title: Application of positive airway pressure in restoring pulmonary function and thoracic mobility in the postoperative period of bariatric surgery: a randomized clinical trial.
abstract: OBJECTIVE
  To evaluate whether the application of bilevel positive airway pressure in the postoperative period of bariatric surgery might be more effective in restoring lung volume and capacity and thoracic mobility than the separate application of expiratory and inspiratory positive pressure.
  
  
  METHODS
  Sixty morbidly obese adult subjects who were hospitalized for bariatric surgery and met the predefined inclusion criteria were evaluated. The pulmonary function and thoracic mobility were preoperatively assessed by spirometry and cirtometry and reevaluated on the 1st postoperative day. After preoperative evaluation, the subjects were randomized and allocated into groups: EPAP Group (n=20), IPPB Group (n=20) and BIPAP Group (n=20), then received the corresponding intervention: positive expiratory pressure (EPAP), inspiratory positive pressure breathing (IPPB) or bilevel inspiratory positive airway pressure (BIPAP), in 6 sets of 15 breaths or 30 minutes twice a day in the immediate postoperative period and on the 1st postoperative day, in addition to conventional physical therapy.
  
  
  RESULTS
  There was a significant postoperative reduction in spirometric variables (p<0.05), regardless of the technique used, with no significant difference among the techniques (p>0.05). Thoracic mobility was preserved only in group BIPAP (p>0.05), but no significant difference was found in the comparison among groups (p>0.05).
  
  
  CONCLUSIONS
  The application of positive pressure does not seem to be effective in restoring lung function after bariatric surgery, but the use of bilevel positive pressure can preserve thoracic mobility, although this technique was not superior to the other techniques.
authors.affiliation: Faculdade de Ciências da Saúde, Universidade Metodista de Piracicaba, Piracicaba, SP, Brazil.
authors.forename: Patrícia
authors.initials: P
authors.lastname: Brigatto
authors.affiliation: Faculdade de Ciências da Saúde, Universidade Metodista de Piracicaba, Piracicaba, SP, Brazil.
authors.forename: Jéssica C
authors.initials: JC
authors.lastname: Carbinatto
authors.affiliation: Faculdade de Ciências da Saúde, Universidade Metodista de Piracicaba, Piracicaba, SP, Brazil.
authors.forename: Carolina M
authors.initials: CM
authors.lastname: Costa
authors.affiliation: Faculdade de Ciências Exatas e da Natureza, UNIMEP, Piracicaba, SP, Brazil.
authors.forename: Maria I L
authors.initials: MI
authors.lastname: Montebelo
authors.affiliation: Clínica Bariátrica de Piracicaba, Piracicaba, SP, Brazil.
authors.forename: Irineu
authors.initials: I
authors.lastname: Rasera-Júnior
authors.affiliation: Faculdade de Ciências da Saúde, Universidade Metodista de Piracicaba, Piracicaba, SP, Brazil.
authors.forename: Eli M
authors.initials: EM
authors.lastname: Pazzianotto-Forti
mesh_terms: D000328:Adult; D050110:Bariatric Surgery; D005260:Female; D006801:Humans; D008168:Lung / Q000502:physiology*; D011175:Positive-Pressure Respiration; D011182:Postoperative Care / Q000379:methods*; D020127:Recovery of Function; D012129:Respiratory Function Tests; D013909:Thorax / Q000502:physiology