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Fisioterapia e as complicações pulmonares no pós-operatório de esofagectomia: uma revisão integrativa da literatura

Physiotherapy and postoperative pulmonary complications after esophagectomy: an integrative literature review

Lidiane de Freitas Sarmento, Vívian Pinto

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Resumo

Objetivo: Identificar fatores que influenciam no desenvolvimento das principais complicações pulmonares no pós-operatório de esofagectomias e as condutas fisioterápicas na prevenção e tratamento das mesmas. Métodos: Revisão integrativa realizada através de busca bibliográfica nas bases de dados PubMed, Biblioteca Virtual em Saúde, Cochrane e Scielo, nos últimos 10 anos, nos idiomas português e inglês, incluindo artigos que abordassem a fisioterapia no pré e pós-operatório de esofagectomias, principais complicações pulmonares e fatores de risco. Resultados: Pneumonia, atelectasia, derrame pleural, SARA e quilotórax foram as complicações identificadas e os fatores influenciadores foram nível de atividade física, administração de corticoides, perda sanguínea intraoperatória, idade, duração da cirurgia, localização do tumor, VEF1 < 65% do predito, DPOC e fisioterapia respiratória. A realização da fisioterapia no pré e pós-operatório mostrou redução na incidência de complicações, melhora na função pulmonar, tempo de antibioticoterapia, permanência de dreno torácico e taxa de reintubação (p<0,05). Porém, não houve resultados significativos na redução do tempo de hospitalização.

Palavras-chave

Fisioterapia; Esofagectomia; Lesão pulmonar; Ventilação não invasiva.

Abstract

Objective: To identify the factors which influence the development of the major pulmonary complications in the postoperative of esophagectomies and conducts of physical therapy in the prevention and treatment of the same. Methods: Integrative review conducted through the literature search in the following databases: PubMed, VirtualHealth Library, Cochrane and Scielo, over the last 10 years, in Portuguese and English, including articles related to physiotherapy in pre and postoperative of esophagectomy surgery, the major pulmonary complications and risk factors. Results: Pneumonia, atelectasis, pleural effusion, ARDS and chylothorax were identified of the main complications and influencing factors were level of physical activity, corticoid administration, intraoperative blood loss, age, duration of surgery, tumor location, FEV1 < 65% of the predicted, COPD and respiratory physiotherapy. Conclusion: The physical therapy in pre and postoperative showed reduced incidence of complications, improve lung function, duration of antibiotic therapy, presence of thoracic drain and reintubation rate (p<0,05). However there were no significant results in reducing the length of hospitalization.

Keywords

Physical therapy specialty; Esophagectomy; Lung injury; Noninvasive ventilation.

Referências

1. Instituto Nacional do Câncer. Disponível em: < http://www.inca.gov.br/>. Acesso em: 2 dez. 2013.

2. Khushalani NI. Cancer of the esophagus and stomach. Mayo Clin Proc. 2008;83:712–22.

3. Begg CB, Cramer LD, Hoskins WJ, Brennan MF. Impact of hospital volume on operative mortality for major cancer surgery. JAMA. 1998 Nov 25;280(20):1747-51.

4. Steyerberg EW, Neville BA, Koppert LB, Lemmens VE, Tilanus HW, Coebergh JW, et al. Surgical mortality in patients with esophageal cancer: development and validation of a simple risk score. J Clin Oncol. 2006 Sep 10;24(26):4277-82.

5. Tercioti Jr V, Lopes LR, Neto JSC, Andreollo NA. New aspects of the neo-adjuvant therapy in esophageal squamous cell carcinoma. A review of medical literature. ABCD, Arq Bras Cir Dig. 2009 Jan-Mar;22(1):33-40. Portuguese.

6. Tinoco RC, Tinoco AC, EL-Kadre LJ, Rios RA, Sueth DM, Pena FM. Laparoscopic transhiatal esophagectomy: outcomes. Arq Gastroenterol. 2007Apr-Jun;44(2):141-4. Portuguese.

7. Pinto CE, Dias JA, Sá EAM, Tsunoda AT, Pinheiro RN. Surgical Treatment for Esophageal Cancer. Rev Bras Cancerol. 2007;53(4):425-30. Portuguese.

