Prophylactic respiratory physiotherapy after cardiac surgery: systematic review.
OBJECTIVE
To assess whether respiratory physiotherapy prevents pulmonary complications after cardiac surgery.


METHODS
Searches through Medline, Embase, Cinahl, the Cochrane library, and bibliographies, for randomised trials comparing any type of prophylactic respiratory physiotherapy with another type or no intervention after cardiac surgery, with a follow up of at least two days, and reporting on respiratory outcomes.


METHODS
Investigators assessed trial validity independently. Information on study design, population, interventions, and end points was abstracted by one investigator and checked by the others.


RESULTS
18 trials (1457 patients) were identified. Most were of low quality. They tested physical therapy (13 trials), incentive spirometry (eight), continuous positive airway pressure (five), and intermittent positive pressure breathing (three). The maximum follow up was six days. Four trials only had a no intervention control; none showed any significant benefit of physiotherapy. Across all trials and interventions, average values postoperatively were: incidence of atelectasis, 15-98%; incidence of pneumonia, 0-20%; partial pressure of arterial oxygen per inspired oxygen fraction, 212-329 mm Hg; vital capacity, 37-72% of preoperative values; and forced expiratory volume in one second, 34-72%. No intervention showed superiority for any end point. For the most labour intensive intervention, continuous positive airway pressure, the average cost of labour for each patient day was 27 euro (pound 19; 32 dollars).


CONCLUSIONS
The usefulness of respiratory physiotherapy for the prevention of pulmonary complications after cardiac surgery remains unproved. Large randomised trials are needed with no intervention controls, clinically relevant end points, and reasonable follow up periods.
Pasquina
Patrick
P
Division of Surgical Intensive Care, Department of Anaesthesiology, Pharmacology and Surgical Intensive Care, Geneva University Hospitals, Switzerland. Patrick.Pasquina@hcuge.ch
Tramèr
Martin R
MR
Walder
Bernhard
B
D006801:Humans; D008171:Lung Diseases / Q000517:prevention & control* / Q000534:rehabilitation; D026741:Physical Therapy Modalities / Q000379:methods*; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control* / Q000534:rehabilitation; D016032:Randomized Controlled Trials as Topic; D018401:Sample Size; D019616:Thoracic Surgical Procedures / Q000534:rehabilitation*; D016896:Treatment Outcome