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ISSN: 2576-8816 Mini Review

Efficacy of Active Cycle of Breathing Technique

on Functional Improvement in Post CABG Patient

Monisha R1* and TS Muthukumar2

1
Assistant Professor, SRM College of Physiotherapy, India
2
Professor, Sri Ramakrishna College of Physiotherapy, India
*Corresponding author: Monisha R, Assistant Professor, India
Submission: April 06, 2018; Published: April 26, 2018

Abstract

Purpose: The purpose of this study was to evaluate the efficacy of active cycle of breathing techniques (ACBT) following coronary artery bypass
graft (CABG) surgery. Material and methods: 15 patients with CABG were included in this study. Patients were evaluated using 6-minute walk test
(6MWT), chest expansion and a 10-cm visual analogue scale for pain perception. Results: sixth and ninth day post-operatively, chest expansion and six
minute walk test variables were significantly increased in both groups compared to pre-operative values.

Conclusion: ACBT improves functional capacity from the sixth to ninth day post-operatively. After a 5-day treatment, functional capacity was
well preserved with the usage of ACBT. Respiratory physiotherapy methods had similar effects on the rate of atelectasis, pulmonary function, and pain
perception.

Keywords: Physiotherapy; Coronary artery bypass surgery; Lung function tests; Exercise

Background
bronchus. This technique incorporated breathing exercises to
The number of people with CAD have sudden death as their first
improve the effectiveness of cough, loosen and clear secretions and
symptom, 50% of patient are diagnosed as having coronary artery
improve the ventilation [6].
disease in all over the world. Etiology behind this drastic increase
is because of poor dietary habits and lack of physical activity. It Objective
is due to sedentary life styles and high stressful environment [1].
The use of anesthesia and blood loss coupled with restricted
CAD is invited because of other risk factors like diabetes mellitus,
mobility and pain due to incision primarily affects the oxygen
hypertension and personal habits like smoking and alcoholism
transport [7-9]. This leads to Sub -optimal muco-cilliary escalator,
[2]. Due to lack of physical activity in majority of cases with CAD,
Decrease lung volume and capacities, Mucus retention and
diseases of the coronary arteries are due to atherosclerosis [3].
plugging in lungs and increased work of breathing. Because of pain,
Cardiac arrest is the commonest cause for death in the world,
ventilation is further affected. However, pain relieving modalities
4.8 million men & 4.4 million women in worldwide die each year
and air way clearance techniques are available but nevertheless
because of CAD. When comparing the magnitude of CABG, it is
none of the technique so far as been shown to provide improvement
the most common surgery performed in the world [4]. In India,
[10]. Hence the postoperative treatment still remains in debate and
the number of CABG is quite high, but the documented evidence
lacks the much-needed practice. The ACBT focus on normalizing
of these official records is unavailable in some hospitals. The
respiratory pattern, promoting airway clearance and reducing
incidence of CAD varies greatly between countries and with advent
work of breathing. ACBT important to control the immediate post-
of age correlates well with the mortality. From the past years, aim of
operative complications.
the CABG is to relieve pain and to prolong life and also the long term
survival depends not only on the operative procedure, but also on Method
the extent of damage of the left ventricle [5].
The purpose of this study is to record Efficacy of ACBT in
Role of active cycle of breathing technique in CABG reducing post operative co morbidities in CABG patients. The
patients research has been done so that it may serve as a guideline for
Active cycle of breathing (ACBT) is an active breathing technique planning and implementing a study in a way that is most likely
performed by the patient to help secretions from the main stem to achieve the goal in patients with post operative respiratory

Volume 5 - Issue 1
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 Res Med Eng Sci Copyright © Monisha R

complications in CABG. The study was carried out for duration of 6 the treatment and recording, self demonstration was performed
months and the treatment duration was carried out for the period and to make sure that the patients understand it [11,12].
of 6 days. The patients were treated daily for 40 minutes once daily
Data Collection
and the values of the parameter selected were assessed on the 2nd
post operative day to 9th post operative day. Before proceeding with Table 1-3; Figures 1-3
Table 1: Visual Analogue Scale.

Sl. NO. Pre test Post test (x1- x11) (x1- x11)2
1 8 1 -0.73 0.5
2 9 2 0.27 0.07
3 10 4 2.27 5.15
4 8 3 0.27 0.07
5 9 0 1.73 2.99
6 6 2 0.27 0.07
7 10 1 1.27 1.61
8 8 1 0.27 0.07
9 9 0 1.73 2.99
10 7 2 0.27 0.07
11 9 1 -0.73 0.53
12 10 3 1.27 1.61
13 8 2 0.27 0.07
14 9 1 -0.73 0.53
15 5 1 -0.73 0.53
Table 2: Chest Expansion.

Sl. No. Pre-test Post-test (x1- x11) (x2- x21)2

1 2 2.8 0.05 0.0025
2 2.5 3 0.25 0.0625
3 2.8 3.2 0.45 0.2025
4 2.5 3.2 0.45 0.2025
5 1.5 2 -o.75 0.5625
6 2 2.7 -0.05 0.0025
7 1.9 2.5 -0.25 0.0625
8 1.5 2 -0.75 0.5625
9 2.8 3.3 0.55 0.3025
10 2.5 3.2 0.45 0.2025
11 2 2.7 -0.05 0.0025
12 1.7 2.2 -0.55 0.3025
13 2.3 2.9 0.15 0.0225
14 1.9 2.7 -0.05 0.0025
15 2 2.7 -0.05 0.0025
Table 3: Six Minute Walk Distance Test.

