2O and sensitivity 2l / min CG: WP with SIMV, tidal volume of 7 ml / kg, decelerating flow, respiratory rate of 12, 100% FiO2, PEEP 4 cmH2O, sensitivity 2l / min Outcomes: days of ICU, IMV time, PaO2, oxygenation index |
A respiratory weaning protocol based on SA is practicable; it may accelerate tracheal extubation and simplify ventilatory management in fast-track patients after cardiac surgery. The evaluation of potential advantages of the use of such technology on patient outcome and resource utilization deserves further studies |
Thomas et al.[5252 Thomas AN, Ryan JP, Doran BR, Pollard BJ. Nasal CPAP after coronary artery surgery. Anaesthesia. 1992;47(4):316-9.], 1992 |
Nasal CPAP |
Oxygen by mask |
14 / 14 |
59±4 / 55±10 |
14 / 14 |
IG: on the first day after surgery, 60 minutes of nasal CPAP with 5 cmH2O pressure CG: use of facial mask for oxygen therapy Outcomes: pain, pulmonary shunt, cardiac index |
We conclude that the use of nasal CPAP is a simple, tolerable and effective method of treating hypoxemia in adult patients after coronary artery bypass surgery and warrants further study |
Westerdahl et al.[5353 Westerdahl E, Lindmark B, Almgren SO, Tenling A. Chest physiotherapy after coronary artery bypass graft surgery: a comparison of three different deep breathing techniques. J Rehabil Med. 2001;33(2):79-84.], 2001 |
RVE, VEBH, EM, EULL, AM, blow bottle |
RVE, VEBH, EM, EULL, AM, RI and PEP / RVE, VEBH, EM, EULL, AM |
36 / 30 / 32 |
66±9.4 / 65.9±8.8 / 63.5±9.2 |
36 / 30 / 32 |
IG: EM, EULL, VEBH, AM. RVE in blow bottle , with 10 cm of water and plastic tube with 40 cm long and 1 cm in diameter, generating an expiratory resistance of 10 (± 1) cmH2O. 30 replicates were performed for RVE every hour during the day IG: EM, EULL, VEBH, AM. RVE through a face mask connected to a T tube with PEP 10 cmH2O and RI -5cmH2O. Thirty replicates were performed for RVE every hour during the day CG: EM, EULL, VEBH, AM and RVE without any device. Thirty replicates were performed for RVE every hour during the day Outcomes: VC, inspiratory capacity, FEV1, RV, TLC, diffusing capacity , pain, atelectasis, pleural effusion |
No major differences among the treatment groups were found, but the impairment in pulmonary function tended to be less marked using the blow bottle technique. The blow bottle group had signicantly less reduction in total lung capacity compared to the deep breathing group, while the IR-PEP group did not signi. cantly differ from the other two groups. |
Westerdahl et al.[5454 Westerdahl E, Lindmark B, Eriksson T, Friberg O, Hedenstierna G, Tenling A. Deep-breathing exercises reduce atelectasis and improve pulmonary function after coronary artery bypass surgery. Chest. 2005;128(5):3482-8.], 2005 |
VEBH, EM, AM, PE |
RVE, VEBH, EM, AM, PE, blow bottle |
48 / 42 |
66±9 / 65±9 |
36 / 31 |
IG: care given once or twice daily for the first four days. EM, VEBH, PE and AM CG: PE, EM, VEBH, AM. Three sets of 10 repetitions of RVE were carried through every hour during the day, in the first four days. RVE in the blow bottle, with 10 cm of water and plastic tube with 50 cm long and 1 cm in diameter, generating an expiratory resistance 10 cmH2O Outcomes: VC, FVC, FEV1, inspiratory capacity, residual functional capacity, TLC, atelectasis, PaO2, PaCO2, pain, IMV time |
Patients performing deep-breathing exercises after CABG surgery had significantly smaller atelectatic areas and better pulmonary function on the fourth postoperative day compared to a control group performing no exercises |
Westerdahl et al.[5555 Westerdahl E, Lindmark B, Eriksson T, Hedenstierna G, Tenling. The immediate effects of deep breathing exercises on atelectasis and oxygenation after cardiac surgery. Scand Cardiovasc J. 2003;37(6):363-7.], 2003 |
RVE |
RVE, blow bottle/RVE, RI and PEP |
21 / 20 / 20 |
66±9 / 64±8 / 64±10 |
18 / 16 / 15 |
IG: three sets of 10 repetitions of RVE without any device IG: three sets of 10 repetitions of RVE in the blow bottle, with 10 cm of water and plastic tube with 50 cm long and 1 cm in diameter, generating an RE 10 cmH2O CG: three sets of 10 repetitions of RVE through a face mask connected to a T tube with PEP 15 cmH2O and RI -5 cmH2OOutcomes: atelectasis, PaO2, PaCO2, IMV time |
A significant decrease of atelectatic area,increase in aerated lung area and a small increase in PaO2 were found after performance of 30 deep breaths.No difference among the three breathing techniques was found |