Comparisons and Correlations of Pain Intensity and Respiratory and Peripheral Muscle Strength in the Pre- and Postoperative Periods of Cardiac Surgery

Overview

Journal Rev Bras Ter Intensiva

Specialties Critical Care
General Medicine

Date 2019 Jan 24

PMID 30672972

Citations 8

Authors

Thayse Campos de Menezes

Daniela Bassi

Ricardo Cesar Cavalcanti

Juliana Emanuelle Santos Luz Barros

Karolyne Soares Barbosa Granja

Ana Carolina do Nascimento Calles

Ana Luiza Exel

Affiliations

Soon will be listed here.

Abstract

Objective: To evaluate respiratory and peripheral muscle strength after cardiac surgery. Additionally, we compared the changes in these variables on the third and sixth postoperative days.

Methods: Forty-six patients were recruited, including 17 women and 29 men, with a mean age of 60.50 years (SD = 9.20). Myocardial revascularization surgery was performed in 36 patients, replacement of the aortic valve in 5 patients, and replacement of the mitral valve in 5 patients.

Results: A significant reduction in respiratory and peripheral muscle strength and a significant increase in pain intensity were observed on the third and sixth postoperative days (p < 0.05), except for the variable maximal inspiratory pressure; on the sixth postoperative day, maximal inspiratory pressure values were already similar to the preoperative and predicted values (p > 0.05). There was an association between peripheral muscle strength, specifically between maximal expiratory pressure preoperatively (rs = 0.383; p = 0.009), on the third postoperative day (rs = 0.468; p = 0.001) and on the sixth postoperative day (rs = 0.311; p = 0.037). The effect sizes were consistently moderate-to-large for respiratory muscle strength, the Medical Research Council scale and the visual analog scale, in particular between preoperative assessment and the sixth postoperative day.

Conclusion: There is a decrease in respiratory and peripheral muscle strength after cardiac surgery. In addition, maximal expiratory pressure is the variable that is most associated with peripheral muscle strength. These variables, especially respiratory and peripheral muscle strength, should be considered by professionals working in the intensive care setting.

Citing Articles

Functional Physical Analysis and Quality of Life in the Preoperative and Early Postoperative Periods of Cardiac Surgery and 30 Days After Hospital Discharge.

Silva L, Magnaguagno D, da Silva M, Borghi-Silva A, Winkelmann E Braz J Cardiovasc Surg. 2024; 39(4):e20220453.

PMID: 38748911 PMC: 11095118. DOI: 10.21470/1678-9741-2022-0453.

Clinical and functional outcomes associated with pulmonary complications after coronary artery bypass grafting.

Souza A, da Cunha Carvalho R, da Cruz Dias D, Santana D, de Cassia Mascarenhas H, Cordeiro A J Cardiothorac Surg. 2024; 19(1):92.

PMID: 38355549 PMC: 10865619. DOI: 10.1186/s13019-024-02538-9.

Anterior Quadratus Lumborum Block and Quadriceps Strength: A Prospective Cohort Study.

Kadoya Y, Tanaka N, Suzuka T, Yamanaka T, Iwata M, Ozu N J Clin Med. 2023; 12(11).

PMID: 37298032 PMC: 10253824. DOI: 10.3390/jcm12113837.

Inspiratory Muscle and Functional Performance of Patients Entering Cardiac Rehabilitation after Cardiac Valve Replacement.

Gempel S, Cohen M, Milian E, Vidret M, Smith A, Jones I J Cardiovasc Dev Dis. 2023; 10(4).

PMID: 37103021 PMC: 10141801. DOI: 10.3390/jcdd10040142.

A Prospective Study of 73 Patients to Compare Forward Head Angle, Forward Shoulder Angle, Maximal Inspiratory Pressure, and Self-Reported Breathing-Related Symptoms Before and After Open-Heart Surgery.

Thanasarn B, Pibul W, Kulchanarat C, Piathip D, Yuenyongchaiwat K Med Sci Monit Basic Res. 2023; 29:e938802.

PMID: 36849799 PMC: 9921079. DOI: 10.12659/MSMBR.938802.

References

Neder J, Andreoni S, Lerario M, Nery L . Reference values for lung function tests. II. Maximal respiratory pressures and voluntary ventilation. Braz J Med Biol Res. 1999; 32(6):719-27. DOI: 10.1590/s0100-879x1999000600007. View

Hawkes A, Nowak M, Bidstrup B, Speare R . Outcomes of coronary artery bypass graft surgery. Vasc Health Risk Manag. 2007; 2(4):477-84. PMC: 1994021. DOI: 10.2147/vhrm.2006.2.4.477. View

Paternostro-Sluga T, Grim-Stieger M, Posch M, Schuhfried O, Vacariu G, Mittermaier C . Reliability and validity of the Medical Research Council (MRC) scale and a modified scale for testing muscle strength in patients with radial palsy. J Rehabil Med. 2008; 40(8):665-71. DOI: 10.2340/16501977-0235. View

