Acute Effect of Positive Expiratory Pressure Versus Breath Stacking Technique After Cardiac Surgery

Universidade Federal de Santa Maria

Status: Completed

Conditions: Cardiac Complication; Complication, Postoperative

Treatments: Other: Expiratory Positive Airway Pressure; Other: Breath Stacking

Study type: Interventional

Funder types: Other

Identifiers

NCT04013360

92331518.6.0000.5346

Details and patient eligibility

About

This study evaluates the efficacy and safety of a single session of positive expiratory pressure and of breath stacking technique in patients after cardiac surgery. The same patients will receive the two interventions, with an interval of 24 hours, and the acute effect of each will be verifed.

Full description

Physiotherapy uses techniques and equipment that reduce postoperative pulmonary complications. The technique called breath stacking consists of an instrumental feature composed of a unidirectional valve coupled to a face mask to promote the accumulation of successive inspiratory volumes. The technique is used to prevent atelectasis and improve gas exchange. Another therapy is called expiratory positive airway pressure (EPAP) that uses positive end expiratory pressure (PEEP) in spontaneously breathing patients, keeping the airway open during expiration. The EPAP system consists of a face mask, a one-way valve and the expiratory resistor, which is responsible for resistance to expiratory flow, which will determine the level of PEEP.

Enrollment: 24 patients

Sex: All

Volunteers: No Healthy Volunteers

Inclusion criteria

Patients with indication for coronary artery bypass grafting and valve replacement, with surgical procedure for median sternotomy.

Exclusion criteria

• incapacity to understand the Informed Consent Form.
• cognitive dysfunction that prevents the performance of evaluations or interventions,
• intolerance to the use of EPAP or BS mask
• with chronic obstructive pulmonary disease (COPD)
• cerebrovascular disease
• chronic-degenerative musculoskeletal disease
• chronic infectious disease
• in treatment with steroids, hormones or cancer chemotherapy
• hemodynamic complications (arrhythmia, myocardial infarction during the operation, with blood loss ≥ 20% of the total blood volume, defined by Mannuci, et al., 2007)
• mean arterial pressure <70 mmHg and reduced cardiac output, requiring the use of intra aortic balloon or vasoactive drugs
• tracheal intubation for more than 12 hours after admission to the ICU or reintubated
• individuals unable to maintain airway permeability.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Crossover Assignment

Masking: Single Blind

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24 participants in 2 patient groups

Breath Stacking

Active Comparator group

Description:

Instrument composed of a one-way valve coupled to a face mask to promote the accumulation of successive inspiratory volumes.

Treatment:

Other: Breath Stacking

Other: Expiratory Positive Airway Pressure

Expiratory Positive Airway Pressure

Active Comparator group

Description:

Therapeutic technique consisting of a face mask, a one-way valve and an expiratory resistor, responsible for resistance to expiratory flow, which will determine the level of pressure in the airway.

Treatment:

Other: Breath Stacking

Other: Expiratory Positive Airway Pressure