The online version of this article (doi:10.1186/cc10340) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
FP contributed to the conception and design of the trial, data collection, statistical analysis, and writing of the manuscript. DPV contributed to data collection, and the revision of the manuscript. SBdeN contributed to the study design, data collection and the revision of the manuscript. LFB contributed to the data collection, and the revision of the manuscript. PB contributed to the study design and the revision of the manuscript. BAdeM contributed to the study design and the revision of the manuscript. JMB contributed to the conception and design of the trial, statistical analysis and writing of the manuscript. MJS contributed to the conception and design of the trial, interpretation of the data and writing of the manuscript. All authors read and approved the final version of the manuscript.
Cardiac surgery is associated with post-operative reductions of functional residual capacity (FRC). Manual hyperinflation (MH) aims to prevent airway plugging, and as such could prevent the reduction of FRC after surgery. The main purpose of this study was to determine the effect of MH on post-operative FRC of cardiac surgical patients.
This was a randomized controlled trial of patients after elective coronary artery bypass graft and/or valve surgery admitted to the intensive care unit (ICU) of a university hospital. Patients were randomly assigned to a "routine MH group" (MH was performed within 30 minutes after admission to the ICU and every 6 hours thereafter, and before tracheal extubation), or a "control group" (MH was performed only if perceptible (audible) sputum was present in the larger airways causing problems with mechanical ventilation, or if oxygen saturation (SpO2) dropped below 92%). The primary endpoint was the reduction of FRC from the day before cardiac surgery to one, three, and five days after tracheal extubation. Secondary endpoints were SpO2 (at similar time points) and chest radiograph abnormalities, including atelectasis (at three days after tracheal extubation).
A total of 100 patients were enrolled. Patients in the routine MH group showed a decrease of FRC on the first post-operative day to 71% of the pre-operative value, versus 57% in the control group (P = 0.002). Differences in FRC became less prominent over time; differences between the two study groups were no longer statistically significant at Day 5. There were no differences in SpO2 between the study groups. Chest radiographs showed more abnormalities (merely atelectasis) in the control group compared to patients in the routine MH group (P = 0.002).
MH partly prevents the reduction of FRC in the first post-operative days after cardiac surgery.
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- Manual hyperinflation partly prevents reductions of functional residual capacity in cardiac surgical patients - a randomized controlled trial
Denise P Veelo
Selma B de Nijs
Ludo FM Beenen
Bas AJM de Mol
Jan M Binnekade
Marcus J Schultz
- BioMed Central
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