The Scientific Basis for Postoperative Respiratory Care

Abstract

Postoperative pulmonary complications (PPCs) are common and expensive. Costs, morbidity, and mortality are higher with PPCs than with cardiac or thromboembolic complications. Preventing and treating PPCs is a major focus of respiratory therapists, using a wide variety of techniques and devices, including incentive spirometry, CPAP, positive expiratory pressure, intrapulmonary percussive ventilation, and chest physical therapy. The scientific evidence for these techniques is lacking. CPAP has some evidence of benefit in high risk patients with hypoxemia. Incentive spirometry is used frequently, but the evidence suggests that incentive spirometry alone has no impact on PPC. Chest physical therapy, which includes mechanical clapping and postural drainage, appears to worsen atelectasis secondary to pain and splinting. As with many past respiratory therapy techniques, the profession needs to take a hard look at these techniques and work to provide only practices based on good evidence. The idea of a PPC bundle has merit and should be studied in larger, multicenter trials. Additionally, intraoperative ventilation may play a key role in the development of PPCs and should receive greater attention.

The Effect of Incentive Spirometry on Postoperative Pulmonary Function Following Laparotomy

“…[2][3][4][5]8,[17][18][19] The functional mechanisms associated with the onset of PPC are not completely understood but likely involve a combination of decreased lung volume resulting in atelectasis and impaired mucociliary clearance. 1,[4][5][6]17,18 Deep breathing and coughing exercises may help mobilize secretions and reexpand areas of collapsed lung postoperatively. The resultant sustained alveolar inflation and maintenance of normal functional residual capacity is thought to prevent PPC.…”

“…[3][4][5][6][7][8][9][10][11][12][13][14][15][16] Risk factors include older age, smoking, malnutrition, preoperative or intraoperative blood loss, emergency surgery, and upper abdominal or thoracic surgery. [2][3][4][5]8,[17][18][19] The functional mechanisms associated with the onset of PPC are not completely understood but likely involve a combination of decreased lung volume resulting in atelectasis and impaired mucociliary clearance. 1,[4][5][6]17,18 Deep breathing and coughing exercises may help mobilize secretions and reexpand areas of collapsed lung postoperatively.…”

Identificação dos diagnósticos de enfermagem da classe de respostas cardiovasculares/pulmonares em pacientes submetidos à cirurgia bariátrica

“…O padrão respiratório ineficaz e a ventilação espontânea prejudicada estão relacionados com a ventilação disfuncional, que é definida como o funcionamento anormal ou incompleto do movimento do ar para dentro e para fora dos pulmões com um padrão e ritmo respiratório, profundidade de inspiração e força de expiração (15), estando associado à mecânica da ventilação e não aos processos de troca gasosa e transporte de oxigênio/dióxido de carbono (16).…”

“…Os cuidados para estes diagnósticos em questão são: manter em semi-Fowler; avaliar expansibilidade torácica (amplitude e simetria) e uso de musculatura acessória; realizar ausculta pulmonar; comunicar saturação de oxigênio pela oximetria de pulso (SpO 2 ) inferior a 92%; avaliar sinais e sintomas de infecção pulmonar; avaliar complicações relacionadas à ventilação mecânica e observar sinais e sintomas de hipoxemia (16).…”

Comparative efficacy of different modules on pulmonary functions after lung resection

“…Evidence for the effectiveness of physiotherapy in preventing postoperative pulmonary complications after abdominal surgery is provided in randomized controlled trials. 5 There are, however, no sufficient data on the efficacy of physiotherapy after thoracic surgery. Although incentive spirometry is used widely in clinical practice, it has not been shown to be of additional value after major abdominal or cardiac surgery.…”