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

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Essa M. Sweity ◽  
Aidah A. Alkaissi ◽  
Wafiq Othman ◽  
Ahmad Salahat
Keyword(s):  
Artery Bypass ◽  
Bypass Graft ◽  
Hospital Length ◽  
Pulmonary Complications ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Postoperative Pulmonary Complications ◽  
Mechanical Ventilation Duration ◽  
Postoperative Oxygenation ◽  
Incentive Spirometry

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.

scholarly journals Preoperative Incentive Spirometry for Preventing Postoperative Pulmonary Complications in Patients Undergoing Coronary Artery Bypass Graft Surgery: A Prospective, Randomized Controlled Trial

2021 ◽  
Author(s):  
Essa M Sweity ◽  
Aidah A Alkaissi ◽  
Wafiq Othman ◽  
Ahmad Salahat
Keyword(s):  
Artery Bypass ◽  
Bypass Graft ◽  
Hospital Length ◽  
Pulmonary Complications ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Postoperative Pulmonary Complications ◽  
Mechanical Ventilation Duration ◽  
Postoperative Oxygenation ◽  
Incentive Spirometry

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 take place to reduce PPCs. One device usually used for this reason is the 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 that there was a significant difference between the IS group and control group 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 group 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 group IS group, the median was six days versus seven days in the control group (p < 0.001). Median of the amount of arterial blood oxygen and oxygen saturation was significantly effective improvement in IS group with (p < 0.005). Conclusion: Preoperative incentive spirometry for 2 days along with exercises of deep breathing, encouraged coughing and early ambulation following CABG are in connection with prevention and decrease 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.

The Effect of High-Flow Nasal Oxygen Therapy on Postoperative Pulmonary Complications and Hospital Length of Stay in Postoperative Patients: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 35 (10) ◽  
pp. 1129-1140 ◽  
Author(s):  
Zhonghua Lu ◽  
Wei Chang ◽  
Shanshan Meng ◽  
Ming Xue ◽  
Jianfeng Xie ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Oxygen Therapy ◽  
Hospital Length ◽  
Pulmonary Complications ◽  
High Flow ◽  
Hospital Length Of Stay ◽  
Cochrane Library ◽  
Control Group ◽  
Postoperative Pulmonary Complications ◽  
High Flow Oxygen

Objective: To evaluate the effect of high-flow nasal cannula oxygen (HFNO) therapy on hospital length of stay (LOS) and postoperative pulmonary complications (PPCs) in adult postoperative patients. Data Sources: PubMed, Embase, the Cochrane Library, Web of Science of Studies, China National Knowledge Index, and Wan Fang databases were searched until July 2018. Study Selection: Randomized controlled trials (RCTs) comparing HFNO with conventional oxygen therapy or noninvasive mechanical ventilation in adult postoperative patients were included. The primary outcomes were hospital LOS and PPCs; short-term mortality (defined as intensive care unit, hospital, or 28-day mortality) and intubation rate were the secondary outcomes. Data Extraction: Demographic variables, high-flow oxygen therapy application, effects, and side effects were retrieved. Data were analyzed by the methods recommended by the Cochrane Collaboration. The strength of evidence was assessed by the Grading of Recommendations Assessment, Development and Evaluation. Random errors were evaluated with trial sequential analysis. Data Synthesis: Fourteen studies (2568 patients) met the inclusion criteria and were included. Compared to the control group, the pooled effect showed that HFNO was significantly associated with a shorter hospital stay (mean difference: −0.81; 95% confidence interval [CI]: −1.34 to −0.29, P = .002), but not mortality (risk ratio [RR]: 1.0, 95% CI: 0.63 to 1.59, P = 1.0). Weak evidence of a reduction in reintubation rate (RR: 0.76, 95% CI: 0.57-1.01, P = .06) and PPC rate (RR: 0.89, 95% CI: 0.75-1.06, P = .18) with HFNO versus control group was recorded. Conclusions: The available RCTs suggest that, among the adult postoperative patients, HFNO therapy compared to the control group significantly reduces hospital LOS.

scholarly journals Counterintuitive results from observational data: a case study and discussion

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e026447 ◽  
Author(s):  
Erik Doty ◽  
David J Stone ◽  
Ned McCague ◽  
Leo Anthony Celi
Keyword(s):  
Intensive Care ◽  
Medical Information ◽  
Current Knowledge ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Critical Care Patient ◽  
Care Patient ◽  
Hospital Length ◽  
Hospital Length Of Stay

