Effectiveness of a perioperative pulmonary rehabilitation program following coronary artery bypass graft surgery in patients with and without COPD

Jui-O Chen, Jui-Fang Liu, Yu-Qi Liu, Yu-Mu Chen, Mei-Lien Tu, Hong-Ren Yu, Meng-Chih Lin, Chiu-Chu Lin, Shih-Feng Liu, Jui-O Chen, Jui-Fang Liu, Yu-Qi Liu, Yu-Mu Chen, Mei-Lien Tu, Hong-Ren Yu, Meng-Chih Lin, Chiu-Chu Lin, Shih-Feng Liu

Abstract

Purpose: It is unclear whether the effectiveness of pulmonary rehabilitation program (PRP) after cardiac surgery differs between patients with and without COPD. This study aimed to compare the effectiveness of PRP between patients with and without COPD undergoing coronary artery bypass graft (CABG) surgery.

Patients and methods: We retrospectively included patients who underwent CABG surgery and received 3-week PRP from January 2009 to December 2013. We excluded patients who underwent emergency surgery, had an unstable hemodynamic status, were ventilator dependent or did not complete the PRP. Demographics, muscle strength, degree of dyspnea, pulmonary function and postoperative complications were compared.

Results: Seventy-eight patients were enrolled (COPD group, n=40; non-COPD group, n=38). Maximal inspiratory pressure (MIP; -34.52 cmH2O vs -43.25 cmH2O, P<0.01; -34.67 cmH2O vs -48.18 cmH2O, P<0.01), maximal expiratory pressure (MEP; 32.15 cmH2O vs 46.05 cmH2O, P<0.01; 37.78 cmH2O vs 45.72 cmH2O, P<0.01) and respiratory rate (RR; 20.65 breath/minute vs 17.02 breath/minute, P<0.01; 20.65 breath/minute vs 17.34 breath/minute, P<0.01) in COPD and non-COPD groups, respectively, showed significant improvement, but were not significantly different between the two groups. Forced vital capacity (FVC; 0.85 L vs 1.25 L, P<0.01), forced expiratory volume in 1 second (FEV1; 0.75 L vs 1.08 L, P<0.01), peak expiratory flow (PEF; 0.99 L vs 1.79 L, P<0.01) and forced expiratory flow between 25% and 75% of vital capacity (FEF25-75; 0.68 L vs 1.15 L, P<0.01) showed significant improvement between postoperative Days 1 and 14 in the COPD group. FVC (1.11 L vs 1.36 L, P<0.05), FEV1 (96 L vs 1.09 L, P<0.05) and FEF25-75 (1.03 L vs 1.26 L, P<0.05) were significantly improved in the non-COPD group. However, only PEF (80.8% vs 10.1%, P<0.01) and FEF25-75 (67.6% vs 22.3%, P<0.05) were more significantly improved in the COPD group than in the non-COPD group.

Conclusion: PRP significantly improved respiratory muscle strength and lung function in patients with and without COPD who underwent CABG surgery. However, PRP is more effective in improving PEF and FEF25-75 in COPD patients.

Keywords: COPD; coronary artery bypass graft; pulmonary complications; pulmonary function; pulmonary rehabilitation program; respiratory muscle strength.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Overview of patient selection. Abbreviations: CABG, coronary artery bypass graft; PRP, pulmonary rehabilitation program.
Figure 2
Figure 2
FVC, FEV1, peak flow and FEF25–75 on postoperative Days 1 and 14. Note: PRP was significantly more effective in improving pulmonary function especially peak flow and FEF25–75 in patients with COPD (*P<0.05, **P<0.01). Abbreviations: FVC, forced vital capacity; FEV1, forced expiratory volume in 1 second; FEF25–75, forced expiratory flow between 25% and 75%; PRP, pulmonary rehabilitation program.

