Lung Expansion Technics on Chest Wall Mechanics and Preventing Pulmonary Complication After Abdominal Surgery

University of Sao Paulo General Hospital

Status: Completed

Conditions: Surgical Procedure, Unspecified

Treatments: Procedure: Breathing exercises

Study type: Interventional

Funder types: Other

Identifiers

NCT01993602

FAPESP (Other Identifier)

0150/11

Details and patient eligibility

About

The lung expansion techniques are widely used to prevent postoperative pulmonary complications. However, the effect of each technique on thoracoabdominal mechanics after abdominal surgery and if it influences the rate of postoperative pulmonary complications remains unknown. The investigators hypothesis is that the lung expansion technique that more increases lung volume after abdominal surgery, will be the most efficient in preventing postoperative pulmonary complication after abdominal surgery. The investigators objectives will be to compare the effect of different lung expansion techniques on lung volumes and activation of inspiratory muscle, and prevention of pulmonary complications in patients undergoing upper abdominal surgery. This study will involve 171 patients undergoing elective abdominal surgery. Patients will be randomly divided into 5 groups: no therapy group (n=35), continuous positive airway pressure (CPAP, n=34); volumetric incentive spirometry (VIS, n=34); flow oriented incentive spirometry (FIS, n=33) and deep breathing (DB, n=35). The thoracoabdominal mechanics will be assessed before and 3 days after surgery. Complications will be evaluated by a researcher who did not know to which group each patient belongs.

Full description

The assessments performed were thoracoabdominal kinematics (by optoelectronic pletysmography)and respiratory muscles activity (by surface electromyography). The follow pulmonary complications were considered: pneumonia, tracheobronchitis, atelectasis and acute respiratory failed

Enrollment: 171 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• candidates for elective upper abdominal surgery expected to last longer than 120 minutes
• absent of spine or thoracic deformity
• no previous lung parenchyma resection
• no tracheostomy
• able to understand and perform the maneuvers proposed.

Exclusion criteria

• cancellation of surgery
• mechanical ventilation for more than 24 hours in the postoperative period
• need for chest tube use
• postoperative cardiac complications
• surgical complication
• reoperation

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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171 participants in 5 patient groups

Control group

No Intervention group

Description:

no intervention was performed in this group during postoperative period,

volumetric incentive spirometry

Active Comparator group

Description:

patients performed breathing exercises using volumetric incentive spirometer during five postoperative days

Treatment:

Procedure: Breathing exercises

Flow oriented incentive spirometry

Active Comparator group

Description:

patients performed breathing exercises using flow oriented incentive spirometer during five postoperative days

Treatment:

Procedure: Breathing exercises

Deep breathing group

Active Comparator group

Description:

patients performed deep breathing exercises without any device during five postoperative days

Treatment:

Procedure: Breathing exercises

Continuous positive airway pressure group

Active Comparator group

Description:

patients performed breathing exercises using continuous positive airway pressure group during five postoperative days

Treatment:

Procedure: Breathing exercises