Preoperative physiotherapy in prevention of pulmonary complications in pediatric cardiac surgery. Incentive spirometry versus routine chest physiotherapy for prevention of pulmonary complications after abdominal surgery Does removal of deep breathing exercises from a physiotherapy program including pre-operative education and early mobilisation after cardiac surgery alter patient outcomes? [Ineffectiveness of incentive spirometry as coadjuvant of conventional physiotherapy for the prevention of postoperative respiratory complications after thoracic and esophageal surgery]. The influences of positive end expiratory pressure (PEEP) associated with physiotherapy intervention in phase I cardiac rehabilitation. Duration of anaesthesia, type of surgery, respiratory co-morbidity, predicted VO2max and smoking predict postoperative pulmonary complications after upper abdominal surgery: an observational study. Short-Term Respiratory Physical Therapy Treatment in the PACU and Influence on Postoperative Lung Function in Obese Adults Preoperative physiotherapy for the prevention of respiratory complications after upper abdominal surgery: pragmatic, double blinded, multicentre randomised controlled trial An evaluation of preoperative methods of preventing postoperative pulmonary complications. [Mask physiotherapy for prevention of pulmonary complications after heart surgery. A controlled study]. Incentive spirometry decreases respiratory complications following major abdominal surgery. Does physiotherapy reduce the incidence of postoperative pulmonary complications following pulmonary resection via open thoracotomy? A preliminary randomised single-blind clinical trial. Three different mask physiotherapy regimens for prevention of post-operative pulmonary complications after heart and pulmonary surgery Postoperative pulmonary complications and lung function in high‐risk patients: a comparison of three physiotherapy regimens after upper abdominal surgery in general anesthesia [Prevention of postoperative pulmonary complications after heart-lung surgery. Comparison of 3 different mask physiotherapy regimens]. Prophylactic nasal continuous positive airway pressure following cardiac surgery protects from postoperative pulmonary complications: a prospective, randomized, controlled trial in 500 patients. Efficacy of breathing and coughing exercises in the prevention of pulmonary complications after coronary artery surgery. Effects of Aerobic Exercise Applied Early After Coronary Artery Bypass Grafting on Pulmonary Function, Respiratory Muscle Strength, and Functional Capacity: A Randomized Controlled Trial. Prevention of respiratory complications after abdominal surgery: a randomised clinical trial [Prophylactic inspiratory muscle training before coronary artery bypass graft]. Preoperative inspiratory muscle training to prevent postoperative pulmonary complications in patients undergoing esophageal resection (PREPARE study): study protocol for a randomized controlled trial Incentive spirometry does not enhance recovery after thoracic surgery Prophylaxis against pulmonary complications in patients undergoing gall-bladder surgery. A comparison between early mobilization, physiotherapy with and without bronchodilatation. Prophylactic Inspiratory Muscle Training in Patients Undergoing Coronary Artery Bypass Graft
OBJECTIVE To evaluate the occurrence and risk of pulmonary complications in children who underwent pre- and postoperative physiotherapeutic intervention in cardiac surgeries , as well as to compare these patients to those who underwent only postoperative physiotherapeutic intervention . METHODS A r and omized controlled trial was performed with 135 patients from 6 years of age and younger with congenital heart disease who had undergone cardiac surgery . Patients were r and omly assigned to the intervention group ( G1 ) in which they underwent pre- and postoperative physiotherapy or to the control group ( G2 ) in which they underwent only postoperative physiotherapy . Mann-Whitney and the Chi-square tests were used to compare the variables between the groups . The magnitude of the absolute risk was calculated by the number of patients needed to treat . Statistical significance was set at 5 % ( P<0.05 ) . RESULTS 17 patients ( 25 % ) in G1 , and 29 patients ( 43.3 % ) in G2 presented pulmonary complications ( P= 0.025 ) , pneumonia was the most frequent complication , and among the 17 patients in G1 , seven ( 10.3 % ) developed pneumonia , six ( 8.8 % ) developed atelectasis , and four ( 5.9 % ) presented complications due to both complications . In G2 , 13 patients ( 19.4 % ) developed pneumonia , eight ( 11.9 % ) developed atelectasis , and eight ( 11.9 % ) developed pneumonia associated with atelectasis . Absolute risk reduction for the primary outcome was of 18.3 % and the number of needed to treat was 5.5 . CONCLUSION Preoperative respiratory physiotherapy significantly reduced the risk of pulmonary complications in postoperative pediatric cardiac surgery We entered 876 patients into a clinical trial aim ed at preventing pulmonary complications after abdominal surgery . Patients either received