References

    1. WHO [homepage on the internet] Chronic respiratory disease. 2017. [cited October 20, 2017]. Available from:
    1. Ministry of Health and Welfare [webpage on the Internet] 2016 statistics of causes of death. 2017. [cited October 25, 2017]. Available from: .
    1. Decramer M, Janssens W. Chronic obstructive pulmonary disease and comorbidities. Lancet Respir Med. 2013;1(1):73–83.
    1. Savas Oz B, Kaya E, Arslan G, Karabacak K, Cingoz F, Arslan M. Pretreatment before coronary artery bypass surgery improves post-operative outcomes in moderate chronic obstructive pulmonary disease patients. Cardiovasc J Afr. 2013;24(5):184–187.
    1. Michalopoulos A, Geroulanos S, Papadimitriou L, et al. Mild or moderate chronic obstructive pulmonary disease risk in elective coronary artery bypass grafting surgery. World J Surg. 2001;25(12):1507–1511.
    1. Almassi GH, Shroyer AL, Collins JF, et al. Chronic obstructive pulmonary disease impact upon outcomes: the veterans affairs randomized on/off bypass trial. Ann Thorac Surg. 2013;96(4):1302–1309.
    1. Rajendran AJ, Pandurangi UM, Murali R, Gomathi S, Vijayan VK, Cherian KM. Pre-operative short-term pulmonary rehabilitation for patients of chronic obstructive pulmonary disease undergoing coronary artery bypass graft surgery. Indian Heart J. 1998;50(5):531–534.
    1. Weiner P, Zeidan F, Zamir D, et al. Prophylactic inspiratory muscle training in patients undergoing coronary artery bypass graft. World J Surg. 1998;22(5):427–431.
    1. Wynne R, Botti M. Postoperative pulmonary dysfunction in adults after cardiac surgery with cardiopulmonary bypass: clinical significance and implications for practice. Am J Crit Care. 2004;13(5):384–393.
    1. Massard G, Wihlm JM. Postoperative atelectasis. Chest Surg Clin N Am. 1998;8:503–528.
    1. Siafakas NM, Mitrouska I, Bouros D, Georgopoulos D. Surgery and the respiratory muscles. Thorax. 1999;54:458–465.
    1. Vassilakopoulos T, Petrof BJ. Ventilator-induced diaphragmatic dysfunction. Am J Respir Care Med. 2004;169:336–341.
    1. Gracey DR, Divertie MB, Didier EP. Preoperative pulmonary preparation of patients with chronic obstructive pulmonary disease: a prospective study. Chest. 1979;76(2):123–129.
    1. Hall JC, Tarala RA, Hall JL, Mander J. A multivariate analysis of the risk of pulmonary complications after laparotomy. Chest. 1991;99(4):923–927.
    1. Li C, Yang WH, Zhou J, et al. Risk factors for predicting postoperative complications after open infrarenal abdominal aortic aneurysm repair: results from a single vascular center in China. J Clin Anesth. 2013;259(5):371–378.
    1. McAlister FA, Bertsch K, Man J, et al. Incidence of and risk factors for pulmonary complications after nonthoracic surgery. Am J Respir Crit Care Med. 2005;171(5):514–517.
    1. Nici L, Donner C, Wouters E, et al. American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. Am J Respir Crit Care Med. 2006;173:390–1413.
    1. Rochester CL, Vogiatzis I, Holland AE, et al. An official American Thoracic Society/European Respiratory Society policy statement: enhancing implementation, use, and delivery of pulmonary rehabilitation. Am J Respir Crit Care Med. 2015;192(11):1373–1386.
    1. Hulzebos EH, Smit Y, Helders PP, van Meeteren NL. Preoperative physical therapy for elective cardiac surgery patients. Cochrane Database Syst Rev. 2012;14:11.
    1. Shakouri SK, Salekzamani Y, Taghizadieh A, et al. Effect of respiratory rehabilitation before open cardiac surgery on respiratory function: a randomized clinical trial. J Cardiovasc Thorac Res. 2015;7(1):13–17.
    1. Smetana GW, Lawrence VA, Cornell JE, American College of Physicians Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med. 2006;144(8):581–595.
    1. Powers SK, Wiggs MP, Sollanek KJ, Smuder AJ. Ventilator-induced diaphragm dysfunction: cause and effect. Am J Physiol Regul Integr Comp Physiol. 2013;305(5):R464–R477.
    1. Woods SE, Bolden T, Engel A. The influence of chronic obstructive pulmonary disease in patients undergoing coronary artery bypass graft surgery. Int J Med Sci. 2010;2:308–313.
    1. Scott BH, Seifert FC, Grimson R, Glass PS. Octogenarians undergoing coronary artery bypass graft surgery: resource utilization, postoperative mortality, and morbidity. J Cardiothorac Vasc Anesth. 2005;19(5):583–588.
    1. Decramer M, Janssens W, Derom E, et al. Contribution of four common pulmonary function tests to diagnosis of patients with respiratory symptoms: a prospective cohort study. Lancet Respir Med. 2013;1(9):705–713.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj