Técnica de empilhamento de ar: duração dos efeitos obtidos no pico de fluxo expiratório e no pico de fluxo de tosse em pacientes submetidos à cirurgia torácica não cardíaca
Data
2024-05-29
Autores
Teodoro, Renata de Jesus 
Orientadores
Faresin, Sonia Maria
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Após uma intervenção cirúrgica intratorácica, os pacientes apresentam alterações fisiopatológicas que resultam em tosse menos eficaz. A técnica de empilhamento de ar (TEA), utilizada inicialmente em pacientes com neuropatias, determina aumento no pico de fluxo expiratório (PFE) e no pico de fluxo da tosse (PFE) e estudos recentes demonstraram sua eficácia em pacientes submetidos a cirurgia torácica não cardíaca que, por diferentes motivos, também apresentam reduções nestas variáveis e consequentemente na capacidade de tossir. No entanto, a literatura carece de estudos capazes de indicar o tempo de duração destes efeitos benéficos. OBJETIVOS: Avaliar a duração dos efeitos da TEA no PFE e no PFT, de pacientes submetidos à cirurgia torácica não cardíaca e se esses efeitos sofrem interferência de características clínicas dos pacientes ou relacionadas ao próprio procedimento operatório. MÉTODO: Trinta doentes submetidos à cirurgia torácica não cardíaca eletiva, receberam a TEA no 3º PO e os valores de PFE e PFT foram obtidos imediatamente, a cada 30 minutos até a segunda hora e a cada 60 minutos até a sexta hora após sua aplicação. Todos os participantes foram avaliados no pré-operatório e 3º PO com relação aos sinais vitais, pressões inspiratórias máxima (PImáx) e expiratória máxima (PEmáx), PFE e PFT. RESULTADOS: Nove doentes (30%) eram do sexo feminino, a idade média do grupo foi de 53+/-12 anos. O PFE e PFT apresentaram, respectivamente, aumento significante de 45 +/- 11% para 103+/- 11% (p=0,02) e de 42+/- 10% para 103+/- 6% (p=0,01) do previsto após a TEA. Os efeitos se mantiveram por até 300 min (p=0,03) no PFE e até 240 min (p=0,04) no PFT. A idade não foi um fator relevante na duração dos efeitos. Em portadores de DPOC, a duração dos efeitos se estendeu até 240 min (p=0,03) e nos sem DPOC até 300 min (p=0,03). Não houve diferença na duração dos efeitos nos tabagistas e não tabagistas, que se mantiveram até 300 min para o PFE (p=0,02) e até 240 min para o PFT (p=0,02). Os pacientes sem e com dreno de tórax mantiveram os efeitos no PFE até 300 min (p=0,01 e p=0,02, respectivamente). A duração dos efeitos no PFT dos pacientes sem dreno foi até 300 min (p=0,02) e para pacientes com dreno até 180 minutos (p= 0,02). CONCLUSÃO: Em pacientes submetidos a cirurgia torácica não cardíaca, os efeitos da TEA sobre o PFE e PFT se mantiveram até 300 e 240 minutos, respectivamente. Nos pacientes portadores de DPOC os efeitos sobre o PFE e PFT tiveram menor duração que nos pacientes sem DPOC. Não houve diferenças na duração dos efeitos sobre o PFE e PFT de tabagistas ou não tabagistas. Não houve diferenças na duração dos efeitos sobre o PFE de pacientes com dreno e no PFT a duração dos efeitos foi menor nos pacientes com dreno de tórax.