ObjectiveTo explore the issue of counterintuitive data via analysis of a representative case in which the data obtained was unexpected and inconsistent with current knowledge. We then discuss the issue of counterintuitive data while developing a framework for approaching such findings.DesignThe case study is a retrospective analysis of a cohort of coronary artery bypass graft (CABG) patients. Regression was used to examine the association between perceived pain in the intensive care unit (ICU) and selected outcomes.SettingMedical Information Mart for Intensive Care-III, a publicly available, de-identified critical care patient database.Participants844 adult patients from the database who underwent CABG surgery and were extubated within 24 hours after ICU admission.Outcomes30 day mortality, 1 year mortality and hospital length of stay (LOS).ResultsIncreased pain levels were found to be significantly associated with reduced mortality at 30 days and 1 year, and shorter hospital LOS. A one-point increase in mean pain level was found to be associated with a reduction in the odds of 30 day and 1 year mortality by a factor of 0.457 (95% CI 0.304 to 0.687, p<0.01) and 0.710 (95% CI 0.571 to 0.881, p<0.01) respectively, and a 0.916 (95% CI −1.159 to –0.673, p<0.01) day decrease in hospital LOS.ConclusionThe finding of an association between increased pain and improved outcomes was unexpected and clinically counterintuitive. In an increasingly digitised age of medical big data, such results are likely to become more common. The reliability of such counterintuitive results must be carefully examined. We suggest several issues to consider in this analytic process. If the data is determined to be valid, consideration must then be made towards alternative explanations for the counterintuitive results observed. Such results may in fact indicate that current clinical knowledge is incomplete or not have been firmly based on empirical evidence and function to inspire further research into the factors involved.

scholarly journals Risk Factors for Postoperative Pulmonary Complications after Abdominal Surgery

2016 ◽  
Vol 4 (2) ◽  
pp. 259-263 ◽  
Author(s):  
Nertila Kodra ◽  
Vjollca Shpata ◽  
Ilir Ohri
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Clinical Laboratory ◽  
Multivariate Regression Analysis ◽  
Hospital Length ◽  
Pulmonary Complications ◽  
Hospital Length Of Stay ◽  
Postoperative Pulmonary Complications ◽  
Increased Risk ◽  
Surgical Ward

BACKGROUND: Incidence of postoperative pulmonary complications (PPC) in patients undergoing non-cardiothoracic surgery remains high and the occurrence of these complications has enormous implications for the patient and the health care system.AIM: The aim of the study was to identify risk factors for PPC in patients undergoing abdominal surgical procedures.MATERIALS AND METHODS: A prospective cohort study in abdominal surgical patients, admitted to the emergency and surgical ward of the UHC of Tirana, Albania, was conducted during the period: March 2014-March 2015. We collected data on the occurrence of a symptomatic and clinically significant PPC using clinical, laboratory, and radiology data. We evaluated the relations between PPCs and various pre-operative or intra-operative factors to identify risk factors.RESULTS: A total of 450 postoperative patients admitted to the surgical emergency and surgical ward were studied. The mean age were 59.85 ±13.64 years with 59.3% being male. Incidence of PPC was 27.3% (123 patients) and hospital length of stay was 4.93 ± 4.65 days. Length of stay was substantially prolonged for those patients who developed PPC (7.48 ± 2.89 days versus 3.97± 4.83 days, p < 0.0001. PPC were identified as risk factors for mortality, OR: 21.84; 95%CI: 11.66-40.89; P < 0.0001. The multivariate regression analysis identified as being independently associated with an increased risk of PPC: age ≥ 65 years (OR 11.41; 95% CI: 4.84-26.91, p < 0.0001), duration of operation ≥ 2.5 hours (OR 8.38; 95%CI: 1.52-46.03, p = 0.01, history of previous pulmonary diseases (OR 11.12; 95% CI: 3.28-37.65, P = 0.0001) and ASA > 2 (OR 6.37; 95% CI: 1.54-26.36, P = 0.01). CONCLUSION: We must do some efforts in reducing postoperative pulmonary complications, firstly to identify which patients are at increased risk, and then following more closely high-risk patients because those patients are most likely to benefit.

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