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Cordeiro ALL, Almeida LC, Leite JFDS, Barbosa HDCM, Guimarães ARF, Forgiarini LA, Cena J, Petto J. Ventilatory Muscle Strength Six Months After Coronary Artery Bypass Grafting in Patients Submitted to Inspiratory Muscular Training Based on Anaerobioc Threshold: A Clinical Trial. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2023. [DOI: 10.36660/ijcs.20210238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
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Baris O, Findik O, Argun Baris S, Benli ED, Duzyol C, Tekeli Kunt A. Multidimensional Evaluation of Pulmonary Function and Exercise Capacity by BODE Index in Patients with On-Pump Coronary Artery Bypass Grafting. Am J Cardiol 2021; 150:55-59. [PMID: 34006373 DOI: 10.1016/j.amjcard.2021.03.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/20/2021] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
Coronary artery bypass grafting (CABG) often causes physiological changes in patients. Although functional changes, such as lung function and exercise capacity changes, are observed in patients, there are no detailed studies examining this. The aim was to compare preoperative and postoperative pulmonary function and exercise capacity in patients undergoing on-pump CABG with a multidimensional index (BODE index). Demographic and surgical characteristics of patients were recorded. Pulmonary function test, six-minute walk test (6MWT), and modified Medical Research Council (mMRC) dyspnea score were assessed and BODE index were calculated in preoperative and at six months postoperatively. A total of 75 patients were included with a mean ± standard deviation age of 59.8±10.0 years. The male to female ratio was 57/18. There was a statistically significant decrease in the forced expiratory flow at 25-75% (FEF25-75%) value after CABG. Other pulmonary function test values were also lower in the postoperative period compared to the preoperative period, but these changes were not significant. The mean distance achieved in the 6MWT (p=0.02) and the mMRC dyspnea score (p=0.001) were significantly better postoperatively. The BODE index, which combines these parameters, had increased in the postoperative period. Age (OR 1.09; 95% CI: 1.008-1.181) and postoperative FEF25-75% (OR -0.96; 95% CI: 0.938-0.988) were the independent predictors of BODE score ≥3 in multivariate analysis. Despite the decrease in pulmonary function in patients undergoing CABG, there was an improvement in exercise capacity and dyspnea score.
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Amabile A, Geirsson A. Type A aortic dissection in the elderly: One additional reason to pursue healthy ageing. J Card Surg 2021; 36:2765-2766. [PMID: 33974292 DOI: 10.1111/jocs.15616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Andrea Amabile
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Arnar Geirsson
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
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Roncada G. Osteopathic treatment leads to significantly greater reductions in chronic thoracic pain after CABG surgery: A randomised controlled trial. J Bodyw Mov Ther 2020; 24:202-211. [PMID: 32825989 DOI: 10.1016/j.jbmt.2020.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 06/30/2019] [Accepted: 03/08/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND There are a number of long-term postoperative complications after coronary artery bypass graft (CABG) surgery. Pulmonary function is decreased by 12% and 30%-50% of the patients have chronic thoracic pain. METHODS This randomised controlled trial with two parallel groups aimed to explore the effectiveness of osteopathic treatments (OTs) on these conditions. The standard care (SC) group and the and OT group received a 12-week standard cardiac rehabilitation programme, which was supplemented with four OTs for the OT group only. The outcome assessors were blinded to the patients' allocation. RESULTS Eighty-two patients with median sternotomy after CABG surgery were randomly allocated in a 1:1 ratio (SC: n = 42, OT: n = 42). Slow vital capacity and pain intensity were measured at baseline and at 12 weeks and 52 weeks after surgery. Pain intensity was significantly lower in the OT group 12 weeks after surgery (3.6-0.80 vs. 2.6 to 1.2, p = 0.030). One year after surgery, there still was a significantly lower pain intensity in the OT group (3.6-0.56, vs. 2.6 to 1.2, p = 0.014). No significant changes between groups were found in pulmonary function. There were no adverse events reported. CONCLUSIONS From this study, it can be concluded that the addition of OT to exercise-based cardiac rehabilitation may lead to significantly greater reductions in thoracic pain after CABG surgery. TRIAL REGISTRATION This study was registered on ClinicalTrials.gov (NCT01714791).
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Affiliation(s)
- Gert Roncada
- Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium; Commission for Osteopathic Research, Practice and Promotion, Mechelen, Belgium.
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Thoracic mobility and its relation to pulmonary function and rib-cage deformity in patients with early onset idiopathic scoliosis: a long-term follow-up. Spine Deform 2020; 8:257-268. [PMID: 32077084 DOI: 10.1007/s43390-019-00018-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 08/11/2019] [Indexed: 10/25/2022]
Abstract
STUDY DESIGN A group of adult patients with idiopathic scoliosis, diagnosed before the age of ten, at a mean of 26.5 years after treatment with either brace or surgery during childhood and adolescence attended a clinical follow-up. OBJECTIVES To evaluate the relation between thoracic mobility, rib-cage deformity, and pulmonary function. Long-term studies of pulmonary function in relation to thoracic mobility after treatment in this patient group have not been published. METHODS A total of 106 patients, 57 braced and 49 operated patients, attended the follow-up. We examined thoracic mobility (range of motion of the thoracic spine, thorax expansion, and breathing movements) and rib-cage deformity (curve size and trunk deformity) as well as pulmonary function, especially total lung capacity (TLC). Respiratory muscle strength was evaluated in a subgroup. RESULTS Thoracic range of motion was significantly less among the surgically treated patients compared with both the brace-treated and comparison group. Thorax expansion and breathing movements during maximal breathing were significantly reduced in the scoliotic patients compared with the reference values, with no significant differences between the treatment groups. The brace-treated group had better pulmonary function than the operated group, as measured by the TLC, forced vital capacity (FVC), and forced expiratory volume in one second (FEV1) (percentage of predicted values). The respiratory muscle strength was significantly lower only in the surgically treated patients when compared with reference values. The results of a multivariate analysis revealed that the strongest factors explaining TLC percentage of predicted were gender, brace model, and smoking habits. CONCLUSIONS Thoracic mobility was significantly reduced at mean 26.5 years after completed treatment in both brace-treated and surgically treated patients with early onset scoliosis, compared with the reference values, which did not influence TLC as strongly as gender, brace model, and smoking habits. LEVELS OF EVIDENCE Level III.
