Effects of Segmental Breathing Exercise in Patients Awaiting Coronary Artery Bypass Graft Surgery (CABG)
Study Details
Study Description
Brief Summary
To determine the effects of preoperative segmental breathing exercise on postoperative pulmonary complications in patients awaiting coronary artery bypass graft surgery (CABG).
This study will be a randomized controlled trial. This study will be conducted in cardiac surgery department at Faisalabad institute of cardiology. sample size will be 44including both male and female. Non- probability purposive sampling technique will be used.
Modified healthy heart questionnaire will be used as a screening tool. Baseline, Preoperative at week 4 and postoperatively before discharge at week 5 assessment will be done by 6-minute walk test. Subjects in group A (interventional group) will be treated using segmental breathing exercises combined with Conventional Treatment (deep breathing exercise ) and the group B (control group) will be treated with only conventional treatment. Group-A (interventional group) will receive segmental breathing exercises for one month 5 days a week and 2 sessions per day for 15 minutes for each patient. conventional treatment will be for one month 5 days a week 10 to 15 repetitions of deep breathing exercise 2times a day. Dyspnea will be checked basekline,preoperatively at week 4and postoperatively at week5 by modified Borg scale. Quality of life will be checked baseline ,preoperatively at week 4 and postoperatively before discharge at week 5by SF-12 Questionnaire. Outcome variables will be 6MWT, dyspnea, quality of life, oxygen saturation, heart rate, blood pressure , oxygen therapy and lcu stay. Data will be analyzed on SPSS-25.
| Condition or Disease | Intervention/Treatment | Phase |
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N/A |
Detailed Description
This study will be a randomized controlled trial. This study will be conducted in cardiac surgery department at Faisalabad institute of cardiology. sample size will be 44including both male and female. Non- probability purposive sampling technique will be used.
Modified healthy heart questionnaire will be used as a screening tool. Baseline, Preoperative at week 4 and postoperatively before discharge at week 5 assessment will be done by 6-minute walk test. Subjects in group A (interventional group) will be treated using segmental breathing exercises combined with Conventional Treatment (deep breathing exercise ) and the group B (control group) will be treated with only conventional treatment. Group-A (interventional group) will receive segmental breathing exercises for one month 5 days a week and 2 sessions per day for 15 minutes for each patient. conventional treatment will be for one month 5 days a week 10 to 15 repetitions of deep breathing exercise 2times a day. Dyspnea will be checked baseline, preoperatively at week 4and postoperatively at week 5 by modified Borg scale. Quality of life will be checked baseline, preoperatively at week 4and postoperatively before discharge at week 5 by SF-12 Questionnaire. Outcome variables will be 6MWT, dyspnea, quality of life, oxygen saturation, heart rate, blood pressure , oxygen therapy and icu stay . Data will be analyzed on SPSS-25.
A study found that different evidence show different conclusions about the post op poor cardiopulmonary health. Impaired pulmonary function is common in cardiac patients. It was found that pulmonary impairment is more frequent after cardiac surgery than after other major surgical procedures. breathing techniques like diaphragmatic breathing, segmental breathing help in reducing post op complications.
A study evaluated the effects of stretching combined with breathing exercise on hemodynamic and oxygenation changes in CABG patients. According to the findings, combined stretching-breathing exercise improved heart rate and arterial blood oxygenation in CABG patients, which can help patients recover faster as part of a rehabilitation program.
A study suggested that post-operative pulmonary impairment is common in the early period after cardiac surgery. Preoperative inspiratory muscle training which include incentive spirometry (IS), diaphragmatic breathing exercises and segmental breathing exercises (apical costal expansion exercises, lateral costal expansion exercises, posterior costal expansion exercises) result in improved inspiratory muscle power and better alveolar-arterial oxygen gradients.
A Single blinded randomized clinical trial was conducted that had evaluated the effect of preoperative breathing exercises on the incidence of atelectasis and hypoxemia inpatient candidate for CABG was examined. Arterial blood gases and atelectasis were compared between groups. Study concluded that Preoperative breathing exercise does not reduce pulmonary complications in patients undergoing CABG.