SI. No. Pre-test Post-test X1-X1’ (X1-X1’)2

1 5 1 -0.47 0.2209
2 7 1 -0.47 0.2209
3 6 3 1.53 2.3409
4 4 1 -0.47 0.2209
5 5 1 -0.47 0.2209
6 6 2 0.53 0.2809

Volume 5 - Issue 1
How to cite this article: Monisha R,TS Muthukumar. Efficacy of Active Cycle of Breathing Technique on Functional Improvement in Post CABG Patient. Res Med Eng
Sci. 5(1). RMES.000602.2018. DOI: 10.31031/RMES.2018.05.000602
393
 Res Med Eng Sci Copyright © Monisha R

7 5 1 -0.47 0.2209
8 6 1 -0.47 0.2209
9 5 1 -0.47 0.2209
10 4 2 0.53 0.2809
11 6 2 0.53 0.2809
12 4 1 -0.47 0.2209
13 5 2 0.53 0.2809
14 6 1 -0.47 0.2209
15 7 2 0.53 0.2809

Figure 1: DATA of visual analogue scale.

Figure 2: Chest expansion.

Figure 3: Six minutes walk test.

Volume 5 - Issue 1
How to cite this article: Monisha R,TS Muthukumar. Efficacy of Active Cycle of Breathing Technique on Functional Improvement in Post CABG Patient. Res Med Eng
Sci. 5(1). RMES.000602.2018. DOI: 10.31031/RMES.2018.05.000602 394
 Res Med Eng Sci Copyright © Monisha R

Discussion 2. Savci S, Inal-Ince D, Arikan HA (2000) Comparison of autogenic drainage

and the active cycle of breathing techniques in patients with chronic
The purpose of this study is to determine the efficacy of Active obstructive pulmonary diseases. J Cardiopulm Rehabil 20(1): 37-43.
Cycle of Breathing Technique. The study was conducted out for a 3. Inal-Ince D, Savci S, Topeli (2004) A Active cycle of breathing techniques
period of 6 months with 28° of freedom. Literature review states in noninvasive ventilation for acute hypercapnic respiratory failure. Aust
that there is significant difference between Active Cycle of Breathing J Physiother 50(2): 67-73.
techniques on post operative CABG patients. The result in various 4. Knaus WA, Draper EA, Wagner DP (1985) APACHE II: a severity of
parameters was compared. disease classification system. Crit Care Med 13: 818-829.
5. Quanjer PH, Tammeling GJ, Cotes JE (1993) Lung volumes and forced
Early post-operative mobilization has been shown to increase
ventilatory flows. Report Working Party Standardization of Lung
lung volume, improve ventilation/perfusion matching, and mobilize Function Tests, European Community for Steel and Coal. Official
secretion. In post CABG patients, impaired oxygen transport results Statement of the European Respiratory Society. Eur Respir J Suppl 16:
in a deteriorated functional work capacity, and exercise capacity 5-40.

is one of the major concerns in post-operative recovery. Maximal 6. (2002) ATS Committee on Proficiency Standards for Clinical Pulmonary
oxygen uptake measured during a standard treadmill or bicycle Function Laboratories American Thoracic Society. ATS statement:
guidelines for the six-minute walk test. Am J Respir Crit Care Med 166:
test is the best available method to assess aerobic exercise capacity, 111- 117.
6MWT is a reliable alternative for measuring the functional exercise
7. Enright PL, Sherill DL (1998) Reference equations for the six minutes
capacity. Because these tests require significant effort or special walk in healthy adults. Am J Respir Crit Care Med 158: 1384-1387.
skills from the patients, walking tests have become a common
8. Westerdahl E, Lindmark B, Almgren SO (2001) Chest physiotherapy after
method to determine functional capacity. To our knowledge, only coronary artery bypass graft surgery a comparison of three different
4 studies used 6MWT after cardiac surgery to provide reference deep breathing techniques. J Rehabil Med 33(2): 79-84.
values for defining disability. In this study, we used 6MWT to assess 9. Deloach LJ, Higgins MS, Caplan AB (1998) The visual analog scale in the
the efficacy of the ACBT after CABG in terms of effectiveness of immediate postoperative period: intrasubject variability and correlation
functional capacity. Pre- and post-operative 6MWT distances were with a numeric scale. Anaesth Analg 86: 102-106.
shown significant difference; chest expansion following CABG 10. Green SB, Salkind NJ, Akey TM (2000) Using SPSS for Windows:
has attained a near normal value following ACBT at the end of Analyzing and Understanding Data. (2nd edn), Prentice Hall, New Jersey,
USA.
treatment session
11. Westerdahl E, Lindmark B, Eriksson T (2003) The immediate effects of
Conclusion deep breathing exercises on atelectasis and oxygenation after cardiac
surgery. Scand Cardiovasc J 37(6): 363-367.
The Active Cycle of Breathing Technique is more effective
method of treatment on post operative CABG patients. 12. Blaney F, Sawyer T (1997) Sonographic measurement of diaphragmatic
motion after upper abdominal surgery: A comparison of three breathing
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Volume 5 - Issue 1
How to cite this article: Monisha R,TS Muthukumar. Efficacy of Active Cycle of Breathing Technique on Functional Improvement in Post CABG Patient. Res Med Eng
Sci. 5(1). RMES.000602.2018. DOI: 10.31031/RMES.2018.05.000602
395