Effect of Active Cycle of Breathing Technique as Add on to Routine Chest Physical Therapy on Respiratory Parameters in Coronary Artery Bypass Graft Patients (CABG ACBT ABG)

Effects of Pre and Post Operative Active Cycle of Breathing Technique as Add on to Routine Chest Physical Therapy on Respiratory Parameters in Coronary Artery Bypass Graft Patients

A controlled trial was conducted to determine the effect of the active cycle of breathing technique (ACBT) in improving respiratory parameters after coronary artery bypass graft surgery. The main aim of this study was to determine the effects of pre and postoperative active cycle of breathing technique (ACBT) in coronary artery disease patients undergoing coronary artery bypass graft surgery in improving respiratory parameters such as arterial blood gas (ABG), oxygen saturation (SpO2) and respiratory rate. The intervention group performed an active cycle of breathing technique with routine chest physical therapy while the control group performed routine chest physical therapy. Arterial blood gas (ABG), oxygen saturation (SpO2), and respiratory rate were measured at baseline and five days after surgery, every 2 hours on postoperative days 1, 2, and 3 and 4 hours on days 4 and 5.

Participants in the intervention group performed preoperative routine chest physical therapy sessions were followed as:

• Incentive spirometry, 3 sessions per day, 10 repetitions
• Percussions, 3 sessions per day, 20 repetitions
• 3-minutes walking, 2 sessions per day
• ACBT, 3 sessions per day

The preoperative chest physiotherapy treatment plan was continued after CABG surgery. In addition to these, the following were included postoperatively:

• Nebulization, 3 sessions per day
• 3 minutes of walking, 2 sessions per day
• ACBT, 3 sessions per day While participants in the control group performed the same pre and postoperative sessions except ACBT.

Study Overview

• Status: Active, not recruiting
• Conditions: Coronary Artery Bypass Graft
• Intervention / Treatment: Procedure: Active cycle of breathing technique, incentive spirometer, percussion, 3-minute of walking; Procedure: incentive spirometer, percussion, 3-minute of walking

Detailed Description

This single-blinded randomized controlled trial was conducted at the Faisalabad Institute of Cardiology, Faisalabad, Pakistan, to assess the effects the Active Cycle of Breathing Technique (ACBT) as add on to routine chest physical therapy in the preoperative care of coronary artery bypass graft (CABG) patients. The primary aim was to evaluate ACBT's impact on minimizing postoperative respiratory complications. A secondary aim was to educate patients in the preoperative period to reduce surgery-related stress and support respiratory drive.

Patients with coronary artery disease are generally advised bed rest to manage shortness of breath. However, CABG is an invasive procedure that involves the placement of an endotracheal tube, raising infection risks and leading to weakened respiratory muscles due to ventilation effects. Post-surgery, patients often experience reduced lung volumes and altered arterial blood gases. Adding ACBT to chest physical therapy in the preoperative period is intended to improve ventilation and arterial blood gas levels postoperatively.

The study involved 72 male and female patients, aged 30 to 65, with double or triple-vessel coronary disease and a 10 to 15-year disease history, scheduled for CABG. Screening was performed using a custom questionnaire based on inclusion and exclusion criteria, and non-probability purposive sampling was used to select participants. Patients were randomly assigned to either the intervention or control group using the lottery method. The intervention group received ACBT alongside routine chest physical therapy, while the control group received only standard chest physical therapy, both pre- and postoperatively. Patient confidentiality was maintained through informed consent.

Key study parameters included arterial blood gas (ABG) levels, oxygen saturation (SpO2), and respiratory rate, with ABG samples taken from the brachial and radial arteries and analyzed via an ABG analyzer. SpO2 was measured using a pulse oximeter, and respiratory rate was recorded on a cardiac monitor.

• Study Type: Interventional
• Enrollment (Actual): 72
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Punjab
    • Faisalabad, Punjab, Pakistan, 37000
      • The University of Faisalabad
    • Lahore, Punjab, Pakistan, 54000
      • Dr Sana Ashraf

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Elective coronary artery bypass graft patients
• The study included both male and female
• 30 to 65 years old patients were included in this study
• Adults with stable coronary artery disease for the last 15 years

Exclusion Criteria:

• Patient with unstable vitals
• Preoperative pulmonary dysfunction
• COPD or Emphysema
• Asthma and Severe atelectasis
• Renal disorders
• Connected to the ventilator for more than 48 hours

