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Prevention of postoperative pulmonary complications through respiratory rehabilitation: a controlled clinical study
S Chumillas1, J L Ponce, F Delgado
1Department of Rehabilitation, Lluis Alcanyís Hospital, Xàtiva, Valencia, Spain.
Objective:
To investigate the efficacy of respiratory rehabilitation in preventing postoperative pulmonary complications (PPC) and to define which patients can benefit.
Design:
A randomized clinical trial.
Setting:
A public hospital.
Patients:
Eighty-one patients who had upper abdominal surgery were distributed into two homogeneous groups: control (n = 41) and rehabilitation (n = 40).
Intervention:
Breathing exercises in the rehabilitation group.
Main Outcome Measures:
Preoperative and postoperative clinical evaluation, spirometry, arterial gasometry, and simple chest X-rays.
Results:
The incidence of PPC was 7.5% in the rehabilitation group and 19.5% in the control group; the control group also had more radiologic alterations (p = .01). Stratified PPC analysis did not reveal significant differences between groups. However, high- and moderate-risk patients in the rehabilitation group had fewer PPC. Multivariate analysis showed a greater PPC risk associated with pulmonary history (p = .02) and duration of surgery longer than 120 min (p = .03), while rehabilitation exerted a protective effect (p = .06). Significant postoperative decreases in pulmonary volumes and arterial gas values were recorded in both groups, without significant differences.
Conclusions:
Respiratory rehabilitation protects against PPC and is more effective in moderate- and high-risk patients, but does not affect surgery-induced functional alterations.