Randomized clinical study of the prevention of pulmonary complications after thoracoabdominal resection by two different breathing techniques.
BACKGROUND
Pulmonary complications are frequently seen after thoracoabdominal resection of the oesophagus. The aim of this study was to compare the effects of two different breathing exercise regimens applied in the immediate postoperative period on the risk of pulmonary insufficiency after thoracoabdominal resection.


METHODS
Seventy patients undergoing thoracoabdominal resection for cancer of the oesophagus and cardia were randomized after operation to breathing exercises by inspiratory resistance-positive expiratory pressure (IR-PEP) (n = 36) or continuous positive airway pressure (CPAP) (n = 34). The study groups were well matched for all relevant clinical and demographic data.


RESULTS
Respiratory function deteriorated significantly immediately after operation; the lowest values of forced vital capacity and peak expiratory flow were measured during the first postoperative day and oxygen saturation was lowest on days 4-6. Significantly fewer patients in the CPAP group required reintubation and prolonged artificial ventilation (P < 0.05). There were minor non-significant differences between the study groups with respect to respiratory and other postoperative variables, usually in favour of CPAP.


CONCLUSIONS
Provision of CPAP in the immediate postoperative period decreased the risk of respiratory distress requiring reintubation and the need for artificial ventilation compared with breathing exercises by IR-PEP.
Fagevik Olsén
M
M
Department of Physiotherapy, Anaesthesia and Intensive Care and Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden. monika.olsen@telia.com
Wennberg
E
E
Johnsson
E
E
Josefson
K
K
Lönroth
H
H
Lundell
L
L
D002299:Cardia; D004938:Esophageal Neoplasms / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010366:Peak Expiratory Flow Rate / Q000502:physiology; D011175:Positive-Pressure Respiration / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D012131:Respiratory Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000503:physiopathology / Q000601:surgery*; D014797:Vital Capacity / Q000502:physiology