conventional chest physiotherapy or were encouraged to perform maximal inspiratory manoeuvres for 5 min during each hour while awake , using an incentive spirometer . The incidence of pulmonary complications did not differ significantly between the groups : incentive spirometry 68 of 431 ( 15.8 % , 95 % CI 14.0 - 17.6 % ) , and chest physiotherapy 68 of 445 ( 15.3 % , CI 13.6 - 17.0 % ) . Nor was there a difference between the groups in the incidence of positive clinical signs , pyrexia , abnormal chest radiographs , pathogens in sputum , respiratory failure ( PO2 less than 60 mm Hg ) , or length of stay in hospital . We conclude that prophylactic incentive spirometry and chest physiotherapy are of equivalent clinical efficacy in the general management of patients undergoing abdominal surgery The aim of this study was to establish whether removal of breathing exercises from a regimen including early mobilisation changes the incidence of post-operative pulmonary complications for patients after cardiac surgery . Two hundred and thirty patients undergoing open heart surgery at Monash Medical Centre , Melbourne , were enrolled in this r and omised controlled trial . All patients received physiotherapy treatment pre-operatively and post-operatively for three days . Patients were mobilised as soon as possible after surgery . Breathing group ( control ) patients performed a set routine of deep breathing exercises at each physiotherapy visit while those in the intervention group did not perform this routine . Other than the breathing exercises , patient management was similar between groups in terms of assessment , positioning and mobility . The incidence of postoperative pulmonary complications , post-operative length of stay , oxyhaemoglobin saturation and pulmonary function were measured pre-operatively and post-operatively . Intention-to-treat analysis was performed for post-operative pulmonary complications and length of stay . Other data were analysed using t-tests , chi square and repeated measures analysis of variance . There were no significant differences between the groups in the primary dependent variables . It is concluded that removal of breathing exercises from the routine physiotherapy management of open heart surgery patients does not significantly alter patient outcome We have studied the efficacy of routine use of incentive spirometry ( IS ) in two groups of patients : group 1 ( n = 18 ) with IS , and group 2 ( n = 19 ) , no IS . All patients suffered from lung or esophagus neoplasm and received respiratory physiotherapy before and after the operation . They underwent high chest and abdomen surgery .  The incidence of alterations of pulmonary auscultation , roentgenologic abnormalities and alterations of the alveolar-arterial difference of oxygen ( D[A-a]O2 ) as well as postoperative complications were similar in both groups . Patients undergoing digestive surgery  presented a higher frequency of pleural effusion ( p less than 0.05 ) and of them , the subgroup with IS stayed at the hospital for a longer time ( 47.2 + /- 32 days ) than the subgroup undergoing digestive surgery not su bmi tted to IS ( p less than 0.01 ) probably because of the higher incidence of neoplasms of the mean third of the esophagus in such group . In our study and in the context of the type of surgery studied , the routine use of IS does not decrease the frequency of clinical and roentgenologic alterations neither improves the efficacy of postoperative gas interchange PURPOSE To evaluate the effects of positive end expiratory pressure and physiotherapy intervention during Phase I of cardiac rehabilitation on the behavior of pulmonary function and inspiratory muscle strength in postoperative cardiac surgery . METHODS A prospect i ve r and omized study , in which 24 patients were divided in 2 groups : a group that performed respiratory exercises with positive airway expiratory pressure associated with physiotherapy intervention ( GEP , n = 8) and a group that received only the physiotherapy intervention ( GPI , n = 16 ) . Pulmonary function was evaluated by spirometry on the preoperative and on the fifth postoperative days ; inspiratory muscle strength was measured by maximal inspiratory pressure on the same days . RESULTS Spirometric variables were significantly reduced from the preoperative to the fifth postoperative day for the GPI , while the GEP had a significant reduction only for vital capacity ( P < .05 ) . When the treatments were compared , smaller values were observed in the GPI for peak flow on the fifth postoperative day . Significant reductions of maximal inspiratory pressure from preoperative to the first postoperative day were found in both groups . However , the reduction in maximal inspiratory pressure from the preoperative to the fifth postoperative day was significant only in the GPI ( P < .05 ) . CONCLUSIONS These data suggest that cardiac surgery produces a reduction in inspiratory muscle strength , pulmonary volume , and flow . The association of positive expiratory pressure with physiotherapy intervention was more efficient in minimizing these changes , in comparison to the physiotherapy intervention alone . However , in both groups , the pulmonary volumes were not completely reestablished by the fifth postoperative day , and it was necessary to continue the treatment after hospital convalescence QUESTION Can the risk of developing postoperative pulmonary complications be predicted after  upper abdominal surgery ? DESIGN Prospect i ve observational study . PARTICIPANTS 268 consecutive patients undergoing elective upper abdominal surgery who received st and ardised pre- and postoperative prophylactic respiratory physiotherapy .  