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Inoue AS, Lopes AAB, Tanaka ACS, Feltrim MIZ, Galas FR, Almeida JP, Hajjar LA, Nozawa E. Impacto da Capacidade Funcional Pré-operatória nos Resultados Pós-Operatórios de Cirurgia de Cardiopatia Congênita: Estudo Observacional e Prospectivo. Arq Bras Cardiol 2022; 118:411-419. [PMID: 35262574 PMCID: PMC8856681 DOI: 10.36660/abc.20201137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 03/24/2021] [Indexed: 11/18/2022] Open
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Mejia OAV, Mioto BM, Borgomoni GB, Camilo JM, Watanabe DM, Nunes SP, Sallai VS, Lima MPLD, Palomo JDSH, Costa HMD, Arita ET, Feltrim MIZ, Coimbra V, Dias RD, Galas FRBG, Auler JOC, Jatene FB. Preparando Pacientes e Otimizando Processos no Perioperatório das Cirurgias Cardíacas: Como Redesenhar os Fluxos de Assistência após a COVID-19. Arq Bras Cardiol 2022; 118:110-114. [PMID: 35195218 PMCID: PMC8959051 DOI: 10.36660/abc.20210484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/28/2021] [Indexed: 11/29/2022] Open
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Nozawa E, Gonçalves CD, Almeida POD, Hajjar LA, Galas FRG, Feltrim MIZ. Infra-Abdominal Muscles Activation Brings Benefits to the Pulmonary Function of Patients with Sternal Instability after Cardiac Surgery. Braz J Cardiovasc Surg 2020; 35:41-49. [PMID: 32270959 PMCID: PMC7089742 DOI: 10.21470/1678-9741-2018-0365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To compare physical therapy strategies involving abdominal muscle stabilization, with and without upper limb movement, in patients with sternal instability after heart surgery and during in-hospital care. Methods This prospective, longitudinal, randomized, and comparative clinical study included 20 patients, which were divided into two groups: ARM, the arm group (n=10), and LEG, the leg group (n=10). The study involved the evaluation of scores of visual analog scales for sternal instability, pain, discomfort, functional impairment, lung function, and maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) before and after the interventions. Two protocols consisting of abdominal exercises in both groups with upper limb movements (ARM) and just abdominal activation with leg movements (LEG) were used for three weeks. Results There were statistically significant (P≤0.01) improvements in pain, discomfort, and functional impairment scores, and in MIP (P=0.04) and MEP (P≤0.01) after intervention in both groups and just LEG showed improvement in forced vital capacity (P=0.043) and forced expiratory volume in one second (P=0.011). Conclusion Both strategies promoted improvement in pain, discomfort, and functional impairment scores and in the values of inspiratory and expiratory pressures. Perhaps they were influenced by the time and resolution of the infection process, although exercises with upper limb movements seem to be safe in this population. The activation of the infra-abdominal muscles through leg movements seems to bring more benefits to lung function.
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Affiliation(s)
- Emilia Nozawa
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas São Paulo SP Brazil Department of Physiotherapy of the Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor/HC-FMUSP), São Paulo, SP, Brazil
| | - Cristiane Domingues Gonçalves
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas São Paulo SP Brazil Department of Physiotherapy of the Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor/HC-FMUSP), São Paulo, SP, Brazil
| | - Patricia Oliva de Almeida
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas São Paulo SP Brazil Department of Physiotherapy of the Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor/HC-FMUSP), São Paulo, SP, Brazil
| | - Ludhmila Abrahão Hajjar
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas São Paulo SP Brazil Department of Critical Patients of the Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor/HC-FMUSP), São Paulo, SP, Brazil
| | - Filomena Regina Gomes Galas
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas São Paulo SP Brazil Department of Anesthesia and Surgical Intensive Care of the Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor/HC-FMUSP), São Paulo, SP, Brazil
| | - Maria Ignêz Zanetti Feltrim
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas São Paulo SP Brazil Department of Physiotherapy of the Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor/HC-FMUSP), São Paulo, SP, Brazil
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Franco SS, Malbouisson LMS, Grinberg M, Feltrim MIZ. A propose of pulmonary dysfunction stratification after valve surgery by physiotherapeutic assistance level. Braz J Cardiovasc Surg 2016; 30:188-97. [PMID: 26107450 PMCID: PMC4462964 DOI: 10.5935/1678-9741.20150006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 01/26/2015] [Indexed: 11/20/2022] Open
Abstract
Objective a) to propose and implement an evaluation system; b) to classify the
pulmonary involvement and determine levels of physical therapy; c) to check
the progress postoperatively. Methods Patients underwent physiotherapy assessment preoperatively, postoperatively
and after 5 days of intervention. They were classified into three levels of
care: level 1 - low risk of complication; Level 2 - medium risk; Level 3 -
high risk. We used analysis of variance and Kruskal-Wallis and analysis of
variance for repeated measures or Friedman. Chi-square test or Fisher for
proportions. We considered statistical significance level
P<0.05. Results We studied 199 patients, 156 classified within level 1, 32 at level 2 and 11
at level 3. Thoracoabdominal motion and auscultation changed significantly
postoperatively, persisting at levels 2 and 3 (P<0.05).
