Volumetric incentive spirometer and positive pressure after cardiac surgery

Abstract

Background:Most patients that undergo cardiac surgery develop post-operative pulmonary complications. The use of an incentive spirometer associated withpositive end-expiratory pressure (PEEP) and non-invasive ventilation (NIV) may contribute to the reduction of such complications.

Objective: To compare the efficacy of an incentive spirometer associated with positive end-expiratory pressure to NIV in pulmonary complications in the PO of heart surgery during hospitalization in the intensive care unit (ICU).

Methods: A randomized clinical trial conducted from July 2012 to July 2015 at the ULBRA Mãe de Deus University Hospital -Canoas/RS. Patients were randomized into three groups: Group I – NIV; group II - volumetricincentive spirometer (IS) associated with positive end-expiratory pressure (PEEP) (IS+EPAP); and group III - conventional (CG). The three groups received motor physiotherapy. Post-operative monitoring of pulmonary complications was performed through radiology service reports until the time of discharge from the ICU.

Results: 49 patients were included in the study, 13 patients in Group I, 16 patients in Group II and 20 patients in Group III. The average age of Group I was 61.7 ± 10.4 years, 61.4 ± 10.2 years in Group II, and 62.9 ± 11.5 years in Group III. Atelectasis was the pulmonary complication that had the highest statistical significance when comparing the three groups in the immediate PO (p=0.035).

Conclusion: When comparing non-invasive ventilation (NIV) to incentive spirometry (IS) associated with positive end-expiratory pressure (PEEP) or respiratory exercises, we could not conclude that this particular technique is superior in relation to the decrease of pulmonary complications.