Preventing respiratory problems after abdominal surgery – adapted from the British Medical Journal 1996;312:148-53 – Tips from Other Journals
All patients have some respiratory impairment after abdominal surgery, and several therapies have been undertaken to prevent atelectasis and promote the expansion of collapsed alveoli. Unfortunately, little is known about the comparative value of dIfferent approaches or about individual techniques that are appropriate to specific groups of patients. Hall and colleagues conducted a study to identify the most efficient prophylaxis for respiratory complications in patients undergoing abdomimal surgery.
The study included 456 patients who were admitted to an Australian hospital for laparotomy. The patients were randomly allocated to receive either incentive spirometry or mixed respiratory therapy. The study groups were stratified to include comparable numbers of high- and low-risk patients. Patients who were over 60 years of age or who had an American Society of Anesthesia (ASA) classification greater than I were considered at high risk. Both high- and low-risk patients in the incentive spirometry group were encouraged to use the device at least 10 times per hour. In the mixed therapy group, low risk patients were encouraged to take at least 10 deep breaths per hour in addition to incentive spirometry, high risk patients m this group received conventional chest physiotherapy in addition to incentive spirometry Patients were observed for clinical features of pulmonary collapse or consolidation. Chest radiography was performed on all patients suspected of having a respiratory complication.
Overall, 63 patients (13.8 percent) had clinically important respiratory complications. The incidence of respiratory complications was not significantly different between the two treatment groups (15.2 percent in the incentive spirometry group, compared with 12.4 percent in the mixed therapy group), but the majority of complications (78 percent) occurred in high-risk patients. Most complications were caused by atelectasis. Pneumonia developed in four patients (less than 1 percent), but no deaths were directly attributed to respiratory complications. It was estimated that supervision of deep-breathing exercises and administration of incentive spirometry required approximately the same amounts of staff time. Physiotherapy for high-risk patients took an additional 30 minutes of staff time per patient.
The authors conclude that the most efficient stratagem to avoid respiratory complications in patients undergoing laparotomy consists of deep-breathing exercises for low-risk patients and incentive spirometry for high-risk patients. (Hall JC et al. Prevention of respiratory complications after abdominal surgery: a randomized clinical trial. BMJ 1996;312:148-53.)
COPYRIGHT 1996 American Academy of Family Physicians
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