Pathological Conditions, Signs and Symptoms, Pulmonary Atelectasis, Respiratory Tract Diseases
Conditions
Keywords
Morbid obesity, bariatric surgery, Respiratory muscle endurance, Respiratory muscle strength, spirometry, physiotherapy
Brief summary
The aim of this study is to evaluate the effects of the use of breathing exercises with inspiratory loading on respiratory muscle strength and endurance, lung volumes and capacities and thoracoabdominal mobility in patients after bariatric surgery. It is believed that the use of inspiratory load may mitigate the negative effects of surgical trauma on respiratory muscle dysfunction, preserving respiratory muscle strength, lung volumes and diaphragm mobility, thus reducing the risk of pulmonary complications in the postoperative period.
Detailed description
This is a prospective, randomized and blinded study, where volunteers will be selected anthropometric measurements, assessment of lung volumes and capacities, through spirometry, thoracoabdominal mobility through the circumference, assessment of inspiratory muscle strength and endurance. After these evaluations will be done by lottery randomization, where the volunteers will be divided into five groups. They are: control, incentive spirometry to flow, the volume incentive spirometry, Threshold ™, Power breathe ®, according to their resources to be performed during the postoperative period. Each appeal will be held in 6 sets of 15 repetitions, totaling seven sessions, two in the immediate postoperative period, and five on the first postoperative day. At the end of the intervention volunteers will be reassessed.
Interventions
PROCEDUREincentive spirometry
Incentive spirometry to flow and incentive spirometry to volume
PROCEDUREinspiratory load equipment
Threshold and Power breathe
Sponsors
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior.
Universidade Metodista de Piracicaba
Study design
Allocation
RANDOMIZED
Intervention model
FACTORIAL
Primary purpose
TREATMENT
Masking
DOUBLE (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
25 Years to 55 Years
Healthy volunteers
Yes
Inclusion criteria
* BMI between 40 and 55 Kg/m² * Aged between 25 and 55 years * Submitted to Roux-en-Y type gastric by-pass by laparotomy * Normal preoperative pulmonary function test
Exclusion criteria
* Hemodynamic instability * Hospital stay longer than three days * Presence of postoperative complications * Smoking
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| EVALUATION OF INSPIRATORY MUSCLE ENDURANCE | Preoperatively and on the high hostitalar - On day 1 and day 3 | The endurance test is performed using the Power breathe ® K3. According to Basso and Costa (2012), this assessment divided into two tests: * Test incremental: starting with 10 centimeters of water, the volunteer is instructed to breathe normally for two minutes, thereafter a further minute, the next two minutes of exercise load will be increased, and so on until the volunteer fails to reach the predetermined pressure for three consecutive breaths or present dyspnea and / or fatigue. The largest load that is sustained for at least one minute will be considered the value of sustained maximal inspiratory pressure (PImáxS). * Test constant: is conducted PImáxS to 80%, which is obtained in the previous test, and determined the time limit (Tlim) run 30 minutes. The stopping criteria are the same as the incremental test. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| EVALUATION OF LUNG VOLUMES AND CAPACITIES | Preoperatively and on the high hostitalar - On day 1 and day 3 | Spirometry was carried out according to the guidelines of the American Thoracic Society (ATS) and European Respiratory Society (ERS) (2005). Three types of maneuver were used in order to evaluate the lung volumes and flows: Slow Vital Capacity (SVC), Forced Vital Capacity (FVC) and Maximum Voluntary Ventilation (MVV). The maneuvers were carried out until three acceptable and reproducible curves were obtained, not exceeding more than eight attempts. The values extracted from each maneuver were selected according to Pereira (2002), and the predicted values calculated using the equation proposed by Pereira et al. (1992) for Brazilians. |
Other
| Measure | Time frame | Description |
|---|---|---|
| THORACOABDOMINAL MOBILITY | Preoperatively and on the high hostitalar - On day 1 and day 3 | The measurement of thoracoabdominal mobility was performed by using a tape scaled in centimeters. In the standing position, the measurements were made at levels axillary, xiphoid and abdominal during rest, and at maximal inspiration and maximal expiration. At each level, the measurements were performed three times. It computed the highest value of inspiration and the lowest of expiration. The absolute difference between these values was considered the thoracoabdominal mobility. |
| EVALUATION OF MUSCLE STRENGTH INSPIRATORY | Preoperatively and on the high hostitalar - On day 1 and day 3 | The Sniff is an alternative non-invasive technique for the assessment of inspiratory muscle strength by sniff nasal inspiratory pressure (PNSN). The measurement is performed using a peak pressure generated by nasal nostril during a maximal sniff from functional residual capacity (FRC). The measurement will be performed with one nostril occluded by a silicone nasal plug, which remained connected to the digital manometer by a catheter approximately 1mm diameter (RUPPEL, 1994). The maneuver is a maximal sniff, with the mouth closed, from functional residual capacity (FRC). The Sniff Test will be held in ten maneuvers, with an interval of 30 seconds between each maneuver, being used as a selection criterion Sniff acceptable to generate a peak pressure regularly and a duration between 0 and 5 sec. |
Countries
Brazil
Outcome results
None listed