OUTCOME MEASURES Predictors were 17 preoperative and intraoperative risk factors . A postoperative pulmonary complication was diagnosed when four or more of the following criteria were present : radiological evidence of collapse/consolidation , temperature > 38 degrees C , oxyhaemoglobin saturation < 90 % , abnormal sputum production , sputum culture indicating infection , raised white cell count , abnormal auscultation findings , or physician 's diagnosis of pulmonary complication . RESULTS 35 participants ( 13 % ) developed postoperative pulmonary complications . Five risk factors predicted postoperative pulmonary complications : duration of anaesthesia ( OR 4.3 , 95 % CI 1.7 to 10.8 ) ; surgical category ( OR 2.3 , 95 % CI 1.1 to 4.7 ) ; current smoking ( OR 2.1 , 95 % CI 1.0 to 4.5 ) ; respiratory co-morbidity ( OR 2.1 , 95 % CI 1.0 to 4.4 ) ; and predicted maximal oxygen uptake ( OR 2.0 , 95 % CI 1.0 to 4.3 ) . A clinical rule for predicting the development of postoperative pulmonary complications predicted 82 % of participants who developed complications . The odds of high risk participants developing pulmonary complications were 8.4 ( 95 % CI 3.3 to 21.3 ) times that of low risk participants . CONCLUSION This clinical rule for predicting the risk of developing postoperative pulmonary complications from five risk factors may prove useful in prioritising postoperative respiratory physiotherapy . Further research is needed to vali date the rule Background Even several days after surgery , obese patients exhibit a measureable amount of atelectasis and thus are predisposed to postoperative pulmonary complications . Particularly in ambulatory surgery , rapid recovery of pulmonary function is desired to ensure early discharge of the obese patient . In this study , we wanted to evaluate intensive short-term respiratory physical therapy treatment ( incentive spirometry ) in the postanesthesia care unit ( PACU ) and its impact on pulmonary function in the obese . Methods After ethics committee approval and informed consent , we prospect ively studied 60 obese patients ( BMI 30–40 ) undergoing minor peripheral surgery  , half of which were r and omly assigned to receive  respiratory physiotherapy  during their PACU stay , while the others received routine treatment . Premedication , general anesthesia , and respiratory setting s were st and ardized . We measured arterial oxygen saturation by pulse oximetry on air breathing . Inspiratory and expiratory lung functions were measured preoperatively ( baseline ) and at 10 min , 1 , 2 , 6 , and 24 h after extubation , with the patient supine , in a 30 ° head-up position . The two groups were compared using repeated-measure analysis of variance and t test analysis . Statistical significance was considered to be P < 0.05 . Results There were no differences at the first assessment , but , during the PACU stay , pulmonary function in the physiotherapy group was significantly better than the controls ’ ( p < 0.0001 ) , an effect which persisted for at least 24 h after surgery ( p < 0.009 ) . ConclusionS hort-term respiratory physiotherapy during the PACU stay promotes more rapid recovery of postoperative lung function in the obese during the first 24 Abstract Objective To assess the efficacy of a single preoperative physiotherapy session to reduce  postoperative pulmonary complications ( PPCs )  after upper abdominal surgery . Design Prospect i ve , pragmatic , multicentre , patient and assessor blinded , parallel group , r and omised placebo controlled superiority trial . Setting Multidisciplinary preadmission clinics at three tertiary public hospitals in Australia and New Zeal and . Participants 441 adults aged 18 years or older who were within six weeks of elective major open upper abdominal surgery were r and omly assigned through concealed allocation to receive either an information booklet ( n=219 ; control ) or preoperative physiotherapy ( n=222 ; intervention ) and followed for 12 months . 