8. Guimarães MM, El Dib R, Smith AF, Matos D. Incentive spirometry for prevention of postoperative pulmonary complications in upper abdominal surgery. Cochrane Database Syst Rev. 2009 Jul 8;(3):CD006058.

9. Dimick JB, Pronovost PJ, Cowan JA Jr, Lipsett PA, Stanley JC, Upchurch GR Jr. Variation in postoperative complication rates after high-risk surgery in the United States. Surgery. 2003 Oct;134(4):534-40; discussion 540-1.

10. Overend TJ, Anderson CM, Lucy SD, Bhatia C, Jonsson BI, Timmermans C. The effect of incentive spirometry on postoperative pulmonary complications: a systematic review. Chest. 2001 Sep;120(3):971- 8.

11. Hulscher JBF, van Sandick JW, de Boer AG, Wijnhoven BP, Tijssen JG, Fockens P, et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med. 2002 Nov 21;347(21):1662–9.

12. Atkins BZ, D’Amico TA. Respiratory complications after esophagectomy. Thorac Surg Clin. 2006 Feb;16(1):35-48.

13. Ferguson MK, Durkin AE. Preoperative prediction of the risk of pulmonary complications after esophagectomy for cancer. J Thorac Cardiovasc Surg. 2002 Apr;123(4):661-9.

14. Mirzabeigi E, Johnson C, Ternian A. One lung anesthesia update. Semin Cardiothorac Vasc Anesth. 2005 Sep;9(3):213-26.

15. Ogus H, Selimoglu O, Basaran M, Ozcelebi C, Ugurlucan M, Sayin OA, et al. Effects of intrapleural analgesia on pulmonary function and postoperative pain in patients with chronic obstructive pulmonary disease undergoing coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth. 2007 Dec;21(6):816-9.

16. Tatematsu N, Park M, Tanaka E, Sakai Y, Tsuboyama T. Association between physical activity and postoperative complications after esophagectomy for cancer: a prospective observational study. Asian Pac J Cancer Prev. 2013;14(1):47-51.

17. Pereira MR, Lopes LR, Andreollo NA. Quality of life of esophagectomized patients: adenocarcinoma versus squamous cell carcinoma. Rev Col Bras Cir. 2013 Jan-Feb;40(1):3-9. English, portuguese.

18. Duggan M, Kavanagh BP. Pulmonary atelectasis: a pathogenic perioperative entity. Anesthesiology. 2005 Apr;102(4):838-54.

19. Raymond D. Complications of esophagectomy. Surg Clin North Am. 2012 Oct;92(5):1299-313.

20. Chetta A, Tzani P, Marangio E, Carbognani P, Bobbio A, Olivieri D. Respiratory effects of surgery and pulmonary function testing in the preoperative evaluation. Acta Biomed. 2006 Aug;77(2):69-74.

21. Reeve J. Physiotherapy interventions to prevent postoperative pulmonary complications following lung resection. What is the evidence? What is the practice? New Zealand J Physiotherapy. 2008;36(3):118-30.

22. Nagamatsu Y, Shima I, Yamana H, Fujita H, Shirouzu K, Ishitake T. Preoperative evaluation of cardiopulmonary reserve with the use of expired gas analysis during exercise testing in patients with squamous cell carcinoma of the thoracic esophagus. J Thorac Cardiovasc Surg. 2001 Jun;121(6):1064- 8.

23. Feeney C, Reynolds JV, Hussey J. Preoperative physical activity levels and postoperative pulmonary complications post-esophagectomy. Dis Esophagus. 2011 Sep; 24(7):489-94.

24. Healy LA, Ryan AM, Gopinath B, Rowley S, Byrne PJ, Reynolds JV. Impact of obesity on outcomes in the management of localized adenocarcinoma of the esophagus and esophagogastric junction. J Thorac Cardiovasc Surg. 2007 Nov;134(5):1284-91.

25. Brunelli A, Refai M, Xiumé F, Salati M, Sciarra V, Socci L, Sabbatini A. Performance at symptom limited stair climbing test is associated with increased cardiopulmonary complications, mortality, and costs after major lung resection. Ann Thorac Surg. 2008 Jul;86(1):240-8.

