The Effectiveness of Respiratory Physiotherapy in Mitral Valve Surgery
Condition: Mitral Valve Disease
Study type: Interventional

Summary: 
      This trial was conducted to evaluate the effectiveness of the chest physiotherapy techniques
      to prevent pulmonary collapse based in an score applied in the patients submitted of the
      mitral valve surgery, after their ICU discharge.

      Patients were allocated in groups according their pulmonary function (FVC: forced vital
      capacity), the respiratory muscle performance (MIP: maximal inspiratory pressure; MEP:
      maximal expiratory pressure), the oxygenation level (SpO2), the pulmonary auscultation;
      respiratory frequency (f); the ability to expectorate and the functional independence.

      The group I was allocated those patients which presented decrease of up to 50% of forced
      vital capacity (FVC) of preoperative period, SpO2>92%, minimal pulmonary auscultation
      alterations; frequency (f) between 15 and 25 ipm; able to expectorate without assistance;
      independence to sit; respiratory. In these patients were randomized for two interventions: a)
      Deep breathing exercises: diaphragmatic exercises; inspiratory sighs; maximal inspiration
      exercises. Each kind of exercises was repeated 10 times; b) volume-targeted incentive
      spirometer: used Coach® three sets of 10 repetitions.

      Patients allocated in the group II presented FVC> 30% <49% of preoperative period, ≥ 88% SpO2
      <92%, necessity of oxygen therapy, abnormal pulmonary auscultation, f> 25 <31ipm; dependence
      to expectorate and to sit.. They were assisted by: a) Intermittent Positive Pressure
      Breathing (IPPB) with PEEP - through ventilator (Bird Mark 7™) with exhalation valve spring
      load set at 10 cmH2O. b) CPAP - 10 cmH2O associated with oxygen support to obtain SpO2≥ 95%
      with electronic device (Sullivan®) Each session consisted of 20 minutes, twice daily, one in
      the morning and another in the afternoon.

      All of the patients were conducted in effort to mobilize upper and lower limbs. On the first
      day, the patients walked at least 50 meters, by increasing the distance to at least 150
      meters on the fourth day. Outcome measures were recorded at day 5 of the interventions.
    

Detailed description: 
      The study were conducted with individuals of both gender, aged between 18 and 60 years,
      candidates for mitral valve surgery, up to a maximum 2nd valve replacement. Patients unable
      to perform the functional tests were excluded and patients with signs of neurological
      disorders; hemodynamic instability, respiratory disorders and mechanically ventilated for
      more than 48 hours .
    

Intervention name(s): breathing exercises; incentive spirometry; Intermittent positive pressure breathing; Continuous positive airway pressure
Intervention type(s): Other; Device; Device; Device
Intervention description(s): 3 sets of 10 repetitions of deep breathing exercises; 3 sets of 10 repetitions of deep breathing exercises with incentive spirometry; 20 minutes breathing with intermittent positive pressure; 20 minutes breathing with continuous positive airway pressure
Other intervention name(s): EXE; IS (Coach®); IPPB (BIRD Mark 7™); CPAP (Sullivan®)
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Cardiac valve