Are breathing and coughing exercises necessary after coronary artery surgery?

Abstract

To investigate whether the incidence of post-operative pulmonary complications was significantly higher in a control group compared with treatment groups receiving prophylactic chest physiotherapy after coronary artery surgery, 120 patients completed a randomised controlled study. The patients in group 1 (n = 40) received no pre- or post-operative chest physiotherapy. The patients in group 2 (n = 40) were seen pre-operatively for education and instruction in breathing and coughing exercises and post-operatively received supervision and assistance from a physiotherapist in performing these exercises. The frequency of chest physiotherapy was twice per day on the first two post-operative days and once per day on the third and fourth post-operative days. The patients in group 3 (n = 40) received the same chest physiotherapy as those in group 2 except that the frequency was increased to four times per day on the first two post-operative days and twice per day on the third and fourth post-operative days. The patients in groups 2 and 3 were also advised to perform breathing and coughing exercises independently every hour. Nine patients (7.5%) developed clinically significant post-operative pulmonary complications. Pre-operative lung function was lower and hypoxaemia was more severe in the early post-operative period in these nine patients compared with the remaining patients. The incidence and severity of fever, hypoxaemia, chest x-ray abnormalities and clinically significant post-operative pulmonary complications were not significantly higher in the control group. The findings of this study suggest that the necessity for prophylactic chest physiotherapy after routine coronary artery surgery should be reviewed.