More research findings have indicated that PT may have a positive impact on cardiovascular injuries. A study was conducted in which it was found that it is beneficial for patients who have undergone coronary artery bypass graft (CABG). Segmental breathing exercises were introduced in patient of coronary artery bypass graft. Segmental breathing exercises improve quality of life and reduces pain.
In the preoperative and postoperative settings, chest physiotherapy improve tolerance of the surgical procedure, increased ability to clear secretions, and decreased work of breathing as a result of improvement in diaphragmatic function in a study. Chest physiotherapy consisted of diaphragmatic, pursed lip, segmental breathing exercise, usage of incentive spirometry, coughing exercise contribute to improved pulmonary hygiene and a decreased incidence of postoperative pneumonia.
Chest physiotherapy is the fundamental component in post-operative physiotherapy. This study will specify the preferable technique for early prevention of postoperative pulmonary complications. As there are few literatures available regarding effects of segmental breathing so this study will put a positive impact on society.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Segmental breathing exercise segmental breathing exercise (apical costal expansion exercises, lateral costal expansion exercises, posterior costal expansion exercises) combined with Conventional Treatment ( deep breathing exercise ). Group-A (interventional group) will receive segmental breathing exercises for one month 5 days a week and 2 sessions per day for 15 minutes for each patient |
Other: segmental breathing exercise
Group-A (interventional group) will receive segmental breathing exercises and deep breathing. segmental breathing exercise will be performed by taking a deep and long breath from nose patient inhale air in to lungs and in exhalation therapist will apply pressure on intercostal spaces at apical, lateral and posterior for one month 5 days a week and 2 sessions per day for 15 minutes for each patient. conventional treatment will be for one month 5 days a week 10 to 15 repetitions of deep breathing exercise 2 times a day.
Other: deep breathing
conventional treatment will be for one month 5 days a week 10 to 15 repetitions of deep breathing exercise 2 times a day. . deep breathing exercise will be performed by taking a deep and long breath from nose patient inhale air in to lungs and will exhale through mouth.
|
| Active Comparator: conventional therapy Conventional Treatment (deep breathing exercise). conventional treatment will be for one month 5 days a week 10 to 15 repetitions of deep breathing exercise 2times a day. |
Other: deep breathing
conventional treatment will be for one month 5 days a week 10 to 15 repetitions of deep breathing exercise 2 times a day. . deep breathing exercise will be performed by taking a deep and long breath from nose patient inhale air in to lungs and will exhale through mouth.
|
Outcome Measures
Primary Outcome Measures
- Change in 6 minute walk test [baseline ,week 4 and week 5]
The 6 Minute Walk Test is a sub-maximal exercise test used to assess aerobic capacity and endurance. The distance covered over a time of 6 minutes is used as the outcome by which to compare changes in performance capacity.It measures the walking distance of subjects within a fixed time to quantify the functional capacity of the subjects, which refers to the total distance the subjects walked within 6 minutes.
- Change in Modified Borg Dyspnea Scale [baseline ,week 4 and week 5]
The Modified Borg Dyspnea Scale (MBS) is a 0 to 10 rated numerical score used to measure dyspnea as reported by the patient during submaximal exercise and is routinely administered during six-minute walk testing (6MWT). It starts at number 0 where your breathing is causing you no difficulty at all and progresses through to number 10 where your breathing difficulty is maximal.
- Change in short form-12 Health related quality of life questionnaire [baseline,week 4 and week 5]
It is a self-reported outcome measure assessing the impact of health on an individual's everyday life. The SF-12v2 is a health-related quality-of-life questionnaire consisting of twelve questions that measure eight health domains to assess physical and mental health. Physical health-related domains include General Health (GH), Physical Functioning (PF), Role Physical (RP), and Body Pain (BP). short form-12 questionnaire will be used to measure quality of life in CABG patients. Scores range from 0 to 100, with higher scores indicating better physical and mental health functioning.