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Tukanova K, Papi E, Jamel S, Hanna GB, McGregor AH, Markar SR. Assessment of chest wall movement following thoracotomy: a systematic review. J Thorac Dis 2020; 12:1031-1040. [PMID: 32274172 PMCID: PMC7139064 DOI: 10.21037/jtd.2019.12.93] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Thoracotomy is a major cause of respiratory impairment, increasing the risk of postoperative pulmonary complications (PPC). Systems assessing ribcage kinematics may detect changes in chest expansion following thoracotomy and may thus aid in the development of patient-tailored chest physiotherapy. Hence, we aimed to identify studies assessing changes in chest wall movement following thoracotomy using objective measures. The Cochrane library, MEDLINE, EMBASE, Scopus and Web of Science databases were searched to find relevant articles providing an objective assessment of chest wall movement following thoracotomy. Methodological quality of included studies concerning chest wall movement following thoracotomy was assessed by use of QUADAS-2 tool. A total of 12 articles were included for the assessment of chest wall changes following thoracotomy using objective measures. Four studies measured changes in the cross-sectional area of the ribcage and abdomen using the respiratory inductive plethysmography (RIP), 1 study computed the chest wall compliance by monitoring the intra-pleural pressure, 3 studies measured changes in chest circumference with a simple tape measure and 4 articles performed a compartmental analysis of the chest wall volume by means of an optoelectronic plethysmography (OEP). There was no delay in the collection of data of the index test and reference standard, resulting in a low risk of bias for the flow and timing domain. Across all studies, participants underwent the same reference standard, resulting in a low risk of verification bias. Several objective measures were able to detect changes in chest wall displacement following thoracotomy and differed in the practical use and invasive nature. OEP allows a compartmental analysis of the chest wall volume. Hence, this system allows to assess chest wall movement changes following thoracotomy and the impact of different types of surgical approach. Furthermore, it could aid in the development of tailored physiotherapy.
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Affiliation(s)
- Karina Tukanova
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Enrica Papi
- Department of Surgery and Cancer, Imperial College London, London, UK.,Department of Bioengineering, Imperial College London, London, UK
| | - Sara Jamel
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - George B Hanna
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Alison H McGregor
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sheraz R Markar
- Department of Surgery and Cancer, Imperial College London, London, UK
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Effects of Different Rehabilitation Protocols in Inpatient Cardiac Rehabilitation After Coronary Artery Bypass Graft Surgery. J Cardiopulm Rehabil Prev 2019; 39:E19-E25. [DOI: 10.1097/hcr.0000000000000431] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Carlsson M, Berthelsen O, Fagevik Olsén M. Effects of a prolonged intervention of breathing exercises after cardiac surgery - a randomised controlled trial. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2019. [DOI: 10.1080/21679169.2018.1531923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Maria Carlsson
- Department of Physical Therapy, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Physiotherapy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Ole Berthelsen
- Department of Physical Therapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Monika Fagevik Olsén
- Department of Physical Therapy, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Physiotherapy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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Fjerbaek A, Westerdahl E, Andreasen JJ, Thomsen LP, Brocki BC. Change of position from a supine to a sitting position increases pulmonary function early after cardiac surgery. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2019. [DOI: 10.1080/21679169.2019.1617778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Annette Fjerbaek
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark
| | - Elisabeth Westerdahl
- Department of Physiotherapy, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Jan J Andreasen
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Lars P. Thomsen
- Faculty of Medicine and Health, Respiratory and Critical Care Group (rcare), Aalborg University, Aalborg, Denmark
| | - Barbara C. Brocki
- Department of Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark
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Abstract
BACKGROUND A transannular patch is often used in the contemporary surgical repair of tetralogy of Fallot. This can lead to significant pulmonary insufficiency and increased right ventricular volumes and ultimately pulmonary valve replacement. Cardiopulmonary exercise testing is used to assess exercise capacity in tetralogy of Fallot patients before pulmonary valve replacement. There is only few published literatures on how lung function affects functional capacity in tetralogy of Fallot patients repaired with a transannular patch. METHODS A retrospective chart review was done from 2015 to 2017 on patients with tetralogy of Fallot who underwent maximal effort cardiopulmonary exercise testing with cycle ergometry and with concurrent pulmonary function testing. Tetralogy of Fallot patients repaired with a transannular patch without pulmonary valve replacement were compared with age, gender, and size-matched normal controls. RESULTS In the tetralogy of Fallot group, 24 out of 57 patients underwent primary repair with a transannular patch. When compared to the normal controls, they demonstrated abnormal predicted forced expiratory volume in one second (79 ± 23.1% versus 90.7 ± 14.1%, p<0.05), predicted maximal voluntary ventilation (74 ± 18% versus 90.5 ± 16.2%, p<0.05) while having low-normal predicted forced vital capacity (80.5 ± 17.2% versus 90.2 ± 12.4%, p<0.05) and normal breathing reserve percentage (50.3 ± 11.3% versus 47.5 ± 17.3%, p = 0.52). Cardiopulmonary exercise testing abnormalities included significantly lower percent predicted oxygen consumption (63.2 ± 12.2% versus 87 ± 12.1%, p<0.05), maximal heart rate (171.8 ± 18.9 versus 184.6 ± 13.6, p<0.05), and percent predicted maximum workload (61.7 ± 15.9% versus 88.3 ± 21.5%, p<0.05). CONCLUSIONS Tetralogy of Fallot patients repaired with a transannular patch can have abnormal pulmonary function testing with poor exercise capacity in addition to chronotropic incompetence and impaired muscular power.
