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Prophylactic respiratory physiotherapy after cardiac surgery: systematic review
Patrick Pasquina1, Martin R Tramèr, Bernhard Walder
1Division of Surgical Intensive Care, Department of Anaesthesiology, Pharmacology and Surgical Intensive Care, Geneva University Hospitals, Switzerland. Patrick.Pasquina@hcuge.ch
BMJ (Clinical Research Ed.)
|December 13, 2003
Summary
The effectiveness of respiratory physiotherapy in preventing pulmonary complications after cardiac surgery is not yet proven. More high-quality research with longer follow-up periods is needed to establish its benefits.
Area of Science:
- Cardiology
- Pulmonology
- Evidence-based medicine
Background:
- Pulmonary complications are a significant concern following cardiac surgery.
- Prophylactic respiratory physiotherapy is often employed to mitigate these risks.
Purpose of the Study:
- To systematically review randomized trials assessing the efficacy of respiratory physiotherapy in preventing pulmonary complications post-cardiac surgery.
Main Methods:
- A comprehensive literature search was conducted across major databases (Medline, Embase, Cinahl, Cochrane).
- Included randomized trials compared physiotherapy interventions with other methods or no intervention.
- Trial validity and data extraction were performed independently by investigators.
Main Results:
- Eighteen trials involving 1457 patients were analyzed, with most trials being of low quality.
- Common interventions included physical therapy, incentive spirometry, CPAP, and IPPB.
- No significant benefit of physiotherapy was demonstrated across various pulmonary outcomes, including atelectasis and pneumonia incidence.
Conclusions:
- The current evidence does not support the routine use of respiratory physiotherapy for preventing pulmonary complications after cardiac surgery.
- Large, high-quality randomized trials with appropriate controls and clinically relevant endpoints are necessary to clarify its role.