Oxygenation and respiratory rate changed at levels 2 and 3 postoperatively
(P<0.05) with recovery at the end. Significant
decrease in lung volumes occurred in three levels
(P<0.05) with partial recovery at level 1, lung collapse
occurred at all levels, with recovery by 56% at level 1, 47% at level 2, 27%
at level 3. Conclusion The proposed assessment identified valve surgery patients who require
differentiated physical therapy. Level 1 patients had rapid recovery, while
the level 2 showed significant changes with functional gains at the end.
Level 3 patients, more committed and prolonged recovery, should receive
greater assistance.
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Affiliation(s)
- Satiko Shimada Franco
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Max Grinberg
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Azeka E, Jatene MB, Jatene IB, Horowitz ESK, Branco KC, Souza Neto JD, Miura N, Mattos S, Afiune JY, Tanaka AC, Santos CCL, Guimarães ICB, Manso PH, Pellizari RCRS, Santos MVC, Thomaz AM, Cristofani LM, Ribeiro ACL, Kulikowski LD, Sampaio MC, Pereira AC, Soares A, Soares Junior J, Oh GHY, Moreira V, Mota CCC, Afiune CMC, Pedra C, Pedra S, Pedrosa A, Guimarães V, Caneo LF, Ferreiro CF, Cavalheiro Filho C, Stefanello B, Negrão CE, Turquetto ALR, Mesquita SMF, Maeda WF, Zorzanelli L, Panajotopolos N, Siqueira AWS, Galas FRB, Hajjar LA, Benvenuti LA, Vincenzi P, Odone V, Lopes MH, Strabelli TMV, Franchi SM, Takeuti AD, Duarte MF, Leon RGP, Hermida RPM, Sorpreso ICE, Soares Junior JM, Melo NR, Baracat EC, Bortolotto MRFL, Scanavacca M, Shimoda MS, Foronda G, Romano BW, Silva DB, Omura MM, Barbeiro CPM, Vinhole ARG, Palomo JSH, Gonçalves MAB, Reis ICF, Oliveira LG, Ribeiro CC, Isosaki M, Vieira LP, Feltrim MIZ, Manoel LA, Abud KCO, Paschotto DR, Neves ILI, Senaha LE, Garcia ACCN, Cipriano SL, Santos VC, Ferraz AS, Moreira AELC, De Paulo ARSA, Duque AMPC, Trindade E, Bacal F, Auler Junior JOC, Almeida DR. [I Guidelines of heart failure and heart transplantation in the fetus, in children and adults with congenital cardiopathy, The Brazilian Society of Cardiology]. Arq Bras Cardiol 2015; 103:1-126. [PMID: 25591041 DOI: 10.5935/abc.2014s005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Franco SS, Bardi PN, Grinberg M, Feltrim MIZ. Study of breathing pattern and thoracoabdominal movement in mitral valve disease. Arq Bras Cardiol 2012; 99:1049-55. [PMID: 23138669 DOI: 10.1590/s0066-782x2012005000101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 08/24/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND patients with mitral valve disease can progress to having pulmonary congestion, which increases the work the respiratory muscles. This overload can change the breathing pattern with a predominance of rib cage displacement or presence of paradoxical movements. OBJECTIVE a) to study the breathing pattern and thoracoabdominal movement of patients with mitral valve disease; b) to study the effect of body position on breathing parameters; and c) to correlate pulmonary hypertension with lack of coordination of thoracoabdominal movement. METHODS the breathing pattern and thoracoabdominal movement of patients with mitral valve disease were assessed using respiratory inductive plethysmography during quiet breathing in the dorsal decubitus and sitting positions for two minutes. The variables assessed were tidal volume, breathing time and thoracoabdominal movement. RESULTS of the 65 patients selected, 10 were excluded, 29 were in the mitral stenosis group and 26 in the mitral regurgitation group. Tidal volume, pulmonary ventilation and mean inspiratory flow significantly increased in the sitting position, with no difference between the groups. The thoracoabdominal movement remained coordinated in all groups and positions; except for five patients in the dorsal decubitus position, who lacked coordination (three in the mitral stenosis group; two in the mitral regurgitation group). A significant correlation with pulmonary artery pressure values was observed (r = 0.992; p = 0.007). CONCLUSION No difference in breathing pattern or thoracoabdominal movement was found between patients with mitral stenosis and regurgitation. The sitting position increased tidal volume without altering breathing times. The lack of coordination of the thoracoabdominal movement in the dorsal decubitus position was associated with pulmonary hypertension.
