Conventional Cardiac Rehabilitation Program Versus Addition of Alveolar Recruitment Maneuver Among Patients Undergoing Coronary Artery Bypass Surgery
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- Category: Vol. 77, June 2009
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Conventional Cardiac Rehabilitation Program Versus Addition of Alveolar Recruitment Maneuver Among Patients Undergoing Coronary Artery Bypass Surgery,DALIA M. EL-ZORKANY and NADINE B.M. NOUR
Abstract
Introduction: Cardiac rehabilitation (CR) is a worldwide standard practice, following cardiac surgery, however in Egypt we are still lagging behind such practice. Long term follow-up is a major determinant together with physician’s incompli-ance to such multi-disciplinary approach. Our goal was to highlight the importance of CR program, through a short term follow-up period. Prolonged mechanical ventilation can have numerous drawbacks following cardiac surgery, atelectasis is one of them and recruitment maneuvers (RM) can effectively re-expand atelectatic lung tissue and aid in early postoperative separation from mechanical ventilator. We examined the effectiveness of CR program alone versus recruitment maneu-ver added to the CR program in regards to functional capacity of the patients using 6 minutes walk test (6MWT).
Materials and Methods: 70 patients scheduled for elective coronary artery bypass graft using conventional cardiopul-monary bypass (CPB) were randomly allocated into two equal groups (Group A: CR alone n=35 & Group B: CR+RM n=35). Among both groups a CR program had been discussed, explained and handed to them. In Group (A) prior to discon-tinuation from CPB, mechanical ventilation was resumed, while in Group (B) a RM was performed (30 cm H2O for 15 s) and then mechanical ventilation was resumed. Patients were transported to ICU. PaO2/FiO2 were recorded at follow-ing intervals (T-Base) following separation from CPB (T-CPB) 15 minutes following transfer to ICU (T-ICU) and 6 hours following extubation (T-EXT). Following separation from the ventilator, patients were asked to adhere to the CR program and a daily 6MWT was performed, the test was interrupted if any criteria of fatigue occurred. Spirometric values were also recorded at baseline and following thereafter. All patients were asked to show up once after 6 weeks and were reassessed.
Results: In the immediate postoperative period, patients in Group B demonstrated better PaO2/FiO2, better exercise tolerance, greater 6MWT distances and better spirometric values compared to patients in Group A; however such values were comparable afterwards. Among all patients 6MWT distance, spirometric values and exercise tolerance had im-proved afterwards specially after 6 weeks.
Conclusion: CR program has added benefits to patients following CABG, a RM added to CR program temporary
improves pulmonary functions and allows early ambulation which aids in the early beginning of CR. Recommendations: Benefits of CR program should be studied in Egypt in a larger and longer term study and its primary objective is to highlight morbidity, mortality and quality of life after surgery.