Secondary Outcome Measures
- duration of oxygen therapy. [week 5]
For how many hours patient received oxygen therapy during hospital stay after CABG.
- The length of icu stay [week 5]
how many days patient stay in icu after CABG.The average ICU length of stay (LOS) is 3.3 days, and for every day spent in an ICU bed, the average patient spends an additional 1.5 days in a non-ICU bed.
Eligibility Criteria
Criteria
Inclusion Criteria:
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patients who will be willing to participate in study
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Patient having age 40 to 65 years of age both male and female
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Diagnosed patients of Double vessel coronary artery disease and Triple vessel coronary artery disease
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Controlled diabetic and hypertensive patients.
Exclusion Criteria:
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patient on bronchodilators.
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Left ventricular ejection fraction< 40 %.
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Valvular disease.
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Patient having dysrhythmias or pacemaker dependent.
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Anemic patient.
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Patient having asthma, chronic obstructive pulmonary disease and interstitial lung disease
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Patient with neurological disorder.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Faisalabad institute of cardiology | Faisalabad | Punjab | Pakistan | 38000 |
Sponsors and Collaborators
- Riphah International University
Investigators
- Principal Investigator: Sumera Abdul Hameed, MS, Riphah International University
Study Documents (Full-Text)
None provided.More Information
Publications
- Alaparthi GK, Amin R, Gatty A, Raghavan H, Bairapareddy KC, Vaishali K, Borghi-Silva A, Hegazy FA. Contrasting effects of three breathing techniques on pulmonary function, functional capacity and daily life functional tasks in patients following valve replacement surgery- A pilot randomized clinical trial. Heliyon. 2021 Jul 22;7(7):e07643. doi: 10.1016/j.heliyon.2021.e07643. eCollection 2021 Jul.
- Caliskan E, de Souza DR, Boning A, Liakopoulos OJ, Choi YH, Pepper J, Gibson CM, Perrault LP, Wolf RK, Kim KB, Emmert MY. Saphenous vein grafts in contemporary coronary artery bypass graft surgery. Nat Rev Cardiol. 2020 Mar;17(3):155-169. doi: 10.1038/s41569-019-0249-3. Epub 2019 Aug 27.
- Chen JO, Liu JF, Liu YQ, Chen YM, Tu ML, Yu HR, Lin MC, Lin CC, Liu SF. Effectiveness of a perioperative pulmonary rehabilitation program following coronary artery bypass graft surgery in patients with and without COPD. Int J Chron Obstruct Pulmon Dis. 2018 May 16;13:1591-1597. doi: 10.2147/COPD.S157967. eCollection 2018.
- Chen YC, Chen KC, Lu LH, Wu YL, Lai TJ, Wang CH. Validating the 6-minute walk test as an indicator of recovery in patients undergoing cardiac surgery: A prospective cohort study. Medicine (Baltimore). 2018 Oct;97(42):e12925. doi: 10.1097/MD.0000000000012925.
- Cordeiro AL, de Melo TA, Neves D, Luna J, Esquivel MS, Guimaraes AR, Borges DL, Petto J. Inspiratory Muscle Training and Functional Capacity in Patients Undergoing Cardiac Surgery. Braz J Cardiovasc Surg. 2016 Apr;31(2):140-4. doi: 10.5935/1678-9741.20160035.
- Failde I, Medina P, Ramirez C, Arana R. Construct and criterion validity of the SF-12 health questionnaire in patients with acute myocardial infarction and unstable angina. J Eval Clin Pract. 2010 Jun;16(3):569-73. doi: 10.1111/j.1365-2753.2009.01161.x. Epub 2010 Apr 21.
- Gomes Neto M, Martinez BP, Reis HF, Carvalho VO. Pre- and postoperative inspiratory muscle training in patients undergoing cardiac surgery: systematic review and meta-analysis. Clin Rehabil. 2017 Apr;31(4):454-464. doi: 10.1177/0269215516648754. Epub 2016 Jul 10.
