Systematic Review: Effectiveness of Early Chest Physiotherapy in Preventing Postoperative Pulmonary Complications in Patients Undergoing Thoracic or Abdominal Surgery
DOI:
https://doi.org/10.70749/ijbr.v2i02.319Keywords:
Chest Physiotherapy, Postoperative Pulmonary Complications, Thoracic Surgery, Abdominal Surgery, Early Intervention, Systematic ReviewAbstract
Background: Postoperative pulmonary complications (PPCs) are a common concern in patients undergoing thoracic or abdominal surgery, contributing to increased morbidity, extended hospital stays, and elevated healthcare costs. Early initiation of chest physiotherapy (CPT) has been proposed as a strategy to reduce the incidence of PPCs by enhancing respiratory function through various techniques, such as deep breathing exercises, incentive spirometry, and airway clearance. Materials and Methods: This systematic review was conducted following PRISMA guidelines. A comprehensive search was performed across multiple databases, including PubMed, Cochrane Library, Embase, and Scopus, to identify studies assessing the effectiveness of early CPT in reducing PPCs. Studies were screened and selected based on predetermined inclusion criteria focusing on adults undergoing thoracic or abdominal surgery who received CPT within the first 24–48 hours postoperatively. Data extraction and quality assessments were conducted using standardized tools to evaluate study bias and reliability. Results: The review included 12 studies, comprising randomized controlled trials and observational studies. Most studies demonstrated that early CPT significantly reduces the incidence of PPCs, such as atelectasis and pneumonia, and improves lung function. However, the degree of effectiveness varied based on the CPT techniques and timing. Some studies highlighted reductions in hospital stay and ICU admissions, underscoring CPT's potential for improving overall surgical outcomes. Conclusion: Chest physiotherapy after induction of surgery seems to be an efficient method for the prevention of postoperative pulmonary complications in patients who underwent thoracic and abdominal surgery. The results provide evidence for integrating CPT into the postoperative care pathways but the differences in CPT application imply that individualized strategies should be used depending on the patient characteristics and types of surgery. More work needs to be done to support such gains and fine-tune CPT procedure.
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Boden, I., Skinner, E. H., Browning, L., Reeve, J., Anderson, L., Hill, C., Robertson, I. K., Story, D., & Denehy, L. (2018). Preoperative physiotherapy for the prevention of respiratory complications after upper abdominal surgery: Pragmatic, double blinded, multicentre randomised controlled trial. BMJ, j5916. https://doi.org/10.1136/bmj.j5916
Canet, J., & Mazo, V. (2010). Postoperative pulmonary complications. Minerva Anestesiologica, 76(2), 138-143.
Chumillas, S., Ponce, J., Delgado, F., Viciano, V., & Mateu, M. (1998). Prevention of postoperative pulmonary complications through respiratory rehabilitation: A controlled clinical study. Archives of Physical Medicine and Rehabilitation, 79(1), 5-9. https://doi.org/10.1016/s0003-9993(98)90198-8
Cordeiro, A. L. L., Mascarenhas, H. de C., Landerson, L., Araújo, J. da S., Borges, D. L., de Melo, T. A., Guimarães, A., & Petto, J. (2020). Inspiratory Muscle Training Based on Anaerobic Threshold on the Functional Capacity of Patients After Coronary Artery Bypass Grafting: Clinical Trial. Brazilian Journal of Cardiovascular Surgery, 35(6). https://doi.org/10.21470/1678-9741-2019-0448
Fernandez-Bustamante, A., Frendl, G., Sprung, J., Kor, D. J., Subramaniam, B., Martinez Ruiz, R., Lee, J., Henderson, W. G., Moss, A., Mehdiratta, N., Colwell, M. M., Bartels, K., Kolodzie, K., Giquel, J., & Vidal Melo, M. F. (2017). Postoperative pulmonary complications, early mortality, and hospital stay following Noncardiothoracic surgery. JAMA Surgery, 152(2), 157. https://doi.org/10.1001/jamasurg.2016.4065
Flaatten, H., Jung, C., Vallet, H., & Guidet, B. (2019). How Does Frailty Affect ICU Outcome? Current Anesthesiology Reports, 9(2), 144–150. https://doi.org/10.1007/s40140-019-00324-1
Gosselink, R., Bott, J., Johnson, M., Dean, E., Nava, S., Norrenberg, M., Schönhofer, B., Stiller, K., Van de Leur, H., & Vincent, J. L. (2008). Physiotherapy for adult patients with critical illness: Recommendations of the European respiratory society and European Society of Intensive Care Medicine task force on physiotherapy for critically ill patients. Intensive Care Medicine, 34(7), 1188-1199. https://doi.org/10.1007/s00134-008-1026-7
Gosselink, R., Bott, J., Johnson, M., Dean, E., Nava, S., Norrenberg, M., Schönhofer, B., Stiller, K., Van de Leur, H., & Vincent, J. L. (2008). Physiotherapy for adult patients with critical illness: Recommendations of the European respiratory society and European Society of Intensive Care Medicine task force on physiotherapy for critically ill patients. Intensive Care Medicine, 34(7), 1188-1199. https://doi.org/10.1007/s00134-008-1026-7
Hulzebos, E. H., Helders, P. J., Favié, N. J., De Bie, R. A., Brutel de la Riviere, A., & Van Meeteren, N. L. (2006). Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery. JAMA, 296(15), 1851. https://doi.org/10.1001/jama.296.15.1851
Kılıç, M., Baş, S. Ş., & Turan, S. K. (2017). Comparison of Effect of Noninvasive Pressure Techniques on Postoperative Pulmonary Functions in Patients Undergoing Major Abdominal Surgery. Turkish Journal of Medical & Surgical Intensive Care Medicine/Dahili ve Cerrahi Yoğun Bakım Dergisi, 8(3).