After an intrathoracic surgical intervention, patients experience pathophysiological changes that result in less effective coughing. The air stacking technique (TEA), initially used in patients with neuropathies, determines an increase in peak expiratory flow (PEF) and peak cough flow (PEF) and recent studies have demonstrated its effectiveness in patients undergoing nonthoracic thoracic surgery. which, for different reasons, also present reductions in these variables and consequently in the ability to cough. However, the literature lacks studies capable of indicating the duration of these beneficial effects. OBJECTIVES: To evaluate the duration of the effects of TEA on the PEF and PFT of patients undergoing noncardiac thoracic surgery and whether these effects are influenced by the patients' clinical characteristics or those related to the surgical procedure itself. METHOD: Thirty patients undergoing elective noncardiac thoracic surgery received TEA on the 3rd POD and PEF and PFT values were obtained immediately, every 30 minutes until the second hour and every 60 minutes until the sixth hour after its application. All participants were evaluated preoperatively and on the 3rd PO regarding vital signs, maximum inspiratory (MIP) and maximum expiratory (PEmax) pressures, PEF and PFT. RESULTS: Nine patients (30%) were female, the average age of the group was 53+12 years. The PFE and PFT showed, respectively, a significant increase from 45+11% to 103+11% (p=0.02) and from 42+10% to 103+6% (p=0.01) of the predicted value after TEA. The effects remained for up to 300 min (p=0.03) in the PFE and up to 240 min (p=0.04) in the PFT. Age was not a relevant factor in the duration of the effects. In people with COPD, the duration of the effects extended up to 240 min (p=0.03) and in those without COPD up to 300 min (p=0.03). There was no difference in the duration of the effects in smokers and nonsmokers, which remained up to 300 min for PFE (p=0.02) and up to 240 min for PFT (p=0.02). Patients without and with a chest tube maintained the effects on PEF up to 300 min (p=0.01 and p=0.02, respectively). The duration of effects on the PFT of patients without a drain was up to 300 min (p=0.02) and for patients with a drain up to 180 minutes (p= 0.02). CONCLUSION: In patients undergoing noncardiac thoracic surgery, the effects of TEA on PEF and PFT were maintained up to 300 and 240 minutes, respectively. In patients with COPD, the effects on PEF and PFT lasted shorter than in patients without COPD. There were no differences in the duration of effects on the PFE and PFT of smokers or nonsmokers. There were no differences in the duration of the effects on the PEF of patients with a chest tube and in the PFT the duration of the effects was shorter in patients with a chest tube.
After an intrathoracic surgical intervention, patients experience pathophysiological changes that result in less effective coughing. The air stacking technique (TEA), initially used in patients with neuropathies, determines an increase in peak expiratory flow (PEF) and peak cough flow (PEF) and recent studies have demonstrated its effectiveness in patients undergoing nonthoracic thoracic surgery. which, for different reasons, also present reductions in these variables and consequently in the ability to cough. However, the literature lacks studies capable of indicating the duration of these beneficial effects. OBJECTIVES: To evaluate the duration of the effects of TEA on the PEF and PFT of patients undergoing noncardiac thoracic surgery and whether these effects are influenced by the patients' clinical characteristics or those related to the surgical procedure itself. METHOD: Thirty patients undergoing elective noncardiac thoracic surgery received TEA on the 3rd POD and PEF and PFT values were obtained immediately, every 30 minutes until the second hour and every 60 minutes until the sixth hour after its application. All participants were evaluated preoperatively and on the 3rd PO regarding vital signs, maximum inspiratory (MIP) and maximum expiratory (PEmax) pressures, PEF and PFT. RESULTS: Nine patients (30%) were female, the average age of the group was 53+12 years. The PFE and PFT showed, respectively, a significant increase from 45+11% to 103+11% (p=0.02) and from 42+10% to 103+6% (p=0.01) of the predicted value after TEA. The effects remained for up to 300 min (p=0.03) in the PFE and up to 240 min (p=0.04) in the PFT. Age was not a relevant factor in the duration of the effects. In people with COPD, the duration of the effects extended up to 240 min (p=0.03) and in those without COPD up to 300 min (p=0.03). There was no difference in the duration of the effects in smokers and nonsmokers, which remained up to 300 min for PFE (p=0.02) and up to 240 min for PFT (p=0.02). Patients without and with a chest tube maintained the effects on PEF up to 300 min (p=0.01 and p=0.02, respectively). The duration of effects on the PFT of patients without a drain was up to 300 min (p=0.02) and for patients with a drain up to 180 minutes (p= 0.02). CONCLUSION: In patients undergoing noncardiac thoracic surgery, the effects of TEA on PEF and PFT were maintained up to 300 and 240 minutes, respectively. In patients with COPD, the effects on PEF and PFT lasted shorter than in patients without COPD. There were no differences in the duration of effects on the PFE and PFT of smokers or nonsmokers. There were no differences in the duration of the effects on the PEF of patients with a chest tube and in the PFT the duration of the effects was shorter in patients with a chest tube.
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Citação
TEODORO, Renata de Jesus. Técnica de empilhamento de ar: duração dos efeitos obtidos no pico de fluxo expiratório e no pico de fluxo de tosse em pacientes submetidos à cirurgia torácica não cardíaca. 2024. 119 f. Tese (Doutorado em Pneumologia) - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2024.