26. Ware JH, Dockery DW, Louis TA, Xu XP, Ferris BG Jr, Speizer FE. Longitudinal and cross sectional estimates of pulmonary function decline in never smoking adults. Am J Epidemiol. 1990 Oct;132(4):685-700.

27. Hossack KF, Bruce RA. Maximal cardiac function in sedentary normal men and women: comparison of age-related changes. J Appl Physiol Respir Environ Exerc Physiol. 1982 Oct;53(4):799-804.

28. Spina RJ, Turner MJ, Ehsani AA. Exercise training enhances cardiac function in response to an afterload stress in older men. Am J Physiol. 1997 Feb;272(2Pt2):H995–1000.

29. Borkan GA, Hults DE, Gerzof SG, Robbins AH, Silbert CK. Age changes in body composition revealed by computed tomography. J Gerontol. 1983 Nov;38(6):673-7.

30. Alibakhshi A, Aminian A, Mirsharifi R, Jahangiri Y, Dashti H, Karimian F. The effect of age on the outcome of esophageal cancer surgery. Ann Thorac Med. 2009 Apr;4(2):71-4.

31. Nakamura M, Iwahashi M, Nakamori M, Ishida K, Naka T, Iida T, et al. An analysis of the factors contributing to a reduction in the incidence of pulmonary complications following an esophagectomy for esophageal cancer. Langenbecks Arch Surg. 2008 Mar;393(2):127-33.

32. Law S, Wong KH, Kwok KF, Chu KM, Wong J. Predictive factors for postoperative pulmonary complications and mortality after esophagectomy for cancer. Ann Surg. 2004 Nov;240(5):791-800.

33. Shirinzadeh A, Talebi Y. Pulmonary Complications due to Esophagectomy. J Cardiovasc Thorac Res. 2011;3(3):93-6.

34. Brooks-Brunn J. Predictors of postoperative pulmonary complications following abdominal surgery. Chest. 1997 Mar;111(3):564-71.

35. Bonde P, McManus K, McAnespie M, McGuigan J. Lung surgery: identifying the subgroup at risk for sputum retention. Eur J Cardiothorac Surg. 2002 Jul;22(1):18-22.

36. Hall JC, Tarala RA, Hall JL, Mander J. A multivariate analysis of the risk of pulmonary complications after laparotomy. Chest. 1991 Apr;99(4):923-7.

37. Qaseem A, Snow V, Fitterman N, Hornbake ER, Lawrence VA, Smetana GW, et al. Risk assessment and strategies to reduce perioperative pulmonary complications for patients undergoing noncardiothoracic surgery: a guideline from the American College of Physicians. Ann Intern Med. 2006 Apr 18;144(8):575-80.

38. Dales RE, Dionne G, Leech JA, Lunau M, Schweitzer I. Preoperative prediction of pulmonary complications following thoracic surgery. Chest. 1993 Jul;104(1):155-9.

39. Jiao WJ, Wang TY, Gong M, Pan H, Liu YB, Liu ZH. Pulmonary complications in patients with chronic obstructive pulmonary disease following transthoracic esophagectomy. World J Gastroenterol. 2006 Apr 28;12(16):2505-9.

40. Van Heusden-Scholtalbers LAG, ter Voert JM, Staal JB, Bonenkamp HJ, Nijhuis-van der Sanden MWG, van Goor H. Preoperative physical exercise training for patients scheduled for major abdominal surgery (Protocol). Cochrane Database Syst Rev. 2012;(9). Art. No.: CD010122.

41. Avendano CE, Flume PA, Silvestri GA, King LB, Reed CE. Pulmonary complications after esophagectomy. Ann Thorac Surg. 2002 Mar;73(3):922-6.

42. Pasquina P, Tramèr MR, Granier JM, Walder B. Respiratory physiotherapy to prevent pulmonary complications after abdominal surgery: a systematic review. Chest. 2006 Dec;130(6):1887-99.

