Preoperative incentive spirometry for preventing postoperative pulmonary complications in patients undergoing coronary artery bypass graft surgery: a prospective, randomized controlled trial

Abstract

Background Postoperative pulmonary complications (PPCs) often occur after cardiac operations and are a leading cause of morbidity, inhibit oxygenation, and increase hospital length of stay and mortality. Although clinical evidence for PPCs prevention is often unclear and crucial, measures occur to reduce PPCs. One device usually used for this reason is incentive spirometry (IS). The aim of the study is to evaluate the effect of preoperative incentive spirometry to prevent postoperative pulmonary complications, improve postoperative oxygenation, and decrease hospital stay following coronary artery bypass graft (CABG) surgery patients. Methods This was a clinical randomized prospective study. A total of 80 patients were selected as candidates for CABG at An-Najah National University Hospital, Nablus-Palestine. Patients had been randomly assigned into two groups: incentive spirometry group (IS), SI performed before surgery (study group) and control group, preoperative spirometry was not performed. The 40 patients in each group received the same protocol of anesthesia and ventilation in the operating room. Result The study findings showed a significant difference between the IS and control groups in the incidence of postoperative atelectasis. There were 8 patients (20.0%) in IS group and 17 patients (42.5%) in the control group (p = 0.03). Mechanical ventilation duration was significantly less in IS group. The median was four hours versus six hours in the control group (p < 0.001). Hospital length of stay was significantly less in IS group, and the median was six days versus seven days in the control group (p < 0.001). The median of the amount of arterial blood oxygen and oxygen saturation was significantly improved in the IS group (p < 0.005). Conclusion Preoperative incentive spirometry for two days along with the exercise of deep breathing, encouraged coughing, and early ambulation following CABG are in connection with prevention and decreased incidence of atelectasis, hospital stay, mechanical ventilation duration and improved postoperative oxygenation with better pain control. A difference that can be considered both significant and clinically relevant. Trial registration Thai Clinical Trials Registry: TCTR20201020005. Registered 17 October 2020—retrospectively registered.

Effectiveness of Preoperative Chest Physiotherapy in Patients Undergoing Elective Cardiac Surgery, a Systematic Review and Meta-Analysis

“…An earlier RCT conducted by Sweity et al (2021) to assess the effect of preoperative incentive spirometry was compatible with our findings, as the study showed a significant difference between the interventional and control groups in the incidence of postoperative atelectasis, mechanical ventilation duration, and hospital LOS. The median of the amount of arterial blood oxygen and oxygen saturation was significantly improved in the intervention group [ 43 ].…”

Pre and postoperative nurse-guided incentive spirometry versus physiotherapist-guided pre and postoperative breathing exercises in patients undergoing cardiac surgery: An evaluation of postoperative complications and length of hospital stay

“…The acute or chronic collapse of part or entire lung was defined as atelectasis. [1] 3.2.10. Dyspnea.…”

“…Postoperative pulmonary complications are common after cardiac surgery and the incidences of postoperative pulmonary complications are 30 to 60%. [ 1 ] Postoperative complications increase morbidities, mortality, and the cost of hospitalization. [ 1 , 2 ] Major postoperative complications that affect the quality of life of patients after cardiac surgery are atelectasis, pneumonia, bronchitis, respiratory insufficiency, pulmonary edema, and pleural effusion.…”

“…[ 4 ] There is no specific etiology for atelectasis but general anesthesia, impaired diaphragm functions, chest wall shift, abdominal distension, pleural effusion, and pain may contribute to atelectasis. [ 1 ] Also, pain and postoperative fear associated with changes in lung mechanics can affect the performance of periodic deep inspiration and effective cough. This allows accumulation of secretion, and the collapse of the alveolar, and that affects exchanges of oxygen and carbon dioxide.…”

“…[ 12 ] Incentive spirometry reduces pleural tension, enhances lung expansibility, and improves ventilation-perfusion. [ 1 ] Moreover, atelectasis could be reversed by repeated incentive spirometry procedures. [ 13 ]…”