Artículos Seleccionados 1997 - NEUMOCARDIOLOGIA

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Exercise physiology in patients with left ventricular assist devices.

Effective physical therapy for chronic obstructive pulmonary disease. Pilot study of exercise in hot spring water.

A regional comparison of cardiac rehabilitation personnel. Adherence to the 1995 American Association of Cardiovascular and Pulmonary Rehabilitation Guidelines by Staff Position.

[Mask physiotherapy for prevention of pulmonary complications after heart surgery. A controlled study]

The disablement process in patients with pulmonary disease.

The effects of a community-based pulmonary rehabilitation programme on exercise tolerance and quality of life: a randomized controlled trial.

The effectiveness of incentive spirometry with physical therapy for high-risk patients after coronary artery bypass surgery.

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TITULO: Exercise physiology in patients with left ventricular assist devices.

AUTOR/ES: Humphrey-R

DIRECCION: Department of Physical Therapy, Virginia Commonwealth University, Medical College of Virginia Health Sciences Campus, Richmond 23298-0224, USA.

FUENTE: J-Cardiopulm-Rehabil. 1997 Mar-Apr; 17(2): 73-5

IDIOMA: ENGLISH

PAIS: UNITED-STATES

RESUMEN: LVAD use in the heart failure population is increasing and allows severely impaired patients an opportunity for exercise rehabilitation before cardiac transplantation. Although the LVAD provides nearly all of the cardiac output at rest, the native left ventricle contributes a modest amount during exercise, with the LVAD capable of providing a mechanical cardiac output of 10 L/min or greater. Given the parameters of the LVAD, exercise training responses should yield greater changes in submaximal exercise tolerance rather than changes in peak oxygen consumption. Heart rate and LVAD rate are driven by separate mechanisms but increase similarly during exercise. Blood pressure responses are somewhat variable early post LVAD implantation but normalize. Ratings of perceived exertion appear to be reliable and useful in this population. Evidence to date suggests that early mobilization and progressive exercise training in this population is safe and improves the transplantation experience. Although central contributions to oxygen consumption are limited by the inherent mechanical parameters of the LVAD, adequate cardiac output is provided for routine physical activities and moderate exercise training while the patient awaits transplantation.

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TITULO: Effective physical therapy for chronic obstructive pulmonary disease. Pilot study of exercise in hot spring water.

AUTOR/ES: Kurabayashi-H; Kubota-K; Machida-I; Tamura-K; Take-H; Shirakura-T

DIRECCION: Division of Rehabilitation, Kusatsu Branch Hospital, Gunma University Hospital, Japan.

FUENTE: Am-J-Phys-Med-Rehabil. 1997 May-Jun; 76(3): 204-7

IDIOMA: ENGLISH

PAIS: UNITED-STATES

RESUMEN: Respiratory function and arterial blood gas were examined before and after a two-month exercise program performed in a pool filled with hot spring water in 22 patients (70.9 +/- 9.1 years of age) with stable chronic obstructive pulmonary disease (12 cases of bronchial asthma and 10 cases of pulmonary emphysema) treated at our hospital between 1991 and 1994. The ratio of forced expired volume in one second to forced vital capacity (FEV1%) was significantly increased after the exercise program (P < 0.05), whereas the ratio of forced vital capacity to predicted normal value (%FVC) did not change. In addition, a tendency toward an increase in peak flow without an increase in maximum expiratory flow at 25 and 50% (V25 and V50) was observed. Although PaO2 was not increased, PaCO2 was selectively decreased by the exercise program (P < 0.05). The changes in respiratory function and arterial blood gas were considered attributable to respiratory muscle training and small airway clearance. Exercise in a pool filled with hot spring water may be useful in treating chronic obstructive pulmonary disease.

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TITULO: A regional comparison of cardiac rehabilitation personnel. Adherence to the 1995 American Association of Cardiovascular and Pulmonary Rehabilitation Guidelines by Staff Position.

AUTOR/ES: Bennett-SB; Pescatello-LS

DIRECCION: New Britain General Hospital, Connecticut 06050, USA.

