THE PREDICTIVE ROLE OF RESPIRATORY MUSCLE FUNCTION ON POSTOPERATIVE PULMONARY COMPLICATIONS AFTER LUNG RESECTION

Filipa Kendal; Gustavo Silva; Marta Drummond; Paulo Viana; Paulo Pinho; José Oliveira; Pedro Teixeira Bastos

doi:10.34635/rpc.933

Filipa Kendal Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal; Department of Cardiothoracic Surgery, Centro Hospitalar São João, Porto, Portugal; CESPU, Polithecnic Health Institute of the North, Gndra, Portugal http://orcid.org/0000-0001-8092-9220
Gustavo Silva Research Center in Sports Sciences, Health and Human Development (CIDESD), University Institute of Maia (ISMAI), Maia, Portugal http://orcid.org/0000-0003-3930-7037
Marta Drummond Pulmonology Department, Centro Hospitalar São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal http://orcid.org/0000-0002-6773-3503
Paulo Viana Pulmonology Department, Centro Hospitalar São João, Porto, Portugal; Health School, Polytechnic Institute of Porto, Porto, Portugal http://orcid.org/0000-0002-2681-0445
Paulo Pinho Department of Cardiothoracic Surgery, Centro Hospitalar São João, Porto, Portugal http://orcid.org/0000-0002-5235-0286
José Oliveira Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal http://orcid.org/0000-0002-1829-4196
Pedro Teixeira Bastos Department of Cardiothoracic Surgery, Centro Hospitalar São João, Porto, Portugal http://orcid.org/0000-0002-9952-0000

Resumo

Introdução: A avaliação pré-operatória para cirurgia pulmonar geralmente não inclui a avaliação da função muscular respiratória, a qual pode ser um preditor de complicações pulmonares pós-operatórias (CPP).

Objetivos: Verificar se a função muscular respiratória pré-operatória prediz CPP em doentes submetidos a ressecção pulmonar por toracotomia.

Métodos: Além das avaliações das funções musculares pulmonares e respiratórias, a aptidão física foi avaliada através do teste de marcha de 6 minutos. Foram registadas as CPP até 30 dias após a alta hospitalar. A análise da função discriminante foi realizada para identificar quais as variáveis que atuam como melhores preditores de CPP. Foi utilizada regressão logística para analisar a associação entre as variáveis da função muscular respiratória e a CPP.

Resultados: Doentes com CPP (n = 20), em comparação com aqueles que não desenvolveram CPP (n = 85), apresentaram hábito tabágico pesado significativo (t = –2,412; p = 0,027; d = 0,547), diminuição do volume expiratório forçado no primeiro segundo (FEV1; t = –2,932; p = 0,004; d = 0,703), do pico de fluxo expiratório (PEF; t = –2,412; p = 0,018; d = 0,586) e da capacidade de difusão de monóxido de carbono (DLCO; t = 2,183; p = 0,039; d = 0,673). Em relação à função muscular respiratória, a pressão expiratória máxima estava significativamente reduzida nos doentes com CPP (PEmáx; t = 3,116; p = 0,002; d = 0,744). Os coeficientes estruturais da função discriminante mostraram que a pressão expiratória máxima (MEP%; –0,519), o FEV1 % (-0,488), a DLCO% (-0,465), o PEF% (-0,402) e os maços de cigarros por ano (0,374) foram os fatores mais importantes para discriminar os doentes que desenvolveram CPP. Os resultados da regressão logística indicaram que os doentes com menor PEmáx (%) apresentam risco aumentado de CPP (OR = 7,440; IC 95% = 1,228 – 19,471).

Conclusão: A pressão expiratória máxima pré-operatória foi o preditor mais forte de CPP e deverá ser considerado para avaliação de risco em candidatos cirúrgicos.

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O PAPEL DA FUNÇÃO DOS MÚSCULOS RESPIRATÓRIOS COMO PREDITOR DE COMPLICAÇÕES PULMONARES PÓS-OPERATÓRIAS DE RESSECÇÃO PULMONAR

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