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Dos Santos TD, Pereira SN, Portela LOC, Cardoso DM, Lago PD, Dos Santos Guarda N, Moresco RN, Pereira MB, de Albuquerque IM. Moderate-to-high intensity inspiratory muscle training improves the effects of combined training on exercise capacity in patients after coronary artery bypass graft surgery: A randomized clinical trial. Int J Cardiol 2018; 279:40-46. [PMID: 30581100 DOI: 10.1016/j.ijcard.2018.12.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 11/22/2018] [Accepted: 12/04/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND The effects of adding moderate-to-high intensity inspiratory muscle training (IMT) to short-term aerobic and resistance exercise (combined training [CT]), after coronary artery bypass grafting (CABG) are not established. This study aimed to determine the effects of moderate-to-high intensity IMT + CT on exercise capacity, respiratory muscle strength, inspiratory muscle endurance, quality of life (QoL), and laboratory biomarkers in patients after CABG who were participants of a phase II cardiac rehabilitation program. METHODS Twenty-four patients were randomly assigned to either the IMT + CT group (n = 12), who performed moderate-to-high intensity IMT with CT or the sham-IMT + CT group (n = 12). Patients completed two sessions per week for 12 weeks. Each patient underwent a cardiopulmonary exercise test, six-minute walk test (6MWT), respiratory muscle strength and endurance evaluation, QoL questionnaire, and serum advanced oxidation protein products, ferric reducing antioxidant power [FRAP], nitrate/nitrate, and high-sensitivity C-reactive protein, before and after the 12-week intervention. RESULTS The IMT + CT group showed significantly greater improvements in peak oxygen uptake (1.3 mL∙kg-1∙min-1; 95% confidence interval [95% CI], 0.5 to 2.2), distance covered during the 6MWT (78.8 m; 95% CI, 28.1 to 129.5), maximal inspiratory pressure (23.0 cmH2O; 95% CI, 9.3 to 36.7), QoL (-15.1 points; 95% CI, -26.9 to -3.3), and FRAP (83.7 μmol/L; 95% CI, 20.2 to 147.1) compared to the sham-IMT + CT group as a result of the intervention. CONCLUSIONS Short-term moderate-to-high intensity IMT with CT provided additional benefits in exercise capacity, inspiratory muscle strength, QoL, and antioxidant profile in patients after CABG. Trial Registration clinicaltrials.gov Identifier: NCT02885077.
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Affiliation(s)
- Tamires Daros Dos Santos
- Functional Rehabilitation Graduate Program, Department of Physiotherapy and Rehabilitation, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
| | - Sergio Nunes Pereira
- Cardiology Service of Hospital Universitário de Santa Maria (HUSM), Empresa Brasileira de Serviços Hospitalares (EBSERH), Santa Maria, Rio Grande do Sul, Brazil
| | - Luiz Osório Cruz Portela
- Laboratory of Performance in Simulated Environment, Department of Collective Sports, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
| | - Dannuey Machado Cardoso
- Pneumological Sciences Graduate Program, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Pedro Dal Lago
- Research Group on Cardiopulmonary Interaction (GPIC), Health Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil
| | - Naiara Dos Santos Guarda
- Laboratory of Clinical Biochemistry, Department of Clinical and Toxicological Analysis, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
| | - Rafael Noal Moresco
- Laboratory of Clinical Biochemistry, Department of Clinical and Toxicological Analysis, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
| | - Marisa Bastos Pereira
- Functional Rehabilitation Graduate Program, Department of Physiotherapy and Rehabilitation, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil; Hospital Universitário de Santa Maria (HUSM), Empresa Brasileira de Serviços Hospitalares (EBSERH), Santa Maria, Rio Grande do Sul, Brazil
| | - Isabella Martins de Albuquerque
- Functional Rehabilitation Graduate Program, Department of Physiotherapy and Rehabilitation, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil.
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Tamura K, Maruyama T, Sakurai S. Usefulness of sternal closure with bioresorbable plate in respiratory function after coronary artery bypass grafting. Gen Thorac Cardiovasc Surg 2018; 67:277-282. [PMID: 30206774 DOI: 10.1007/s11748-018-1010-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 09/06/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of our study is to investigate that sternal reconstruction using bioresorbable plate in median sternotomy may reduce postoperative respiratory dysfunction when compared with wire cerclage only. METHODS We reviewed 107 patients who were undergone coronary artery bypass grafting with median sternotomy. Patients were divided into two groups; patients underwent sternal reconstruction with bioresorbable plate and wire cerclage (S group, n = 56), patients with wire cerclage only (N group, n = 51), and perioperative respiratory function and postoperative pain score data were analyzed and compared between two groups. RESULTS There was no significantly difference in preoperative respiratory function in both groups. However, in postoperative change rate of respiratory function, N group had significant decrease compared with S group in vital capacity (VC) (N: S = 74.8 ± 12.4: 85.2 ± 14.8%, p = 0.020), VC as a percentage of predicated VC (N: S = 75.0 ± 12.5: 86.4 ± 15.1%, p = 0.012), and forced expiratory volume in the first second (N: S = 73.7 ± 9.2: 85.3 ± 16.4%, p = 0.012). In Prince Henry Pain Scale, there were significantly more in N group compared with S group (N: S = 3.4 ± 1.0: 2.6 ± 1.4, p = 0.003). CONCLUSION Sternal fixation with bioresorbable plate could reduce impairment of postoperative respiratory function in comparison to wire cerclage only.
