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. 2015 Mar-Apr;30(2):188-97.
doi: 10.5935/1678-9741.20150006.

A propose of pulmonary dysfunction stratification after valve surgery by physiotherapeutic assistance level

Satiko Shimada Franco  1 , Luiz Marcelo Sá Malbouisson  2 , Max Grinberg  1 , Maria Ignêz Zanetti Feltrim  1
Affiliations

A propose of pulmonary dysfunction stratification after valve surgery by physiotherapeutic assistance level

Satiko Shimada Franco et al. Rev Bras Cir Cardiovasc. 2015 Mar-Apr.

Abstract
in English, Portuguese

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.

Objetivo: a) propor e aplicar um sistema de avaliação; b) classificar o comprometimento pulmonar e determinar os níveis de assistência fisioterapêutica; c) verificar a evolução no pós-operatório de cirurgia valvar.

Métodos: Pacientes realizaram avaliação fisioterapêutica no pré-operatório, pós-operatório e após 5 dias de intervenção. Foram classificados em três níveis de atenção: nível 1 - baixo risco de complicação; nível 2 - médio risco; nível 3 - alto risco. Utilizou-se Análise de Variância e Kruskal-Wallis e Análise de Variância para medidas repetidas ou Friedmann. Teste qui-quadrado ou Fisher para as proporções. Considerou-se nível de significância estatística P<0,05.

Resultados: Foram estudados 199 pacientes, 156 classificados no nível 1, 32 nível 2 e 11 nível 3. Movimento toracoabdominal e ausculta pulmonar alteraram significantemente no pós-operatório, persistindo nos níveis 2 e 3 (P<0,05). Oxigenação e frequência respiratória se modificaram nos níveis 2 e 3 no pós-operatório (P<0,05), com recuperação no final. Diminuição significante dos volumes pulmonares ocorreu nos três níveis (P<0,05), com recuperação parcial no nível 1. Colapso pulmonar ocorreu em todos os níveis, com recuperação em 56% no nível 1, 47% no nível 2, 27% no nível 3.

Conclusão: A avaliação proposta identificou pacientes de cirurgia valvar que necessitam de assistência fisioterapêutica diferenciada. Pacientes do nível 1 tiveram rápida recuperação, enquanto os do nível 2 mostraram alterações significativas, com ganhos funcionais no final. Pacientes do nível 3, mais comprometidos e com recuperação prolongada, devem receber maior assistência.

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Conflict of interest statement

Potential Conflict of Interest The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
The flowchart of patients in the study protocol.
Fig. 2
Fig. 2
Percentage of radiological changes of level 1 in the pre, post and discharge of study.
Fig. 4
Fig. 4
Percentage of radiological changes of level 3 in the pre, post and discharge of study.
Fig. 3
Fig. 3
Percentage of radiological changes of level 2 in the pre, post and discharge of study.
See this image and copyright information in PMC

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