Respiratory therapy with positive expiratory pressure in patients after left ventricle geometric reconstruction

Relevance. The respiratory system of patients with post-infarction left ventricle aneurysm and chronic heart failure is often characterized by decreased external respiratory function and the development of respiratory complications in the early postoperative period. Positive expiratory pressure therapy (PEP-therapy) is considered an effective method of respiratory rehabilitation after cardiac surgery. However, there is currently no data on the application of this technique in patients after LVGR (left ventricle geometric reconstruction). The aim: to study the functional state of the respiratory system in patients after LVGR in the early postoperative period using PEP-therapy. Materials and Methods. 57 patients after LVGR surgery were examined. Two groups of patients were identified: group I — patients undergoing PEP-therapy (n = 27), and group II — patients undergoing standard respiratory gymnastics (n = 30, control group). The study included 3 stages: I Stage — before surgery; II Stage — 2–3 days after surgery; III Stage — 10–12 days after surgery. Results and Discussion. At the preoperative stage, cardiorespiratory system disorders were found in groups I and II (FVC: 89.2% and 87.3%; EDV: 174.2 ml and 179.9 ml, respectively), as well as the risk of developing sleep-­disordered breathing (Oxygen desaturation index [ODI]: 7.1 and 6.7, respectively). On the second day after surgery, a significant decrease in all spirometry indicators was observed in both groups, with the ODI in groups I and II increasing by 2.9 (p < 0.001) and 3.1 (p  <  0.001) times, respectively. Chest CT revealed atelectasis in various parts of the lungs in 100% of the examined patients. Upon discharge from the hospital, group I after PEP-therapy showed better recovery of respiratory parameters compared to the control group (FEV₁: 22.1% vs 9.4%; PEF: 58.1% vs 19.5%, respectively). The ODI in group I returned to baseline values, and the number of patients with atelectasis decreased by 1.6 times. In group II, the ODI remained increased by 57.2%, and CT results remained unchanged. Conclusions: The use of PEP-therapy in the early period after LVGR surgery allows not only to reduce the number and volume of atelectasis but also to more effectively restore respiratory parameters and pulmonary gas exchange compared to the course of standard respiratory gymnastics.