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Affiliation(s)
- Satiko Shimada Franco
- Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Brasil
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Abstract
This study investigated the effects of diaphragmatic breathing (DB) on ventilation and breathing pattern, seeking to identify predictors of its efficacy in patients with chronic obstructive pulmonary disease (COPD). Twenty-nine patients with moderate and severe COPD were monitored using respiratory inductance plethysmography and metabolic gas analysis. After 4 minutes of natural breathing, subjects completed 2 minutes of DB followed by 4 minutes of natural breathing. Dyspnea was measured using a visual analogue scale. Diaphragmatic mobility was assessed using chest radiography. DB was associated with a significant increase in tidal volume and reduction in breathing frequency, leading to higher ventilation and oxygen saturation, with a reduction in dead space ventilation and ventilatory equivalent for carbon dioxide. A total of 10 subjects with moderate (5) and severe (5) COPD performed DB with asynchronous thoracoabdominal motion, worsening the dyspnea, and decreasing the gain of tidal volume. Diaphragmatic mobility, inspiratory muscular strength, lower scores for dyspnea and hypoxemia as well as coordinated thoracoabdominal motion are associated with effective DB. In patients with COPD, DB can improve breathing pattern and ventilatory efficiency without causing dyspnea in patients whose respiratory muscular system is preserved.
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Affiliation(s)
- Marcelo Fernandes
- Physiotherapy Division, Heart Institute, University of São Paulo School of Medicine, São Paulo, Brazil.
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Auler Junior JOC, Nozawa E, Toma EK, Degaki KL, Feltrim MIZ, Malbouisson LMS. [Alveolar recruitment maneuver to reverse hypoxemia in the immediate postoperative period of cardiac surgery.]. Rev Bras Anestesiol 2007; 57:476-88. [PMID: 19462124 DOI: 10.1590/s0034-70942007000500003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2006] [Accepted: 06/12/2007] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To evaluate the effects of the alveolar recruitment maneuver on oxygenation and exhaled tidal volume, in patients with hypoxemia, in the immediate postoperative period of cardiac surgery. METHODS This is a prospective, consecutive study. Among the 469 cardiac surgeries performed from February to April 2006, 40 patients (8.5%) who, at the time of admission to the surgical intensive care unit, presented PaO2/FIO2 < 200, were included in the protocol. A standard prospective protocol of alveolar recruitment maneuvers with pressure of 20 cmH2O in the upper airways in the presence of the ratio PaO2/FIO2 < 200, 30 cmH2O with PaO2/FIO2 < 150, and 40 cmH2O when Pa2O2/FIO2 remained below 150 after recruitment maneuver with pressure of 30 cmH2O, was applied to this group of patients. Continuous positive pressure was applied to the airways with a mechanical ventilator, 3 times, for approximately 30 seconds each. Parameters of oxygenation and exhaled tidal volume were compared before and immediately after the recruitment maneuvers. RESULTS Of the 40 patients in the study, 30 showed good responses to recruitment maneuvers with 20 cmH2O, and 10 cases required 30 cmH2O. It was not necessary to apply pressure of 40 cmH2O. There was a significant improvement in oxygenation after the recruitment maneuvers, demonstrated by an increase in PaO2/FIO2 (p = 0.001), peripheral oxygen saturation (p = 0.004), and exhaled tidal volume (p = 0.038). CONCLUSIONS Alveolar recruitment maneuvers were successful on correcting hypoxemia and increasing the exhaled tidal volume in patients on mechanical ventilation in the immediate postoperative period of cardiac surgery.
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Feltrim MIZ, Jatene FB, Bernardo WM. [In high-risk patients, submitted to myocardial revascularization, does preoperative chest physiotherapy prevent pulmonary complications ? ]. Rev Assoc Med Bras (1992) 2007; 53:8-9. [PMID: 17420882 DOI: 10.1590/s0104-42302007000100008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Park M, Sangeam M, Volpe M, Leite P, Viecilli P, Feltrim M, Nozawa E, Lorenzi-filho G, Timerman S, Cardoso L, Ramires J. Crit Care 2001; 5:P5. [DOI: 10.1186/cc1338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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