[Prevention of postoperative pulmonary complications after heart-lung surgery. Comparison of 3 different mask physiotherapy regimens]. Preoperative physiotherapy in prevention of pulmonary complications in pediatric cardiac surgery. [Mask physiotherapy for prevention of pulmonary complications after heart surgery. A controlled study]. Efficacy of breathing and coughing exercises in the prevention of pulmonary complications after coronary artery surgery. The influences of positive end expiratory pressure (PEEP) associated with physiotherapy intervention in phase I cardiac rehabilitation. An evaluation of preoperative methods of preventing postoperative pulmonary complications. Prevention of respiratory complications after abdominal surgery: a randomised clinical trial Randomized Controlled Study to Evaluate the Efficacy of a Preoperative Respiratory Rehabilitation Program to Prevent Postoperative Pulmonary Complications after Esophagectomy Does physiotherapy reduce the incidence of postoperative pulmonary complications following pulmonary resection via open thoracotomy? A preliminary randomised single-blind clinical trial. Incentive spirometry does not enhance recovery after thoracic surgery Perioperative rehabilitation and physiotherapy for lung cancer patients with chronic obstructive pulmonary disease. Does removal of deep breathing exercises from a physiotherapy program including pre-operative education and early mobilisation after cardiac surgery alter patient outcomes? Three different mask physiotherapy regimens for prevention of post-operative pulmonary complications after heart and pulmonary surgery Randomized clinical study of the prevention of pulmonary complications after thoracoabdominal resection by two different breathing techniques Preoperative physiotherapy for the prevention of respiratory complications after upper abdominal surgery: pragmatic, double blinded, multicentre randomised controlled trial The prevention of pulmonary complications after upper abdominal surgery in patients with noncompromised pulmonary status. Preoperative inspiratory muscle training to prevent postoperative pulmonary complications in patients undergoing esophageal resection (PREPARE study): study protocol for a randomized controlled trial
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 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 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 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 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 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 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 Background / Aims : Patients with postoperative pulmonary complications after esophagectomy often have increased mortality . The purpose of the study was to examine the efficacy of preventing postoperative pulmonary complications by an intensive preoperative respiratory rehabilitation ( PR ) program for esophageal cancer patients . Methods : This study was a prospect i ve r and omized controlled study . Thirty patients in the PR group and 30 patients in the no preoperative respiratory rehabilitation ( NPR ) group were included . The PR group received preoperative rehabilitation for more than 7 days , while the NPR group did not receive any preoperative rehabilitation . All patients underwent postoperative rehabilitation from the first postoperative day . The postoperative pulmonary complications were evaluated using the Clavien-Dindo classification ( CDC ) and the Utrecht Pneumonia Scoring System ( UPSS ) . Results : The CDC grade in the PR group was significantly lower than that in the NPR group ( p = 0.014 ) . The UPSS score in the PR group was significantly lower than that in the NPR group at postoperative day 1 ( p = 0.031 ) . In the multivariate analysis , NPR was an independent risk factor for postoperative pulmonary complications greater than CDC grade II ( OR : 3.99 , 95 % CI : 1.28 - 12.4 , p = 0.017 ) . Conclusions : This study showed that the intensive PR program was capable of reducing the postoperative pulmonary complications in esophageal cancer patients 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 : 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 OBJECTIVE The purpose of this study was to investigate the impact of pulmonary rehabilitation on surgical morbidity and lung function in lung cancer patients with chronic obstructive pulmonary disease ( COPD ) . METHODS Prospect ively , 22 lung cancer patients with COPD who underwent lobectomy between 2000 and 2003 were enrolled for this study as a rehabilitation group (  Rehab . Group ) . The criteria of COPD were preoperative forced expiratory volume in 1 second (FEV1)/forced vital capacity ( FVC ) < or = 70 % and more than 50 % of low attenuation area in a computed tomography . Preoperatively patients performed aggressive pulmonary exercise for two weeks and received chest physiotherapy postoperatively .  As a historical control , 60 patients with lung cancer who fulfilled the same criteria but did not receive rehabilitation between 1995 and 1999 ( control group ) were entered in this study . RESULTS Patient background s were all equivalent between the two groups . However , FEV1 and FEV1/FVC were significantly lower in the Rehab . Group ( p < 0.05 ) . Prolonged oxygen supplement and tracheostomy tended to be more frequent in the control group . The ratio of actual postoperative to predicted postoperative FEV1 was significantly better in the Rehab . Group ( p = 0.047 ) . Furthermore , postoperative hospital stay was significantly longer in the control group ( p = 0.0003 ) . CONCLUSION Despite lower FEV1 and FEV1/FVC in the Rehab . Group , postoperative pulmonary complications and long hospital stay could be effectively prevented and FEV1 was well preserved by rehabilitation and physiotherapy 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 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 Pulmonary complications are frequently seen after thoracoabdominal resection of the oesophagus . The aim of this study was to compare the effects of two different breathing exercise regimens applied in the immediate postoperative period on the risk of pulmonary insufficiency after thoracoabdominal resection 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 Controversy exists regarding the routine use of breathing exercises in the prevention of pulmonary complications after upper abdominal surgery . We prospect ively r and omized 153 patients who had noncompromised pulmonary status ; the control group ( 84 patients ) engaged in no breathing exercises , and the respiratory therapy group ( 69 patients ) engaged in preoperative and postoperative breathing exercises supervised by the physical therapist .  Postoperative pulmonary complications were classified using criteria derived from chest roentgenograms , arterial blood gas sample s , and temperature registration . The incidences of postoperative complications in the treatment group and in the control groups were 19 % and 60 % , respectively . In the present study , preoperative lung function tests had no additional or predictive value . We advise preoperative and postoperative breathing exercises as a prophylactic treatment in all patients scheduled for upper abdominal surgery 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
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 .