432 completed the trial . Interventions Preoperatively , participants received an information booklet ( control ) or an additional 30 minute physiotherapy education and breathing exercise training session ( intervention ) . Education focused on PPCs and their prevention through early ambulation and self directed breathing exercises to be initiated immediately on regaining consciousness after surgery . Postoperatively , all participants received st and ardised early ambulation , and no additional respiratory physiotherapy was provided . Main outcome measures The primary outcome was a PPC within 14 postoperative hospital days assessed daily using the Melbourne group score . Secondary outcomes were hospital acquired pneumonia , length of hospital stay , utilisation of intensive care unit services , and hospital costs . Patient reported health related quality of life , physical function , and post-discharge complications were measured at six weeks , and all cause mortality was measured to 12 months . Results The incidence of PPCs within 14 postoperative hospital days , including hospital acquired pneumonia , was halved ( adjusted hazard ratio 0.48 , 95 % confidence interval 0.30 to 0.75 , P=0.001 ) in the intervention group compared with the control group , with an absolute risk reduction of 15 % ( 95 % confidence interval 7 % to 22 % ) and a number needed to treat of 7 ( 95 % confidence interval 5 to 14 ) . No significant differences in other secondary outcomes were detected . Conclusion In a general population of patients listed for elective upper abdominal surgery , a 30 minute preoperative physiotherapy session provided within existing hospital multidisciplinary preadmission clinics halves the incidence of PPCs and specifically hospital acquired pneumonia . Further research is required to investigate benefits to mortality and length of stay . Trial registration Australian New Zeal and Clinical Trials Registry ANZCTR 12613000664741 The effectiveness of three current regimes of preoperative respiratory care in reducing postoperative respiratory complications following herniorrhaphy  was studied prospect ively . No smoking for five days plus intensive physiotherapy , five days no smoking , and routine hospital admission two days preoperatively were the regimes . Clinical , bacteriological , chest X-ray , blood gas and respiratory function test data were the criteria for assessment . The same surgical and anaesthetic team performed each operation . No statistical difference between the groups for pulmonary complications was noted . A significant correlation was found between the preoperative vital capacity and arterial pO2 ; also between the preoperative forced expiratory volume in one second-vital capacity ratio with the postoperative arterial pO2 The objective of this prospect i ve , consecutive , r and omized , controlled study was to investigate the effects of mask physiotherapy on postoperative complications after heart surgery . Sixty-six low-risk male patients undergoing coronary artery by-pass graft surgery were evaluated . The patients were treated with routine chest physiotherapy alone or supplied with either positive expiratory pressure ( PEP ) , or inspiratory resistance-positive expiratory pressure ( IR-PEP ) . Postoperative pulmonary complications were assessed by forced vital capacity ( FVC ) , arterial oxygen tension ( PaO2 ) , and chest X-ray examination . There was an almost equal decrease and subsequent rise in spirometric and blood gas values in all three groups , but patients treated with the PEP mask had a borderline significantly higher increase in PaO2 from day three to day six compared with patients treated with no mask . There was an almost equal frequency of atelectasis in the three treatment groups . It is concluded that no significant differences in outcome were found between the three groups Pulmonary complications are the leading cause of morbidity and mortality following major abdominal surgery . Chest physiotherapy aims to decrease the likelihood of these complications and hasten recovery . Exercises aim ed at maximising inspiratory effort are the most beneficial for the patients . The incentive spirometer is a h and held device that patients use to achieve effective inspiration . In a nonr and omised pilot study of 263 patients we have found that the addition of the incentive spirometer , as part of an intensive post-operative physiotherapy programme , decreased the occurrence of pulmonary complications ( 6 vs 17 % , p = 0.01 ) and length of stay on the surgical high dependency unit ( 3.1 vs 4 days p = 0.03 ) . The two groups were comparable when age , sex , smoking history , the need for emergency surgery and post-operative analgesia were compared OBJECTIVE This study investigates whether targeted postoperative respiratory physiotherapy decreased the incidence of postoperative pulmonary complications and length of stay for patients undergoing elective pulmonary resection via open thoracotomy . METHODS Seventy-six patients participated in a prospect i ve , single-blind , parallel-group , r and omised trial with concealed allocation , assessor blinding and intention-to-treat analysis . Treatment group participants received daily respiratory physiotherapy interventions until discharge . Control group participants received st and ard medical/nursing care involving a clinical pathway . The presence of postoperative pulmonary complications was assessed on a daily basis during hospitalisation using a st and ardised diagnostic tool . Length of stay was recorded . RESULTS Postoperative pulmonary complications developed in two participants ( 4.8 % ) in the treatment group and in one participant ( 2.9 % ) in the control group ; the difference ( treatment minus control ) was 1.8 % ( 95 % confidence interval ( CI ) -10.6 % to 13.1 % ) ( p=1.00 ) . No significant difference was found between groups for length of stay ( treatment group , median 6.0 days ; control group 6.0 days ) ( p=0.87 ) . A preoperative forced expiratory volume in 1s of 1.5l or less ( p=0.005 ) and a history of chronic obstructive pulmonary disease ( p=0.008 ) were associated with a greater number of criteria for a postoperative pulmonary complication being met . CONCLUSIONS In this patient population , given the low incidence of postoperative pulmonary complications , targeted respiratory physiotherapy may not be required in addition to st and ard care involving a clinical pathway following pulmonary resection via open thoracotomy . These results should be extrapolated with caution to those patients undergoing pulmonary resection with poor preoperative lung function Objective An investigation into the incidence of post-operative complications after thoracic surgery with  3 different physiotherapy masks . Design A prospect i ve , consecutive , r and omized comparison . Setting Department of Thoracic and Heart Surgery at a University Hospital . The treatments were performed by experienced and specially trained physiotherapists . Patients 160 patients were evaluated . 60 patients undergoing heart surgery , 59 patients having pulmonary resection , and 41 patients with exploratory thoractomy . Interventions In each operative category the patients were treated with one of three face mask systems used in addition to routine chest physiotherapy . These were either continuous positive airway pressure ( CPAP ) , positive expiratory pressure ( PEP ) , or inspiratory resistance — positive expiratory pressure ( IR-PEP ) . Measurements and results Post-operative pulmonary complications were assessed by forced vital capacity ( FVC ) , arterial oxygen tension ( PaO2 ) , and chest X-ray examination , all measured pre-operatively and on the fourth and ninth post-operative day . The patients filled in a question naire expressing their opinion about their mask treatment . There was an equal decrease in FVC , FVC% , and PaO2 , and equal frequency of atelectasis in the 3 mask treatments . More patients with the PEP mask favoured their system than did those with the other 2 systems . Conclusion There was no statistically significant difference between the treatments : continuous positive airway pressure ( CPAP ) , positive expiratory pressure ( PEP ) , and inspiratory resistance — positive expiratory pressure ( IR-PEP ) on post-operative complications . Any of the three treatments may be used as supplement to st and ard chest physiotherapy The effect of three postoperative regimes of respiratory therapy on  pulmonary complications and lung function was compared in high‐risk patients . Fifty‐one patients were r and omized 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 object of the investigation was to compare the effect of three different physiotherapy masks on the incidence of postoperative complications after thoracic surgery . It was carried out as a prospect i ve , consecutive , r and omized comparison at a Department of Thoracic and Heart Surgery at a University Hospital . The therapy was performed by experienced and specially trained physiotherapists . One hundred and sixty patients were evaluated ; 60 patients undergoing heart surgery , 59 patients having pulmonary resection , and 41 patients with exploratory thoracotomy . In each operative category the patients were treated with one of three face mask systems used in addition to routine chest physiotherapy . These were either continuous positive airway pressure ( CPAP ) , positive expiratory pressure ( PEP ) , or inspiratory resistance -- positive expiratory pressure ( IR-PEP ) . Postoperative pulmonary complications were assessed by forced vital capacity ( FVC ) , arterial oxygen tension ( PaO2 ) , and chest X-ray examination , all parameters were measured preoperatively and on the fourth and ninth postoperative day . The patients filled in a question naire concerning their opinions about their mask treatment . IR-PEP showed a lesser decrease in PaO2 on day nine . Otherwise there was an equal decrease in FVC and PaO2 , and equal frequency of atelectasis in the three mask treatments . It is therefore concluded that any of the three therapies : continuous positive airway pressure ( CPAP ) , positive expiratory pressure ( PEP ) , and inspiratory resistance -- positive expiratory pressure ( IR-PEP ) may be used as supplement to st and ard chest physiotherapy BACKGROUND Continuous positive airway pressure is a noninvasive respiratory support technique that may prevent pulmonary complications following cardiac surgery . This study was conducted to determine the efficacy of prophylactic nasal continuous positive airway pressure ( nCPAP ) compared with st and ard treatment . The primary end points were pulmonary adverse effects defined as hypoxemia ( Pao(2)/fraction of inspired oxygen [ Fio(2 ) ] < 100 ) , pneumonia , and reintubation . The secondary end point was the readmission rate to the ICU or intermediate care unit ( IMCU ) . METHODS We