Sachs M, Enright P, Stukovsky K, Jiang R, Barr R . Performance of maximum inspiratory pressure tests and maximum inspiratory pressure reference equations for 4 race/ethnic groups. Respir Care. 2009; 54(10):1321-8. PMC: 3616895. View

Sasseron A, de Figueiredo L, Trova K, Cardoso A, Lima N, Olmos S . Does the pain disturb the respiratory function after open heart surgery?. Rev Bras Cir Cardiovasc. 2010; 24(4):490-6. DOI: 10.1590/s0102-76382009000500010. View

Tobin M, Laghi F, Jubran A . Narrative review: ventilator-induced respiratory muscle weakness. Ann Intern Med. 2010; 153(4):240-5. PMC: 2924757. DOI: 10.7326/0003-4819-153-4-201008170-00006. View

Norman K, Stobaus N, Gonzalez M, Schulzke J, Pirlich M . Hand grip strength: outcome predictor and marker of nutritional status. Clin Nutr. 2010; 30(2):135-42. DOI: 10.1016/j.clnu.2010.09.010. View

van Venrooij L, Verberne H, de Vos R, Borgmeijer-Hoelen M, van Leeuwen P, de Mol B . Postoperative loss of skeletal muscle mass, complications and quality of life in patients undergoing cardiac surgery. Nutrition. 2011; 28(1):40-5. DOI: 10.1016/j.nut.2011.02.007. View

Fernandez-Lao C, Cantarero-Villanueva I, Fernandez-de-Las-Penas C, Del Moral-Avila R, Castro-Sanchez A, Arroyo-Morales M . Effectiveness of a multidimensional physical therapy program on pain, pressure hypersensitivity, and trigger points in breast cancer survivors: a randomized controlled clinical trial. Clin J Pain. 2011; 28(2):113-21. DOI: 10.1097/AJP.0b013e318225dc02. View

10.

Ferreira-Valente M, Pais-Ribeiro J, Jensen M . Validity of four pain intensity rating scales. Pain. 2011; 152(10):2399-2404. DOI: 10.1016/j.pain.2011.07.005. View

11.

Urell C, Westerdahl E, Hedenstrom H, Janson C, Emtner M . Lung Function before and Two Days after Open-Heart Surgery. Crit Care Res Pract. 2012; 2012:291628. PMC: 3423658. DOI: 10.1155/2012/291628. View

12.

Sasaki N, Meyer M, Eikermann M . Postoperative respiratory muscle dysfunction: pathophysiology and preventive strategies. Anesthesiology. 2013; 118(4):961-78. DOI: 10.1097/ALN.0b013e318288834f. View

13.

Siregar S, Groenwold R, de Mol B, Speekenbrink R, Versteegh M, Brandon Bravo Bruinsma G . Evaluation of cardiac surgery mortality rates: 30-day mortality or longer follow-up?. Eur J Cardiothorac Surg. 2013; 44(5):875-83. DOI: 10.1093/ejcts/ezt119. View

14.

Dassios T, Katelari A, Doudounakis S, Dimitriou G . Aerobic exercise and respiratory muscle strength in patients with cystic fibrosis. Respir Med. 2013; 107(5):684-90. DOI: 10.1016/j.rmed.2013.01.016. View

15.

Crisafulli E, Venturelli E, Siscaro G, Florini F, Papetti A, Lugli D . Respiratory muscle training in patients recovering recent open cardiothoracic surgery: a randomized-controlled trial. Biomed Res Int. 2013; 2013:354276. PMC: 3745889. DOI: 10.1155/2013/354276. View

16.

Baldwin C, Bersten A . Alterations in respiratory and limb muscle strength and size in patients with sepsis who are mechanically ventilated. Phys Ther. 2013; 94(1):68-82. DOI: 10.2522/ptj.20130048. View

17.

Scherner M, Madershahian N, Kuhr K, Rosenkranz S, Stoger E, Rahmanian P . Aortic valve replacement after previous heart surgery in high-risk patients: transapical aortic valve implantation versus conventional aortic valve replacement-a risk-adjusted and propensity score-based analysis. J Thorac Cardiovasc Surg. 2013; 148(1):90-7. DOI: 10.1016/j.jtcvs.2013.07.046. View

18.

Sattari M, Baghdadchi M, Kheyri M, Khakzadi H, Mashayekhi S . Study of patient pain management after heart surgery. Adv Pharm Bull. 2013; 3(2):373-7. PMC: 3848238. DOI: 10.5681/apb.2013.060. View

19.

Iida Y, Yamazaki T, Kawabe T, Usui A, Yamada S . Postoperative muscle proteolysis affects systemic muscle weakness in patients undergoing cardiac surgery. Int J Cardiol. 2014; 172(3):595-7. DOI: 10.1016/j.ijcard.2014.01.062. View

20.

Mello L, Rosatti S, Hortense P . Assessment of pain during rest and during activities in the postoperative period of cardiac surgery. Rev Lat Am Enfermagem. 2014; 22(1):136-43. PMC: 4292697. DOI: 10.1590/0104-1169.3115.2391. View