[The use of oscillatory respiratory therapy with positive expiratory pressure (PEP-therapy) to restore the functional state of the lungs in patients after cardiac surgery].

A A Eremenko, T P Zyulyaeva, A P Alferova, D V Fomina, M S Grekova, O O Grin, S S Dmitrieva, A V Molochkov, A P Gens, K V Kotenko
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Abstract

Postoperative pulmonary complications in cardiac surgery patients occur in 10-35% of cases, depending on differences in their definition, patient characteristics and type of surgical intervention, most of them are associated with ineffective coughing and evacuation of bronchial secretions.

Objective: To determine the effectiveness of stimulating the evacuation of bronchial secretions with the help of oscillating PEP therapy carried out during the first three days.

Material and methods: A randomized prospective study of 60 adult patients after elective cardiac surgery was performed (Clinical Trials.gov. protocol number NCT05159401). Oscillatory PEP-therapy was performed in 30 patients using Acapella DHGreen device (SmithMedicalASD, USA) 10-12 hours after tracheal extubation 3 times a day for 3 days after surgery. The control group (30 patients). The inclusion criteria: age over 18 years, spontaneous breathing after tracheal extubation, clear consciousness and productive contact with the patient, the ability to maintain adequate gas exchange on the low-flow oxygen inhalation, adequate analgesia (<2 points of VAS). Exclusion criteria: the need for re-intubation and mechanical ventilation, non-invasive mask ventilation, high-flow oxygen therapy, acute cerebrovascular accident, ongoing bleeding, cardiac insufficiency (inotropic index >10), shocks syndrome of various etiologies, the use of any extracorporeal support, any neuromuscular disorders, pneumothorax, hydro-or hemothorax. Before each session and 20 minutes after its end, when breathing air, blood oxygen saturation was recorded using a pulse oximeter (SpO2), the maximum inspiratory capacity (MIC) was measured using a Coach-2 incentive spirometer from SmithsMedical and spirometry with a portable ultrasonic spirometer Spiro Scout (Schiller, Switzerland). For the purposes of this work, the total index of the spirometry maximum inspiratory capacity (SMIC) was used - the sum of the respiratory volume and the reserve volume of inspiration in ml.

Results: Difficulties in evacuation of sputum were noted in 90% of patients. Three-day sessions of oscillating PEP- therapy are accompanied by a significant improvement in the passage of sputum, as evidenced by a 3-fold increase in the number of patients with productive cough. The increase in MIC in the main group was 46.9% and 21.3%, respectively (p=0.042), and the number of patients with values greater than MICo. 1500 ml increased from 23.3% to 7.6% (p<0.001). The effectiveness of oscillatory PEP-therapy is confirmed by a 7-fold decrease in the frequency of radiological changes in the lungs at the end of sessions (p<0.001), while in the control group the frequency of their occurrence practically did not change and remained at a high level. The total number of patients with respiratory insufficiency (SpO2≤92%) decreased by 8.6 times after completion of all PEP- therapy sessions (p=0.001), however, without statistically significant difference with the control group.

Conclusions: Oscillatory PEP- therapy in cardiac surgery patients has a positive effect on sputum passage, ventilation parameters and oxygenating lung function. The procedure was well tolerated and there were no complications associated with it.

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[使用呼气正压振荡呼吸疗法(PEP疗法)恢复心脏手术后患者的肺功能状态]。
心脏手术患者术后肺部并发症的发生率为10%-35%,这取决于其定义、患者特征和手术干预类型的不同,其中大多数并发症与支气管分泌物的无效咳嗽和排空有关:材料与方法:对 60 名住院患者进行随机前瞻性研究:对 60 名择期心脏手术后的成年患者进行了随机前瞻性研究(临床试验网,协议编号 NCT05159401)。30 名患者在术后 3 天内使用 Acapella DHGreen 设备(SmithMedicalASD,美国)在气管拔管后 10-12 小时进行振荡 PEP 治疗,每天 3 次。对照组(30 名患者)。纳入标准:年龄在 18 岁以上,气管拔管后有自主呼吸,意识清楚,能与患者进行有效接触,在低流量氧气吸入时能维持充分的气体交换,有充分的镇痛(10),各种病因引起的休克综合征,使用任何体外支持,任何神经肌肉疾病,气胸,水肿或血胸。每次治疗前和结束后 20 分钟,呼吸空气时使用脉搏血氧仪(SpO2)记录血氧饱和度,使用 SmithsMedical 公司生产的 Coach-2 激励式肺活量计测量最大吸气量(MIC),使用便携式超声波肺活量计 Spiro Scout(瑞士席勒公司)测量肺活量。在这项工作中,使用的是肺活量测定最大吸气容量总指数(SMIC)--以毫升为单位的呼吸量和储备吸气量之和:90%的患者排痰困难。在接受为期三天的 PEP 振荡疗法后,患者的排痰情况明显改善,有痰咳嗽患者的人数增加了三倍。在完成所有 PEP- 疗法疗程后,主要组的 MIC 分别增加了 46.9% 和 21.3%(p=0.042),而 MICo 值大于 1500 毫升的患者人数从 23.3% 增加到 7.6%(pp2≤92%),减少了 8.6 倍(p=0.001),但与对照组相比没有统计学意义上的显著差异:结论:心脏手术患者的振荡 PEP 治疗对痰液排出、通气参数和氧合肺功能有积极影响。该疗法的耐受性良好,无相关并发症。
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来源期刊
CiteScore
0.60
自引率
0.00%
发文量
59
期刊介绍: The journal deals with the study of the mechanism of a physiological and therapeutic effect of physical and health resort factors, methods and results of their employment, as well as with theoretical and practical problems involved in the use of exercise therapy in combined treatment of different diseases. The results of research and experience of using physical and health resort methods in medical practice and organization of physiotherapeutic and sanatorial and health resort service, book reviews on physiotherapy, health resort science and exercise therapy are published. Scientific life of allied specialities, proceedings of congresses, conferences, symposia (including foreign), the activity of republican and local societies, etc., are covered.
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