Does the addition of deep breathing exercises to physiotherapy-directed early mobilisation alter patient outcomes following high-risk open upper abdominal surgery? Cluster randomised controlled trial

The use of a modified, oscillating positive expiratory pressure device reduced fever and length of hospital stay in patients after thoracic and upper abdominal surgery: a randomised trial

“…23 Silva and colleagues reported that the addition of deep breathing exercises to physiotherapy-directed early mobilisation did not further reduce PPCs, compared with mobilisation alone. 24 Mackay and colleagues reported that the addition of deep breathing and coughing exercises to a physiotherapist-directed program of early mobilisation in high-risk, open abdominal surgery patients did not significantly reduce the incidence of clinically significant PPCs. 25 However, both of these studies had smaller sample sizes and were single-centre studies.…”

physiotherapy management of patients undergoing abdominal surgery: A survey of current practice

“…The use of prophylactic respiratory interventions in the early postoperative stage is consistent with physiotherapy service provision in other countries and expert consensus (Hanekom et al, 2012;Patman et al, 2017), despite the necessity for DB&C interventions remaining contentious across different major surgical groups (Pasquina, Tramèr, & Walder, 2003;Reeve et al, 2010), including those undergoing UAS (Mackay, Ellis, & Johnston, 2005;Pasquina, Tramèr, Granier, & Walzer, 2006;Silva, Li, & Rickard, 2013). For example, in patients undergoing UAS, two studies (Mackay et al, 2005;Silva et al, 2013) have demonstrated that the addition of deep breathing exercises to physiotherapy-directed early (POD1) postoperative ambulation does not further reduce PPCs compared with early postoperative ambulation alone. This suggests that early postoperative ambulation on POD1 may be all that is necessary in low-risk patients, and that the routine use of prophylactic DB&C may not be justified.…”

The physiotherapy management of patients undergoing abdominal surgery

“…A similar study replicated this protocol with a more realistic ambulation protocol. Silva et al (2013) randomised 86 high-risk UAS patients into three groups: mobilisation alone, mobilisation plus DB&C, and delayed mobilisation (commenced on the third postoperative day) plus DB&C. Participants were ambulated once daily to a BORG intensity of 6/10. There were no significant differences in PPC rate between groups even in the group that rested in bed for three days; although this group were no more likely to get a PPC, they had increased requirements for physiotherapy to assist in their physical recovery and significantly longer LOS (MD 4.4, 95%CI 0.3 to 8.8).…”