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Randomized Controlled Trial
. 2022 Mar 14;48(1):e20210280.
doi: 10.36416/1806-3756/e20210280. eCollection 2022.

Effects of the breath stacking technique after upper abdominal surgery: a randomized clinical trial

[Article in English, Portuguese]
Débora da Luz Fernandes  1 , Natiele Camponogara Righi  1 , Léo José Rubin Neto  2 , Jéssica Michelon Bellé  2 , Caroline Montagner Pippi  2 , Carolina Zeni do Monte Ribas  2 , Lidiane de Fátima Ilha Nichele  3 , Luis Ulisses Signori  4 , Antônio Marcos Vargas da Silva  4
Affiliations
Randomized Controlled Trial

Effects of the breath stacking technique after upper abdominal surgery: a randomized clinical trial

[Article in English, Portuguese]
Débora da Luz Fernandes et al. J Bras Pneumol. .

Abstract
in English, Portuguese

Objective: To evaluate the effect of the association of the breath stacking (BS) technique associated with routine physiotherapy on pulmonary function, lung volumes, maximum respiratory pressures, vital signs, peripheral oxygenation, thoracoabdominal mobility, and pain in the surgical incision in patients submitted to upper abdominal surgery during the postoperative period, as well as to analyze BS safety.

Methods: This was a randomized clinical trial involving 34 patients divided into a control group (CG; n = 16), who underwent conventional physiotherapy only, and the BS group (BSG; n = 18), who underwent conventional physiotherapy and BS. Both groups performed two daily sessions from postoperative day 2 until hospital discharge. The primary outcomes were FVC and Vt. The safety of BS was assessed by the incidence of gastrointestinal, hemodynamic, and respiratory repercussions.

Results: Although FVC significantly increased at hospital discharge in both groups, the effect was greater on the BSG. Significant increases in FEV1, FEV1/FVC ratio, PEF, and FEF25-75% occurred only in the BSG. There were also significant increases in Ve and Vt in the BSG, but not when compared with the CG values at discharge. MIP and MEP significantly increased in both groups, with a greater effect on the BSG. There was a significant decrease in RR, as well as a significant increase in SpO2 only in the BSG. SpO2 acutely increased after BS; however, no changes were observed in the degree of dyspnea, vital signs, or signs of respiratory distress, and no gastrointestinal and hemodynamic repercussions were observed.

Conclusions: BS has proven to be safe and effective for recovering pulmonary function; improving lung volumes, maximum respiratory pressures, and peripheral oxygenation; and reducing respiratory work during the postoperative period after upper abdominal surgery.

Objetivo:: Avaliar o efeito da técnica de breath stacking (BS) associada à fisioterapia de rotina na função pulmonar, volumes pulmonares, pressões respiratórias máximas, sinais vitais, oxigenação periférica, mobilidade toracoabdominal e dor na incisão cirúrgica em pacientes no pós-operatório de cirurgia abdominal alta, bem como analisar a segurança do BS.

Métodos:: Trata-se de um ensaio clínico randomizado com 34 pacientes divididos em grupo controle (n = 16), que realizou apenas a fisioterapia convencional, e grupo BS (n = 18), que realizou a fisioterapia convencional e BS. Ambos os grupos realizaram duas sessões diárias desde o 2º dia do pós-operatório até a alta hospitalar. Os desfechos primários foram CVF e Vt. A segurança do BS foi avaliada pela incidência de repercussões gastrointestinais, hemodinâmicas e respiratórias.

Resultados:: Embora a CVF tenha aumentado significativamente no momento da alta hospitalar em ambos os grupos, o efeito foi maior no grupo BS. Aumentos significativos do VEF1, VEF1/CVF, PFE e FEF25-75% ocorreram apenas no grupo BS. Também houve aumentos significativos do Ve e do Vt no grupo BS, mas não em comparação com os valores do grupo controle no momento da alta. A PImáx e a PEmáx aumentaram significativamente em ambos os grupos, com efeito maior no grupo BS. Houve uma diminuição significativa da FR e um aumento significativo da SpO2 apenas no grupo BS. A SpO2 aumentou agudamente após o BS; entretanto, não foram observadas alterações no grau de dispneia, sinais vitais e sinais de desconforto respiratório, e não foram observadas repercussões gastrointestinais e hemodinâmicas.

Conclusões:: O BS mostrou-se seguro e eficaz na recuperação da função pulmonar; melhoria dos volumes pulmonares, pressões respiratórias máximas e oxigenação periférica; e redução do trabalho respiratório no pós-operatório de cirurgia abdominal alta.

Trial registration: ClinicalTrials.gov NCT04418700.

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Conflict of interest statement

CONFLICT OF INTEREST: None declared.

Figures

Figure 1
Figure 1. Flow chart of the patient selection process. PO: postoperative.
See this image and copyright information in PMC

References

    1. Boden I, Browning L, Skinner EH, Reeve J, El-Ansary D, Robertson IK. The LIPPSMAck POP (Lung Infection Prevention Post Surgery - Major Abdominal - with Pre-Operative Physiotherapy) trial study protocol for a multi-centre randomised controlled trial. Trials. 2015;16:573–573. doi: 10.1186/s13063-015-1090-6. - DOI - PMC - PubMed
    1. Khyati S, Amaravdi SK, Rajan Samuel S, Augustine AJ, Singh V. Effectiveness of inspiratory muscle training (IMT) on pulmonary function and functional capacity in chronic smoker's v/s non-smokers patients undergoing open abdominal surgery - A study protocol. Int J Surg Protoc. 2020;24:31–35. doi: 10.1016/j.isjp.2020.10.005. - DOI - PMC - PubMed
    1. Arruda KA, Cataneo DC, Cataneo AJ. Surgical risk tests related to cardiopulmonary postoperative complications comparison between upper abdominal and thoracic surgery. Acta Cir Bras. 2013;28(6):458–466. doi: 10.1590/S0102-86502013000600010. - DOI - PubMed
    1. Katsura M, Kuriyama A, Takeshima T, Fukuhara S, Furukawa TA. Preoperative inspiratory muscle training for postoperative pulmonary complications in adults undergoing cardiac and major abdominal surgery. Cochrane Database Syst Rev. 2015;(10):CD010356–CD010356. doi: 10.1002/14651858.CD010356.pub2. - DOI - PMC - PubMed
    1. Jeong BH, Shin B, Eom JS, Yoo H, Song W, Han S. Development of a prediction rule for estimating postoperative pulmonary complications. PLoS One. 2014;9(12):e113656. doi: 10.1371/journal.pone.0113656. - DOI - PMC - PubMed

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