prospect ively r and omized 500 patients scheduled for elective cardiac surgery . Following extubation either in the operating room ( early ) or in the ICU ( late ) , patients were allocated to st and ard treatment ( control ) including 10 min of intermittent nCPAP at 10 cm H(2)O every 4 h or prophylactic nCPAP ( study ) at an airway pressure of 10 cm H(2)O for at least 6 h. RESULTS Prophylactic nCPAP significantly improved arterial oxygenation ( Pao(2)/Fio(2 ) ) without altering heart rate and mean arterial BP . Pulmonary complications including hypoxemia ( defined as Pao(2)/Fio(2 ) < 100 ) , pneumonia , and reintubation rate were reduced in study patients compared to controls ( 12 of 232 patients vs 25 of 236 patients , respectively ; p = 0.03 ) . The readmission rate to the ICU or IMCU was significantly lower in nCPAP-treated patients ( 7 of 232 patients vs 14 of 236 patients , respectively ; p = 0.03 ) . CONCLUSIONS The long-term administration of prophylactic nCPAP following cardiac surgery improved arterial oxygenation , reduced the incidence of pulmonary complications including pneumonia and reintubation rate , and reduced readmission rate to the ICU or IMCU . Thus noninvasive respiratory support with nCPAP is a useful tool to reduce pulmonary morbidity following elective cardiac surgery One hundred twenty patients undergoing coronary artery surgery completed a r and omized controlled study design ed to investigate whether prophylactic chest physiotherapy affected the incidence of postoperative pulmonary complications . Group 1 patients received no preoperative or postoperative chest physiotherapy . Group 2 patients received preoperative education and instruction in breathing and coughing exercises and postoperative supervision and assistance in performing the same . These exercises were supervised by a physiotherapist twice per day on the first 2 postoperative days and once per day on the 3rd and 4th postoperative days . Physiotherapy for group 3 patients was the same as for group 2 patients except that patients were seen by a physiotherapist 4 times per day on the first 2 postoperative days and twice per day on the 3rd and 4th postoperative days . Group 2 and 3 patients were instructed to practice breathing and coughing exercises every hour . Overall , an incidence of clinical ly significant postoperative pulmonary complications of 7.5 percent was demonstrated . In general , these patients demonstrated lower levels of preoperative pulmonary function and very low early postoperative oxygenation compared with those who did not develop pulmonary complications . There was no indication that the incidence or severity of fever , hypoxemia , chest roentgenologic abnormalities or clinical ly significant postoperative pulmonary complications was different between groups . These results suggest that the necessity for prophylactic chest physiotherapy after routine coronary artery surgery should be review ed BACKGROUND Physical activity is beneficial in several clinical situations and recommended for patients with ischemic heart disease , as well as for those undergoing cardiac surgery . METHODS In a r and omized controlled trial , 34 patients underwent coronary artery bypass grafting .  A r and omized control group ( n = 15 ) su bmi tted to conventional physiotherapy . The intervention group ( n = 19 ) received the same protocol plus additional aerobic exercise with cycle ergometer .  Pulmonary function by spirometry , respiratory muscle strength by manovacuometry , and functional capacity through  6-minute walking test was assessed before surgery and at hospital discharge . RESULTS There was significant reduction in pulmonary function in both groups . In both groups , inspiratory muscle strength was maintained while expiratory muscle strength significantly decreased . Functional capacity was maintained in the intervention group ( 364.5 [ 324.5 to 428 ] vs. 348 [ 300.7 to 413.7 ] meters , P = .06 ) , but it decreased significantly in control group patients ( 320 [ 288.5 to 393.0 ] vs. 292 [ 237.0 to 336.0 ] meters , P = .01 ) . A significant difference in functional capacity was also found in intergroup analyses at hospital discharge ( P = .03 ) . CONCLUSION Aerobic exercise applied early on coronary artery bypass grafting patients may promote maintenance of functional capacity , with no impact on pulmonary function and respiratory muscle strength when compared with conventional physiotherapy Abstract Objective : To evaluate the prevention of respiratory complications after abdominal surgery by a comparison of a global policy of incentive spirometry with a regimen consisting of deep breathing exercises for low risk patients and incentive spirometry plus physiotherapy  for high risk patients . Design : Stratified r and omised trial . Setting : General surgical service of an urban teaching hospital . Patients : 456 patients undergoing abdominal surgery . Patients less than 60 years of age with an American Society of Anesthesia classification of 1 were considered to be at low risk . Outcome measures : Respiratory complications were defined as clinical features consistent with collapse or