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Chest physiotherapy with positive expiratory pressure breathing after abdominal and thoracic surgery: a systematic review
Linköping University Hospital.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
2010 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 54, no 3, 261-267 p.Article, review/survey (Refereed) Published
Abstract [en]

A variety of chest physiotherapy techniques are used following abdominal and thoracic surgery to prevent or reduce post-operative complications. Breathing techniques with a positive expiratory pressure (PEP) are used to increase airway pressure and improve pulmonary function. No systematic review of the effects of PEP in surgery patients has been performed previously. The purpose of this systematic review was to determine the effect of PEP breathing after an open upper abdominal or thoracic surgery. A literature search of randomised-controlled trials (RCT) was performed in five databases. The trials included were systematically reviewed by two independent observers and critically assessed for methodological quality. We selected six RCT evaluating the PEP technique performed with a mechanical device in spontaneously breathing adult patients after abdominal or thoracic surgery via thoracotomy. The methodological quality score varied between 4 and 6 on the Physiotherapy Evidence Database score. The studies were published between 1979 and 1993. Only one of the included trials showed any positive effects of PEP compared to other breathing techniques. Today, there is scarce scientific evidence that PEP treatment is better than other physiotherapy breathing techniques in patients undergoing abdominal or thoracic surgery. There is a lack of studies investigating the effect of PEP over placebo or no physiotherapy treatment.

Place, publisher, year, edition, pages
2010. Vol. 54, no 3, 261-267 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-92057DOI: 10.1111/j.1399-6576.2009.02143.xISI: 000274313000001OAI: oai:DiVA.org:uu-92057DiVA: diva2:165006
Available from: 2004-09-09 Created: 2004-09-09 Last updated: 2011-01-04Bibliographically approved
In thesis
1. Effects of Deep Breathing Exercises after Coronary Artery Bypass Surgery
Open this publication in new window or tab >>Effects of Deep Breathing Exercises after Coronary Artery Bypass Surgery
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Deep breathing exercises are widely used in the postoperative care to prevent or reduce pulmonary complications, but no scientific evidence for the efficacy has been found after coronary artery bypass grafting (CABG) surgery.

The aim of the thesis was to describe postoperative pulmonary function and to evaluate the efficacy of deep breathing exercises performed with or without a blow bottle device for positive expiratory pressure (PEP) 10 cmH2O or an inspiratory resistance-positive expiratory pressure (IR-PEP) mask with an inspiratory pressure of -5 cmH2O and an expiratory pressure of +10 to +15 cmH2O.

Patients undergoing CABG were instructed to perform 30 slow deep breaths hourly during daytime for the first four postoperative days. Patient management was similar in the groups, except for the different breathing techniques.

Measurements were performed preoperatively, on the fourth postoperative day and four months after surgery. The immediate effect of the deep breathing exercises was examined on the second postoperative day. Pulmonary function was assessed by spirometry, diffusion capacity for carbon monoxide and arterial blood gases. Atelectasis was determined by chest roentgenograms or spiral computed tomography (CT).

Lung volumes were markedly reduced on the fourth postoperative day. Four months after surgery the pulmonary function was still significantly reduced. On the second and fourth postoperative day all patients had atelectasis visible on CT. A single session of deep breathing exercises performed with or without a mechanical device caused a significant reduction in atelectasis and an improvement in oxygenation. No major differences between deep breathing performed with or without a blow bottle or IR-PEP-device were found, except for a lesser decrease in total lung capacity in the blow bottle group on the fourth postoperative day. Patients who performed deep breathing exercises after CABG had significantly smaller atelectasis and better pulmonary function on the fourth postoperative day compared to a control group who performed no exercises.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2004. 56 p.
Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 0282-7476 ; 1368
Physical therapy, atelectasis, breathing exercises, coronary artery bypass, computed tomography, physiotherapy, postoperative care, postoperative complications, respiratory function tests, thoracic surgery, Sjukgymnastik
National Category
urn:nbn:se:uu:diva-4520 (URN)91-554-6022-4 (ISBN)
Public defence
2004-10-01, B-husets aula, Örebro University Hospital, Södra Grev Rosengatan, Örebro, 13:15
Available from: 2004-09-09 Created: 2004-09-09Bibliographically approved

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