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Deep-Breathing Exercises Reduce Atelectasis and Improve Pulmonary Function After Coronary Artery Bypass Surgery^*

^* From the Department of Medical Sciences, Clinical Physiology (Drs. Westerdahl and Hedenstierna) and Department of Neuroscience, Section of Physiotherapy (Dr. Lindmark), University Hospital, Uppsala; the Departments of Cardiothoracic Surgery (Dr. Friberg) and Radiology (Dr Eriksson), Örebro University Hospital, Örebro; and the Department of Cardiothoracic Anesthesia (Dr, Tenling), Karolinska University Hospital, Huddinge, Sweden.

Correspondence to: Elisabeth Westerdahl, RPT, PhD, Department of Physiotherapy, Örebro University Hospital, SE-701 85 Örebro, Sweden; e-mail: elisabeth.westerdahl{at}orebroll.se

Study objectives: To investigate the effects of deep-breathing exercises on pulmonary function, atelectasis, and arterial blood gas levels after coronary artery bypass graft (CABG) surgery.

Design, setting, and patients: In a prospective, randomized trial, patients performing deep-breathing exercises (n = 48) were compared to a control group (n = 42) who performed no breathing exercises postoperatively. Patient management was similar in the groups in terms of assessment, positioning, and mobility.

Interventions: The patients in the deep-breathing group were instructed to perform breathing exercises hourly during daytime for the first 4 postoperative days. The exercises consisted of 30 slow, deep breaths performed with a positive expiratory pressure blow-bottle device (+ 10 cm H₂O).

Measurements and results: Spirometric measurements, spiral CT (three transverse levels), arterial blood gas analysis, and scoring of subjective experience of the breathing exercises were performed on the fourth postoperative day. Atelectasis was only half the size in the deep-breathing group compared to the control group, amounting to 2.6 ± 2.2% vs 4.7 ± 5.7% (p = 0.045) at the basal level and 0.1 ± 0.2% vs 0.3 ± 0.5% (mean ± SD) [p = 0.01] at the apical level. Compared to the control subjects, the patients in the deep-breathing group had a significantly smaller reduction in FVC (to 71 ± 12%, vs 64 ± 13% of the preoperative values; p = 0.01) and FEV₁ (to 71 ± 11%, vs 65 ± 13% of the preoperative values; p = 0.01). Arterial oxygen tension, carbon dioxide tension, fever, or length of ICU or hospital stay did not differ between the groups. In the deep-breathing group, 72% of the patients experienced a subjective benefit from the exercises.

Conclusions: Patients performing deep-breathing exercises after CABG surgery had significantly smaller atelectatic areas and better pulmonary function on the fourth postoperative day compared to a control group performing no exercises.

Key Words: atelectasis • breathing exercises • cardiac surgery • coronary artery bypass • CT • physical therapy • postoperative care • postoperative complications • thoracic surgery

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