[Ability to cough following large upper abdominal and thoracoabdominal interventions]

In 40 patients who underwent large abdominal or thoraco-abdominal operations, the efficacy of intentional coughing was determined by recording the peak expiratory flow rate (PEFR) of two consecutive coughs. The measurements were made preoperatively and then 1, 2, 24, and 36 hrs. postoperatively. They consisted of two series, the first one completely uninfluenced, the second one following detailed instruction and manual assistance by the therapist. Before instruction, PEFR of the first cough averaged 5070 ml/s. and statistically significantly increased to 7100 ml/s. after instruction. The postoperative values decreased to about 30% of those found preoperatively. It was not before the first postoperative day that the values began to improve to above 40%. In all instances, the absolute PEFR-values of the first cough were significantly higher by 16 to 60% than those of the second one. From the results it is concluded that, after abdominal or thoraco-abdominal surgery, continuous instruction and assistance by the personnel are crucial for the efficacy of coughing.