- Matheus GB, Dragosavac D, Trevisan P, Costa CE, Lopes MM, Ribeiro GC. Inspiratory muscle training improves tidal volume and vital capacity after CABG surgery. Rev Bras Cir Cardiovasc. 2012 Jul-Sep;27(3):362-9. doi: 10.5935/1678-9741.20120063. English, Portuguese.
- Moradian ST, Heydari AA, Mahmoudi H. What is the Role of Preoperative Breathing Exercises in Reducing Postoperative Atelectasis after CABG? Rev Recent Clin Trials. 2019;14(4):275-279. doi: 10.2174/1574887114666190710165951.
- Pacaric S, Turk T, Eric I, Orkic Z, Petek Eric A, Milostic-Srb A, Farcic N, Barac I, Nemcic A. Assessment of the Quality of Life in Patients before and after Coronary Artery Bypass Grafting (CABG): A Prospective Study. Int J Environ Res Public Health. 2020 Feb 22;17(4):1417. doi: 10.3390/ijerph17041417.
- Pehlivan E, Turna A, Gurses A, Gurses HN. The effects of preoperative short-term intense physical therapy in lung cancer patients: a randomized controlled trial. Ann Thorac Cardiovasc Surg. 2011;17(5):461-8. doi: 10.5761/atcs.oa.11.01663. Epub 2011 Jul 13.
- Pooria A, Pourya A, Gheini A. Postoperative complications associated with coronary artery bypass graft surgery and their therapeutic interventions. Future Cardiol. 2020 Sep;16(5):481-496. doi: 10.2217/fca-2019-0049. Epub 2020 Jun 4.
- Reychler G, Beaumont M, Latiers AC, Pieters T, Fremault A. Dyspnea could be accurately assessed by a caregiver in hospitalized patients with respiratory diseases: Interrater reliability and agreement study. Braz J Phys Ther. 2021 Nov-Dec;25(6):735-740. doi: 10.1016/j.bjpt.2021.04.010. Epub 2021 May 24.
- Sahar W, Ajaz N, Haider Z, Jalal A. Effectiveness of Pre-operative Respiratory Muscle Training versus Conventional Treatment for Improving Post operative Pulmonary Health after Coronary Artery Bypass Grafting. Pak J Med Sci. 2020 Sep-Oct;36(6):1216-1219. doi: 10.12669/pjms.36.6.2899.
- Savci S, Degirmenci B, Saglam M, Arikan H, Inal-Ince D, Turan HN, Demircin M. Short-term effects of inspiratory muscle training in coronary artery bypass graft surgery: a randomized controlled trial. Scand Cardiovasc J. 2011 Oct;45(5):286-93. doi: 10.3109/14017431.2011.595820. Epub 2011 Jul 27.
- Thybo Karanfil EO, Moller AM. Preoperative inspiratory muscle training prevents pulmonary complications after cardiac surgery - a systematic review. Dan Med J. 2018 Mar;65(3):A5450.
- Yang J, Biery DW, Singh A, Divakaran S, DeFilippis EM, Wu WY, Klein J, Hainer J, Ramsis M, Natarajan P, Januzzi JL, Nasir K, Bhatt DL, Di Carli MF, Blankstein R. Risk Factors and Outcomes of Very Young Adults Who Experience Myocardial Infarction: The Partners YOUNG-MI Registry. Am J Med. 2020 May;133(5):605-612.e1. doi: 10.1016/j.amjmed.2019.10.020. Epub 2019 Nov 9.
- Zolfaghari M, Mirhosseini SJ, Baghbeheshti M, Afshani A, Moazzam S, Golabchi A. Effect of physiotherapy on quality of life after coronary artery bypass graft surgery: A randomized study. J Res Med Sci. 2018 Jun 6;23:56. doi: 10.4103/jrms.JRMS_96_17. eCollection 2018.
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