title: The use of a modified, oscillating positive expiratory pressure device reduced fever and length of hospital stay in patients after thoracic and upper abdominal surgery: a randomised trial.
abstract: OBJECTIVE
  Does the use of an oscillating positive expiratory pressure (PEP) device reduce postoperative pulmonary complications in thoracic and upper abdominal surgical patients?
  
  
  METHODS
  A multi-centre, parallel-group, randomised controlled trial with intention-to-treat analysis, blinding of some outcomes, and concealed allocation.
  
  
  METHODS
  A total of 203 adults after thoracic or upper abdominal surgery with general anaesthesia.
  
  
  METHODS
  Participants in the experimental group used an oscillating PEP device, thrice daily for 5 postoperative days. Both the experimental and control groups received standard medical postoperative management and early mobilisation.
  
  
  METHODS
  Fever, days of antibiotic therapy, length of hospital stay, white blood cell count, and possible adverse events were recorded for 28 days or until hospital discharge.
  
  
  RESULTS
  The 99 participants in the experimental group and 104 in the control group were well matched at baseline and there was no loss to follow-up. Fever affected a significantly lower percentage of the experimental group (22%) than the control group (42%), with a RR of 0.56 (95% CI 0.36 to 0.87, NNT 6). Similarly, length of hospital stay was significantly shorter in the experimental group, at 10.7 days (SD 8.1), than in the control group, at 13.3 days (SD 11.1); the mean difference was 2.6 days (95% CI 0.4 to 4.8). The groups did not differ significantly in the need for antibiotic therapy, white blood cell count or total expense of treatment.
  
  
  CONCLUSIONS
  In adults undergoing thoracic and upper abdominal surgery, postoperative use of an oscillating PEP device resulted in fewer cases of fever and shorter hospital stay. However, antibiotic therapy and total hospital expenses were not significantly reduced by this intervention.
  
  
  BACKGROUND
  NCT00816881.
authors.affiliation: Department of Critical Care Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine.
authors.forename: Xiang-yu
authors.initials: XY
authors.lastname: Zhang
authors.affiliation: Department of Critical Care Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine.
authors.forename: Qixing
authors.initials: Q
authors.lastname: Wang
authors.affiliation: Department of Critical Care Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine.
authors.forename: Shouqin
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Shanghai Jiangong Hospital.
authors.forename: Weilin
authors.initials: W
authors.lastname: Tan
authors.affiliation: Department of Thoracic Surgery, Shanghai Putuo District Center Hospital.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Tongji University School of Medicine, Shanghai, China.
authors.forename: Jue
authors.initials: J
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000368:Aged; D000768:Anesthesia, General; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005260:Female; D005334:Fever / Q000517:prevention & control*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008171:Lung Diseases / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities / Q000295:instrumentation*; D011175:Positive-Pressure Respiration / Q000295:instrumentation*; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control*; D019616:Thoracic Surgical Procedures / Q000534:rehabilitation*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Length of stay; Mucus-clearance device; Postoperative pulmonary complications