Effect of Different Breathing Techniques on Dyspnea and Cardiopulmonary Parameters Among Patients After Open Heart Surgery

Effect of Segmental Breathing Versus Active Cycle Breathing Techniques on Dyspnea and Cardiopulmonary Parameters Among Patients After Open Heart Surgery: Randomized Controlled Trial.

Open heart surgery is often associated with postoperative pulmonary complications, reduced lung expansion, dyspnea, and impaired cardiopulmonary function. Breathing exercises are commonly used after surgery to improve lung ventilation, enhance oxygenation, and support respiratory recovery. However, limited evidence is available comparing the effectiveness of segmental breathing exercises and active cycle breathing technique (ACBT) in patients after open heart surgery.

This randomized controlled trial will compare the effects of segmental breathing exercises and ACBT on dyspnea and cardiopulmonary parameters in adults undergoing open heart surgery. Participants will be randomly assigned to either the segmental breathing exercise group, the ACBT group, or the standard care group during the postoperative period following extubation.

Cardiopulmonary parameters, including oxygen saturation, respiratory rate, heart rate, and blood pressure, as well as dyspnea severity and postoperative pulmonary complications, will be assessed before and after the interventions.

The findings of this study may help identify the most effective breathing exercise technique for improving respiratory outcomes, reducing postoperative pulmonary complications, and supporting evidence-based postoperative rehabilitation after cardiac surgery.

Study Overview

• Status: Recruiting
• Conditions: Coronary Artery Disease; Dyspnea; Postoperative Respiratory Dysfunction; Cardiopulmonary Dysfunction
• Intervention / Treatment: Behavioral: Segmental Breathing Exercises; Behavioral: Active Cycle Breathing Technique; Other: Standard postoperative care

Detailed Description

This randomized clinical trial evaluates the effects of segmental breathing exercises (SBE) and active cycle breathing technique (ACBT) on dyspnea, cardiopulmonary parameters, and postoperative pulmonary complications in adults undergoing elective open-heart surgery with cardiopulmonary bypass.

Participants will be randomly assigned to one of three groups: segmental breathing exercises group, active cycle breathing technique group, or standard care group. Patients in the intervention groups will perform the assigned breathing exercises after extubation, including sessions conducted 1 hour and 6 hours post-intervention during the early postoperative period.

Cardiopulmonary parameters, including oxygen saturation, respiratory rate, heart rate, and blood pressure parameters, will be monitored throughout hospitalization. Dyspnea and postoperative pulmonary complications, including atelectasis and pneumonia, will also be assessed.

The primary purpose of this study is to determine the effectiveness of breathing exercise interventions in improving postoperative respiratory outcomes and reducing pulmonary complications after cardiac surgery. The study also aims to support evidence-based postoperative rehabilitation practices for healthcare professionals caring for patients after open-heart surgery.

• Study Type: Interventional
• Enrollment (Estimated): 99
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Muslim Aqeel Essa, Master Student; Phone Number: +9647822218483; Email: muslim.eesa2402m@conursing.uobaghdad.edu.iq
• Study Contact Backup: Name: Rusul Khalid Kadhim, Master Student

Study Locations

• Iraq
  • Baghdad Governorate
    • Baghdad, Baghdad Governorate, Iraq, 10001
      • Recruiting
      • Ibn Al-Bitar Specialized Hospital for Cardiac Surgery
      • Principal Investigator: Muslim Aqeel Essa, Master student
    • Baghdad, Baghdad Governorate, Iraq, 10001
      • Recruiting
      • Iraqi Center for Heart Diseases
      • Principal Investigator: Muslim Aqeel Essa, Master student
  • Kerbala Governorate
    • Karbala, Kerbala Governorate, Iraq, 56001
      • Recruiting
      • Al-Hassan Al-Mujtaba Hospital
      • Principal Investigator: Muslim Aqeel Essa, Master student

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Age 18-75 years.
• Scheduled for elective open-heart surgery.
• Can understand instructions and perform Segmental breathing and Active cycle breathing techniques.
• Stable preoperative hemodynamic condition.

Exclusion Criteria:

• Emergency cardiac surgeries.
• Patients with pre-existing severe pulmonary disease (e.g., COPD, asthma, restrictive lung disease, Atelectasis, and Tuberculosis).
• Neurological disorders affecting breathing effort.
• Patients with rib fractures, recent thoracic trauma, or contraindications for coughing maneuvers.
• Inability to provide informed consent (cognitive impairment, language barrier).

