Effectiveness of oscillating PEP-therapy in early period after cardiac surgery

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OBJECTIVE

To evaluate the effectiveness and safety of oscillating PEP-therapy in early postoperative period after cardiac surgery.

MATERIAL AND METHODS

The study included 60 cardiac patients. Oscillating PEP-therapy was performed using Acapella device 10—12 hours after tracheal extubation. Blood gases were measured on room air before and in 20 min after the procedure.

RESULTS

Poor sputum evacuation was observed in 93.3% of patients. After single session of PEP-therapy, the number of patients with a productive cough increased by more than in 8 times (p<0.001). The number of patients with maximum inspiratory lung capacity (MILC) <500 ml decreased from 25% to 0%, >1500 ml — increased from 8.3 to 28.3% (p<0.01). Median MILC increased by 38.9% (p<0.001), SpO₂ — by 3.2% (p<0.001). The most significant effect of PEP-therapy was observed in 11 patients with concomitant respiratory diseases: SpO₂ increased from 92.1 to 94.7% (p=0.011), MILC increased by 44.2% (p=0.005), PaO₂/PAO₂decreased from 0.65 to 0.59 (p=0.001). The total number of patients with respiratory failure (SpO₂<92%) decreased by 3.86 times (p=0.0015).

CONCLUSION

Oscillating PEP-therapy has a positive effect on sputum passage, ventilatory parameters and oxygenation in cardiac surgery patients. The most significant effect is observed in patients with concomitant respiratory diseases. We found good tolerability of the procedure and no associated complications.

Keywords:

oscillating PEP-therapy

breathing simulator

intensive care unit

cardiac surgery patients

Authors:

Eremenko A.A.

Petrovsky National Research Center of Surgery;
Sechenov First Moscow State Medical University

ORCID: 0000-0001-5809-8563

Zyulyaeva T.P.

Petrovsky National Scientific Center of Surgery

Alferova A.P.

Petrovsky National Scientific Center of Surgery

Received:

13.07.2021

Accepted:

12.08.2021

List of references:

