Positive expiratory pressure in postoperative cardiac patients in intensive care: A randomized controlled trial

Objective: To evaluate effectiveness of positive expiratory pressure blow-bottle device compared to expiratory positive airway pressure and conventional physiotherapy on pulmonary function in postoperative cardiac surgery patients in intensive care unit. Design: A randomized controlled trial. Settings: Tertiary care. Subjects: 48 patients (16 in each group; aged 64.5 +/- 9.1 years, 38 male) submitted to cardiac surgery. Interventions: Patients were randomized into conventional physiotherapy (G1), positive expiratory pressure blow-bottle device (G2) or expiratory positive airway pressure, both associated with conventional physiotherapy (G3). G2 and G3 performed three sets of 10 repetitions in each session for each technique. Main measures: Pulmonary function (primary); respiratory muscle strength, radiological changes, pulmonary complications, length of intensive care unit and hospital stay (secondary) assessed preoperatively and on the 3rd postoperative day. Results: Pulmonary function (except for forced expiratory volume in one second/ forced vital capacity % predicted) and respiratory muscle strength showed significant reduction from the preoperative to the 3rd postoperative in all groups (P < 0.001), with no difference between groups (P > 0.05). Regarding radiological changes, length of intensive care unit stay and length of hospital stay, there was no significant difference between groups (P > 0.05). Conclusion: Both positive expiratory pressure techniques associated with conventional physiotherapy were similar, but there was no difference regarding the use of positive expiratory pressure compared to conventional physiotherapy.

Automated summary

In postoperative cardiac surgery patients, positive expiratory pressure blow-bottle device and expiratory positive airway pressure showed similar effects on pulmonary function compared to conventional physiotherapy. Although there were significant reductions in pulmonary function and respiratory muscle strength after surgery, there were no significant differences between the three groups in terms of these outcomes.