Chest physiotherapy during immediate postoperative period among patients undergoing upper abdominal surgery
randomized clinical trial
Keywords:
Physical therapy (specialty), Postoperative period, Surgery, Anesthesia recovery period, SpirometryAbstract
CONTEXT AND OBJECTIVE: Abdominal surgical procedures increase pulmonary complication risks. The aim of this study was to evaluate the effectiveness of chest physiotherapy during the immediate postoperative period among patients undergoing elective upper abdominal surgery. DESIGN AND SETTING: This randomized clinical trial was performed in the post-anesthesia care unit of a public university hospital. METHODS: Thirty-one adults were randomly assigned to control (n = 16) and chest physiotherapy (n = 15) groups. Spirometry, pulse oximetry and anamneses were performed preoperatively and on the second postoperative day. A visual pain scale was applied on the second postoperative day, before and after chest physiotherapy. The chest physiotherapy group received treatment at the post-anesthesia care unit, while the controls did not. Surgery duration, length of hospital stay and postoperative pulmonary complications were gathered from patients’ medical records. RESULTS: The control and chest physiotherapy groups presented decreased spirometry values after surgery but without any difference between them (forced vital capacity from 83.5 ± 17.1% to 62.7 ± 16.9% and from 95.7 ± 18.9% to 79.0 ± 26.9%, respectively). In contrast, the chest physiotherapy group presented improved oxygen-hemoglobin saturation after chest physiotherapy during the immediate postoperative period (p < 0.03) that did not last until the second postoperative day. The medical record data were similar between groups. CONCLUSIONS: Chest physiotherapy during the immediate postoperative period following upper abdominal surgery was effective for improving oxygen-hemoglobin saturation without increased abdominal pain. Breathing exercises could be adopted at post-anesthesia care units with benefi ts for patients.
Downloads
References
Siafakas NM, Mitrouska I, Bourus D, Georgopoulos D. Surgery and the respiratory muscles. Thorax. 1999;54(5):458-65.
Brooks D, Parsons J, Newton J, et al. Discharge criteria from perioperative physical therapy. Chest. 2002;121(2):488-94.
Warner DO. Preventing postoperative pulmonary com- plications: the role of the anesthesiologist. Anesthesiology. 2000;92(5):1467-72.
Saad IA, De Capitani EM, Toro IF, Zambon L. Clinical vari- ables of preoperative risk in thoracic surgery. Sao Paulo Med J. 2003;121(3):107-10.
Ferguson MK. Preoperative assessment of pulmonary risk. Chest. 1999;115(5 Suppl): 58S-63S.
Overend TJ, Anderson CM, Lucy SD, Bhatia C, Jonsson BI, Timmermans C. The effect of incentive spirometry on postop- erative pulmonary complications: a systematic review. Chest. 2001;120(3):971-8.
Doyle RL. Assessing and modifying the risk of postoperative pulmonary complications. Chest. 1999;115(5 Suppl):77S- 81S.
Ephgrave KS, Kleiman-Wexler R, Pfaller M, Booth B, Werk- meister L, Young S. Postoperative pneumonia: a prospective study of risk factors and morbidity. Surgery. 1993;114(4):815-9; discussion 819-21.
Rigg JR. Pulmonary atelectasis after anaesthesia: pathophysiol- ogy and management. Can Anaesth Soc J. 1981;28(4):305- 13.
Kisner C, Colby LA. Therapeutic exercise: foundations and techniques. 4th ed. Philadelphia: FA Davis Company; 2002.
Carvalho CRF. Feltrin MIZ. Bases teórico-práticas dos exercícios respiratórios. In: IV Simpósio Internacional de Fisioterapia, 1999. Revista de Fisioterapia da Universidade de São Paulo. 1999;6(Suplemento especial):25.
Pryor JA, Webber BA. Physiotherapy for respiratory and cardiac problems. 2nd ed. Edinburgh: Churchill Livingstone; 1998.
Christensen EF, Schultz P, Jensen OV, et al. Postoperative pul- monary complications and lung function in high-risk patients: a comparison of three physiotherapy regimens after upper abdominal surgery in general anesthesia. Acta Anaesthesiol Scand. 1991;35(2):97-104.
Fagevik Olsén M, Hahn I, Nordgren S, Lönroth H, Lund- holm K. Randomized controlled trial of prophylactic chest physiotherapy in major abdominal surgery. Br J Surg. 1997; 84(11):1535-8.
Huskisson EC. Measurement of pain. Lancet. 1974; 2(7889):1127-31.
Revill SI, Robinson JO, Rosen M, Hogg MI. The reli- ability of a linear analogue for evaluating pain. Anaesthesia. 1976;31(9):1191-8.
Aldrete JA, Kroulik D. A postanesthetic recovery score. Anesth Analg. 1970;49(6):924-34.
Lung function testing: selection of reference values and inter- pretative strategies. American Thoracic Society. Am Rev Respir Dis. 1991;144(5):1202-18.
Knudson RJ, Lebowitz MD, Holberg CJ, Burrows B. Changes in the normal maximal expiratory flow-volume curve with growth and aging. Am Rev Respir Dis. 1983;127(6):725-34.
Denehy L, Carroll S, Ntoumenopoulos G, Jenkins S. A ran- domized controlled trial comparing periodic mask CPAP with physiotherapy after abdominal surgery. Physiother Res Int. 2001;6(4):236-50.
Hall JC, Tarala RA, Hall JL, Mander J. A multivariate analysis of the risk of pulmonary complications after laparotomy. Chest. 1991;99(4):923-7.
Thomas JA, McIntosh JM. Are incentive spirometry, intermit- tent positive pressure breathing, and deep breathing exercises effective in the prevention of postoperative pulmonary complica- tions after upper abdominal surgery? A systematic overview and meta-analysis. Phys Ther. 1994;74(1):3-10; discussion 10-6.
Hall JC, Tarala R, Harris J, Tapper J, Christiansen K. Incentive spirometry versus routine chest physiotherapy for prevention of pulmonary complications after abdominal surgery. Lancet. 1991;337(8747):953-6.
Kocabas A, Kara K, Ozgur G, Sonmez H, Burgut R. Value of preoperative spirometry to predict postoperative pulmonary complications. Respir Med. 1996;90(1):25-33.
Roukema JA, Carol EJ, Prins JG. The prevention of pul- monary complications after upper abdominal surgery in patients with noncompromised pulmonary status. Arch Surg. 1988;123(1):30-4.
Beaussier M. Frequency, intensity, development and repercus- sions of postoperative pain as a function of the type of surgery]. Ann Fr Anesth Reanim. 1998;17(6):471-93.
Chumillas S, Ponce JL, Delgado F, Viciano V, Mateu M. Prevention of postoperative pulmonary complications through respiratory rehabilitation: a controlled clinical study. Arch Phys Med Rehabil. 1998;79(1):5-9.
Bien MY, Zadai CC, Kigin CM, Hoaglin DC. The effect of selective drainage positions on oxygen saturation in obese patients after upper abdominal surgery. Zhonghua Yi Xue Za Zhi (Taipei). 1993;51(3):183-92.
