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Original Research: Respiratory Care |

Comparison of Lung Expansion Techniques on Thoracoabdominal Mechanics and Incidence of Pulmonary Complications After Upper Abdominal SurgeryLung Expansion After Abdominal Surgery: A Randomized and Controlled Trial

Adriana C. Lunardi, PhD; Denise M. Paisani, PhD; Cibele C. B. Marques da Silva, MSc; Desiderio P. Cano, MSc; Clarice Tanaka, PhD; Celso R. F. Carvalho, PhD
Author and Funding Information

From the Department of Physical Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil.

CORRESPONDENCE TO: Celso R. F. Carvalho, PhD, Department of Physical Therapy, School of Medicine of University of São Paulo, Av. Dr. Arnaldo, 455 Room 1210, São Paulo, SP, Brazil 01246-903; e-mail: cscarval@usp.br


FUNDING/SUPPORT: This study was supported by the São Paulo Research Foundation [Grants 2010/50120-4 and 2010/19196-4].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(4):1003-1010. doi:10.1378/chest.14-2696
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OBJECTIVE:  Lung expansion techniques (LETs) are widely used to prevent postoperative pulmonary complications (PPCs). However, the effects of each of these techniques on thoracoabdominal mechanics and PPC incidence after abdominal surgery remain unclear. The objective of this study was to compare the effects of LET on pulmonary volumes, respiratory muscle activation, and PPC incidence after major, elective upper abdominal surgery.

METHODS:  This randomized controlled trial enrolled 137 patients who were randomly assigned into four groups: control (n = 35), flow incentive spirometry (n = 33), deep breathing (n = 35), and volume incentive spirometry (n = 34). Each intervention was performed tid during 5 consecutive days. Subsequently, PPCs (pneumonia, atelectasis, or severe hypoxemia) were analyzed by a blinded assessor until hospital discharge. Lung volumes (optoelectronic plethysmography) and inspiratory muscular activation (surface electromyography) were assessed before and 3 days after surgery. Intention-to-treat analysis was performed.

RESULTS:  Before surgery, all groups were homogenous for age, sex, BMI, lung function, and thoracoabdominal mechanics. After surgery, no difference was observed in the lung volumes and inspiratory muscular activation during the lung expansion technique (P > .05). The PPC incidence was higher in the deep breathing group (P < .05). Higher American Society of Anesthesiologists scores and surgery duration were the only predictors of PPC (n = 14, 11.2%).

CONCLUSIONS:  LETs do not modify the changes on thoracoabdominal mechanics or prevent PPCs after abdominal surgery. The indiscriminate use of LETs should not be routinely prescribed to prevent PPCs; however, more studies are required to confirm our results and to change the standard practice.

TRIAL REGISTRY:  ClinicalTrials.gov; No.: NCT01993602; URL: www.clinicaltrials.gov

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