FUENTE: J-Cardiopulm-Rehabil. 1997 Mar-Apr; 17(2): 92-102

IDIOMA: ENGLISH

PAIS: UNITED-STATES

RESUMEN: PURPOSE: The American Association of Cardiopulmonary Rehabilitation (AACVPR) established guidelines for cardiac rehabilitation (CR) personnel regarding educational degree attainment, licensure, and certification. New England hospital-based CR personnel were surveyed by staff position to determine their adherence to these guidelines. METHODS: The New England Hospital-Based CR Program Questionnaire was designed to obtain information regarding program characteristics and personnel credentialing. Initially, 117 program directors agreed to participate, and 108 returned completed questionnaires for a response rate of 92.3%. RESULTS: Of the CR programs surveyed, 41% were within hospitals containing 101 to 250 beds, whereas most of those providing inpatient (66.6%) and outpatient (82.4%) CR enrolled less than 200 patients annually. Overall, 40.7% of personnel (n = 450) by staff position reported that they met the minimum recommendations, whereas 7.0% (n = 470) met the preferred AACVPR recommendations. Registered nurses (n = 67) and physical therapists (n = 58) were most compliant with the minimum guidelines: 89.6% and 84.5%, respectively. In contrast, 10.9% of the program directors/coordinators (PD/C; n = 128) met the minimum qualifications, and 5.5% met the preferred AACVPR qualifications. Most PD/C had Advanced Cardiac Life Support Certification (84.4%), but few (18%) attained American College of Sports Medicine (ACSM) certification. CONCLUSIONS: Overall, compliance of New England hospital-based CR personnel with the AACVPR minimum/preferred guidelines for educational degree and certification was lacking, as was acquisition of ACSM certification. The effect of these findings on the future status of recommended and required CR personnel qualifications for hire merits attention.

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TITULO: [Mask physiotherapy for prevention of pulmonary complications after heart surgery. A controlled study]

TITULO ORIGINAL: Fysioterapi med maskebehandling til forebyggelse af pulmonale komplikationer efter hjertekirurgi. Et kontrolleret studie.

AUTOR/ES: Larsen-KR; Ingwersen-U; Thode-S; Jakobsen-SH

DIRECCION: Amtssygehuset i Gentofte, thoraxkirurgisk afdeling R, fysioterapiafsnittet og medicinsk/lungemedicinsk afdeling Y.

FUENTE: Ugeskr-Laeger. 1997 Mar 31; 159(14): 2096-9

IDIOMA: DANISH; NON-ENGLISH

PAIS: DENMARK

RESUMEN: The objective of this prospective, consecutive, randomized, controlled study was to investigate the effects of mask physiotherapy on postoperative complications after heart surgery. Sixty-six low-risk male patients undergoing coronary artery by-pass graft surgery were evaluated. The patients were treated with routine chest physiotherapy alone or supplied with either positive expiratory pressure (PEP), or inspiratory resistance-positive expiratory pressure (IR-PEP). Postoperative pulmonary complications were assessed by forced vital capacity (FVC), arterial oxygen tension (PaO2), and chest X-ray examination. There was an almost equal decrease and subsequent rise in spirometric and blood gas values in all three groups, but patients treated with the PEP mask had a borderline significantly higher increase in PaO2 from day three to day six compared with patients treated with no mask. There was an almost equal frequency of atelectasis in the three treatment groups. It is concluded that no significant differences in outcome were found between the three groups.

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TITULO: The disablement process in patients with pulmonary disease.

AUTOR/ES: Jette-DU; Manago-D; Medved-E; Nickerson-A; Warzycha-T; Bourgeois-MC

DIRECCION: Graduate Program in Physical Therapy, Graduate School for Health Studies, Simmons College, Boston, MA 02115, USA. djette@vmsvax.simmons.edu

