title: A propose of pulmonary dysfunction stratification after valve surgery by physiotherapeutic assistance level.
abstract: OBJECTIVE
  a) to propose and implement an evaluation system; b) to classify the pulmonary involvement and determine levels of physical therapy; c) to check the progress postoperatively.
  
  
  METHODS
  Patients underwent physiotherapy assessment preoperatively, postoperatively and after 5 days of intervention. They were classified into three levels of care: level 1 - low risk of complication; Level 2 - medium risk; Level 3 - high risk. We used analysis of variance and Kruskal-Wallis and analysis of variance for repeated measures or Friedman. Chi-square test or Fisher for proportions. We considered statistical significance level P<0.05.
  
  
  RESULTS
  We studied 199 patients, 156 classified within level 1, 32 at level 2 and 11 at level 3. Thoracoabdominal motion and auscultation changed significantly postoperatively, persisting at levels 2 and 3 (P<0.05). Oxygenation and respiratory rate changed at levels 2 and 3 postoperatively (P<0.05) with recovery at the end. Significant decrease in lung volumes occurred in three levels (P<0.05) with partial recovery at level 1, lung collapse occurred at all levels, with recovery by 56% at level 1, 47% at level 2, 27% at level 3.
  
  
  CONCLUSIONS
  The proposed assessment identified valve surgery patients who require differentiated physical therapy. Level 1 patients had rapid recovery, while the level 2 showed significant changes with functional gains at the end. Level 3 patients, more committed and prolonged recovery, should receive greater assistance.
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Satiko Shimada
authors.initials: SS
authors.lastname: Franco
authors.affiliation: Anestesiology Department, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Luiz Marcelo Sá
authors.initials: LM
authors.lastname: Malbouisson
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Max
authors.initials: M
authors.lastname: Grinberg
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Maria Ignêz Zanetti
authors.initials: MI
authors.lastname: Feltrim
mesh_terms: D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D003371:Cough / Q000503:physiopathology; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006349:Heart Valve Diseases / Q000534:rehabilitation / Q000601:surgery*; D006351:Heart Valves / Q000601:surgery*; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010092:Oximetry; D011182:Postoperative Care; D011184:Postoperative Period; D057234:Preoperative Period; D011859:Radiography; D020127:Recovery of Function; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014797:Vital Capacity