Patients who have undergone coronary artery bypass grafting are at risk for pulmonary complications that impair their breathing capacity and exercise tolerance. Preoperative pulmonary rehabilitation, focusing on deep breathing and coughing exercises, may prevent these complications.
Coronary artery bypass grafting is a major surgical procedure that improves symptoms, survival, and quality of life for patients with coronary artery disease. However, the procedure can lead to postoperative pulmonary complications such as infections, pneumonia, and respiratory failure, which can reduce breathing capacity and exercise tolerance. To prevent these complications, a team proposes to train patients preoperatively in deep breathing and coughing exercises, and inspiratory muscle training.
Exercises in the pre-operative period
Previous research has shown that alterations in breathing and the coughing process lead to alveolar collapse and impaired gas exchange related to pain and stress.
This study specifically focuses on the results of pre-intervention training provided by nurses, the results being evaluated over the first three post-operative days. It included 80 patients with a mean age of 63.08 (±8.20) years, the majority of whom were men (70%), in order to evaluate the effect of this training on deep breathing and coughing exercises prior to surgery. The mean duration of anesthesia was 258.10 (±42.42) minutes, the mean intubation time was 711.13 (±165.45) minutes and the mean post-operative discharge time was 7.12 (±1.17) days.
Patients in the experimental (with preoperative training) and control (without preoperative training) groups did not show statistically significant differences in individual and surgical characteristics, except for mean age, which was significantly higher in the experimental group (p < 0.05). Constants and PO2 values were similar between the two groups (p > 0.05).
Improved early results
In the experimental group, a significant difference was observed in diastolic blood pressure, which was lower on the first postoperative day. In addition, significant differences were noted in both groups regarding pulse, respiratory rate, and PO2 (p < 0.05), with the lowest values during the immediate postoperative period for pulse and respiratory rate, and the highest value for PO2 during this same period. The values of the 6-minute walk test (6MT) and walking speed were higher in the experimental group on the first and third postoperative days.
In the experimental group, patients walked a shorter distance on the first day after surgery compared to the third day. Participants in the control group moved less on the first postoperative day.
Limitations should be noted. In this single-institution study, randomization of patients was not possible due to unavoidable interactions between patients within the facility. Thus, data from the control group were collected first, followed by those from the intervention group, which precluded randomization.
In addition, for ethical reasons, it was necessary to teach breathing exercises to patients in the control group. Furthermore, data collection was limited to the first three days after surgery, which only reflects early results and does not provide information on long-term effects.
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