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Introduction: Patients undergoing coronary artery bypass grafting (CABG) often have reduced respiratory and peripheral muscle strength and function.(1) In these settings, electroanalgesia stands out as a potential strategy to reverse such deleterious effects.(2,3) Objective: To investigate the impact of electroanalgesia on respiratory and peripheral muscle strength and lung function in patients undergoing coronary artery bypass grafting. Methods: This is a randomized controlled trial. Patients had their maximal inspiratory pressure (MIP), expiratory pressure (MEP), vital capacity (VC) and peripheral muscle strength (MRC) measured prior to surgery and at intensive care unit (ICU) and hospital discharge. Research participants were randomized to the Electroanalgesia (EG) or the Control (CG) Group by drawing lots. Conventional transcutaneous electrical nerve stimulation (TENS) was performed with a pulse amplitude of 0.25 milliseconds, frequency of 100Hz and current of 10-20 milliamps. Minimum time to analgesia was 10 minutes and analgesic effects lasted 20 minutes. Intensity was adjusted according to patient level of tolerance. Results: One hundred patients were evaluated (50 per group). Mean patient age was 52±8 years and male patients prevailed. Patients in the EG had higher MIP (95%CI: 13cmH2O; 9.43 to 16.57), MEP (95%CI: 12cmH2O; 9.22 to 14.78) and VC (95%CI: 8mL/kg; 5.02 to 10.98) at hospital discharge compared to baseline values. Peripheral muscle strength did not differ significantly between groups. Conclusion: Electroanalgesia minimized respiratory muscle strength and vital capacity losses but had no impact on peripheral muscle strength. [ABSTRACT FROM AUTHOR]

Introduction: Cardiac surgery is considered a complex procedure in the treatment of cardiovascular diseases, but it is associated with complications that can be caused by the decline in pulmonary function and inspiratory muscle strength.(1) In this scenario, inspiratory muscle training (IMT) may be useful to optimize muscle and lung function and decrease postoperative complications. Patients with sleep disorders may be less responsive to training, thus increasing postoperative risk.(2) Objective: To investigate the impact of inspiratory muscle training on sleep quality and lung function in patients submitted to coronary artery bypass grafting (CABG). Methods: This is a randomized controlled trial. Participants were randomized to the inspiratory muscle Training (TG) or the Control (CG) Group by drawing lots. Patients in the CG were submitted to non-invasive ventilation, breathing exercises, kinesiotherapy, cycloergometry and walking. Patients in the TG were submitted to the standard unit protocol plus maximal inspiratory pressure (MIP) evaluation and started inspiratory muscle training with 40% of MIP. Pulmonary function, vital capacity (VC), peak expiratory flow (PEF), ventilatory muscle strength (maximal inspiratory and expiratory pressure) and sleep quality (Pittsburgh Sleep Quality Index Questionnaire - PSQI and Epworth Sleepiness Scale - EPS) were evaluated prior to surgery and at hospital discharge. Results: One hundred and two patients participated in this study, 54 in the CG and 48 in the TG. Inspiratory muscle training had a stronger impact on sleepiness at hospital discharge (EPS 95%CI: 7; 6.39 to 7.61; PSQI 95%CI: 8; 7.61 to 8.39). Patients undergoing inspiratory muscle training showed a significant improvement in MIP (95%CI: 18; 17.14 to 18.86), maximal expiratory pressure (MEP) (95%CI: 6; 5.37 to 6.63) and VC (95%CI: 12; 1.61 to 2.39). In contrast, PEF did not differ significantly between groups (95%CI: 5; -11.78 to 1.78). Conclusion: Inspiratory muscle training was an effective strategy to mitigate ventilatory muscle strength and sleep quality losses after coronary artery bypass grafting. Brazilian Registry of Clinical Trials (ReBEC) registration number RBR-8dqrdq. [ABSTRACT FROM AUTHOR]