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Affiliation(s)
- Kiyoshi Tamura
- Department of Cardiovascular Surgery, Soka Municipal Hospital, 2-21-1 Soka, Soka, Saitama, 340-8560, Japan.
| | - Toshiyuki Maruyama
- Department of Cardiovascular Surgery, Soka Municipal Hospital, 2-21-1 Soka, Soka, Saitama, 340-8560, Japan
| | - Syogo Sakurai
- Department of Cardiovascular Surgery, Soka Municipal Hospital, 2-21-1 Soka, Soka, Saitama, 340-8560, Japan
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Andresdottir GT, Hjaltason H, Ragnarsdottir M. Irregular amplitude and frequency of respiratory movements in hemispheric stroke. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2017. [DOI: 10.1080/21679169.2016.1261367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Haukur Hjaltason
- Department of Neurology, Landspitali University Hospital, Reykjavik, Iceland
| | - Maria Ragnarsdottir
- Department of Physiotherapy, Landspitali University Hospital, Reykjavik, Iceland
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Roncada G. Effects of osteopathic treatment on pulmonary function and chronic thoracic pain after coronary artery bypass graft surgery (OstinCaRe): study protocol for a randomised controlled trial. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 16:482. [PMID: 27884147 PMCID: PMC5123325 DOI: 10.1186/s12906-016-1468-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 11/19/2016] [Indexed: 01/14/2023]
Abstract
Background Coronary artery bypass graft surgery (CABG) is an effective and widespread coronary revascularisation technique, nevertheless there are a number of long-term postoperative complications from which patients can suffer. One year after CABG surgery pulmonary function is decreased by 12% and 30% of the patients suffer from chronic thoracic pain. To date and to our knowledge there are no effective treatments for these conditions. The aim of the present clinical trial is to explore the effectiveness of osteopathic treatment on these conditions. Methods The study is designed as a randomised controlled trial with two parallel groups. Group A will receive a standard cardiac rehabilitation programme during 12 weeks and group B will receive the same standard cardiac rehabilitation programme supplemented with four osteopathic treatments (OT). OT will be performed at week 4, 5, 8 and 12 after surgery. Three hundred and eight patients (Group A: n = 154, Group B: n = 154) will be enrolled from the cardiothoracic surgery department of the Jessa Hospital Hasselt. Blinding will be assured for the staff of the cardiac rehabilitation centre and outcome assessors. Primary outcome measure will be the mean difference in change from baseline in slow vital capacity (SVC) at 12 weeks after surgery between groups. Secondary outcome measures will be the change from baseline in quality of life, pain, thoracic stiffness and maximal aerobic capacity at 12 weeks after surgery. A follow-up is planned 52 weeks after surgery for SVC, quality of life, pain and thoracic stiffness. Intention to treat analysis will be executed. Discussion The OstinCare study has been designed to explore the potential long-term added value of osteopathic treatment in the management of decreased pulmonary function, chronic thoracic pain and diminished thoracic mobility after CABG surgery. Trial registration The protocol has been retrospectively registered on ClinicalTrials.gov (NCT01714791).
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Caruso FCR, Simões RP, Reis MS, Guizilini S, Alves VLDS, Papa V, Arena R, Borghi-Silva A. High-Intensity Inspiratory Protocol Increases Heart Rate Variability in Myocardial Revascularization Patients. Braz J Cardiovasc Surg 2016; 31:38-44. [PMID: 27074273 PMCID: PMC5062699 DOI: 10.5935/1678-9741.20160007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 02/05/2016] [Indexed: 11/20/2022] Open
Abstract
Objective: To evaluate heart rate variability during an inspiratory muscle endurance
protocol at three different load levels [30%, 60% and 80% of maximal
inspiratory pressure], in patients who had previously undergone
coronary artery bypass grafting. Methods: Nineteen late postoperative myocardial revascularization patients
participating in a cardiovascular rehabilitation program were studied.
Maximal inspiratory pressure maneuvers were performed. An inspiratory muscle
endurance protocol at 30%, 60% and 80% of maximal inspiratory pressure was
applied for four minutes each, in random order. Heart rate and RR intervals
were recorded and heart rate variability was analyzed by time (RMSSD-the
mean of the standard deviations for all R-R intervals, and RMSM-root-mean
square differences of successive R-R intervals) and frequency domains
indices (high and low frequency) in normalized units. ANOVA for repeated
measurements was used to compare heart rate variability indices and Student
t-test was used to compare the maximal inspiratory pressure and maximal
expiratory pressure values. Results: Heart rate increased during performance of maximal respiratory pressures
maneuvers, and the maximal inspiratory pressure and maximal expiratory
pressure mean values were significantly lower than predicted values
(P<0.05). RMSSD increased significantly at 80% in
relation to rest and 30% of maximal inspiratory pressure and RMSM decreased
at 30% and 60% of maximal inspiratory pressure in relation to rest
(P<0.05). Additionally, there was significant and
progressive decrease in low frequency and increase in high frequency at 30%,
60% and 80% of maximal inspiratory pressure in relation to the resting
condition. Conclusion: These results suggest that respiratory muscle training at high intensities
can promote greater parasympathetic activity and it may confer important
benefits during a rehabilitation program in post-coronary artery bypass
grafting.
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Affiliation(s)
| | - Rodrigo Polaquini Simões
- Laboratory of Cardiopulmonary Physiotherapy, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Michel Silva Reis
- Department of Physiotherapy, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Solange Guizilini
- Department of Sciences of Human Movement, Federal University of São Paulo, Santos, SP, Brazil
| | | | - Valeria Papa
- Hospital São Francisco of Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Ross Arena
- Department of Physical Therapy and Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Audrey Borghi-Silva
- Laboratory of Cardiopulmonary Physiotherapy, Federal University of São Carlos, São Carlos, SP, Brazil
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Monitoring of Heart and Breathing Rates Using Dual Cameras on a Smartphone. PLoS One 2016; 11:e0151013. [PMID: 26963390 PMCID: PMC4786286 DOI: 10.1371/journal.pone.0151013] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 02/23/2016] [Indexed: 11/19/2022] Open
Abstract
Some smartphones have the capability to process video streams from both the front- and rear-facing cameras simultaneously. This paper proposes a new monitoring method for simultaneous estimation of heart and breathing rates using dual cameras of a smartphone. The proposed approach estimates heart rates using a rear-facing camera, while at the same time breathing rates are estimated using a non-contact front-facing camera. For heart rate estimation, a simple application protocol is used to analyze the varying color signals of a fingertip placed in contact with the rear camera. The breathing rate is estimated from non-contact video recordings from both chest and abdominal motions. Reference breathing rates were measured by a respiration belt placed around the chest and abdomen of a subject; reference heart rates (HR) were determined using the standard electrocardiogram. An automated selection of either the chest or abdominal video signal was determined by choosing the signal with a greater autocorrelation value. The breathing rate was then determined by selecting the dominant peak in the power spectrum. To evaluate the performance of the proposed methods, data were collected from 11 healthy subjects. The breathing ranges spanned both low and high frequencies (6-60 breaths/min), and the results show that the average median errors from the reflectance imaging on the chest and the abdominal walls based on choosing the maximum spectral peak were 1.43% and 1.62%, respectively. Similarly, HR estimates were also found to be accurate.
