A Randomized Controlled Trial Comparing Two Lung Expansion Therapies After Upper Abdominal Surgery.

Area of Science:

• Pulmonary Medicine
• Critical Care
• Surgical Outcomes

Background:

• Lung expansion therapy is crucial for improving alveolar ventilation and preventing postoperative pulmonary complications.
• The comparative effects of different lung expansion therapies on non-intubated patients remain under-described.
• Upper abdominal surgery poses a significant risk for pulmonary complications.

Purpose of the Study:

• To compare the effectiveness of incentive spirometry (IS) versus EzPAP lung expansion therapy in altering postoperative ventilation distribution.
• To assess the incidence of postoperative pulmonary complications between IS and EzPAP groups.
• To determine if EzPAP offers an advantage over IS in dorsal ventilation redistribution.

Main Methods:

• A randomized controlled trial involving 112 adult patients undergoing upper abdominal surgery.
• Patients received either IS or EzPAP therapy three times daily from postoperative days 1-5.
• Electrical impedance tomography (EIT) was used to measure dorsal end-expiratory lung impedance changes (ΔEELI%) on postoperative days 1, 3, and 5.

Main Results:

• No significant difference in the increase of dorsal ΔEELI% was observed between the IS and EzPAP groups on postoperative days 1, 3, or 5.
• Both therapies led to an increase in dorsal ventilation redistribution post-therapy.
• Hospital length of stay and the incidence of postoperative pulmonary complications were similar between the two groups.

Conclusions:

• Neither incentive spirometry nor EzPAP therapy demonstrated a significant advantage in improving dorsal lung ventilation or reducing postoperative pulmonary complications in this patient cohort.
• The study found no significant difference in outcomes between IS and EzPAP for non-intubated patients after upper abdominal surgery.
• Both lung expansion therapies are viable options for postoperative care in this setting.