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(Chest. 2006;130:1887-1899.)
© 2006 American College of Chest Physicians

Respiratory Physiotherapy To Prevent Pulmonary Complications After Abdominal Surgery*

A Systematic Review

Patrick Pasquina; Martin R. Tramèr, MD, DPhil; Jean-Max Granier and Bernhard Walder, MD

* From the Division of Intensive Care (Mr. Pasquina and Mr. Granier) and the Division of Anesthesiology (Drs. Tramèr and Walder), Department APSI (Anesthésie, Pharmacologie et Soins Intensifs), Geneva University Hospitals, Geneva, Switzerland.

Correspondence to: Patrick Pasquina, Division of Intensive Care, Geneva University Hospitals, 1211 Geneva 14, Switzerland; e-mail: Patrick.Pasquina{at}hcuge.ch

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.

Key Words: abdominal surgery • atelectasis • continuous positive airway pressure • incentive spirometry • intermittent positive pressure breathing • metaanalysis • physical therapy • pneumonia • respiratory physiotherapy






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