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Johansson EL, Ternestén-Hasseus E, Olsén MF, Millqvist E. Physical Therapy Treatment of Impaired Chest Mobility in Patients with Airway Sensory Hyperreactivity. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2016; 22. [PMID: 26847527 DOI: 10.1002/pri.1658] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 03/23/2015] [Accepted: 08/14/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND PURPOSE In sensory hyperreactivity (SHR), patients have symptoms from the airways and the chest induced by environmental irritants like scenting products and cigarette smoke. They are characterized by increased cough reaction to inhaled capsaicin compared with healthy controls. Lung function tests are normal, and asthma medications have no or little effect. In a recent published article, patients with SHR were found to have impaired chest mobility and increased pain sensitivity. The purpose of this study was to evaluate if a physiotherapeutic intervention can increase chest mobility in SHR, influence these patients' symptoms and reduce capsaicin cough sensitivity. METHODS Forty-one SHR patients were initially randomized in to groups, one for training and one for symptom registration in this controlled training study. It consisted of a daily training programme containing simple movements to increase the flexibility of the chest, a breathing exercise and a relaxation session as well as symptom registration. Chest expansion was measured with a measuring tape and thoracic and abdominal movement with light sensors. Pain sensitivity was assessed using pressure algometry and a standardized capsaicin inhalation threshold provocation-evaluated cough sensitivity. RESULTS Twenty seven patients were left for analyses after 12 weeks and 26 patients after 24 weeks. Chest mobility and upper thoracic respiratory movements improved (p < 0.01), feeling of chest pressure and the capsaicin cough sensitivity decreased (p < 0.01). The patients also showed of significantly lowered pain pressure thresholds measured with algometry, compared with healthy controls (p < 0.001). CONCLUSION Improvement of chest mobility after physiotherapeutic intervention indicates that these patients may have acquired a dysfunctional breathing pattern. The regular use of a training programme and structural breathing instructions can be used to improve chest mobility, chest symptoms and capsaicin cough sensitivity in patients with SHR and signs of dysfunctional breathing. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Ewa-Lena Johansson
- Departments of Physiotherapy and Occupational Therapy, Sahlgrenska University Hospital/Sahlgrenska, Gothenburg, Sweden
| | - Ewa Ternestén-Hasseus
- Department of Internal Medicine/Respiratory Medicine and Allergology, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Monika Fagevik Olsén
- Departments of Physiotherapy and Occupational Therapy, Sahlgrenska University Hospital/Sahlgrenska, Gothenburg, Sweden
| | - Eva Millqvist
- Department of Internal Medicine/Respiratory Medicine and Allergology, the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Bottio T, Bejko J, Guariento A, Tarzia V, Pittarello D, Gerosa G. Bilateral mini-thoracotomy off-pump Jarvik 2000 implantation in regional asymmetric paravertebral analgesia. J Cardiovasc Med (Hagerstown) 2016; 17:160-4. [DOI: 10.2459/jcm.0000000000000191] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Hagman C, Janson C, Malinovschi A, Hedenström H, Emtner M. Measuring breathing patterns and respiratory movements with the respiratory movement measuring instrument. Clin Physiol Funct Imaging 2015; 36:414-20. [DOI: 10.1111/cpf.12302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 08/04/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Carina Hagman
- Center for Clinical Research Dalarna; Falun Sweden
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research; Uppsala University; Uppsala Sweden
- Department of Neuroscience, Physiotherapy; Uppsala University; Uppsala Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research; Uppsala University; Uppsala Sweden
| | - Andrei Malinovschi
- Department of Medical Sciences, Clinical Physiology; Uppsala University; Uppsala Sweden
| | - Hans Hedenström
- Department of Medical Sciences, Clinical Physiology; Uppsala University; Uppsala Sweden
| | - Margareta Emtner
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research; Uppsala University; Uppsala Sweden
- Department of Neuroscience, Physiotherapy; Uppsala University; Uppsala Sweden
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Early feasibility testing and engineering development of a sutureless beating heart connector for left ventricular assist devices. ASAIO J 2015; 60:617-25. [PMID: 25238500 DOI: 10.1097/mat.0000000000000134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
APK Advanced Medical Technologies (Atlanta, GA) is developing a sutureless beating heart (SBH) left ventricular assist device (LVAD) connector system consisting of anchoring titanium coil, titanium cannula with integrated silicone hemostatic valve, coring and delivery tool, and LVAD locking mechanism to facilitate LVAD inflow surgical procedures. Feasibility testing was completed in human cadavers (n = 4) under simulated normal and hypertensive conditions using saline to observe seal quality in degraded human tissue and assess anatomic fit; acutely in ischemic heart failure bovine model (n = 2) to investigate short-term performance and ease of use; and chronically for 30 days in healthy calves (n = 2) implanted with HeartWare HVAD to evaluate performance and biocompatibility. Complete hemostasis was achieved in human cadavers and animals at LV pressures up to 170 mm Hg. In animals, off-pump (no cardiopulmonary bypass) anchoring of the connector was accomplished in less than 1 minute with no residual bleeding after full delivery and locking of the LVAD; and implant of connector and LVAD were successfully completed in under 10 minutes with total procedure blood loss less than 100 ml. In chronic animals before necropsy, no signs of leakage or disruption at the attachment site were observed at systolic LV pressures >200 mm Hg.
