Respiratory muscle strength is not decreased in patients undergoing cardiac surgery
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RESEARCH ARTICLE
Open Access
Respiratory muscle strength is not decreased in patients undergoing cardiac surgery Charlotte Urell1*, Margareta Emtner1,2, Hans Hedenstrom3 and Elisabeth Westerdahl3,4
Abstract Background: Postoperative pulmonary impairments are significant complications after cardiac surgery. Decreased respiratory muscle strength could be one reason for impaired lung function in the postoperative period. The primary aim of this study was to describe respiratory muscle strength before and two months after cardiac surgery. A secondary aim was to describe possible associations between respiratory muscle strength and lung function. Methods: In this prospective observational study 36 adult cardiac surgery patients (67 ± 10 years) were studied. Respiratory muscle strength and lung function were measured before and two months after surgery. Results: Pre- and postoperative respiratory muscle strength was in accordance with predicted values; MIP was 78 ± 24 cmH2O preoperatively and 73 ± 22 cmH2O at two months follow-up (p = 0.19). MEP was 122 ± 33 cmH2O preoperatively and 115 ± 38 cmH2O at two months follow-up (p = 0.18). Preoperative lung function was in accordance with predicted values, but was significantly decreased postoperatively. At two-months follow-up there was a moderate correlation between MIP and FEV1 (r = 0.43, p = 0.009). Conclusions: Respiratory muscle strength was not impaired, either before or two months after cardiac surgery. The reason for postoperative lung function alteration is not yet known. Interventions aimed at restore an optimal postoperative lung function should focus on other interventions then respiratory muscle strength training. Keywords: Cardiac surgery, Lung function, Median sternotomy, Respiratory muscle strength
Background Postoperative pulmonary impairments such as atelectasis, pleural effusion, pulmonary oedema, bronchospasm and pneumonia are significant complications after cardiac surgery and the reported incidence for postoperative pulmonary complications varies from 5 to 90 % depending on how the complications are defined [1–4]. The causes of pulmonary impairment are multifactorial, and one potential reason is the limited ability to take deep breaths. A restrictive and shallow breathing pattern is commonly observed after cardiac surgery performed though median sternotomy, and sternal pain is reported as one risk factor during the first postoperative days [5–7]. The respiratory muscles, and particular diaphragm, play a vital role in the * Correspondence: [email protected] 1 Department of Neuroscience: Physiotherapy, Uppsala University, BOX 593/ BMCSE-751 24 Uppsala, Sweden Full list of author information is available at the end of the article
breathing process. During surgery the opening of the thorax might affect nerves and muscles, but it is today unknown if decreased respiratory muscle function is a possible cause of respiratory impairment. Preoperative respiratory dysfunction has been shown to prolong postoperative mechanical ventilation after heart va
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