Postoperative pulmonary complications and lung function in high‐risk patients: a comparison of three physiotherapy regimens after upper abdominal surgery in general anesthesia

Abstract

The effect of three postoperative regimens of respiratory therapy on pulmonary complications and lung function was compared in high-risk patients. Fifty-one patients were randomized to: 1) conventional chest physiotherapy alone (PHYS), 2) chest physiotherapy and positive expiratory pressure (PEP), or 3) chest physiotherapy with both positive expiratory pressure and inspiratory resistance (RMT). Treatments were given twice daily by a physiotherapist and self-administered. The incidence of postoperative pulmonary complications (PPC) was respectively, 71%, 76% and 65% in the PHYS-, PEP- and RMT-groups. The incidence of PPC requiring treatment with antibiotic, bronchodilator or supplementary oxygen according to the existing clinical practice was 47%, 47% and 29%. The incidence of atelectasis was 65%, 64% and 60% and of pneumonia 29%, 35% and 6%. There was no difference between the groups, except for a tendency to a lower frequency of pneumonia in the RMT-group. Postoperatively forced vital capacity (FVC) decreased to mean 54%, forced expired volume in 1 s to 48% and functional residual capacity to 76% of preoperative values. Arterial oxygen tension (PaO2) declined to mean 8.1 kPa and arterial saturation (SaO2) to 89%. There was no difference between the groups except for FVC, PaO2 and SaO2 (P = 0.008, P = 0.008 and P = 0.002), which showed the least decrease in the RMT-group. None of the regimens could be considered as satisfactory concerning the prevention of PPC, but RMT seemed to be the most efficient. Insufficient self-administration of treatment was probably one of the causes of the overall high incidence of PPC in this study.

The Effect of Abdominal Support on Functional Outcomes in Patients Following Major Abdominal Surgery: A Randomized Controlled Trial

“…1,2 The reported incidence of PPCs ranges from 10% to 88%, depending on the definition used and the population studied. [1][2][3][4][5][6][7][8] The incidence of PPCs also depends on the procedure and on individual patients' postoperative risk factors. 1 Compared to peripheral surgery, thoracic and upper abdominal surgeries result in the highest incidence of PPCs.…”

“…Breathing exercises and early mobilization are cornerstones of postoperative management. 2,4,10,13,[20][21][22][23] Early mobility following surgery is deemed crucial, since postoperative immobilization is widely held to contribute to cardiovascular instability, 10 thromboembolic complications, 24 and catabolism, 10 in addition to pulmonary morbidity. 25 Sitting out of bed has been shown to be associated with an increase in postoperative functional residual capacity, 25 and it has been suggested that a programme of active enforced progressive mobilization can improve pulmonary function following colon resection.…”

Chest physical therapy in surgery: a theoretical model about who to treat

“…return to pre-operative respiratory status [6][7][8][9]. Another development in the care of post-operative patients is the change of routines concerning mobilisation.…”

“…Over the last few decades, treatments have changed, becoming more active, whereby the patients are encouraged to carry out a larger part of the training by themselves [6,7]. The use of deep breathing exercises has developed with the introduction of different breathing devices, including incentive spirometry and positive expiratory pressure (PEP), to facilitate breathing post-operatively and to accelerate the…”

Chest physiotherapy during immediate postoperative period among patients undergoing upper abdominal surgery: randomized clinical trial

“…[10][11][12] The effects of different chest physiotherapy regimens have been evaluated among high-risk postoperative patients and none of them could be considered highly satisfactory with regard to preventing such complications. 13 On the other hand, preoperative chest physiotherapy reduced the incidence of postoperative pulmonary complications and improved mobilization and oxygen-hemoglobin saturation after major abdominal surgery. 14 The hypothesis of this study was that chest physiotherapy during the immediate postoperative period among patients who had undergone upper abdominal surgery would improve the postoperative results or prevent postoperative pulmonary complications.…”