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

INTRODUCTION

Loss of physical activity and pulmonary dysfunction with its associated complications represent two of the most important causes of morbidity and mortality following cardiac surgery.

AIM

To evaluate whether a physiotherapy program based on respiratory training with or without musculoskeletal mobilization, started preoperatively, may provide a significant improvement in pulmonary and musculoskeletal recovery postoperatively in a sufficiently large sample of patients undergoing elective cardiac surgery.

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSIONS

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