Early Respiratory Therapy Reduces Postoperative Atelectasis in Children Undergoing Lung Resection

Abstract

BACKGROUND: Early physiotherapy reduces pulmonary complications after lung resection in adult patients. However, the effectiveness and the techniques used in postoperative physiotherapy in children undergoing lung resection have not been well described. Therefore, the standardization of a physiotherapeutic attendance after lung resection in children is necessary. METHODS: This was a retrospective and prospective, interventional, descriptive, and quantitative study. We evaluated 123 pediatric subjects undergoing lung resection. Fifty-two children were prospectively submitted to a standardized physiotherapy protocol that included a mask with a positive expiratory pressure of 10 cm H 2 O, expiratory rib cage compression, coughing, lifting the upper limbs, and ambulation, starting within the first 4 hours after surgery and continuing 3 times each day. A historical control group of 71 subjects received physiotherapeutic techniques without specific standardization and with variability in the start date and number of days attended. We recorded the presence of postoperative complications, prolonged air leak, postoperative bronchoscopy, the time of chest tube removal, and hospital stay following surgery. RESULTS: The group that received a standardized protocol of physiotherapy had fewer instances of atelectasis than the control group (15.4% vs 7.6%, P ‫؍‬ .01). Subjects in the control group were more likely than those in the intervention group to require fiberoptic bronchoscopy for bronchial toilet (n ‫؍‬ 14 [19.7%] vs n ‫؍‬ 5 [9.6%], P < .001). There was no difference in the time of drainage or hospital stay between the groups. CONCLUSIONS: Implementation of a standardized physiotherapeutic protocol after lung resection in children decreases atelectasis but does not reduce the time of chest tube removal or the duration of hospital stay.

A review article on the benefits of early mobilization following spinal surgery and other medical/surgical procedures

“…arm lifting and walking in <4 postoperative hours/and continued for 3 times/day) in 52 children undergoing lung resections versus 71 controls (who did not receive these early therapies). [12] The treatment group exhibited fewer instances of AT, while more children in the control group required postoperative fiberoptic bronchoscopy. Of interest, no differences were encountered in the average time of drainage/chest tube utilization or LOS.…”

Association of Daily Step Count with the Prolonged Air Leak in Thoracic Surgery Patients

“…8,9,18,19 When the studies that reveal the relation of postoperative complications with exercises are examined, it can be seen that the patients are generally divided into two groups. [18][19][20][21] In many of these studies, one of the groups is given a standard exercise program, and the other group is given an intensive exercise program. [18][19][20][21] A comparison between the two groups shows that fewer complications develop in the group that was given the more intensive exercise program.…”

“…[18][19][20][21] In many of these studies, one of the groups is given a standard exercise program, and the other group is given an intensive exercise program. [18][19][20][21] A comparison between the two groups shows that fewer complications develop in the group that was given the more intensive exercise program. [18][19][20][21] As a result of similar studies, it has become the accepted view that prompt and sufficient mobilization decreases complications and shortens the duration of hospitalization.…”

“…[18][19][20][21] A comparison between the two groups shows that fewer complications develop in the group that was given the more intensive exercise program. [18][19][20][21] As a result of similar studies, it has become the accepted view that prompt and sufficient mobilization decreases complications and shortens the duration of hospitalization. [18][19][20][21] Our study differs from the published studies in the literature regarding the applied exercise method and the grouping of the patients.…”

Current challenges in the recognition, prevention and treatment of perioperative pulmonary atelectasis

“…Smoking cessation 6-8 weeks before surgery has been shown to be beneficial and is strongly encouraged [4,49]. Patients with a chronic pulmonary disease may be prescribed increased doses of bronchodilator therapy to reduce bronchial hyperreactivity and increased airway clearance therapy (ACT) to reduce secretion retention and improve the airway patency [4,55,64,65].…”