Contract-Relax (CR) Technique in the Management of Diaphragmatic Paresis After Cardiac Surgery
- Conditions
- Surgery, Cardiac
- Interventions
- Procedure: Usual physical therapyProcedure: Contract-Relax technique
- Registration Number
- NCT05068219
- Lead Sponsor
- CMC Ambroise Paré
- Brief Summary
Postoperative respiratory complications are common complications of patients after cardiac surgery and increase morbidity and mortality and hospital length of stay. Diaphragmatic dysfunction accounts for between 2 and 15% of these complications. Diaphragmatic paresis is one of these dysfunctions and could be due to an intra-operative phrenic nerve injury or harvesting of a mammary artery responsible for diaphragmatic devascularization. It alters the ventilatory mechanics and causes acute respiratory distress often requiring the use of mechanical ventilation. The diagnosis of this dysfunction can be made by thoracic ultrasound with assessment of diaphragmatic excursion. For patient with paresis, ultrasound criteria is an excursion \< 25 mm after deep inspiration for at least one of the two hemidiaphragms. This dysfunction is most often transient in the postoperative period, but it can also become persistent.
Contract-Relax (CR) physical therapy technique can be applied to any muscle, providing muscle strengthening, neuromotor stimulation, and a gain in joint amplitude.
Currently, post-cardiac surgery management of respiratory physiotherapy is the same for a patient with or without paresis. Moreover, the CR technique of the diaphragm is not part of this "standard" rehabilitation.
The objective of this study is to determine if the CR technique associated with the current respiratory management allows an early rehabilitation of patients with diaphragmatic paresis after cardiac surgery.
- Detailed Description
This is a single-center, prospective, comparative, randomized, controlled, parallel group, single blind study, trial assessing the efficacy of the association of CR with a "standard" respiratory rehabilitation for patient with diaphragmatic paresis after cardiac surgery.
This study compares two group :
* "Control" group : Standard rehabilitation (4 rehabilitation sessions a day in Intensive Care Unit (ICU) and 2 sessions in cardiac surgery unit).
* "Interventional' group : Standard rehabilitation + 3 CR during each session. A stratification of the randomization is planned according to diaphragmatic involvement (unilateral versus bilateral).
Diaphragmatic excursion will be assessed by thoracic ultrasound in time motion (TM) mode at D3 and D5, before the first physiotherapy session of the day.
The probe is placed on the mid-clavicular line under the costal grill, with an orientation at 90° of the diaphragmatic dome. The aim is to see the diaphragm through an acoustic window: the liver on the right and the spleen on the left. The diaphragm appears as a hyper echogenic line, the excursion is measured with the TM mode.
Oxygen saturation SpO2 will be taken before and after each respiratory physiotherapy session taking place at D3 and D4. A measurement will be taken on D5 before the first rehabilitation session of the day.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 27
- Cardiac surgery under extracorporeal circulation,
- Postoperative diaphragmatic paresis (Diaphragmatic excursion <25mm),
- Consent for participation,
- Affiliation to the social security system
- History of respiratory pathologies,
- History of neurological pathologies,
- Post-operative cardiac and circulatory complications,
- Pregnant or breastfeeding women,
- Unable to understand,
- Guardianship, curators or safeguard of justice.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description CR technique Usual physical therapy Standard rehabilitation + 3 CR Usual technique Usual physical therapy Standard rehabilitation CR technique Contract-Relax technique Standard rehabilitation + 3 CR
- Primary Outcome Measures
Name Time Method Diaphragmatic excursion in maximum inspiration Day 5 Diaphragmatic excursion ratio in maximum inspiration at D3 and D5. These measurements are determined by ultrasound in TM mode at D3 before the first rehabilitation session of the day (M1max, displacement, mm) and at D5 before the first rehabilitation session of the day (M2max, displacement, mm).
- Secondary Outcome Measures
Name Time Method Hospital length of stay Day 30 Duration of hospitalization (days).
Pain score : Numeric Rating Scale (NRS) Day 4 Self-assessment by the patient of the pain felt with a Numeric Rating Scale (NRS) from 0 (No pain) to 10 (Worst Possible Pain) after each session of respiratory physiotherapy at D3 and D4.
Diaphragmatic excursion in normal inspiration Day 5 Diaphragmatic excursion ratio in normal inspiration at D3 and D5. These measurements are determined by TM ultrasound at D3 before the first rehabilitation session of the day (M1rest, displacement, mm) and at D5 before the first rehabilitation session of the day (M2rest, displacement, mm).
Oxygen saturation Day 5 SpO2 (%) before and after each physiotherapy session on D3 and D4 and before the first rehabilitation session of the day on D5.
Non-invasive ventilation Day 30 Duration of non-invasive ventilation : NIV, optiflow, CPAP (hours).
Intensive care unit ICU length of stay Day 30 Duration of ICU stay (days).
Oxygenation Day 30 Time of oxygen therapy weaning (hours). The reference time t0 will be the time of postoperative extubation.
Incidence of respiratory complications Day 30 Occurence of reintubation, lung disease, atelectasis, bronchial fibroscopy, bronchospasm, pleural effusion, pneumothorax.
Trial Locations
- Locations (1)
CMC Ambroise Paré
🇫🇷Neuilly-sur-Seine, Ile-de-France, France