The effect of selective drainage positions on oxygen saturation in obese patients after upper abdominal surgery.

The obese patients undergoing upper abdominal surgery are at particularly high risk to develop postoperative pulmonary complications, and hypoxemia is one of the most common ones reported. During the initial postoperative period, they are often advised to maintain a semi-sitting position to optimize oxygenation. Although chest physical therapy usually avoids a Trendelenburg position, no published data indicate this position as being able to induce desaturation in obese patients following upper abdominal surgery. We studied fifteen adult obese patients without cardiopulmonary disease undergoing upper abdominal surgery. All patients were tested for 5 minutes during the first 3 postoperative days in each of 3 positions: semi-sitting, bed-flat lateral decubitus, and 15 degrees of Trendelenburg lateral decubitus positions. A statistically significant difference in oxygen saturation related to position was found only on the first postoperative day between semi-sitting and bed-flat lateral decubitus positions. The difference in mean SaO2 value between these 2 positions, however, was only 0.88%; and no significant correlation between the magnitude of obesity and the mean SaO2 difference was found. Although arterial oxygen saturation demonstrated statistically significant daily improvement during the first 3 postoperative days, the mean SaO2 values for any 2 consecutive days differed by less than 0.78%. Thus, in obese patients following upper abdominal surgery, 15 degrees of Trendelenburg lateral decubitus and bed-flat lateral decubitus positions do not induce clinically significant desaturation and can be used if necessary and appropriate. In obese patients with borderline oxygenation, supplemental oxygen used postoperatively can maintain adequate oxygenation and allow aggressive positioning.

Breathing exercises for the medical patient: the art and the science.

The art of breathing exercises can be traced to the late 1800s. In the past 10 years, the increased demand for treatment for respiratory muscle failure of dysfunction has resulted in numerous studies evaluating methods of treatment or training. This article provides an overview of research and practice, focused on treating the medical patient experiencing dyspnea or loss of respiratory muscle strength and endurance.

Chest physical therapy for the postoperative or traumatic injury patient.

Techniques of chest physical therapy have been used since the early 1900s to decrease postoperative pulmonary complications. Through investigations since the 1950s, documentation as to the efficacy of chest physical therapy in actually reducing postoperative pulmonary complications has been published. However, the careful documentation of techniques employed (such as full Trendelenburg's position versus a modified position and vibration of particular force and frequency) has not been done. Also, because of an inability to specify the risk factors of postoperative pulmonary complications occurring in particular patients or to qualitate the occurrence of these complications, it is difficult to establish what treatment is most efficacious. This article is a critical review of investigations to date with recommendations for further research stemming from this review.