Preoperative incentive spirometry for preventing postoperative pulmonary complications in patients undergoing coronary artery bypass graft surgery: a prospective, randomized controlled trial

Essa M Sweity, Aidah A Alkaissi, Wafiq Othman, Ahmad Salahat, Essa M Sweity, Aidah A Alkaissi, Wafiq Othman, Ahmad Salahat

Abstract

Background: Postoperative pulmonary complications (PPCs) often occur after cardiac operations and are a leading cause of morbidity, inhibit oxygenation, and increase hospital length of stay and mortality. Although clinical evidence for PPCs prevention is often unclear and crucial, measures occur to reduce PPCs. One device usually used for this reason is incentive spirometry (IS). The aim of the study is to evaluate the effect of preoperative incentive spirometry to prevent postoperative pulmonary complications, improve postoperative oxygenation, and decrease hospital stay following coronary artery bypass graft (CABG) surgery patients.

Methods: This was a clinical randomized prospective study. A total of 80 patients were selected as candidates for CABG at An-Najah National University Hospital, Nablus-Palestine. Patients had been randomly assigned into two groups: incentive spirometry group (IS), SI performed before surgery (study group) and control group, preoperative spirometry was not performed. The 40 patients in each group received the same protocol of anesthesia and ventilation in the operating room.

Result: The study findings showed a significant difference between the IS and control groups in the incidence of postoperative atelectasis. There were 8 patients (20.0%) in IS group and 17 patients (42.5%) in the control group (p = 0.03). Mechanical ventilation duration was significantly less in IS group. The median was four hours versus six hours in the control group (p < 0.001). Hospital length of stay was significantly less in IS group, and the median was six days versus seven days in the control group (p < 0.001). The median of the amount of arterial blood oxygen and oxygen saturation was significantly improved in the IS group (p < 0.005).

Conclusion: Preoperative incentive spirometry for two days along with the exercise of deep breathing, encouraged coughing, and early ambulation following CABG are in connection with prevention and decreased incidence of atelectasis, hospital stay, mechanical ventilation duration and improved postoperative oxygenation with better pain control. A difference that can be considered both significant and clinically relevant. Trial registration Thai Clinical Trials Registry: TCTR20201020005. Registered 17 October 2020-retrospectively registered.

Keywords: Atelectasis; CABG; Coronary artery bypass grafting; Incentive spirometry; Length of stay; Oxygenation; Postoperative pulmonary complications; Ventilation time.

Conflict of interest statement

The author(s) declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Consort diagram of patient screening and allocation
Fig. 2
Fig. 2
Percentage rate of atelectasis occurrence among IS and control groups. *p value of ≤ 0.05
Fig. 3
Fig. 3
Graphical comparison of median length of stay at the hospital per day between IS and control group. *p value of ≤ 0.05
Fig. 4
Fig. 4
Graphical comparison of median duration of mechanical ventilation per hour between IS and control groups. *p value of ≤ 0.05
Fig. 5
Fig. 5
Graphical comparison of median partial pressure of oxygen (Pao2) between IS and control groups. *p value of ≤ 0.05
Fig. 6
Fig. 6
Graphical comparison of median oxygen saturation of arterial blood (SaO2%) between IS and control groups. *p value of ≤ 0.05
Fig. 7
Fig. 7
Graphical comparison of the median numerical rating scale (NRS) pain scale between IS and control groups. *p value of ≤ 0.05

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