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Factorial Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: The intervention group; The intervention group: The intervention group (n=36) was instructed to perform the ACBT with routine chest physical therapy pre and postoperatively. The preoperative chest physical therapy was conducted 3 days before surgery and the postoperative CPT, including ACBT, was performed 3 times in the ICU for up to 5 days after surgery. Preoperative routine chest physical therapy sessions were followed as: Incentive spirometer, 3 sessions per day, 10 repetitions; Percussions, 3 sessions per day, 20 repetitions; 3-minutes walking, 2 sessions per day; ACBT, 3 sessions per day The preoperative chest physiotherapy treatment plan was continued after CABG surgery. In addition to these, the following were included postoperatively: Nebulization, 3 sessions per day; 3 minutes of walking, 2 sessions per day; ACBT, 3 sessions per day	Procedure: Active cycle of breathing technique, incentive spirometer, percussion, 3-minute of walking; The intervention group: patients were asked to perform Active cycle of breathing technique as add on to routine chest physical therapy such as Incentive spirometer, percussion, 3-minute of walking 3 days before surgery and five days postoperative.; Incentive spirometry, 3 sessions per day, 10 repetitions; Percussions, 3 sessions per day, 20 repetitions; 3-minutes walking, 2 sessions per day; ACBT, 3 sessions per day the following were included postoperatively:; Nebulization, 3 sessions per day; ACBT, 3 sessions per day
Experimental: The control group; The control group: The routine Chest physical therapy was performed 3 days before surgery at the preoperative bay and 5 days after surgery in the ICU with 3 sessions each day. Preoperative chest physical therapy sessions were followed as: Incentive spirometer, 3 sessions per day, 10 repetitions.; Percussions, 3 sessions per day, 20 repetitions.; 3-minutes walking, 2 sessions per day The preoperative chest physiotherapy treatment plan was continued after CABG surgery. In addition to these, the following were included postoperatively:; Nebulization, 3 sessions per day; 3-minutes walking, 2 sessions per day	Procedure: incentive spirometer, percussion, 3-minute of walking; The control group The routine CPT was performed 3 days before surgery at the preoperative bay and 5 days after surgery in the ICU with 3 sessions each day. Preoperative chest physical therapy sessions were followed as: Incentive spirometry, 3 sessions per day, 10 repetitions.; Percussions, 3 sessions per day, 20 repetitions.; 3-minutes walking, 2 sessions per day The preoperative chest physiotherapy treatment plan was continued after CABG surgery. In addition to these, the following were included postoperatively:; Nebulization, 3 sessions per day; 3-minutes walking, 2 sessions per day

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Arterial blood gas	Arterial Blood Gas (ABG) is a critical test used to evaluate a patient's acid-base balance, oxygenation, and ventilation status by measuring the levels of oxygen (O₂), carbon dioxide (CO₂), and bicarbonate (HCO₃-) in arterial blood.	ABG test was conducted once preoperative for both groups and after surgery every 2 hours on postoperative days 1, 2, and 3, and every 4 hours on days 4 and 5.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
oxygen saturation (SpO₂)	SpO₂ (Oxygen Saturation) is a measurement that estimates the percentage of oxygen-saturated hemoglobin in the blood. SpO₂ monitoring is vital in clinical settings, especially for patients with respiratory or cardiac conditions, during and after surgery.	SpO₂ was measured once preoperative for both groups and after surgery every 2 hours on postoperative days 1, 2, and 3, and every 4 hours on days 4 and 5.
Respiratory rate	Respiratory rate (RR) refers to the number of breaths a person takes per minute. It is a key vital sign used to assess breathing and overall respiratory function.	Respiratory rate was measured once preoperative for both groups and after surgery every 2 hours on postoperative days 1, 2, and 3, and every 4 hours on days 4 and 5.

Collaborators and Investigators

• Sponsor: Sadaf Bukhari

Study record dates

Study Major Dates

• Study Start (Actual): March 1, 2024
• Primary Completion (Estimated): December 1, 2024
• Study Completion (Estimated): December 20, 2024

Study Registration Dates

• First Submitted: November 18, 2024
• First Submitted That Met QC Criteria: November 21, 2024
• First Posted (Estimated): November 26, 2024

Study Record Updates

• Last Update Posted (Estimated): November 26, 2024
• Last Update Submitted That Met QC Criteria: November 21, 2024
• Last Verified: November 1, 2024

More Information

Terms related to this study

• Other Study ID Numbers: Tuf/IRB/292/24

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No