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Segmental Breathing Exercises; Patients receive segmental breathing exercises after open heart surgery to improve lung expansion and cardiopulmonary function	Behavioral: Segmental Breathing Exercises; Deep breathing exercises focusing on specific lung segments to improve ventilation, lung expansion, and oxygenation in post open heart surgery patients.
Experimental: Active Cycle Breathing Technique; Patients receive active cycle breathing technique (ACBT) after open heart surgery to enhance airway clearance and improve respiratory function.	Behavioral: Active Cycle Breathing Technique; A combination of breathing control, thoracic expansion exercises, and forced expiration technique to improve airway clearance and lung function.
Active Comparator: Standard Postoperative Care; Patients receive routine postoperative care without structured breathing exercise interventions.	Other: Standard postoperative care; Participants will receive routine postoperative care according to institutional protocols following cardiac surgery. This includes standard medical and nursing management such as oxygen therapy, pain control, monitoring of vital signs, and mobilization as tolerated, without additional structured respiratory physiotherapy interventions.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Oxygen Saturation (SpO₂)	Assessment of peripheral oxygen saturation in patients after open heart surgery undergoing breathing exercises (segmental breathing exercises or active cycle breathing technique)	Measurements will be obtained at baseline pre-intervention, 1 hour post-intervention, and 6 hours post-intervention during hospital stay
Respiratory Rate	Assessment of respiratory rate in patients after open heart surgery undergoing breathing exercises.	Measurements will be obtained at baseline pre-intervention,1 hour post-intervention, and 6 hours post-intervention
Heart Rate	Assessment of heart rate in patients after open heart surgery undergoing breathing exercises.	Measurements will be obtained at baseline pre-intervention, 1 hour post-intervention, and 6 hours post-intervention during hospital stay
Systolic Blood Pressure, Diastolic Blood Pressure, and Pulse Pressure	Assessment of Systolic Blood Pressure Pulse Pressure, and Diastolic Blood Pressure in patients after open heart surgery undergoing breathing exercises.	Measurements will be obtained at baseline pre-intervention, 1 hour post-intervention, and 6 hours post-intervention during hospital stay

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Dyspnea Index	Assessment of dyspnea index in patients after open heart surgery using a standardized dyspnea scale contain ten questions for score 0 = Never. 1 = Almost never. 2 = Sometimes. 3 = Almost always. 4 = Always , the higher number is the worst that to evaluate changes before interventions and after implementation of segmental breathing exercises or active cycle breathing techniques.	measur at baseline pre-intervention and post-intervention after 6 hours.

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mean Arterial Pressure	Assessment of Mean Arterial Pressure in patients after open heart surgery undergoing breathing exercises.	Measurements will be obtained at baseline pre-intervention, 1 hour post-intervention, and 6 hours post-intervention during hospital stay

Collaborators and Investigators

• Sponsor: University of Baghdad
• Investigators: Principal Investigator: Wafaa Abd Ali Hattab, Assist prof, College of Nursing , University of Baghdad

Publications and helpful links

General Publications

• Salehi Derakhtanjani A, Ansari Jaberi A, Haydari S, Negahban Bonabi T. Comparison the Effect of Active Cyclic Breathing Technique and Routine Chest Physiotherapy on Pain and Respiratory Parameters After Coronary Artery Graft Surgery: A Randomized Clinical Trial. Anesth Pain Med. 2019 Oct 16;9(5):e94654. doi: 10.5812/aapm.94654. eCollection 2019 Oct.

Helpful Links

• Comparison the effect of active cyclic breathing technique and routine chest physiotherapy on pain and respiratory parameters after coronary artery graft surgery: A randomized clinical trial.

Study record dates

Study Major Dates

• Study Start (Actual): January 2, 2026
• Primary Completion (Estimated): July 10, 2026
• Study Completion (Estimated): October 10, 2026

Study Registration Dates

• First Submitted: May 7, 2026
• First Submitted That Met QC Criteria: May 14, 2026
• First Posted (Actual): May 18, 2026

Study Record Updates

• Last Update Posted (Actual): May 18, 2026
• Last Update Submitted That Met QC Criteria: May 14, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Cardiac Surgery; Dyspnea; Adult Patients; Open Heart Surgery; Breathing Exercises; Active Cycle Breathing Technique; Segmental Breathing Exercises; Postoperative Patients; Cardiopulmonary Parameters
• Additional Relevant MeSH Terms: Vascular Diseases; Cardiovascular Diseases; Heart Diseases; Respiratory Tract Diseases; Respiration Disorders; Signs and Symptoms, Respiratory; Arteriosclerosis; Arterial Occlusive Diseases; Coronary Disease; Myocardial Ischemia; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Coronary Artery Disease; Dyspnea
• Other Study ID Numbers: UOB-NUR-2026-03

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: IPD will not be shared due to patient privacy and confidentiality concerns.

Drug and device information, study documents

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