Prevention of postoperative pulmonary complications through respiratory rehabilitation: a controlled clinical study.

OBJECTIVE

To investigate the efficacy of respiratory rehabilitation in preventing postoperative pulmonary complications (PPC) and to define which patients can benefit.

DESIGN

A randomized clinical trial.

SETTING

A public hospital.

PATIENTS

Eighty-one patients who had upper abdominal surgery were distributed into two homogeneous groups: control (n = 41) and rehabilitation (n = 40).

INTERVENTION

Breathing exercises in the rehabilitation group.

MAIN OUTCOME MEASURES

Preoperative and postoperative clinical evaluation, spirometry, arterial gasometry, and simple chest X-rays.

RESULTS

The incidence of PPC was 7.5% in the rehabilitation group and 19.5% in the control group; the control group also had more radiologic alterations (p = .01). Stratified PPC analysis did not reveal significant differences between groups. However, high- and moderate-risk patients in the rehabilitation group had fewer PPC. Multivariate analysis showed a greater PPC risk associated with pulmonary history (p = .02) and duration of surgery longer than 120 min (p = .03), while rehabilitation exerted a protective effect (p = .06). Significant postoperative decreases in pulmonary volumes and arterial gas values were recorded in both groups, without significant differences.

CONCLUSIONS

Respiratory rehabilitation protects against PPC and is more effective in moderate- and high-risk patients, but does not affect surgery-induced functional alterations.