43. Nomori H, Kobayashi R, Fuyuno G, Morinaga S, Yashima H. Preoperative respiratory muscle training. Assessment in thoracic surgery patients with special reference to postoperative pulmonary complications. Chest. 1994 Jun;105(6):1782-8.

44. Hulzebos EH, Helders PJ, Favié NJ, De Bie RA, Brutel de la Riviere A, Van Meeteren NL. Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery: a randomized clinical trial. JAMA. 2006 Oct 18; 296(15):1851-7.

45. Weiner P, Zeidan F, Zamir D, Pelled B, Waizman J, Beckerman M, Weiner M. Prophylactic inspiratory muscle training in patients undergoing coronary artery bypass graft. World J Surg. 1998 May;22(5):427-31.

46. Dudzińska K, Mayzner-Zawadzka E. Tobacco smoking and the perioperative period. Anestezjol Intens Ter. 2008 Apr-Jun;40(2):108-13.

47. Ramos MC, Agrelli TF, Carneiro EM, Crema E. Smoking doesn’t limit the increase in respiratory muscle strength in patients undergoing pre-inspiratory muscle training esophagectomy. Fisioter Pesqui. 2012 Jan-Mar;19(1):63-7. Portuguese.

48. Paisani DM, Chiavegato LD, Faresin SM. Lung volumes, lung capacities and respiratory muscle strength following gastroplasty. J Bras Pneumol. 2005 Mar-Apr;31(2):125-32. English, portuguese.

49. Ysayama L, Lopes LR. The influence of the respiratory muscular training in the recovery of esophagectomies. ABCD Arq Bras Cir Dig. 2008 Jun;21(2):61-4. Portuguese.

50. Borg GAV. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377-81.

51. Dettling DS, van der Schaaf M, Blom RL, Nollet F, Busch OR, van Berge Henegouwen MI. Feasibility and effectiveness of pre-operative inspiratory muscle training in patients undergoing oesophagectomy: a pilot study. Physiother Res Int. 2013 Mar;18(1):16-26.

52. Kinugasa S, Tachibana M, Yoshimura H, Ueda S, Fujii T, Dhar DK, et al. Postoperative pulmonary complications are associated with worse short-and long-term outcomes after extended esophagectomy. J Surg Oncol. 2004 Nov 1;88(2):71-7.

53. Djärv T, Blazeby JM, Lagergren P. Predictors of postoperative quality of life after esophagectomy for cancer. J Clin Oncol. 2009 Apr 20;27(12):1963-8.

54. Katsuta T, Saito T, Shigemitsu Y, Kinoshita T, Shiraishi N, Kitano S. Relation between tumor necrosis factor and interleukin 1 producing capacity of peripheral monocytes and pulmonary complications following oesophagectomy. Br J Surg. 1998 Apr;85(4):548-53.

55. Lunardi AC, Resende JM, Cerri OM, Carvalho CRF. Effect of sustained respiratory care until hospital discharge on the incidence of pulmonary complications following esophagectomy for cancer. Fisioter Pesqui. 2008;15(1):72-7. Portuguese.

56. Lunardi AC, Cecconello I, Carvalho CR. Postoperative chest physical therapy prevents respiratory complications in patients undergoing esophagectomy. Rev Bras Fisioter. 2011 Mar-Apr;15(2):160-5.

57. Rentz J, Bull D, Harpole D, Bailey S, Neumayer L, Pappas T, et al. Transthoracic versus transhiatal esophagectomy: a prospective study of 945 patients. J Thorac Cardiovasc Surg. 2003 May;125(5):1114- 20.

58. Grotenhuis BA, Wijnhoven BP, Hötte GJ, van der Stok EP, Tilanus HW, van Lanschot JJ. Prognostic value of body mass index on short-term and long-term outcome after resection of esophageal cancer. World Surg. 2010 Nov;34(11):2621-7.

59. Lococo F, Cesario A, Sterzi S, Magrone G, Dall’armi V, Mattei F, et al. Rationale and clinical benefits of an intensive long-term pulmonary rehabilitation program afteroesophagectomy: preliminary report. Multidiscip Respirator Med. 2012 Jul 28;7(1):21.

