Short-Term Respiratory Physical Therapy Treatment in the PACU and Influence on Postoperative Lung Function in Obese Adul
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CLINICAL RESEARCH
Short-Term Respiratory Physical Therapy Treatment in the PACU and Influence on Postoperative Lung Function in Obese Adults Martin Zoremba & Frank Dette & Laura Gerlach & Udo Wolf & Hinnerk Wulf
Received: 19 March 2009 / Accepted: 30 June 2009 / Published online: 21 July 2009 # Springer Science + Business Media, LLC 2009
Abstract Background Even several days after surgery, obese patients exhibit a measureable amount of atelectasis and thus are predisposed to postoperative pulmonary complications. Particularly in ambulatory surgery, rapid recovery of pulmonary function is desired to ensure early discharge of the obese patient. In this study, we wanted to evaluate intensive short-term respiratory physical therapy treatment (incentive spirometry) in the postanesthesia care unit (PACU) and its impact on pulmonary function in the obese. Methods After ethics committee approval and informed consent, we prospectively studied 60 obese patients (BMI 30–40) undergoing minor peripheral surgery, half of which were randomly assigned to receive respiratory physiotherapy during their PACU stay, while the others received routine treatment. Premedication, general anesthesia, and respiratory settings were standardized. We measured arterial oxygen saturation by pulse oximetry on air breathing. Inspiratory and expiratory lung functions were measured preoperatively (baseline) and at 10 min, 1, 2, 6, and 24 h after extubation, with the patient supine, in a 30° head-up position. The two groups were compared using repeatedmeasure analysis of variance and t test analysis. Statistical significance was considered to be P4. Overall piritramide consumption was recorded within the first 24 h. Incentive Spirometry All patients were mobilized after discharge from the PACU as early as possible by the nursing staff. A physiotherapist supervised the respiratory physiotherapy treatment at all times. The exercises were started approximately 15 min after extubation, and the patients were encouraged to perform 15 deep breaths (incentive spirometry) every 10– 15 min within the first 2 h after surgery. If needed, patients were asked to cough during the pause to mobilize secretions. All therapeutic interventions were performed in the sitting position, if possible. The patients in the control group were not instructed to do any breathing exercises. Spirometry and Pulse Oximetry Spirometry and pulse oximetry were standardized, investigatorblinded, with each patient in a 30° head-up position [26] after breathing air without any supplemental oxygen for 5 min. At the preanesthetic visit, a baseline spirometry measurement and pulse oximetry were taken (T0) after thorough demonstration of the correct method. VC, forced vital capacity (FVC), forced
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expiratory volume in 1 s (FEV1), mid-expiratory flow (MEF25–75), peak expiratory flow, peak inspiratory flow, and the forced inspiratory vital capacity were measured and the FEV1-to-FVC ratio was calculated. At each assessment time, spirometry was performed at leas
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