consolidation , a temperature above 38 ° C , plus either confirmatory chest radiology or positive results on sputum microbiology . We also recorded the time that staff devoted to prophylactic respiratory therapy . Results : There was good baseline equivalence between the groups . The incidence of respiratory complications was 15 % ( 35/231 ) for patients in the incentive spirometry group and 12 % ( 28/225 ) for patients in the mixed therapy group ( P=0.40 ; 95 % confidence interval -3.6 % to 9.0 % ) . It required similar amounts of staff time to provide incentive spirometry and deep breathing exercises for low risk patients . The inclusion of physiotherapy for high risk patients , however , result ed in the utilisation of an extra 30 minutes of staff time per patient . Conclusions : When the use of re sources is taken into account , the most efficient regimen of prophylaxis against respiratory complications after abdominal surgery is deep breathing exercises for low risk patients and incentive spirometry for high risk patients . Key messages Key messages Most postoperative respiratory complications were due to atelectasis : less than 1 % of the patients developed pneumonia An American Society of Anesthesia classification > 1 and an age > /=60 years is a simple way of defining patients at high risk of respiratory complications and other adverse events after abdominal surgery A regimen consisting of deep breathing exercises ( low risk patients ) and incentive spirometry ( high risk patients ) is an efficient way of providing prophylaxis against respiratory complications after abdominal Pulmonary complications after cardiac surgery are a leading cause of postoperative morbidity and mortality . Respiratory muscle weakness may contribute to the postoperative pulmonary abnormalities . We hypothesized that : inspiratory muscle strength ( PImax at RV ) and endurance ( PmPeak/PImax ) decrease following  coronary artery bypass grafting ( CABG ) ; that this weakness is associated with impaired pulmonary function tests ( PFT ) , impaired gas exchange and a higher rate of pulmonary complications ; and that prophylactic inspiratory muscle training ( PIMT ) will prevent these changes . 30 c and i date s for CABG , ranging in age from 33 to 79 , were evaluated and r and omized into 2 groups : 15 received PIMT using a threshold trainer for 30 min/day for 1 month before operation , while 15 served as controls and received sham training . There was a significant decrease in respiratory muscle function , PFT , and gas exchange in the control group following CABG , while in the trained group these parameters where similar to those before entering the study . The differences between the groups were statistically significant . In addition , 4 ( 27 % ) in the control group , but only 1 ( 7 % ) in the trained group had postoperative pulmonary complications . We conclude that CABG is followed by significant deterioration in inspiratory muscle function , PFT and arterial blood gases . Decrease in these parameters can be prevented by PIMT , which may also prevent postoperative pulmonary complications Background Esophageal resection is associated with a high incidence of postoperative pneumonia . Respiratory complications account for almost half of the readmissions to the critical care unit . Postoperative complications can result in prolonged hospital stay and consequently increase healthcare costs . In cardiac surgery a preoperative inspiratory muscle training program has shown to prevent postoperative pneumonia and reduce length of hospital stay . While in some surgical centers inspiratory muscle training is already used in the preoperative phase in patients undergoing esophageal resection , the added value of this intervention on the reduction of pulmonary complications has not yet been investigated in large surgical population s other than cardiac surgery in a r and omized and controlled study design . Methods / Design The effect of a preoperative inspiratory muscle training program on the incidence of postoperative pneumonia in patients undergoing esophageal resection will be studied in a single blind multicenter r and omized controlled trial ( the PREPARE study ) . In total 248 patients ( age > 18 years ) undergoing esophageal resection for esophageal cancer will be included in this study . They are r and omized to either usual care or usual care with an additional inspiratory muscle training intervention according to a high-intensity protocol which is performed with a tapered flow resistive inspiratory loading device . Patients have to complete 30 dynamic inspiratory efforts twice daily for 7 days a week until surgery with a minimum of 2 weeks . The starting training load will be aim ed to be 60 % of maximal inspiratory pressure and will be increased based on the rate of perceived exertion . The main study endpoint is the incidence of postoperative pneumonia . Secondary objectives are to evaluate the effect of preoperative inspiratory muscle training on length of hospital stay , duration of mechanical ventilation , incidence of other postoperative ( pulmonary ) complications , quality of life , and on