Lockstone, J., Parry, S. M., Denehy, L., Robertson, I. K., Story, D., Parkes, S., & Boden, I. (2020). Physiotherapist administered, non-invasive ventilation to reduce postoperative pulmonary complications in high-risk patients following elective upper abdominal surgery; a before-and-after cohort implementation study. Physiotherapy, 106, 77-86. https://doi.org/10.1016/j.physio.2018.12.003
Mackay, M. R., Ellis, E., & Johnston, C. (2005). Randomised clinical trial of physiotherapy after open abdominal surgery in high risk patients. Australian Journal of Physiotherapy, 51(3), 151-159. https://doi.org/10.1016/s0004-9514(05)70021-0
Manapunsopee, S., Thanakiatpinyo, T., Wongkornrat, W., Chuaychoo, B., & Thirapatarapong, W. (2019). Effectiveness of Incentive Spirometry on Inspiratory Muscle Strength After Coronary Artery Bypass Graft Surgery. Heart, Lung and Circulation, 29(8). https://doi.org/10.1016/j.hlc.2019.09.009
Miskovic, A., & Lumb, A. (2017). Postoperative pulmonary complications. British Journal of Anaesthesia, 118(3), 317-334. https://doi.org/10.1093/bja/aex002
Pasquina, P., Tramér, M. R., Granier, J.-M., & Walder, B. (2006). Respiratory Physiotherapy To Prevent Pulmonary Complications After Abdominal Surgery. Chest, 130(6), 1887–1899. https://doi.org/10.1378/chest.130.6.1887
Pazzianotto-Forti, E. M., Munno, C. M., Merino, D. F. B., Simões da Rocha, M. R., de Mori, T. A., & Júnior, I. R. (2019). Effects of inspiratory exercise with linear and nonlinear load on respiratory variables post-bariatric surgery. Respiratory Care. https://karger.com/res/article-pdf/100/11/1114/3979841/000517012.pdf
Schaefer, M. S., Wania, V., Bastin, B., Schmalz, U., Kienbaum, P., Beiderlinden, M., & Treschan, T. A. (2014). Electrical impedance tomography during major open upper abdominal surgery: a pilot-study. BMC Anesthesiology, 14(1). https://doi.org/10.1186/1471-2253-14-51
Stiller, K. (2000). Physiotherapy in intensive care. Chest, 118(6), 1801-1813. https://doi.org/10.1378/chest.118.6.1801
Vester-Andersen, M., Lundstrøm, L., Møller, M., Waldau, T., Rosenberg, J., & Møller, A. (2014). Mortality and postoperative care pathways after emergency gastrointestinal surgery in 2904 patients: A population-based cohort study. British Journal of Anaesthesia, 112(5), 860-870. https://doi.org/10.1093/bja/aet487
Westerdahl, E., Lindmark, B., Eriksson, T., Friberg, Ö., Hedenstierna, G., & Tenling, A. (2005). Deep-breathing exercises reduce atelectasis and improve pulmonary function after coronary artery bypass surgery. Chest, 128(5), 3482-3488. https://doi.org/10.1378/chest.128.5.3482
Westerdahl, E., Lindmark, B., Eriksson, T., Friberg, Ö., Hedenstierna, G., & Tenling, A. (2005). Deep-breathing exercises reduce atelectasis and improve pulmonary function after coronary artery bypass surgery. Chest, 128(5), 3482-3488. https://doi.org/10.1378/chest.128.5.3482
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