Material and Methods
postoperative pain, arrhythmia, atelectasis, hemodynamic disturbance, psychiatric, air leak
ARRHYTHMIA, POSTOPERATIVE COMPLICATIONS, THORACIC, ATELECTASIS, COMPLICATION
A prospective randomized trial of 60 patients who underwent pulmonary resection at Akdeniz University Hospital Thoracic Surgery Clinic between September-2016 and July-2017, were enrolled in the study. Average age of the patients was 54,8(18-65 age), 30 out of which were women and 30 of which were men. All patients enrolled were given detailed information about the study and a signed confirmation form was received from each patient. An approval was received from ‘Akdeniz University, Faculty of Medicine, Ethics Committee for Clinical Studies’ in order to carry out the study.Age, gender, body mass index (BMI) of the patients, their length of hospital stays, type of the operation made and postoperative complications such as atelectasis, prolonged air leak and arrhythmia were recorded.The patients were divided into 2 groups as control group and study group and each group consisted of randomly selected 30 patients. 30 patients in the study group were given respiration exercise training, intensive spirometer training and applied bi-level positive airway pressure(BIPAP) 3 hours a day for 7 days, while the other 30 patients in the control group were not provided with any training on preoperative pulmonary rehabilitation.In the postoperative period, after the patients were extubated, both groups were applied the same pulmonary rehabilitation methods which are routine practices. Patients did respiration exercises and applied incentive spirometer for 4-6 hours a day while in intensive care and 2-4 sessions a day during their stay in the hospital ward. BIPAP was performed as in 3 sessions for 3 days after the operation. In the preoperative period, hemodynamic parameters were measured, respiratory function test (RFT) and arterial blood gas (ABG) test were made for all the patients. paCO2 and paO2 values were studied during ABG test and FEV1 and FVC values were studied during RFT test. Effectiveness of the study was investigated by carrying out measurements by RFT and ABG, at the 4th, 12th, 24th and 48th hours following extubation in the postoperative period. In the postoperative period, the patients who showed severe hemodynamic disturbance and psychiatric problems to the extent of avoiding their participation in the study were excluded.In the preoperative period, patients in the study group were asked to apply the following respiratory exercise plan;With the aim of training and providing their adaptation to the study, the patients were given information about the operation to be made, the region and position to be operated, postoperative pain, endotracheal tube, drainage tubes, oxygen therapy and intensive care process.Information was provided about effectiveness of breathing exercises, incentive spirometer and BIPAP application in providing sufficient amount of ventilation and secretion drainage, due to the fact that the operation to be made as well as the anesthesia and mechanical ventilation during the operation will decrease the respiration capacity. For this purpose, the following exercises were done by the patients for 7 days as 3 hours a day.1. Breathing exercisesa. Diaphragmatic breathing exercises 10 repeat/dayb. Segmental breathing exercises (unilateral, posterior, bilateral basal and apical) 10 repeat/dayc. Puckered lip breathing 10 repeat/day2. Use of incentive spirometer 15 repeat/day3. Coughing technique4. BIPAP application 20 min/dayIn statistical analysis SPSS (Statistical Package for Social Science Version 20) was used and distribution according to age, gender, BMI as well as smoking history of the groups were studied with ‘student t’ test, ABG and RFT parameters were studied with Repeated Measures ANOVA, student t’ test, their length of stay in hospital was studied with the comparative ‘Mann Whitney U Test’ while the complication rates were studied with ‘Fisher's Exact Test, Pearson chi-square test’ and p <0,05 was considered to be statistically significant.