Treinamento muscular inspiratório com incentivador a fluxo Respiron® no pós-operatório tardio de cirurgia cardÃaca pode melhorar desfechos funcionais? Um estudo duplo-cego, randomizado e sham controlado
Does inspiratory muscle training with the flow-oriented incentive spirometer Respiron® on late postoperative cardiac surgery improve functional outcomes? A double-blind, randomized, sham-controlled study
Paulo Eugênio Silva, Karina Martins Gomes Almeida, Vanesca de Santana Dias, Flavio Maciel Dias de Andrade, Mônica Lajana Oliveira Almeida
Resumo
Introdução: Nos últimos anos, tem crescido o número de pacientes encaminhados para o programa de reabilitação cardiorrespiratória (PRCR). A adição do treinamento muscular inspiratório (TMI) ao PRCR vem demonstrando resultados significativos. Objetivo deste estudo foi avaliar a eficácia de um protocolo de TMI fluxo dependente (TMI-FD) realizado com um inspirômetro de incentivo sobre a pressão inspiratória máxima (PImax) e parâmetros funcionais durante um PRCR. Métodos: Foi realizado um estudo prospectivo, randomizado, duplo-cego e controlado por grupo sham. Foram estudados pacientes no pós-operatório de cirurgia cardiovascular na fase III da reabilitação. Os sujeitos foram randomizados para grupo sham (GS) ou para grupo experimental (GE). Ambos realizaram um PRCR padrão; entretanto, o GS realizou TMI sham, enquanto o GE foi submetido ao TMI-FD. Resultados: A amostra final foi composta por 14 pacientes. Foram avaliadas a pressão inspiratória máxima (PImax), distância percorrida do teste de caminhada de 6 minutos (TC6mim) e a percepção de dispneia pelo escore de dispneia do medical research council (DS-MRC), antes e após quatro semanas de protocolo. Observou-se um aumento significativo da PImax no GE, quando comparado ao GS [mediana (intervalo interquartil)] 110 cmH2 O (15) vs 80 cmH2 O (23); p = 0,002. Ocorreu um aumento significativo na distância percorrida no TC6 a favor do GE na análise intergrupos 525 m (83) vs 375 m (155); p = 0,038. Não foram verificadas diferenças significativas em relação ao DS-MRC, p = 1. Conclusão: O TMIFD realizado com incentivador a fluxo Respiron® foi capaz de aumentar a PImax e a distância percorrida no TC6mim, quando associados ao PRCR convencional.
Palavras-chave
Abstract
Background: Over the last years, the number of patients referred to cardiorespiratory rehabilitation programs (CRP) has been increasing. The addition of inspiratory muscle training (IMT) to CRP has been showing significant results. Objective: to evaluate the effects of a flow-dependent IMT protocol (FD-IMT) carried out with a flow-oriented incentive spirometer on the maximal inspiratory pressure (MIP) and functional parameters during a CRP. Methods: It was carried out a prospective double-blind, randomized, shamcontrolled trial. Post-operative cardiac surgery patients on rehabilitation phase III were enrolled. The subjects were randomized to sham group (SG) or experimental group (EG). Both underwent a standard CRP; however the SG performed a sham IMT while the EG performed the FD-IMT protocol. Results: The sample was composed of 14 patients. Maximal inspiratory pressure, 6-minute walk test (6MWT) and dyspnoea sensation by the Medical Research Council score (DS-MRC) were measured before and after 4 weeks of protocol. It was detected a significant increase in MIP at EG when compared to SG [median (interquartile range)] [110 cmH2 O (15) vs 80 cmH2 O (23); p = 0.002]. There was a significant increase in 6MWT in favour of EG in the intergroup analysis [525 m (83) vs 375 m (155); p = 0.038]. It was not verified significant differences in DSMRC, p=1. Conclusion: The FD-IMT carried out with the flow-oriented incentive spirometer Respiron® was effective to improve MIP and distance walked in the 6MWT when added to standard CRP.
Keywords
Referências
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