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Ubben JF, Lance MD, Buhre WF, Schreiber JU. Clinical Strategies to Prevent Pulmonary Complications in Cardiac Surgery: An Overview. J Cardiothorac Vasc Anesth 2015; 29:481-90. [DOI: 10.1053/j.jvca.2014.09.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Indexed: 11/11/2022]
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Monitoring of regional lung ventilation using electrical impedance tomography after cardiac surgery in infants and children. Pediatr Cardiol 2014; 35:990-7. [PMID: 24569885 DOI: 10.1007/s00246-014-0886-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 02/06/2014] [Indexed: 02/05/2023]
Abstract
Electrical impedance tomography (EIT) is a noninvasive method to monitor regional lung ventilation in infants and children without using radiation. The objective of this prospective study was to determine the value of EIT as an additional monitoring tool to assess regional lung ventilation after pediatric cardiac surgery for congenital heart disease in infants and children. EIT monitoring was performed in a prospective study comprising 30 pediatric patients who were mechanically ventilated after cardiac surgery. Data were analyzed off-line with respect to regional lung ventilation in different clinical situations. EIT data were correlated with respirator settings and arterial carbon dioxide (CO2) partial pressure in the blood. In 29 of 30 patients, regional ventilation of the lung could sufficiently and reliably be monitored by means of EIT. The effects of the transition from mechanical ventilation to spontaneous breathing after extubation on regional lung ventilation were studied. After extubation, a significant decrease of relative impedance changes was evident. In addition, a negative correlation of arterial CO2 partial pressure and relative impedance changes could be shown. EIT was sufficient to discriminate differences of regional lung ventilation in children and adolescents after cardiac surgery. EIT reliably provided additional information on regional lung ventilation in children after cardiac surgery. Neither chest tubes nor pacemaker wires nor the intensive care unit environment interfered with the application of EIT. EIT therefore may be used as an additional real-time monitoring tool in pediatric cardiac intensive care because it is noninvasive.
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Sturgess T, Denehy L, Tully E, El-Ansary D. A pilot thoracic exercise programme reduces early (0–6 weeks) sternal pain following open heart surgery. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2014. [DOI: 10.12968/ijtr.2014.21.3.110] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Tamica Sturgess
- Senior Physiotherapy Manager at Monash Health, Melbourne, Australia
| | - Linda Denehy
- Head of Physiotherapy at the Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - Elizabeth Tully
- Senior Lecturer in Physiotherapy at the Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - Doa El-Ansary
- Senior Lecturer in Physiotherapy at the Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
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Johansson EL, Ternesten-Hasséus E, Olsén MF, Millqvist E. Respiratory movement and pain thresholds in airway environmental sensitivity, asthma and COPD. Respir Med 2012; 106:1006-13. [PMID: 22510540 DOI: 10.1016/j.rmed.2012.03.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 03/01/2012] [Accepted: 03/15/2012] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Patients with "sensory hyperreactivity" (SHR) have airway environmental sensitivity, chronic cough and dyspnoea. Cough, chest discomfort and sense of difficulties getting air are some of the symptoms these patients seek medical attendance for. The patients have increased cough sensitivity to inhaled capsaicin, mediated by ion channel receptors on sensory nerves also known to react to pain stimuli. Whether a link exists between capsaicin airway sensitivity and pain sensitivity has not yet been evaluated. The aim was to investigate chest mobility, respiratory movement and pain sensitivity in SHR patients compared with patients with asthma, chronic obstructive pulmonary disease (COPD) and alleged healthy control subjects. METHODS Thirty-five patients diagnosed with SHR, 19 with COPD, 32 with asthma and 28 control subjects were included. Chest expansion was measured with a measuring tape and thoracic and abdominal movement with light sensors. Pain sensitivity was assessed using a pressure algometer. RESULTS Groups differed significantly in lung function, respiratory rate and pain sensitivity but also in chest expansion and abdominal breathing movement. In comparison with the control and asthma groups but not the COPD patients, SHR patients had an increased respiratory rate and reduced abdominal movement during deep breathing. All patient groups showed lower pain thresholds than the controls. CONCLUSION Patients with SHR have evident signs of dysfunctional breathing and appeared to be most similar to the COPD group except for lung function. Lower pain thresholds among the patients indicate a general up-regulation of the sensory nerve system.
