Postoperative pain due to surgical incision may limit lung expansion. After cardiac
surgery, all patients receive respiratory therapies, because it is critical to expand
lung after surgery to prevent respiratory complications such as lung collapse
(atelectasis) due to shallow breathing or accumulation of airway secretions.
Although incentive spirometer is the most common method used for lung recovery after
cardiac surgery, some studies were not able to find any benefits from the use of
incentive spirometer. Inspiratory positive-pressure breathing (IPPB), Intermittent
positive end expiratory pressure (EzPAP), and chest airway clearance (Metaneb) are
hyperinflation therapies used after surgery. The purpose of this research study is to
determine which hyperinflation respiratory therapy provide better lung recovery after
cardiac surgery.
Hyperinflation Respiratory Therapies:Participants will be randomly assigned one of the
hyperinflation respiratory therapy, intermittent positive pressure breathing (IPPB) and
the EzPAP or the Metaneb.
Intermittent positive pressure breathing (IPPB) is a respiratory therapy technique
which will support your breathing by providing pressure support. This respiratory
method will increase air volume breathing in.
The EzPAP is another respiratory treatment and participants will breath against to
resistance in order to prolong the time the lung remain open.
The Metaneb will provide resistance when patients breathing in order to prolong the
lung opening.
Hyperinflation therapy will be performed every 4 hours in the intensive care unit (ICU).
Each respiratory therapy session will take about 15 minutes. Participants' pulmonary
function will be evaluated daily to monitor the lung recovery with microspirometer which
will take place approximately 5 minutes. Total study duration is about 96 hours after
surgery or until discharge from the Intensive Care Unit.
Risk for Lung over expansion (hyperinflation) therapy:
Hyperinflation respiratory treatments target to expand your lung to prevent complication
such as collapse of small airway after surgery. This over expansion of your lung may
increase work of breathing. All expected complications are typical in the post-operative
cardiac patients and not unique to hyperinflation therapy.
The possible complications listed below:
Over distention of air sucks (alveoli). Sometimes pressure trauma in your lung may
cause pneumothorax.
Infection
Bloody sputum (hemoptysis)
Blood gas changes such as decrease carbon dioxide or increase oxygen in your blood.
Sometimes stomach may distend
Impaction of airway secretions if gas mixture not humidified enough.
Your blood return to the heart maybe decreased which may affect your blood pressure.
Exacerbation of low blood oxygen level (hypoxemia),
Decreased or increased respiration
Air trapping in your airway
You may psychologically dependence to device