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Deep breathing exercises with positive expiratory pressure at a higher rate improve oxygenation in the early period after cardiac surgery: a randomised controlled trial
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Respiratory Medicine and Allergology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
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2010 (English)In: European Journal of Cardio-Thoracic Surgery, ISSN 1010-7940, E-ISSN 1873-734X, Vol. 40, no 1, 162-167 p.Article in journal (Refereed) Published
Abstract [en]

Objective: In addition to early mobilisation, a variety of breathing exercises are used to prevent postoperative pulmonary complications after cardiac surgery. The optimal duration of the treatment is not well evaluated. The aim of this study was to determine the effect of 30 versus 10 deep breaths hourly, while awake, with positive expiratory pressure on oxygenation and pulmonary function the first days after cardiac surgery.

Methods: A total of 181 patients, undergoing cardiac surgery, were randomised into a treatment group, performing 30 deep breaths hourly the first postoperative days, or into a control group performing 10 deep breaths hourly. The main outcome measurement arterial blood gases and the secondary outcome pulmonary function, evaluated with spirometry, were determined on the second postoperative day.

Results: Preoperatively, both study groups were similar in terms of age, SpO(2), forced expiratory volume in 1s and New York Heart Association classification. On the second postoperative day, arterial oxygen tension (PaO(2)) was 8.9±1.7kPa in the treatment group and 8.1±1.4kPa in the control group (p=0.004). Arterial oxygen saturation (SaO(2)) was 92.7±3.7% in the treatment group and 91.1±3.8% in the control group (p=0.016). There were no differences in measured lung function between the groups or in compliance to the breathing exercises. Compliance was 65% of possible breathing sessions.

Conclusions: A significantly increased oxygenation was found in patients performing 30 deep breaths the first two postoperative days compared with control patients performing 10 deep breaths hourly. These results support the implementation of a higher rate of deep breathing exercises in the initial phase after cardiac surgery.

Place, publisher, year, edition, pages
2010. Vol. 40, no 1, 162-167 p.
Keyword [en]
Cardiac surgery, Chest physiotherapy, Deep breathing, Intensive care, Positive expiratory pressure
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-140137DOI: 10.1016/j.ejcts.2010.10.018ISI: 000291483100042PubMedID: 21146420OAI: oai:DiVA.org:uu-140137DiVA: diva2:383072
Available from: 2011-01-04 Created: 2011-01-04 Last updated: 2017-12-11Bibliographically approved
In thesis
1. Lung Function, Respiratory Muscle Strength and Effects of Breathing Exercises in Cardiac Surgery Patients
Open this publication in new window or tab >>Lung Function, Respiratory Muscle Strength and Effects of Breathing Exercises in Cardiac Surgery Patients
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Breathing exercises are widely used after cardiac surgery. The duration of exercises in the immediate postoperative period is not fully evaluated and only limited data regarding the effects of home-based breathing exercises after discharge from hospital have been published.

Aim: The overall aim of this thesis was to evaluate the effects of deep breathing exercises with positive expiratory pressure (PEP) and describe lung function and respiratory muscle strength in patients undergoing cardiac surgery.

Participants and settings: Adult participants (n=131) were randomised to perform either 30 or 10 deep breaths with PEP per hour during the first postoperative days (Study I): the main outcome was oxygenation, assessed by arterial blood gases, on the second postoperative day. In Study III, 313 adult participants were randomly assigned to perform home-based deep breathing exercises with PEP for two months after surgery or not to perform breathing exercises with PEP after the fourth to fifth postoperative day. The main outcome was lung function, assessed by spirometry, two months after surgery. Studies II and IV were descriptive and correlative and investigated pre and postoperative lung function, assessed by spirometry, and respiratory muscle strength, assessed by maximal inspiratory pressure, and maximal expiratory pressure.

Results: On the second postoperative day, arterial oxygen tension (PaO2) and arterial oxygen saturation (SaO2) was higher in the group randomised to 30 deep breaths with PEP hourly. There was no improved recovery of lung function in participants performing home-based deep breathing exercises two months after cardiac surgery, compared to a control group. Subjective experience of breathing or improvement in patient perceived quality of recovery or health-related quality of life did not differ between the groups at two months. Lung function and respiratory muscle strength were in accordance with predicted values before surgery. A 50% reduction in lung function was shown on the second postoperative day. High body mass index, male gender and sternal pain were associated with decreased lung function on the second postoperative day. Two months postoperatively, there was decreased lung function, but respiratory muscle strength had almost recovered to preoperative values.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2013. 58 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 857
Keyword
Breathing exercises, Cardiac surgery, Deep breathing, Lung function, Oxygenation, Physical therapy, Positive expiratory pressure, Spirometry, Respiratory muscle strength
National Category
Physiotherapy
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-192208 (URN)978-91-554-8580-1 (ISBN)
Public defence
2013-03-01, B:42, BMC, Husargatan 3, Uppsala, 09:15 (Swedish)
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Available from: 2013-02-08 Created: 2013-01-17 Last updated: 2013-02-14

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Urell, CharlotteEmtner, MargaretaHedenström, HansWesterdahl, Elisabeth

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