Short-term respiratory physical therapy treatment in the PACU and influence on postoperative lung function in obese adults.
BACKGROUND
Even several days after surgery, obese patients exhibit a measureable amount of atelectasis and thus are predisposed to postoperative pulmonary complications. Particularly in ambulatory surgery, rapid recovery of pulmonary function is desired to ensure early discharge of the obese patient. In this study, we wanted to evaluate intensive short-term respiratory physical therapy treatment (incentive spirometry) in the postanesthesia care unit (PACU) and its impact on pulmonary function in the obese.


METHODS
After ethics committee approval and informed consent, we prospectively studied 60 obese patients (BMI 30-40) undergoing minor peripheral surgery, half of which were randomly assigned to receive respiratory physiotherapy during their PACU stay, while the others received routine treatment. Premedication, general anesthesia, and respiratory settings were standardized. We measured arterial oxygen saturation by pulse oximetry on air breathing. Inspiratory and expiratory lung functions were measured preoperatively (baseline) and at 10 min, 1, 2, 6, and 24 h after extubation, with the patient supine, in a 30 degrees head-up position. The two groups were compared using repeated-measure analysis of variance and t test analysis. Statistical significance was considered to be P < 0.05.


RESULTS
There were no differences at the first assessment, but, during the PACU stay, pulmonary function in the physiotherapy group was significantly better than the controls' (p < 0.0001), an effect which persisted for at least 24 h after surgery (p < 0.009).


CONCLUSIONS
Short-term respiratory physiotherapy during the PACU stay promotes more rapid recovery of postoperative lung function in the obese during the first 24 h.
Zoremba
Martin
M
Department of Anesthesia and Intensive Care Medicine, University of Marburg, 35033, Marburg, Germany. zoremba@med.uni-marburg.de
Dette
Frank
F
Gerlach
Laura
L
Wolf
Udo
U
Wulf
Hinnerk
H
D000762:Anesthesia Recovery Period; D005260:Female; D006801:Humans; D008168:Lung / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000601:surgery*; D010092:Oximetry; D010100:Oxygen / Q000032:analysis / Q000097:blood; D026741:Physical Therapy Modalities; D011175:Positive-Pressure Respiration; D011183:Postoperative Complications / Q000628:therapy*; D011446:Prospective Studies; D001261:Pulmonary Atelectasis / Q000209:etiology / Q000628:therapy*; D013147:Spirometry; D013997:Time Factors; D016896:Treatment Outcome
D010100:Oxygen