COMPARISON OF EFFECTS OF INCENTIVE SPIROMETRY AND DEEP BREATHING EXERCISES ON PULMONARY FUNCTIONS AFTER CORONARY ARTERY BYPASS GRAFTING

Main Article Content

Arooj Fatima
https://orcid.org/0000-0002-2180-6789
Shiza Kazmi
https://orcid.org/0000-0003-2581-7239

Abstract

OBJECTIVE: To compare the effects of incentive spirometry (IS) and deep breathing exercises (DBE) on pulmonary functions after coronary artery bypass grafting (CABG).


METHODS: This quasi-experimental study consisted of 40 patients from both genders aged 35-60 years, undergoing CABG. Two equal groups were selected through convenient sampling. Group-A patients performed IS while group-B performed DBE. The outcome measures were values of oxygen saturation (SaO2)by pulse oximetry, and partial pressures  of oxygen (pO2) and carbon dioxide (pCO2) measured by arterial blood gases (ABGs).


RESULTS: Mean pO2 (mmHg) at day 1 & day 4 was 136±23.04 & 74.42±16.22 respectively in group-A (p<0.001) as compared to 127.96 ±16.99 & 70.80±10.89 respectively in group-B (p<0.001). Mean value of SaO2 at day 1 & day 4 was 98.52±1.68 & 94.07±2.36 in group-A (p<0.001) as compared to 97.90±1.99 and 95.40±2.04 in group-B (p<0.001) respectively. Mean pCO2 (mmHg) was 42.32±4.57 & 40.07±3.49 at day 1 & day 4 in group-A (p<0.05) and 40.85±4.03 & 39.61±3.40 in group-B (p>0.05) respectively. Common complications observed were atelectasis (n=29/40; 72.5%), pleural effusion (n=6/40; 15%) and pulmonary edema (n=5/40; 12.5%). Majority (n=19; 47.5%) of patients were discharged till 5th postoperative day. Median stay at hospital was 3 days in group-A & 4 days in group-B.


CONCLUSION: There was an improvement in ABGs and SaO2 after CABG surgery in patients receiving chest physiotherapy interventions. Both techniques are equally effective in preventing and treating chest complications in patients having CABG.

Article Details

How to Cite
Fatima, A., and S. Kazmi. “COMPARISON OF EFFECTS OF INCENTIVE SPIROMETRY AND DEEP BREATHING EXERCISES ON PULMONARY FUNCTIONS AFTER CORONARY ARTERY BYPASS GRAFTING”. KHYBER MEDICAL UNIVERSITY JOURNAL, Vol. 13, no. 3, Sept. 2021, pp. 131-5, doi:10.35845/kmuj.2021.20239.
Section
Original Articles

