Application Breathing Exercises With Load Inspiratory Postoperative Abdominal Surgery

Study Overview
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Brief Summary
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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
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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.

Official Title
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Application of Breathing Exercises With Load Inspiratory Postoperative Abdominal Surgery: a Randomized Clinical Trial Blind

Conditions
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Pulmonary Atelectasis, Respiratory Tract Diseases, Pathological Conditions, Signs and Symptoms

Intervention / Treatment
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* Procedure: incentive spirometry
* Procedure: inspiratory load equipment


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 25 Years
Maximum Age: 55 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Control<br>Individuals will be treated with conventional physiotherapy according to the routine service of physiotherapy of the hospital. | |
| Experimental: Incentive spirometry to flow<br>Was determined for this study that the flow of inspired air will be sufficient to raise up to three spheres. In addition to direct them to do explosive, fast and deep, lifting the ball explosively breaths. Every fifteen inspirations volunteers will be invited to rest for intervals of 30-60 seconds and repeat six times. The use of incentive spirometry was adapted from the recommendations of the American Association for Respiratory Care (1991). | Procedure: incentive spirometry<br>* Incentive spirometry to flow and incentive spirometry to volume<br>|
| Experimental: incentive spirometry to volume<br>Use of this incentive spirometry will be done as follows: the participants will be instructed to inhale deeply through the mouthpiece, to total lung capacity, starting from functional residual capacity. Will be performed 6 sets of 15 breaths each (deep, slow and sustained) intervals with 30-60 seconds between each series. | Procedure: incentive spirometry<br>* Incentive spirometry to flow and incentive spirometry to volume<br>|
| Experimental: inspiratory load equipment-Threshold<br>This group will use the device Threshold™. Where adjustment is considered 40% of PNSN achieved by the patient evaluation. The volunteer will be instructed to remain in a supine position with 45 ° fowler comfortably with arms and shoulders relaxed and perform an inspiration with enough force to overcome the linear load of the device, then make a normal expiration. This study was determined to carry six sets of 15 repetitions. The rest will be about one to two minutes in each intervention. | Procedure: inspiratory load equipment<br>* Threshold and Power breathe<br>|
| Experimental: inspiratory load equipment-Power breathe<br>To exercise inspiratory muscle in this group will be used device Power breathe ® K2 have the same resistance setting, allowing us to tailor your level of inspiratory muscles. Such adjustment will be made considering 40% of PNSN achieved by the patient in the assessment sniff. For its implementation, the patient will be lying with a tilt of the head of the litter at 45 °, the patient will be asked to inspire to overcome the resistance of the linear unit and after performing a normal expiration. This group will also be achieved 6 series with 15 repetitions each, with an interval of one to two minutes between sets. | Procedure: inspiratory load equipment<br>* Threshold and Power breathe<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| EVALUATION OF INSPIRATORY MUSCLE ENDURANCE | 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. | Preoperatively and on the high hostitalar - On day 1 and day 3 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| EVALUATION OF LUNG VOLUMES AND CAPACITIES | 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. | Preoperatively and on the high hostitalar - On day 1 and day 3 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Morbid obesity, bariatric surgery, Respiratory muscle endurance, Respiratory muscle strength, spirometry, physiotherapy