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Affiliation(s)
- Ewa-Lena Johansson
- Departments of Clinical Neuroscience and Rehabilitation, Physiotherapy, the Sahlgrenska Academy, University of Gothenburg, Sweden
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Olsén MF, Lindstrand H, Broberg JL, Westerdahl E. Measuring chest expansion; A study comparing two different instructions. ACTA ACUST UNITED AC 2011. [DOI: 10.3109/14038196.2011.604349] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Pantoni C, Di Thommazo L, Mendes R, Catai A, Luzzi S, Amaral Neto O, Borghi-Silva A. Effects of different levels of positive airway pressure on breathing pattern and heart rate variability after coronary artery bypass grafting surgery. Braz J Med Biol Res 2011; 44:38-45. [DOI: 10.1590/s0100-879x2010007500129] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2010] [Accepted: 10/29/2010] [Indexed: 11/21/2022] Open
Affiliation(s)
| | | | | | - A.M. Catai
- Universidade Federal de São Carlos, Brasil
| | - S. Luzzi
- Irmandade da Santa Casa de Misericórdia de Araraquara, Brasil
| | - O. Amaral Neto
- Irmandade da Santa Casa de Misericórdia de Araraquara, Brasil
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Gunnesson IL, Olsén MF. Validity in measuring breathing movements with the Respiratory Movement Measuring Instrument, RMMI. Clin Physiol Funct Imaging 2010; 31:1-4. [DOI: 10.1111/j.1475-097x.2010.00970.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Olsén MF, Romberg K. Reliability of the Respiratory Movement Measuring Instrument, RMMI. Clin Physiol Funct Imaging 2010; 30:349-353. [PMID: 20584032 DOI: 10.1111/j.1475-097x.2010.00951.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION A new instrument to measure breathing movements, Respiratory Movement Measuring Instrument (RMMI), has been developed. There is still a lack of knowledge about the reliability of the instrument. OBJECTIVES The aim was to investigate reliability of the RMMI. METHODS In this trial, RMMI (ReMo Inc. Keldnaholt, Reykjavik, Iceland) was used. Inter- and intrarater reliability was performed on 30 volunteers who were tested three times in the supine position. Two of the tests were performed by one of the authors and the third test by the other. Intrasubject reliability was tested on 10 volunteers 12 times randomly during 1 h. Intra-instrument reliability was performed by measuring 12 solid surfaces where the instrument was placed horizontally against a couch or vertically against a chair. RESULTS Intra-rater reliability: The correlations were moderate to strong (r = 0.54-0.94) except for the left lower thoracic position r = 0.35. Inter-rater reliability: The correlations were strong (r = 0.71-0.99) except for the left lower thoracic position r = 0.35. The strongest correlations were seen on the tests on abdominal breathing movements. Intra subject reliability: The over-all difference within and between the participants and test was non-significant (P = 0.98). The average difference between the tests was 1.4 mm. Intra instrument: The differences between the measurements were small (mean 0.15 mm). The over-all difference was non-significant (P = 0.79). CONCLUSION The RMMI is a reliable instrument and usable in both clinical practice and research.
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Affiliation(s)
- Monika Fagevik Olsén
- The Departments of Occupational and Physical Therapy, Sahlgrenska Academy, Gothenburg University.,Department of physical therapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Karin Romberg
- Department of physical therapy, Sahlgrenska University Hospital, Gothenburg, Sweden
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Calderon J, Richebe P, Guibaud JP, Coiffic A, Branchard O, Asselineau J, Janvier G. Prospective Randomized Study of Early Pulmonary Evaluation of Patients Scheduled for Aortic Valve Surgery Performed by Ministernotomy or Total Median Sternotomy. J Cardiothorac Vasc Anesth 2009; 23:795-801. [DOI: 10.1053/j.jvca.2009.03.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2008] [Indexed: 11/11/2022]
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Haeffener MP, Ferreira GM, Barreto SSM, 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; 156:900.e1-900.e8. [PMID: 19061704 DOI: 10.1016/j.ahj.2008.08.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Accepted: 08/03/2008] [Indexed: 11/27/2022]
Abstract
BACKGROUND The use of the incentive spirometry (IS) with expiratory positive airway pressure (EPAP) to prevent postoperative pulmonary complications (PPC) after coronary artery bypass graft (CABG) is not well established. This study sought to determine the effects of IS+EPAP after CABG. METHODS Thirty-four patients undergoing CABG were randomly assigned to a control group or IS+EPAP group. Maximal respiratory pressures, pulmonary function test, 6-minute walk test and chest x-ray were performed at baseline as well as 1 week and 1 month after CABG. RESULTS Maximal inspiratory pressure was significantly higher in the IS+EPAP group compared to controls at both 1 week and 1 month (P<.001). Maximal expiratory pressure was significantly higher at 1 month compared to 1 week in IS+EPAP group (P<.01). At 1 month, forced vital capacity and forced expiratory volume in 1 second was significantly higher in IS+EPAP compared to controls (P<.05). Inspiratory capacity was higher at 1 month in IS+EPAP group compared to controls (P<.05). The distance walked in 6-minute walk test was higher at 1 month in IS+EPAP group (P<.001) compared to controls. Lastly, radiological injury score at 1 week was lower in IS+EPAP compared to controls (P<.004). CONCLUSIONS In patients undergoing CABG, IS+EPAP results in improved pulmonary function and 6-minute walk distance as well as a reduction in PPC.
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Ragnarsdottir M, Geirsson AJ, Gudbjornsson B. Rib cage motion in ankylosing spondylitis patients: a pilot study. Spine J 2008; 8:505-9. [PMID: 18455114 DOI: 10.1016/j.spinee.2006.12.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2006] [Revised: 12/01/2006] [Accepted: 12/30/2006] [Indexed: 02/03/2023]
Abstract
BACKGROUND Assessment of chest expansion is one of the measures of rib cage mobility recommended as "core set for assessing Ankylosing Spondylitis" (AS). A recently developed instrument for measuring respiratory movements is introduced. PURPOSE To compare chest and abdominal wall movements in AS patients with those of controls using a newly developed instrument. STUDY DESIGN A comparative study. PATIENT SAMPLE Fourteen male AS patients were invited to the study. All subjects answered a standardized questionnaire concerning general health. OUTCOME MEASURES Body height and weight and respiratory movements. METHODS Upper and lower chest wall and abdominal motion was measured bilaterally for a period of 1 minute during deep breathing by using a new instrument based on a laser technique, The Respiratory Movement Measuring Instrument (ReMo, Reykjavík, Iceland). Results were compared to healthy controls matched for age, gender, and body mass index. RESULTS The patients' mean age was 47+/-9.5 years, and they had a history of AS for 13+/-6 years. Their mean BMI was 27+/-3.6. The respiratory movements of the upper thoracic level were significantly lower than in the reference group (right p=.01, left p=.05). They had, however, a normal range of lower thoracic and abdominal movement and their respiratory movement patterns were symmetrical. CONCLUSION The AS patients had reduced upper thoracic movements but normal lower thoracic and abdominal wall movements.
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Affiliation(s)
- Maria Ragnarsdottir
- Department of Rehabilitation, Landspitali University Hospital, Hringbraut, 101 Reykjavík, Iceland.
