changes in respiratory movements of cardiac surgery patients
DESCRIPTION
Changes in Respiratory Movements of Cardiac Surgery Patients. María Ragnarsdóttir, PT, MSc Department of Rehabilitation Landspítali - University Hospital, Reykjavík, Iceland. Changes in Respiratory Movements of Cardiac Surgery Patients. Coworkers: Ásdís Kristjánsdóttir, PT, MSc - PowerPoint PPT PresentationTRANSCRIPT
The VI Nordic Congress on Cardiac Rehabilitation, June 14th 2002
Changes in Respiratory Movements of
Cardiac Surgery Patients
María Ragnarsdóttir, PT, MSc Department of RehabilitationLandspítali - University Hospital,Reykjavík, Iceland.
The VI Nordic Congress on Cardiac Rehabilitation, June 14th 2002
Changes in Respiratory Movements of
Cardiac Surgery Patients
Coworkers: Ásdís Kristjánsdóttir, PT, MScIngveldur Ingvarsdóttir, PT, MAPétur Hannesson, PhD, chief radiologistBjarni Torfason, chief physician, ass. professor
The VI Nordic Congress on Cardiac Rehabilitation, June 14th 2002
IntroductionIntroduction
Restrictive respiratory defect following cardiac surgery is well documented.
The ethiology for these findings is not fully understood.
Several factors can contribute to the restrictive respiratory defect.
Diaphragmatic dysfunction is one of the most frequently reported.
The VI Nordic Congress on Cardiac Rehabilitation, June 14th 2002
IntroductionIntroduction
Altered ribcage mechanics have been suggested to be an additional factor
Only one study was found on respiratory movements during quiet breathing following cardiac surgery.
No study was found on deep breathing where submaximal effort is required of the motor system of the respiratoy organs.
The VI Nordic Congress on Cardiac Rehabilitation, June 14th 2002
Introduction
The surgical procedure.
Are the costo-transversal and costo-vertebral joints affected?
Are the respiratory muscles affected?
The VI Nordic Congress on Cardiac Rehabilitation, June 14th 2002
Introduction
What happens when the internal mammary artery is used for CABG?
Does the distortion of the ribcage make the injury more severe?
The VI Nordic Congress on Cardiac Rehabilitation, June 14th 2002
Purpose To quantify the changes in bilateral respiratory movements
following median sternotomy.
To study the correlation between postoperative respiratory movements and: – the width of the sternal opening during the operation; – the difference in height of the two sternal margins during the
operation; – spirometri and x-ray analysis.
The VI Nordic Congress on Cardiac Rehabilitation, June 14th 2002
MethodMethodThe hospital’s Ethics Commity and the Data Protection Authority accepted the study.
All patients signed an informed consent to participate.
Exclusion criteria: Previous cardiac surgery. Inability to walk 50 meters. Late discharge from intensive care (>48 hours).
The VI Nordic Congress on Cardiac Rehabilitation, June 14th 2002
MethodDemographic data
Subjects: 20 (13 men and 7 women).
Mean age: 65 years, + 16.6 SD.
Mean BMI: 27.9, + 5.4 SD (range 15.4 - 36.5).
Smoking: 7 never smoked, 13 smoked (mean p/y 25).
The VI Nordic Congress on Cardiac Rehabilitation, June 14th 2002
Method Respiratory Movements
Respiratory movements were measured using a novel instrument, the Respiratory Movement Measuring Instrument, RMMI.
Manufacturer: ReMo ehf, Keldnaholti112 ReykjavíkIceland.
The VI Nordic Congress on Cardiac Rehabilitation, June 14th 2002
Method Respiratory Movements
RMMI measures abdominal- lower thoracic- and upper thoracic anterior-posterior movements, bilaterally.
Respiratory movements during vital capacity breathing were measured preoperatively and on the 7th postoperative day.
The VI Nordic Congress on Cardiac Rehabilitation, June 14th 2002
MethodMethod Lung Volumes Lung Volumes
The following lung volumes were measured preoperatively and on the 7th postoperative day, using a portable spirometer:
Vital capacity, VC
Forced Vital Capacity, FVC and
Forced Expiratory Volume in one second, FEV1.
The VI Nordic Congress on Cardiac Rehabilitation, June 14th 2002
MethodMethodX-ray analysesX-ray analyses
Chest X-rays were taken prior to the operation and on the first, second and fifth postoperative day as routinely.
On the 5th postoperative day the study patients had an extra sidelying picture taken.