FUENTE: Phys-Ther. 1997 Apr; 77(4): 385-94

IDIOMA: ENGLISH

PAIS: UNITED-STATES

RESUMEN: BACKGROUND AND PURPOSE: The purposes of this study were (1) to describe the disabilities of patients with pulmonary disease and (2) to examine the relationships among impairments, functional limitations, and disability, as described by the disablement process model. SUBJECTS: Subjects were 154 patients with chronic pulmonary disease (64% female, 36% male; mean age = 59 years, SD = 14, range = 24-86). METHODS: Information was abstracted from physical therapy records, including measurements of pulmonary impairment, 6-minute walk distance (6MWD), and Functional Status Questionnaire (FSQ) scores. Multivariate analyses were used to examine the relationships among measurements of impairment, 6MWD, and FSQ scores. RESULTS: Mean FSQ scores ranged from 52.6 for instrumental activities of daily living to 83.3 for basic activities of daily living, where 100 represents the highest level of ability. Fifty percent of patients were not working because of health problems. Percentage of predicted 1-second forced expiratory volume (FEV1), oxyhemoglobin saturation, and the ratio of FEV1 to forced vital capacity were related to 6MWD but not to FSQ scores. The 6MWD was associated with scales of the FSQ, including basic activities of daily living (R2 = .24), instrumental activities of daily living (R2 = .35), and social activity (R2 = .26). CONCLUSION AND DISCUSSION: Patients entering a pulmonary rehabilitation program have clinically important disabilities. The results support the use of the disablement process model and suggest that different and important information is obtained from measurements of impairment, functional limitation, and disability in patients with pulmonary disease.

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TITULO: The effects of a community-based pulmonary rehabilitation programme on exercise tolerance and quality of life: a randomized controlled trial.

AUTOR/ES: Cambach-W; Chadwick-Straver-RV; Wagenaar-RC; van-Keimpema-AR; Kemper-HC

DIRECCION: Dept of Physiotherapy, VU Hospital, Amsterdam, The Netherlands.

FUENTE: Eur-Respir-J. 1997 Jan; 10(1): 104-13

IDIOMA: ENGLISH

PAIS: DENMARK

RESUMEN: The present multicentre study evaluates the differences in efficacy between a 3 month rehabilitation programme including drug treatment, and a 3 month control period of drug treatment only, for asthmatic patients and patients with chronic obstructive pulmonary disease (COPD). The programme was run by physiotherapists in eight local practices, and included exercise training, patient education, breathing retraining, evacuation of mucus, relaxation techniques, and recreational activities. In a randomized controlled trial with a cross-over design, the effects of rehabilitation were evaluated 3 and 6 months after baseline measurements in terms of exercise tolerance and quality of life (QOL). Exercise tolerance was assessed using submaximal cycle ergometer tests and 6 min walking tests. QOL was evaluated by means of the Chronic Respiratory Disease Questionnaire (CRDQ). After 3 months, the patients who started with rehabilitation showed significant improvements in endurance time (421 s) and cardiac frequency (6 beats.min-1) during cycling, walking distance (39 m), and total CRDQ score (17 points) compared to the control group. These improvements were still significant after 6 months. Additional analysis indicated that the asthmatic patients and the patients with COPD responded to rehabilitation in a similar way, with the exception that there was a greater improvement in walking distance for asthmatics. Improvements in exercise tolerance were not significantly correlated with improvements in QOL. Rehabilitation of patients with asthma or chronic obstructive pulmonary disease in local physiotherapy practices improves exercise tolerance and quality of life.

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TITULO: The effectiveness of incentive spirometry with physical therapy for high-risk patients after coronary artery bypass surgery.

AUTOR/ES: Crowe-JM; Bradley-CA

DIRECCION: School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada. crowe@fhs.mcmaster.ca

FUENTE: Phys-Ther. 1997 Mar; 77(3): 260-8

IDIOMA: ENGLISH

PAIS: UNITED-STATES

RESUMEN: BACKGROUND AND PURPOSE: The purpose of this study was to determine whether the addition of incentive spirometry (IS) to postoperative pulmonary physical therapy is more effective than physical therapy alone in reducing postoperative pulmonary complications in high-risk patients after coronary artery bypass grafting (CABG). Patients were given the spirometer and instructed in its use, as often occurs in clinical settings. SUBJECTS: Patients with chronic airflow limitation following CABG (N = 185) participated. METHODS: Subjects were randomly assigned to receive either postoperative pulmonary physical therapy (breathing exercises, secretion removal, mobility) or physical therapy combined with IS. RESULTS: No difference was found between the two groups in atelectasis, spirometry, oxygen saturation, pulmonary infection, or hospital stay. CONCLUSION AND DISCUSSION: Incentive spirometry combined with physical therapy is no more effective than postoperative physical therapy alone in reducing atelectasis for this population. Use of the spirometer, however, was not monitored, and although the study mimicked practice as it often occurs, the effectiveness of the spirometer cannot be fully evaluated.

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