Effects of ACBT on Pulmonary Function After CABG During Phase 1 Cardiac Rehabilitation
Condition: Coronary Artery Bypass Graft Surgery
Study type: Interventional

Summary: 
      This study is designed to determine the effects of Active cycle of breathing technique (ACBT)
      on cardiopulmonary parameters of post CABG patients. A randomized control trial was conducted
      with a sample size of 40 post CABG patients. Non probability Convenience Sampling Technique
      was used to collect sample and randomization was done through sealed envelope method to
      allocate participants to the groups. Patients in experimental group did ACBT along with the
      conventional treatment protocol that was performed in the control group. Subjects completed
      the exercise protocol of 5 days. Both male and female post CABG patients of age 30-65 years
      who were vitally stable were included in study. Data was analyzed on Statistical Package for
      the Social Sciences (SPSS) version 21. Normality was assessed through shapiro wilk test.
      Parametric tests were applied on normally distributed variables and non parametric tests were
      applied for the non normally distributed data. Confidence interval was kept at 95% and p
      value <0.05 was considered significant.
    

Detailed description: 
      Coronary artery bypass graft (CABG) is a surgery in which new routes are created around
      narrow and blocked coronary arteries, that allow proper flow of blood to provide oxygen and
      nutrients to the heart muscles. The grafts used in CABG can be a vein from lower extremity or
      any artery of chest. CABG is a surgery in which obstructed coronary arteries are replaced
      with autologous arteries and veins used as implant, which are fully or moderately congested
      by atherosclerotic plaque. ACBT is a method used to clear out the secretion from the chest.
      The purpose of ACBT treatment is to remove secretions from the chest that helps to reduce the
      frequency of infection, which control the additional airway impairment and worsening the
      lungs functions that may help in reducing the rate of progress of lung disease. After CABG
      surgery respiratory therapy is used rationally to inhibit the post-operative complications.
      Respiratory physiotherapy is routinely used in the prevention and treatment of post-operative
      pulmonary complications after cardiac surgery. The ultimate goal of physiotherapy in CABG
      patient is to improve increase lung volume, prevent atelectasis, enhance
      ventilation-perfusion matching, to increase sputum clearance, and decrease pain. ACBT
      technique can perform independently by patient with about applying manual technique. ACBT is
      very effective to improve oxygen saturation, control respiratory rate, and chest clearance
      after major surgeries. The efficiency of ACBT treatment has been checked out in stable cystic
      fibrosis, Chronic obstructive pulmonary disease and abdominal surgery. However, there is
      limited literature related to its use in patients after CABG surgery. The purpose of this
      research was to examine the effect of ACBT versus conventional chest physiotherapy after CABG
      surgery.

      In 2018 a study was conducted on effect of ACBTs in post coronary artery bypass grafting
      patient and he concluded that ACBTs technique is a better way of treatment in coronary artery
      bypass grafting surgery patients. The determination of this research was to calculate the
      effectiveness of ACBT in CABG surgery patients. In this study total 15 patients were
      involved. All the patients were checked out by visual analogue scale for pain, 6-minute walk
      test (6MWT) for endurance and chest expansion was also measured. It concluded that chest
      expansion and 6MWT was improved in both groups.

      ACBT is an effective technique implemented by the patient to secrete out the sputum from the
      main airway. The ACBT technique is combined breathing maneuvers to advance the efficiency of
      cough, untie and clear the secretions and increase the ventilation.

      In 2016 a study was conducted observed the effects of ACBTs in post CABG surgery patients and
      The ACBTs treatment decrease the intensity of pulmonary impairments in post abdominal
      surgery.There is limited data available in support of effects of ACBTs on pulmonary functions
      after CABG surgery.

      In 2015 a study was conducted to evaluate the effects of ACBTs on chest expansion, arterial
      blood gases, oxygen saturation, blood pressure, respiratory rate and other vitals in Chronic
      Obstructive Pulmonary disease (COPD) patients during 1st phase of cardiac rehab after CABG
      surgery. It concluded that ACBT are much effective than routine physiotherapy protocol in
      patients who have gone under coronary artery bypass grafting.

      The present study is intended to observe the effects of ACBT on pulmonary function including
      lung volumes and capacities, chest expansion as well as the vitals of post operative CABG
      patients undergoing phase 1 cardiac rehabilitation.
    

Intervention name(s): ACBT group; Conventional Physical therapy
Intervention type(s): Other; Other
Intervention description(s): ACBT:
Breathing control 3 to 4 Thoracic Expansion Exercise A: 3 seconds hold B: Chest clapping C: Chest vibration Forced Expiratory Technique Breathing control A: 3 seconds hold B: Chest clapping C: Chest vibration 3 to 4 Thoracic Expansion Exercise Breathing control 1-2 Huff combine with breathing control Huff and cough
Chest Physical Therapy Early mobilization; Chest percussion, deep breathing, Huff and cough. Early mobilization
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Active cycle of breathing technique; Chest expansion; Coronary artery bypass graft surgery; FEV1; FVC; PEFR