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Gregoric ID, La Francesca S, Myers T, Cohn W, Loyalka P, Kar B, Gemmato C, Frazier O. A Less Invasive Approach to Axial Flow Pump Insertion. J Heart Lung Transplant 2008; 27:423-6. [DOI: 10.1016/j.healun.2008.01.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2007] [Revised: 12/20/2007] [Accepted: 01/02/2008] [Indexed: 10/22/2022] Open
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Chang ASY, Smedira NG, Chang CL, Benavides MM, Myhre U, Feng J, Blackstone EH, Lytle BW. Cardiac surgery after mediastinal radiation: extent of exposure influences outcome. J Thorac Cardiovasc Surg 2007; 133:404-13. [PMID: 17258573 DOI: 10.1016/j.jtcvs.2006.09.041] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2006] [Revised: 09/18/2006] [Accepted: 09/29/2006] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Mediastinal radiation for thoracic malignancies uses multiple treatment fields and doses. We investigated whether more extensive radiation exposure is associated with more hospital complications and worse survival after cardiac surgery. METHODS From January 2000 to January 2005, 230 patients underwent cardiac surgery after 3 levels of mediastinal radiation: extensive (Hodgkin disease, thymoma, and testicular cancer; n = 70), variable (eg, non-Hodgkin lymphoma and lung cancer; n = 35); and tangential (breast cancer; n = 125). Hospital complications were recorded prospectively, and time-related survival was assessed by patient follow-up (mean follow-up, 2.2 +/- 1.4 years). RESULTS Patients receiving extensive exposure were youngest (51 vs 64 vs 72 years), with the longest radiation-to-operation interval (25 vs 13 vs 14 years), and had the most diastolic dysfunction, left main stenosis of greater than 70% (21% vs 9% vs 8%), and aortic regurgitation (79% vs 54% vs 50%). Patients receiving extensive and variable exposure had the poorest pulmonary function (percent predicted forced expiratory volume in 1 second, 57% vs 54% vs 67%; percent predicted forced vital capacity, 56% vs 63% vs 66%). All groups received a similar mix of cardiac procedures. Hospital deaths (13% vs 8.6% vs 2.4%) and respiratory complications (24% vs 20% vs 9.6%) were higher after more extensive radiation, and survival was poorer (4-year survival, 64% vs 57% vs 80%) than for patients receiving tangential radiation exposure, and it deviated more from expected matched-population life tables. CONCLUSIONS Among patients undergoing cardiac surgery after thoracic radiation, radiation exposure is heterogeneous, and therefore these patients cannot be managed and assessed as a single uniform cohort. Extensively irradiated patients are more likely to develop radiation heart disease, which increases perioperative morbidity and decreases short- and long-term survival.
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Affiliation(s)
- Albert S Y Chang
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio 44195, USA
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Borghi-Silva A, Mendes RG, Costa FDSM, Di Lorenzo VAP, Oliveira CRD, Luzzi S. The influences of positive end expiratory pressure (PEEP) associated with physiotherapy intervention in phase I cardiac rehabilitation. Clinics (Sao Paulo) 2005; 60:465-72. [PMID: 16358136 DOI: 10.1590/s1807-59322005000600007] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate the effects of positive end expiratory pressure and physiotherapy intervention during Phase I of cardiac rehabilitation on the behavior of pulmonary function and inspiratory muscle strength in postoperative cardiac surgery. METHODS A prospective randomized study, in which 24 patients were divided in 2 groups: a group that performed respiratory exercises with positive airway expiratory pressure associated with physiotherapy intervention (GEP, n = 8) and a group that received only the physiotherapy intervention (GPI, n = 16). Pulmonary function was evaluated by spirometry on the preoperative and on the fifth postoperative days; inspiratory muscle strength was measured by maximal inspiratory pressure on the same days. RESULTS Spirometric variables were significantly reduced from the preoperative to the fifth postoperative day for the GPI, while the GEP had a significant reduction only for vital capacity (P < .05). When the treatments were compared, smaller values were observed in the GPI for peak flow on the fifth postoperative day. Significant reductions of maximal inspiratory pressure from preoperative to the first postoperative day were found in both groups. However, the reduction in maximal inspiratory pressure from the preoperative to the fifth postoperative day was significant only in the GPI (P < .05). CONCLUSIONS 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.
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Ragnarsdóttir M, Kristinsdóttir EK. Breathing movements and breathing patterns among healthy men and women 20-69 years of age. Reference values. Respiration 2005; 73:48-54. [PMID: 16106113 DOI: 10.1159/000087456] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2004] [Accepted: 12/29/2004] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Measurements in absolute terms of the whole respiratory movement pattern (range, type, symmetry, rhythm and frequency of breathing movements) of healthy individuals are valuable for reference, when assessing patients with conditions affecting respiration. OBJECTIVE To establish reference data for breathing movements and patterns for healthy men and women. METHODS Fifty men (mean age 47.8 years) and 50 women (mean age 43.4 years) aged between 20 and 69 years participated in the study. Anterior-posterior breathing movements of the upper and lower thorax and abdomen were measured bilaterally during quiet breathing and deep breathing using the respiratory movement measuring instrument. Descriptive statistics, paired-sample statistics and Kendall's correlation test were used for analysis. RESULTS Breathing movements were symmetrical and did not change significantly with increasing age. The average breathing type for men and women was abdominal during quiet breathing. During deep breathing the abdominal movements were significantly less amongst the women than the men (p < 0.05). The average respiratory rate was 14 during quiet and 7.4 during deep breathing for both sexes. The rhythm (inspiration/expiration ratio) was 1:1.21 for men and 1:1.14 for women during quiet breathing and 1:1.23 for men and 1:1.40 for women during deep breathing. CONCLUSIONS As men and women have similar breathing movements during quiet breathing their reference values can be combined. On the other hand, separate reference values are needed for men and women for deep breathing.
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Affiliation(s)
- María Ragnarsdóttir
- Rehabilitation Department, Landspítali University Hospital, Hringbraut, Reykjavík, Iceland.
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