Bautin AE, Kasherininov IYu, Laletin DA, et al. Prevalence and causes of postoperative acute respiratory failure in cardiac surgery. Vestnik intensivnoj terapii. 2016;4:19-26. (In Russ.).
Faker AA, Damag A, Norman T. Incidence and outcome of pulmonary complications after open cardiac surgery. J Chest Dis Tuberc. 2013;62(4):775-780. https://doi.org/10.1016/j.ejcdt.2013.08.008
Mathis MR, Duggal NM, Likosky DS, et al. Intraoperative mechanical ventilation and postoperative pulmonary complications after cardiac surgery. Anesthesiology. 2019;131:1046-1062. https://doi.org/10.1097/ALN.0000000000002909
Zhang X, Wanga Q, Zhang S, et al. The use of a modified, oscillating positive expiratory pressure device reduced fever and length of hospital stay in patients after thoracic and upper abdominal surgery: A randomized trial. Journal of Physiotherapy. 2015;61(1):16-20. https://doi.org/10.1016/j.jphys.2014.11.013
Esmaeili R, Nasiri E, Ghafari R, et al. Frequency rate of atelectasis in patients following coronary artery bypass graft and its associated factors at Mazandaran Heart Center in 2013-2014. Med Arch. 2015;69(2):72-76. https://doi.org/10.5539/gjhs.v7n7p97
Hassoun-Kheir N, Hussein K, Abboud Z, et al. Risk factors for ventilator-associated pneumonia following cardiac surgery: case-control study. J Hosp Infect. 2020;105(3):546-551. https://doi.org/10.1016/j.jhin.2020.04.009
He S, Chen B, Li W, et al. Ventilator-associated pneumonia after cardiac surgery: A meta-analysis and systematic review. J Thorac Cardiovac Surg. 2014;148(6):148-155. https://doi.org/10.1016/j.jtcvs.2014.07.107
Gupta H, Gupta PK, Fang X, et al. Development and Validation of risk Caculator Predicting Postoperative Respiratory Failure. Chest. 2011;140:581-595. https://doi.org/10.1378/chest.11-0466
Ji Q, Mei Y, Wang X, et al. Risk factors for pulmonary complications cardiac surgery with cardiopulmonary bypass. Int J Med Sci. 2013;10(11):1578-1583. https://doi.org/10.7150/ijms.6904
Kozlov IA, Dzybinskaya EV, Romanov AA, Balandyuk AE. Correction of pulmonary oxygenizing dysfunction in early activation of cardiac patients. Obshchaya reanimatologiya. 2009;2:37-43. (In Russ.).
Bruni A, Garofalo E, Pasin L, et al. Diaphragmatic Dysfunction After Elective Cardiac Surgery: A Prospective Observational Study. J Cardiothorac Vasc Anesth. 2020;34(12):3336-3344. https://doi.org/10.1053/j.jvca.2020.06.038
Saffari NH, Nasiri E, Mousavinasab SN, et al. Frequency rate of atelectasis in patients following coronary artery bypass graft and its associated factors at Mazandaran Heart Center in 2013-2014. Glob J Health Sci. 2015;7(7):97-105. https://doi.org/10.5455/medarh.2015.69.72-76
Talwar S, Agarwala S, Mittal CM, et al. Diaphragmatic palsy after cardiac surgical procedures in patients with congenital heart. Ann Pediatr Cardiol. 2010;3:1:50-57. https://doi.org/10.4103/0974-2069.64370
Eremenko AA, Zyulyaeva TP, Kalinina AA, Rozina NA. Effectiveness of vibroacoustic lung massage in self-breathing patients after cardiac surgery. Clinical and Experimental Surgery. Petrovsky Journal. 2020;8(4):126-134. (In Russ.). https://doi.org/10.33029/2308-1198-2020-8-4-126-134
Agostini P, Singh S. Incentive spirometry following thoracic surgery: what should we be doing? Physiotherapy. 2009;95(2):76-82. https://doi.org/10.1016/j.physio.2008.11.003
Lee AL, Burge AT, Holland AE. Positive expiratory pressure therapy versus other airway clearance techniques for bronchiectasis. Cochrane Database Syst Rev. 2017;27:9-13. https://doi.org/10.1002/14651858.CD011699.pub2
Manapunsopee S, Manapunsopee S, Thanakiatpinyo T, et al. Effectiveness of Incentive Spirometry on Inspiratory Muscle Strength After Coronary Artery Bypass Graft Surgery, Heart. Lung and Circulation. 2019;29(8):1180-1186. https://doi.org/10.1016/j.hlc.2019.09.009
Tse J, Wada K, Wang Y, et al. Impact of Oscillating Positive Expiratory Pressure Device Use on Post-Discharge Hospitalizations: A Retrospective Cohort Study Comparing Patients with COPD or Chronic Bronchitis Using the Aerobika and Acapella Devices. Int J Chron Obstruct Pulmon Dis. 2020;15:2527-2538. https://doi.org/10.2147/COPD.S256866
Van FH, Dunn DK, McNinch NL, Volsko TA. Evaluation of Functional Characteristics of 4 Oscillatory Positive Pressure Devices in a Simulated Cystic Fibrosis Model. Respir Care. 2017;62(4):451-458. https://doi.org/10.4187/respcare.04570
Nicolini A, Cardini F, Landucci N, et al. Effectiveness of treatment with high‐frequency chest wall oscillation in patients with bronchiectasis. BMC Pulmonary Medicine. 2013;13:21. https://doi.org/10.1186/1471-2466-13-21
Wheatley CM, Baker SE, Daines CM, et al. Influence of the Vibralung Acoustical Percussor on pulmonary function and sputum expectoration in individuals with cystic fibrosis. Therapeutic Advances in Respiratory Disease. 2018;12:1-15. https://doi.org/10.1177/1753466618770997
Alam M, Hussain S, Shehzad MI, et al. Comparing the Effect of Incentive Spirometry with Acapella on Blood Gases in Physiotherapy After Coronary Artery Bypass Graft. Cureus. 2020;12(2):e6851. https://doi.org/10.7759/cureus.6851
Beningfield A, Jones A. Peri-operative Chest Physiotherapy for Pediatric Cardiac Patients: A Systematic Review and Meta-Analysis. Physiotherapy. 2018;104(3):51-263. https://doi.org/10.1016/j.physio.2017.08.011
Gaskin L, Corey M, Shin J, et al. Long-term trial of conventional postural drainage and percussion versus positive expiratory pressure. J Pediatr Pulmonol. 1997;131:570-574.
Franks LJ, Walsh J.R., Hall K, et al. Comparing the Performance Characteristics of Different Positive Expiratory Pressure Devices. Respir Care. 2019;64(4):434-444. https://doi.org/10.4187/respcare.06410
Morgan SE, Mosakowski S, Giles BL, et al. Variability in expiratory flow requirements among oscillatory positive expiratory pressure devices. Can J Respir Ther. 2020;56:7-10. https://doi.org/10.29390/cjrt-2019-025
Santos M, Milross M, Eisenhuth J, Alison J. Pressures and Oscillation Frequencies Generated by Bubble-Positive Expiratory Pressure Devices. Respiratory Care. 2017;62(4):444-450. https://doi.org/10.4187/respcare.05164
Stephen M, Bondalapati P, Megally M, et al. Positive Expiratory Pressure Therapy With And Without Oscillation And Hospital Length Of Stay For Acute Exacerbation Of Chronic Obstructive Pulmonary Disease. International Journal of Chronic Obstructive Pulmonary Disease. 2019;14:2553-2561. https://doi.org/10.2147/COPD.S213546
Pieczkoski SM, de Oliveira AL, Haeffner MP, et al. Positive expiratory pressure in postoperative cardiac patients in intensive care: A randomized controlled trial. Clinical Rehabilitation. 2020;35(5):681-691. https://doi.org/10.1177/0269215520972701
Cho YJ, Ryu H, Lee J, et al. A randomized controlled trial comparing incentive spirometry with the Acapella® device for physiotherapy after thoracoscopic lung resection surgery. Anesthesia. 2014;69:891-898. https://doi.org/10.1111/anae.12750

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