Chest
Volume 105, Issue 3, March 1994, Pages 741-747
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Clinical Investigations: Cardiology and Cardiac Surgery
Efficacy of Breathing and Coughing Exercises in the Prevention of Pulmonary Complications After Coronary Artery Surgery

https://doi.org/10.1378/chest.105.3.741Get rights and content

One hundred twenty patients undergoing coronary artery surgery completed a randomized controlled study designed to investigate whether prophylactic chest physiotherapy affected the incidence of postoperative pulmonary complications. Croup 1 patients received no preoperative or postoperative chest physiotherapy. Croup 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. Croup 2 and 3 patients were instructed to practice breathing and coughing exercises every hour. Overall, an incidence of clinically 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 clinically 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 reviewed.

Section snippets

Patients

One hundred twenty-seven consecutive patients undergoing elective CAS who gave informed written consent were included in the study. Patients who were unable to understand written or spoken English were excluded from participation. After obtaining consent, patients were randomly allocated by means of a random numbers table to one of three groups. The study was approved by the Human Ethics Committee of the Royal Adelaide Hospital (RAH).

Group 1: Patients in this group received no chest

RESULTS

Of the initial 120 patients included in the study, seven were early withdrawals following surgery: two from group 1, three from group 2, and two from group 3. Reasons for withdrawal were mechanical ventilation for more than 24 h (four patients) and neurologic complications (three patients). These seven patients were replaced so that an equal number of patients remained in each group.

Descriptive data, including results of pulmonary function testing, for the 120 patients who completed the study

DISCUSSION

Although routine chest physiotherapy is widely used after CAS with the aim of preventing pulmonary complications, relatively few studies could be found which evaluated the efficacy of this treatment.6, 7, 8, 9, 10, 11, 12, 13, 14, 15 In these studies, different regimens of treatment such as breathing and coughing exercises, incentive spirometry, intermittent positive pressure breathing, and periodic application of continuous positive airway pressure were compared. No treatment regimen was found

ACKNOWLEDGMENT

We wish to thank D. Craddock and J. Stubberfield, cardiothoracic surgeons, the interns, registrars, and nursing staff of the Cardiothoracic Surgical Unit and members of the Physiotherapy Department, RAH, for their cooperation. Also, we acknowledge Naomi Haensel, Physiotherapy Department, for her support and encouragement.

REFERENCES (19)

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