References

1. Yazdannik A, Bollbanabad HM, Mirmohammadsadeghi M, Khalifezade A. The effect of incentive spirometry on arterial blood gases after coronary artery bypass surgery (CABG). Iran J Nurs Midwifery Res 2016;21(1):89. https://doi.org/10.4103/1735-9066.174761.
2. Mullen-Fortino M, O'Brien N, Jones M. Critical care of a patient after CABG surgery. Nursing 2019 Critical Care. 2009;4(4):46-53. https://doi.org/10.1097/01.CCN.0000357491.92428.71.
3. Overend TJ, Anderson CM, Lucy SD, Bhatia C, Jonsson BI, Timmermans C. The effect of incentive spirometry on postoperative pulmonary complications: a systematic review. Chest 2001;120(3):971-8. https://doi.org/10.1378/chest.120.3.971.
4. Younossian A, Adler D, Bridevaux P, Kherad O. Postoperative pulmonary complications: how to anticipate and prevent the risk? Rev Med Suisse 2011;7(317):2214, 6-9.
5. Wynne R, Botti M. Postoperative pulmonary dysfunction in adults after cardiac surgery with cardiopulmonary bypass: clinical significance and implications for practice. Am J Crit Care 2004;13(5):384-93.
6. Zarbock A, Mueller E, Netzer S, Gabriel A, Feindt P, Kindgen-Milles D. Prophylactic nasal continuous positive airway pressure following cardiac surgery protects from postoperative pulmonary complications: a prospective, randomized, controlled trial in 500 patients. Chest 2009;135(5):1252-9. https://doi.org/10.1378/chest.08-1602.
7. Westerdahl E, Lindmark B, Eriksson T, Hedenstierna G, Tenling A. Deep-breathing exercises reduce atelectasis and improve pulmonary function after coronary artery bypass surgery. Chest 2005;128(5):3482-8. https://doi.org/10.1378/chest.128.5.3482.
8. Margereson C, Riley J. Postoperative care following cardiothoracic surgery. In: Cardiothoracic surgical nursing trends in adult nursing. John Wiley & Sons; 2008. 129-204.
9. Hough A. Physiotherapy in respiratory care: an evidence-based approach to respiratory and cardiac management: Nelson Thornes; 2001.
10. Brunner LS. Brunner & Suddarth's textbook of medical-surgical nursing: Lippincott Williams & Wilkins; 2010.
11. Renault JA, Costa-Val R, Rosseti MB, Houri Neto M. Comparison between deep breathing exercises and incentive spirometry after CABG surgery. Rev Bras Cir Cardiovasc Apr-Jun 2009;24(2):165-72. https://doi.org/10.1590/s0102-76382009000200012.
12. Rock P, Rich PB. Postoperative pulmonary complications. Curr Opin Anaesthesiol 2003 Apr;16(2):123-31. https://doi.org/10.1097/00001503-200304000-00004.
13. Al-Qubati FAA, Damag A, Noman T. Incidence and outcome of pulmonary complications after open cardiac surgery, Thowra Hospital, Cardiac center, Sana’a, Yemen. Egyptian J Chest Dis Tuberculos2013;62(4):775–780. https://doi.org/10.1016/j.ejcdt.2013.08.008.
14. Afrasiabi A, Hasanzadeh S, Negargar S, Ghafari M, Ansarin K. The effects of incentive spirometry on pulmonary volumes and arterial blood gases after coronary artery bypass surgery. J Kermanshah Univ Med Sci 2006 ; 10(1):e81706.
15. Carvalho CR, Paisani DM, Lunardi AC. Incentive spirometry in major surgeries: a systematic review. Rev Bras Fisioter Sep-Oct 2011;15(5):343-50. https://doi.org/10.1590/s1413-35552011005000025.
16. Tyson AF, Kendig CE, Mabedi C, Cairns BA, Charles AG. The effect of incentive spirometry on postoperative pulmonary function following laparotomy: a randomized clinical trial. JAMA surgery 2015;150(3):229-36. https://doi.org/10.1001/jamasurg.2014.1846.
17. Brooks-Brunn JA. Postoperative atelectasis and pneumonia. Heart Lung 1995;24(2):94-115.
18. Craven R, Hirnle C. Fundamentals of Nursing. Human Health and Function. Fourh Ed. Philadelphia, Lippincott Comp; 2003.
19. Pasquina P, Walder B. Prophylactic respiratory physiotherapy after cardiac surgery: systematic review. Bmj. 2003;327(7428):1379. https://doi.org/10.1136/bmj.327.7428.1379.
20. Mueenudheen T, Moiz JA, Gupta V. A comparative study on the effects of incentive spirometry and deep breathing exercise on pulmonary functions after uncomplicated coronary artery bypass grafting surgery. Indian J Physiother Occup Ther 2012;6(2):63.
21. Manapunsopee S, Thanakiatpinyo T, Wongkornrat W, Chuaychoo B, Thirapatarapong W. Heart Lung Circ 2020 Aug;29(8):1180-6. https://doi.org/10.1016/j.hlc.2019.09.009.
22. Stannard D. Incentive spirometry for preventing pulmonary complications after coronary artery bypass graft. J Perianesth Nurs 2013 Aug;28(4):236-8. https://doi.org/10.1016/j.jopan.2013.05.003.
23. Agostini P, Singh S. Incentive spirometry following thoracic surgery: what should we be doing? Physiotherapy2009 Jun;95(2):76-82. https://doi.org/10.1016/j.physio.2008.11.003.
24. Moradyan T, Farahani M, Mohammadi N, Jamshidi R. The effect of planned breathing exercises on oxygenation in patients after coronary artery bypass surgery. Iran J Cardiovasc Nurs 2012;1(1):8-14.
25. Yánez-Brage I, Pita-Fernández S, Juffé-Stein A, Martínez-González U, Pértega-Díaz S, Mauleón-García Á. Respiratory physiotherapy and incidence of pulmonary complications in off-pump coronary artery bypass graft surgery: an observational follow-up study. BMC Pulm Med 2009;9(1):36. https://doi.org/10.1186/1471-2466-9-36.
26. Siddiqui M-MA, Paras I, Jalal A. Risk factors of prolonged mechanical ventilation following open heart surgery: what has changed over the last decade? Cardiovasc Diagn Ther 2012 Sep; 2(3): 192-9. https://doi.org/10.3978/j.issn.2223-3652.2012.06.05.
27. Freitas ER, Soares BG, Cardoso JR, Atallah AN. Incentive spirometry for preventing pulmonary complications after coronary artery bypass graft. Cochrane Database Syst Rev 2012 Sep 12;2012(9):CD004466. https://doi.org/10.1002/14651858.CD004466.pub3.