Positive expiratory pressure in postoperative cardiac patients in intensive care: A randomized controlled trial

Abstract

Objective: To evaluate effectiveness of positive expiratory pressure blow-bottle device compared to expiratory positive airway pressure and conventional physiotherapy on pulmonary function in postoperative cardiac surgery patients in intensive care unit. Design: A randomized controlled trial. Settings: Tertiary care. Subjects: 48 patients (16 in each group; aged 64.5 ± 9.1 years, 38 male) submitted to cardiac surgery. Interventions: Patients were randomized into conventional physiotherapy (G1), positive expiratory pressure blow-bottle device (G2) or expiratory positive airway pressure, both associated with conventional physiotherapy (G3). G2 and G3 performed three sets of 10 repetitions in each session for each technique. Main measures: Pulmonary function (primary); respiratory muscle strength, radiological changes, pulmonary complications, length of intensive care unit and hospital stay (secondary) assessed preoperatively and on the 3rd postoperative day. Results: Pulmonary function (except for forced expiratory volume in one second/ forced vital capacity % predicted) and respiratory muscle strength showed significant reduction from the preoperative to the 3rd postoperative in all groups ( P < 0.001), with no difference between groups ( P > 0.05). Regarding radiological changes, length of intensive care unit stay and length of hospital stay, there was no significant difference between groups ( P > 0.05). Conclusion: Both positive expiratory pressure techniques associated with conventional physiotherapy were similar, but there was no difference regarding the use of positive expiratory pressure compared to conventional physiotherapy. Clinical Trial Registration Number: NCT03639974. https://clinicaltrials.gov/ct2/show/NCT03639974

The Effects of Inspiratory Muscle Training (IMT) on Patients Undergoing Coronary Artery Bypass Graft (CABG) Surgery: A Systematic Review and Meta-Analysis

“…Various forms of strategies such as aerobic training, endurance training, resistance training, and respiratory muscle training have demonstrated their benefits in inducing morphological and functional changes in the diaphragm while limiting the occurrence of postoperative pulmonary complications (PPCs) [5]. In addition, some devices such as positive expiratory pressure devices, and incentive spirometers are reported to prevent the incidence of PPCs [6]. Prehabilitation programs including nutrition support, smoking ces-sation, exercise interventions, and patient education have been suggested applied before surgery and may help reduce surgery-related complications, although no consensus has been reached.…”