All pictures were evaluated by the same radiologist according to a 4 point scale made by him for this study.
The VI Nordic Congress on Cardiac Rehabilitation, June 14th 2002
MethodA scale for the position of the left diaphragmA scale for the position of the left diaphragm
1 = Normal.
2 = Minor. Left diaphragm is slightly higher than the right diaphragm.
3 = Medium. Left diaphragm is elevated up to the half the height of the left heart border.
4 = Major. Left diaphragm is elevated above half the height of the left heart border.
The VI Nordic Congress on Cardiac Rehabilitation, June 14th 2002
MethodPeri-operative measurements
All the study patients were operated on by the same surgeon
Measurements: Pump timeClamp timeLowest temperatureWidth of sternal openigDifference in hight of the sternal margins
The VI Nordic Congress on Cardiac Rehabilitation, June 14th 2002
MethodPhysiotherapy
All patients received pre- and postoperative physiotherapy according to the standard of the deparment.
The same physical therapist treated all patients.
The VI Nordic Congress on Cardiac Rehabilitation, June 14th 2002
MethodStatistical analysis
Descriptive statistics.
Wilcoxon Signed Ranks Test were used for analysis.
The VI Nordic Congress on Cardiac Rehabilitation, June 14th 2002
ResultsPeri-operative information/measurements
Surgery: AVR 6, AVR and CABG 6, OPCAB 4, CABG 2, MVR 1, VSD 1.
Measurements: Pump time: Mean 75 minutes (0 – 161)
Clamp time: Mean 50.5 minutes (0 – 122)
Lowest temperature: Mean 33.9° C (31.8° - 36.6°)
Sternal opening: Mean width 8.3 cm + 1.2 Mean difference in hight 4.2 cm + 0.5
The VI Nordic Congress on Cardiac Rehabilitation, June 14th 2002
Results Pre-operative respiratory movements in mm
0
5
10
15
20
25
Right AB, LT and UT Left AB; LT and UT
The VI Nordic Congress on Cardiac Rehabilitation, June 14th 2002
Results Postoperative respiratory movements in mm
0
5
10
15
20
25
Right AB, LT and UT Left AB; LT and UT
The VI Nordic Congress on Cardiac Rehabilitation, June 14th 2002
Results Proportion of pre-operative respiratory movements
0
20
40
60
80
100
120
Right AB, LT and UT Left AB, LT and UT
The VI Nordic Congress on Cardiac Rehabilitation, June 14th 2002
ResultsSignificance of changes in breathing movements
Mean95%
confidence interval
t df Sig. (2 tail) difference Lower Upper
R. Abd. -6.20 19 0.000 -0.68 -0.91 -0.45
L. Abd. -5.63 19 0.000 -0.71 -0.98 -0.45
R. LTh -4.00 19 0.001 -0.40 -0.62 -0.19
L. LTh -4.27 19 0.001 -0.39 -0.59 -0.20
R. UTh. 0.11 19 0.907 ns 0.01 -0.18 0.20
L. UTh. -1.77 19 0.929 ns -0.15 -0.33 0.03
The VI Nordic Congress on Cardiac Rehabilitation, June 14th 2002
Results Proportion of preoperative lung volumes
0102030405060708090100
VC FVC FEV1
The VI Nordic Congress on Cardiac Rehabilitation, June 14th 2002
ResultsSignificance of changes in LUNG VOLUMES
Mean95%
confidence interval
t df Sig. (2 tail) difference Lower Upper
VC -11.65 19 0.0001 -0.54 -0.63 -0.44
FVC -9.01 19 0.0001 -0.52 -0.64 -0.40
FEV1 -6.90 19 0.0001 -0.54 -0.70 -0.38
The VI Nordic Congress on Cardiac Rehabilitation, June 14th 2002
0102030405060708090100
PleuralEffusion
Atelectasis Elevateddiaphragm
ResultsX-rays
Proportion of patients with abnormal findings post-op.
The VI Nordic Congress on Cardiac Rehabilitation, June 14th 2002
ResultsCorrelations
No correlation was found between any of the variables analysed.
The VI Nordic Congress on Cardiac Rehabilitation, June 14th 2002
DiscussionDiscussion
The study results in a nutshell!
Future studies.
The VI Nordic Congress on Cardiac Rehabilitation, June 14th 2002
Conclusion
The motor system of the respiratory organs are significantly impaired one week after cardiac surgery through median sternotomy.
Further studies are needed to find out what role this impairment plays in the recovery of these patients and how long lasting the imapirment is.