Comparative study of Anulom Vilom Pranayam (AVP) and Positive Expiratory Pressure (PEP) techniques after uncomplicated Coronary Artery Bypass Grafting
Abstract
Coronary artery disease has evolved to be the leading cause of death and morbidity in this era of urbanization and industrialization. Coronary Artery Bypass Grafting (CABG) is the definitive treatment of choice in Coronary artery diseases. Routine Chest Physiotherapy techniques employ various breathing exercises alongwith coughing techniques. Recent advancements in Cardiopulmonary Physiotherapy, clubbed with alternative breathing strategies, combinely prove to be effective in improving oxygenation and augmenting the mucociliary and cough clearance mechanism of the lungs thereby preventing post-operative respiratory complications. The aim of present study was to compare the effect of Anulom Vilom Pranayam (AVP) with Positive Expiratory Pressure (PEP) Device, in respiratory outcomes, following uncomplicated CABG. Study was conducted on 30 subjects including 28 males and two females (with mean age 56 years) who had undergone uncomplicated CABG. The subjects were randomly divided in 2 groups. Group A performed AVP with Incentive spirometry (IS) whereas group B performed breathing exercise with Positive Expiratory Pressure (PEP) with IS. Outcomes were recorded in the form of changes in Respiratory Rate (RR), Mucociliary Clearance Time (MCT) through Saccharin Test, Peak Expiratory Flow Rate (PEFR), Partial pressures of Oxygen and Carbon dioxide (PaO2 and PaCO2) through ABG analysis and arterial Oxygen Saturation (SpO2) on the first and seventh post-operative day. Improvement in all respiratory parameters was found after treatment in both groups but significant improvement was found in PaO2 with AVP group in comparison with PEP (p =0.038). Hence AVP can be considered beneficial in improving respiratory outcomes following cardiac surgery if practiced properly on a long term basis.
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Introduction
Cardiovascular disease is a leading cause of death globally1 . Coronary Artery Disease (CAD) is marked by a reduction or arrest of blood supply to the myocardium. The etiology happens to be the formation of atherosclerotic plaque in the Coronary arteries supplying the heart.
Treatment for CAD involves medications, combined with lifestyle modifications, undergoing invasive and/or surgical procedures like angioplasty and Coronary Artery Bypass Grafting (CABG). CABG is the definitive procedure for coronary artery disease which involves more than 2 vessels. Arterial or venous grafts are harvested from elsewhere in the body to bypass the atherosclerotic narrowing and improve the coronary circulation to the myocardium.
Conclusion
Present study concludes that the result of this study suggests that AVP+IS is more effective in improvement of PaO2. It also suggests that all other respiratory parameters (PEFR, RR, PaCO2, and MCT) show improvement after treatment with AVP+IS as compared to that seen with PEP+IS. However, both the techniques are equally effective in context of other respiratory parameters considered in this study.