Effectiveness of Preoperative Chest Physiotherapy in Patients Undergoing Elective Cardiac Surgery, a Systematic Review and Meta-Analysis.

Background and Objectives: Patients undergoing cardiac surgery are particularly vulnerable for developing postoperative pulmonary complications (PPCs). This systematic review and meta-analysis aimed to evaluate the role of preoperative chest physiotherapy in such patients. Materials and Methods: All original articles that assessed patients undergoing elective cardiac surgery, with preoperative chest physiotherapy, and compared them to patients undergoing elective cardiac surgery, without preoperative chest physiotherapy, were included. Animal studies, studies conducted prior to the year 2000, commentaries, or general discussion papers whose authors did not present original data were excluded. Studies assessing physiotherapy regimens other than chest physiotherapy were also excluded. The search was performed using the following electronic resources: the Cochrane Central Register of Controlled Trials, the PubMed central database, and Embase. The included studies were assessed for potential bias using the Cochrane Collaboration's tool for assessing the risk of bias. Each article was read carefully, and any relevant data were extracted. The extracted data were registered, tabulated, and analyzed using Review Manager software. Results: A total of 10 articles investigating 1458 patients were included in the study. The studies were published from 2006 to 2019. The populations were patients scheduled for elective CABG/cardiac surgery, and they were classified into two groups: the interventional (I) group, involving 651 patients, and the control (C) group, involving 807 patients. The meta-analysis demonstrated no significant differences between the interventional and control groups in surgery time and ICU duration, but a significant difference was found in the time of mechanical ventilation and the length of hospital stay, favoring the interventional group. A significant difference was shown in the forced expiratory volume in 1s (FEV1% predicted), forced vital capacity (FVC% predicted), and maximum inspiratory pressure (Pi-max), favoring the interventional group. Conclusions: This study is limited by the fact that one of the included ten studies was not an RCT. Moreover, due to lack of the assessment of certain variables in some studies, the highest number of studies included in a meta-analysis was the hospital stay length (eight studies), and the other variables were analyzed in a fewer number of studies. The data obtained can be considered as initial results until more inclusive RCTs are conducted involving a larger meta-analysis. However, in the present study, the intervention was proved to be protective against the occurrence of PPCs. The current work concluded that preoperative chest physiotherapy can yield better outcomes in patients undergoing elective cardiac surgery.

The effect of preoperative chest physiotherapy on oxygenation and lung function in cardiac surgery patients: a randomized controlled study.

BACKGROUND: Postoperative pulmonary complications in patients who undergo open heart surgery are serious life-threatening conditions. Few studies have investigated the potentially beneficial effects of preoperative physiotherapy in patients undergoing cardiac surgery. OBJECTIVES: Assess the effects of preoperative chest physiotherapy on oxygenation and lung function in patients undergoing open heart surgery. DESIGN: Randomized, controlled. SETTING: University hospital. PATIENTS AND METHODS: Patients with planned open heart surgery were randomly allocated into an intervention group of patients who underwent a preoperative home chest physiotherapy program for one week in addition to the traditional postoperative program and a control group who underwent only the traditional postoperative program. Lung function was assessed daily from the day before surgery until the seventh postoperative day. MAIN OUTCOME MEASURES: Differences in measures of respiratory function and oxygen saturation. Length of postoperative hospital stay was a secondary outcome. SAMPLE SIZE: 100 patients (46 in intervention group, 54 in control group). RESULTS: Postoperative improvements in lung function and oxygen saturation in the intervention group were statistically significant compared with the control group. The intervention group also had a statistically significant shorter hospital stay (P<.01). CONCLUSION: Preoperative chest physiotherapy is effective in improving respiratory function following open heart surgery. LIMITATIONS: Relatively small number of patients. CONFLICT OF INTEREST: None. REGISTRATION: ClinicalTrials.gov (NCT04665024).