Introduction: Patients undergoing coronary artery bypass graft (CABG) are prone to functional capacity decline, with increased risk of pulmonary complications and potential loss of quality of life.(1) This decline is often associated with lack of understanding of activities that can be performed after surgery. In these settings, patient guidance can be an effective strategy.(2,3) Objective: To determine the impact of physiotherapy guidance on functional capacity, functionality, postoperative complications, and quality of life in patients submitted to CABG. Methods: This is a randomized controlled trial. Patients were assessed prior to surgery and at hospital discharge. Functional capacity, functionality and quality of life were assessed using the six-minute walk test (6MWT), the functional independence measure (FIM) and the stand test (SST), and the SF-36 questionnaire, respectively. Postoperative pulmonary complications were also investigated. At intensive care unit (ICU) discharge, patients were randomized to the Guidance (GO) or the Control (CG) Group by drawing lots. While at hospital, patients in the GO received verbal guidance and were later given a booklet containing instructions aimed at raising awareness about their condition and how to prevent immobility by staying active during hospital stay. Results: During the experimental period, 114 patients were evaluated (57 per group). Mean patient age was 54±6 years and male patients prevailed. Patients in the GO performed significantly better in the 6MWT (95%CI: 46 meters; 25.53 to 66.47), FIM (95%CI: 12; 9.30 to 14.70) and SST (95%CI: -2 seconds; 4.31 to -1.69) at hospital discharge compared to baseline values. Quality of life did not differ significantly between groups. As to postoperative pulmonary complications, atelectasis rates were lower in the GO relative to the CG (15 patients/26% and 26 patients/46%; GO and CG respectively; p=0.02). Conclusion: Postoperative physiotherapeutic guidance was an effective strategy to reduce functional capacity and functionality losses and decrease atelectasis rates. However, it had no impact on quality of life or other pulmonary complications. [ABSTRACT FROM AUTHOR]

Introduction: Patients submitted to cardiac surgery remain in bed rest during intensive care unit (ICU) stay. Immobility associated with bed rest may lead to clinical and functional impairments.(1) Although these complications can be avoided by early mobilization, in some hospitals this cannot be accomplished due to use of a subxiphoid tube in the immediate postoperative period.(2,3) Objective: To determine the safety and feasibility of early mobilization of cardiac surgery patients carrying a subxiphoid tube. Methods: This was a prospective cohort study. On the first day after surgery, patients were placed in the sedestation in bed, then transferred from sitting to orthostasis, gait training and sedestation in an armchair. On the second postoperative day, the same activities were repeated with progressive increase in walking distance around the ICU. At these time points, patients were using a subxiphoid and/or an intercostal tube. Patients were seen three times per day. However, physical rehabilitation was performed twice daily. The following adverse events were analyzed: chest tube obstruction, accidental removal or displacement, total atrioventricular block, postoperative low output syndrome, cardiorespiratory arrest, pneumomediastinum, infection, and pericardial or myocardial damage. Results: One hundred seventysix patients were evaluated (Table 1). The incidence of complications after early mobilization in patients carrying a subxiphoid tube was low (Table 2). Only 2 patients (0.4%) had complications during or after mobilization, 1 (0.2%) due to tube obstruction and 1 (0.2%) due to accidental tube removal or displacement. Conclusion: Findings of this study suggest early mobilization of patients carrying a subxiphoid tube after cardiac surgery is safe and feasible. [ABSTRACT FROM AUTHOR]

Introduction: Coronary artery bypass grafting (CABG) is a surgical procedure used in coronary artery disease to improve patient symptoms and life expectancy. Benefits aside, pulmonary, and functional postoperative(1) complications may occur due to invasive mechanical ventilation (IMV), cardiopulmonary bypass and immobility, leading to longer hospital stay.(2,3) Objective: To evaluate clinical and functional outcomes associated with postoperative pulmonary complications in patients undergoing coronary artery bypass grafting (CABG). Methods: This is a prospective cohort study. During ICU stay, patients were divided into two groups: No Complicated Group (NCG; patients who did not develop complications during ICU stay) and Complication Group (CG; patients who developed complication during ICU stay). Functional variables were assessed using the following tests: six-minute walk test, gait speed, sit and stand test, Timed Up and Go, peripheral muscle strength, ventilatory lung function and Functional Independence Measure. Tests were applied prior to surgery, at hospital discharge and six months after the surgical procedure. Results: The study evaluated 90 patients, 59 in the NCG and 31 CG. In the six-minute walk test (6MWT) there was a 2% decrease (p=0.43) in the NCG, while the decrease was 13% (p<0.01) in the CG. In the peripheral strength (MRC) the drop was also 2% (p=<0.01) in the NCG, while in the group with complication the drop was 14% (p=<0.01). In maximal inspiratory pressure (MIP) the NCG had a fall of 6% (p=0.67), while the CG had a fall of 16% (p=<0.01). The complication that was most prevalent during the survey in the com group was atelectasis, where in a total of 31 patients, 17(55%) of them were diagnosed. Conclusion: Patients with postoperative complications after coronary artery bypass grafting may have reduced functional performance, muscle strength and lung function at hospital discharge and after six months. [ABSTRACT FROM AUTHOR]