Fisioterapia pré-operatória na prevenção das complicações pulmonares em cirurgia cardíaca pediátrica Preoperative physiotherapy in prevention of pulmonary complications in pediatric cardiac surgery

Abstract

OBJETIVO: Avaliar a incidência e o risco de complicações pulmonares em crianças submetidas a intervenção fisioterapêutica pré e pós-operatória nas cirurgias cardíacas, bem como comparar com aquelas submetidas apenas a intervenção fisioterapêutica pós-operatória. MÉTODOS: Ensaio clínico aleatório, que incluiu 135 pacientes de zero a 6 anos com cardiopatias congênitas, submetidos à cirurgia cardíaca. Os pacientes foram aleatorizados para grupo intervenção (G1), que realizou fisioterapia pré e pós-operatória, ou para grupo controle (G2), somente fisioterapia pós-operatória. Para comparar as variáveis entre os grupos foi utilizado o teste de Mann-Whitney e o Qui quadrado. Foi calculado o risco absoluto e sua magnitude por meio do número necessário para tratar. A significância estatística foi estipulada em 5% (POBJECTIVE: To evaluate the occurrence and risk of pulmonary complications in children who underwent pre-and postoperative physiotherapeutic intervention in cardiac surgeries, as well as to compare these patients to those who underwent only postoperative physiotherapeutic intervention. METHODS: A randomized controlled trial was performed with 135 patients from 6 years of age and younger with congenital heart disease who had undergone cardiac surgery. Patients were randomly assigned to the intervention group (G1) in which they underwent pre- and postoperative physiotherapy or to the control group (G2) in which they underwent only postoperative physiotherapy. Mann-Whitney and the Chi-square tests were used to compare the variables between the groups. The magnitude of the absolute risk was calculated by the number of patients needed to treat. Statistical significance was set at 5% (P<0.05). RESULTS: 17 patients (25%) in G1, and 29 patients (43.3%) in G2 presented pulmonary complications (P= 0.025), pneumonia was the most frequent complication, and among the 17 patients in G1, seven (10.3%) developed pneumonia, six (8.8%) developed atelectasis, and four (5.9%) presented complications due to both complications. In G2, 13 patients (19.4%) developed pneumonia, eight (11.9%) developed atelectasis, and eight (11.9%) developed pneumonia associated with atelectasis. Absolute risk reduction for the primary outcome was of 18.3% and the number of needed to treat was 5.5. CONCLUSION: Preoperative respiratory physiotherapy significantly reduced the risk of pulmonary complications in postoperative pediatric cardiac surgery.

Keywords

• Modalidades de fisioterapia
• Procedimentos cirúrgicos cardíacos
• Criança
• Ensaio Clínico Controlado Aleatório
• Physical therapy modalities
• Cardiac surgical procedures
• Child
• Randomized Controlled Trial