Deep breathing exercises with positive expiratory pressure at a higher rate improve oxygenation in the early period after cardiac surgery — a randomised controlled trial

Urell, Charlotte; Emtner, Margareta; Hedenström, Hans; Tenling, Arne; Breidenskog, Marie; Westerdahl, Elisabeth

doi:10.1016/j.ejcts.2010.10.018

Cited by 44 publications

(39 citation statements)

References 22 publications

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“…The physiotherapist instructed the patients daily on coughing techniques and exercises of the shoulder girdle. All patients performed hourly deep breathing exercises with a positive expiratory pressure (PEP) of 10–15 cm H 2 O, during the first two postoperative days, as described in detail in a previously study [18]. …”

Section: Methodsmentioning

confidence: 99%

“…Oxygenation improves in patients performing a high rate of postoperative breathing exercises [18]. As pronounced lung volume impairment occurs in the immediate period, measured by spirometry [18], the factors that might affect lung volumes on the second postoperative day after open-heart surgery would be of the greatest value to investigate.…”

Section: Introductionmentioning

confidence: 99%

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Lung Function before and Two Days after Open-Heart Surgery

Urell

Westerdahl

Hedenström

et al. 2012

Critical Care Research and Practice

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Reduced lung volumes and atelectasis are common after open-heart surgery, and pronounced restrictive lung volume impairment has been found. The aim of this study was to investigate factors influencing lung volumes on the second postoperative day. Open-heart surgery patients (n = 107, 68 yrs, 80% male) performed spirometry both before surgery and on the second postoperative day. The factors influencing postoperative lung volumes and decrease in lung volumes were investigated with univariate and multivariate analyses. Associations between pain (measured by numeric rating scale) and decrease in postoperative lung volumes were calculated with Spearman rank correlation test. Lung volumes decreased by 50% and were less than 40% of the predictive values postoperatively. Patients with BMI >25 had lower postoperative inspiratory capacity (IC) (33 ± 14% pred.) than normal-weight patients (39 ± 15% pred.), (P = 0.04). More pain during mobilisation was associated with higher decreases in postoperative lung volumes (VC: r = 0.33, P = 0.001; FEV1: r = 0.35, P ≤ 0.0001; IC: r = 0.25, P = 0.01). Patients with high BMI are a risk group for decreased postoperative lung volumes and should therefore receive extra attention during postoperative care. As pain is related to a larger decrease in postoperative lung volumes, optimal pain relief for the patients should be identified.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Lung Function before and Two Days after Open-Heart Surgery

Urell

Westerdahl

Hedenström

et al. 2012

Critical Care Research and Practice

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“…Studies have reported that active breathing exercises such as deep breathing along with directed coughing and incentive spirometry can prevent or reduce atelectasis after heart and thoracic surgeries (55)(56)(57). However, several studies have claimed that there is no sufficient credible evidence establishing a connection between breathing exercises and decreased pulmonary complications after heart and thoracic surgeries (23)(24)(25)(26).…”

Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 99%

“…Therefore, further research is needed to confirm available study results. Some studies have provided evidence that breathing exercises can improve oxygenation after cardiac surgery (56,58). However, other studies have yielded conflicting results, reporting that breathing exercises performed as incentive spirometry and voluntary deep breathing do not have any significant effect on arterial blood oxygenation (46,55,59).…”

Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 99%

Effects of pleasant olfactory mental imagery on the arterial oxygenation in patients with open heart surgery: A randomized controlled trial

Rezaei-Nodehi

Bagheri-Nesami

Shorofi

et al. 2017

Complementary Therapies in Clinical Practice

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“…2,3,[7][8][9] One of the therapeutic principles of chest physical therapy is to create a positive expiratory pressure (PEP), which in turn increases pulmonary expiration time and pulmonary volumes, especially functional residual capacity. 2,10 PEP levels between 10 and 20 cmH 2 O are believed to improve mucus clearance, either by increasing gas pressure behind secretions through collateral ventilation or by preventing airway collapse during expiration.…”

mentioning

confidence: 99%

An Improvised “Blow Glove” Device Produces Similar PEP Values to a Commercial PEP Device: An Experimental Study

Dagan

Wiser

Weissman

et al. 2014

Physiotherapy Canada

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Background: Postoperative positive expiratory pressure (PEP) therapy promotes increased lung volume, secretion clearance, and improved oxygenation. Several commercial devices exist that produce recommended PEP values (10-20 cmH 2 O) when the patient breathes through a fixed orifice resistor. It was hypothesized that an inexpensive, improvised ''blow glove'' device would produce similar PEP values over a wider range of expiration volumes and flow rates. Methods: PEP for different expiration volumes (400-2000 mL) and expiratory flow rates (10-80 L/min) was compared between a commercial PEP device (Resistex, Mercury Medical, Clearwater, FL) and an improvised ''blow glove'' device, recorded by a Vela ventilator (CareFusion, San Diego, CA). Dynamics in positive end expiratory pressure (PEEP) values were evaluated following five consecutive expirations. The ''blow glove'' device was evaluated using various glove compositions and sizes. Results: The improvised ''blow glove'' device produced a significantly higher rate of PEP values in the recommended range than the Resistex device (88.9% vs. 20%, p < 0.0001). No significant difference was observed between small and large glove sizes (88.9% vs. 82.9%, p > 0.05), but the powdered latex glove showed a significantly higher rate of PEP values in the recommended range than the powder-free latex glove (88.9% vs. 44.4%, p < 0.001). Conclusions: A ''blow glove'' PEP device using a powdered latex glove produces PEP values in the recommended range over a wider spectrum of expiratory flow rates and expiration volumes than a commercial PEP device.

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Deep breathing exercises with positive expiratory pressure at a higher rate improve oxygenation in the early period after cardiac surgery — a randomised controlled trial

Cited by 44 publications

References 22 publications

Lung Function before and Two Days after Open-Heart Surgery

Lung Function before and Two Days after Open-Heart Surgery

Effects of pleasant olfactory mental imagery on the arterial oxygenation in patients with open heart surgery: A randomized controlled trial

An Improvised “Blow Glove” Device Produces Similar PEP Values to a Commercial PEP Device: An Experimental Study

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