| Abstract | OBJECTIVES: To examine the efficacy of respiratory physiotherapy for prevention of pulmonary complications after abdominal surgery. METHODS: We searched in databases and bibliographies for articles in all languages through November 2005. Randomized trials were included if they investigated prophylactic respiratory physiotherapy and pulmonary outcomes, and if the follow-up was at least 2 days. Efficacy data were expressed as risk differences (RDs) and number needed to treat (NNT), with 95% confidence intervals (CIs). RESULTS: Thirty-five trials tested respiratory physiotherapy treatments. Of 13 trials with a "no intervention" control group, 9 studies (n = 883) did not report on significant differences, and 4 studies (n = 528) did: in 1 study, the incidence of pneumonia was decreased from 37.3 to 13.7% with deep breathing, directed cough, and postural drainage (RD, 23.6%; 95% CI, 7 to 40%; NNT, 4.3; 95% CI, 2.5 to 14); in 1 study, the incidence of atelectasis was decreased from 39 to 15% with deep breathing and directed cough (RD, 24%; 95% CI, 5 to 43%; NNT, 4.2; 95% CI, 2.4 to 18); in 1 study, the incidence of atelectasis was decreased from 77 to 59% with deep breathing, directed cough, and postural drainage (RD, 18%; 95% CI, 5 to 31%; NNT, 5.6; 95% CI, 3.3 to 19); in 1 study, the incidence of unspecified pulmonary complications was decreased from 47.7% to 21.4 to 22.2% with intermittent positive pressure breathing, or incentive spirometry, or deep breathing with directed cough (RD, 25.5 to 26.3%; NNT, 3.8 to 3.9). Twenty-two trials (n = 2,734) compared physiotherapy treatments without no intervention control subjects; no conclusions could be drawn. CONCLUSIONS: There are only a few trials that support the usefulness of prophylactic respiratory physiotherapy. The routine use of respiratory physiotherapy after abdominal surgery does not seem to be justified. |
| Authors | Patrick Pasquina, Martin R Tramèr, Jean-Max Granier, Bernhard Walder
(Affiliation: Division of Intensive Care, Geneva University Hospitals, 1211 Geneva 14, Switzerland. Patrick.Pasquina at hcuge.ch)
|
| Journal | Chest
(Chest)
Vol. 130
Issue 6
Pg. 1887-99
(Dec 2006)
ISSN: 0012-3692 United States |
| PMID | 17167013
(Publication Type: Journal Article, Meta-Analysis, Review)
|
| Topics |
- Abdomen
(surgery)
- Atelectasis
(prevention & control)
- Humans
- Physical Therapy Modalities
- Pneumonia
(prevention & control)
- Postoperative Complications
(prevention & control)
- Randomized Controlled Trials as Topic
- Respiration, Artificial
- Respiratory Insufficiency
(prevention & control)
- Treatment Outcome
|