60. Law S, Fok M, Chu KM, Wong J. Thoracoscopic esophagectomy for esophageal cancer. Surgery. 1997 Jul;122(1):8-14.

61. Osugi H, Takada N, Masashi, Takemura, Lee S, Ueno M, et al. Thoracoscopic esophagectomy. Nihon Geka Gakkai Zasshi. 2002 Apr;103(4):354-8.

62. Nakatsuchi T, Otani M, Osugi H, Ito Y, Koike T. The necessity of chest physical therapy for thoracoscopic oesophagectomy. J Int Med Res. 2005 Jul-Aug;33(4):434- 41.

63. Djärv T, Metcalfe C, Avery KN, Lagergren P, Blazeby JM. Prognostic value of changes in healthrelated quality of life scores during curative treatment for esophagogastric cancer. J Clin Oncol. 2010 Apr 1;28(10):1666-70.

64. Stock MC, Downs JB, Gauer PK, Alster JM, Imrey PB. Prevention of postoperative pulmonary complications with CPAP, incentive spirometry, and conservative therapy. Chest. 1985 Feb;87(2):151- 7.

65. Ferguson MK, Martin TR, Reeder LB, Olak J. Mortality after esophagectomy: risk factor analysis. World J Surg 1997 Jul-Aug; 21(6):599-603.

66. Antonelli M, Conti G, Rocco M, Bufi M, De Blasi RA, Vivino G, et al. A comparison of noninvasive positive-pressure ventilation and conventional mechanical ventilation in patients with acute respiratory failure. N Engl JMed 1998 Aug 13; 339(7): 429-35.

67. Conti G, Antonelli M, Navalesi P, Rocco M, Bufi M, Spadetta G, Meduri GU. Noninvasive vs conventional mechanical ventilation in patients with chronic obstructive pulmonary disease after failure of medical treatment in the ward: a randomized trial. Intensive Care Med. 2002 Dec; 28(12): 1701-7.

68. Jaber S, Delay JM, Chanques G, Sebbane M, Jacquet E, Souche B, et al. Outcomes of patients with acute respiratory failure after abdominal surgery treated with noninvasive positive pressure ventilation. Chest 2005 Oct; 128(4): 2688-95.

69. Michelet P, D’Journo XB, Seinaye F, Forel JM, Papazian L, Thomas P. Non-invasive ventilation for treatment of postoperative respiratory failure after oesophagectomy. Br J Surg 2009; 96(1): 54–60.

70. Michelet P, Blayac D, Jaber S. Case scenario: management of postesophagectomy respiratory failure with noninvasive ventilation. Anesthesiology. 2010 Aug;113(2):454-61.

71. Liesching T, Kwok H, Hill NS. Acute applications of noninvasive positive pressure ventilation. Chest. 2003 Aug;124(2):699-713.

72. Keenan SP, Sinuff T, Burns KE, Muscedere J, Kutsogiannis J, Mehta S, et al. Clinical practice guidelines for the use of noninvasive positive-pressure ventilation and noninvasive continuous positive airway pressure in the acute care setting. CMAJ. 2011 Feb 22;183(3):E195-214.

73. Fagevik Olsén M, Wennberg E, Johnsson E, Josefson K, Lönroth H, Lundell L. Randomized clinical study of the prevention of pulmonary complications after thoracoabdominal resection by two different breathing techniques. Br J Surg. 2002 Oct; 89(10):1228-34.

74. Huerta S, DeShields S, Shpiner R, Li Z, Liu C, Sawicki M, et al. Safety and efficacy of postoperative continuous positive airway pressure to prevent pulmonary complications after Roux-en-Y gastric bypass. J Gastrointest Surg. 2002 May-Jun;6(3):354-8.

75. Brochard L, Isabey D, Piquet J, Amaro P, Mancebo J, Messadi AA, et al. Reversal of acute exacerbations of chronic obstructive lung disease by inspiratory assistance with a face mask. N Engl J Med. 1990 Nov 29; 323(22):1523-30.

76. Squadrone V, Coha M, Cerutti E, Schellino MM, Biolino P, Occella P, et al. Continuous positive airway pressure for treatment of postoperative hypoxemia: a randomized controlled trial. JAMA. 2005 Feb 2;293(5):589-95.

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