postoperative respiratory muscle function and lung function . Discussion The PREPARE study is the first multicenter r and omized controlled trial to evaluate the hypothesis that preoperative inspiratory muscle training leads to decreased pulmonary complications in patients undergoing esophageal resection . Trial registration NCT01893008 Objective : To investigate the additional effect of incentive spirometry to chest physiotherapy to prevent postoperative pulmonary complications after thoracic surgery for lung and esophageal resections . Design : R and omized controlled trial . Setting : University hospital , intensive care unit , and surgical department . Patients : Sixty‐seven patients ( age , 59 ± 13 yrs ; forced expiratory volume in 1 sec , 93 % ± 22 % predicted ) undergoing elective thoracic surgery for lung ( n = 40 ) or esophagus ( n = 27 ) resection . Interventions : Physiotherapy ( breathing exercises , huffing , and coughing ) ( PT ) plus incentive spirometry ( IS ) was compared with PT alone . Measurements and Main Results : Lung function , body temperature , chest radiograph , white blood cell count , and number of hospital and intensive care unit days were all measured . Pulmonary function was significantly reduced after surgery ( 55 % of the initial value ) and improved significantly in the postoperative period in both groups . However , no differences were observed in the recovery of pulmonary function between the groups . The overall score of the chest radiograph , based on the presence of atelectasis , was similar in both treatment groups . Eight patients ( 12 % ) ( three patients with lobectomy and five with esophagus resection ) developed a pulmonary complication ( abnormal chest radiograph , elevated body temperature and white blood cell count ) , four in each treatment group . Adding IS to regular PT did not reduce hospital or intensive care unit stay . Conclusions : Pulmonary complications after lung and esophagus surgery were relatively low . The addition of IS to PT did not further reduce pulmonary complications or hospital stay . Although we can not rule out beneficial effects in a subgroup of high‐risk patients , routine use of IS after thoracic surgery seems to be ineffective A r and om comparison of early mobilization and chest physiotherapy ( mainly breathing exercises ) with or without bronchodilatating inhalations for prophylaxis against pulmonary complications in patients undergoing elective gall-bladder surgery is presented . The operation was performed with a subcostal incision and peroperatively , intercostal nerve block was administered . Preoperative pulmonary status ( dynamic volume spirometry , peak expiratory flow rate , arterial blood gas analysis ) showed no differences between the groups , and postoperative blood gas analysis and pulmonary X-ray or evident clinical findings did also not show any differences between the groups . Thus early mobilization was as effective in our study as the other prophylactic treatments . In patients without pulmonary disease perhaps early mobilization and efficient analgesia after surgery is as effective as more re source dem and ing physiotherapy for prophylaxis against postoperative pulmonary complications Pulmonary complications after cardiac surgery are a leading cause of postoperative morbidity and mortality . Respiratory muscle weakness may contribute to the postoperative pulmonary abnormalities . We hypothesized that : ( 1 ) there is a decrease in inspiratory muscle strength ( PImax at residual volume ) and endurance ( Pmpeak/PImax ) following coronary artery bypass graft ( CABG ) ; ( 2 ) this weakness is associated with reduced pulmonary function tests ( PFTs ) , impaired gas exchange , and a higher rate of pulmonary complications ; and ( 3 ) prophylactic inspiratory muscle training ( IMT ) can prevent those changes . Eighty-four c and i date s for CABG , with ages ranging from 33 to 82 years , were evaluated prior to operation and r and omized into two groups : 42 patients underwent IMT using a threshold trainer for 30 min/day for 2 weeks , 1 month before operation ( group A ) ; 42 patients served as a control group and underwent sham training ( group B ) . There was a significant decrease in respiratory muscle function , PFTs , and gas exchange in the control group following CABG , whereas these parameters remained similar to those before entering the study in the training group . The differences between the groups were statistically significant . In addition , 11 ( 26 % ) patients in the control group but only 2 ( 5 % ) in the training group needed postsurgical mechanical ventilation longer than 24 hours . CABGs have a significant deteriorating effect on inspiratory muscle function , PFTs , and arterial blood gases . The decrease in these parameters can be prevented by prophylactic inspiratory muscle training , which may also prevent postsurgical pulmonary complications
The usefulness of respiratory physiotherapy for the prevention of pulmonary complications after cardiac surgery remains unproved .
OBJECTIVE To assess whether respiratory physiotherapy prevents pulmonary complications after cardiac surgery .