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Are Incentive Spirometry, Intermittent Positive Pressure Breathing, and Deep Breathing Exercises Effective in the Prevention of Postoperative Pulmonary Complications After Upper Abdominal Surgery? A Systematic Overview and Meta-analysis

JA Thomas, MSc, BScPT, is Lecturer, Department of Physical Therapy, University of Toronto, and Research Coordinator, Physiotherapy Department, The Toronto Hospital, GW 1-553, 200 Elizabeth St, Toronto, Ontario, Canada M5G 2C4.
JM McIntosh, MSc, BPT, is Assistant Clinical Professor, Department of Clinical Epidemiology and Biostatistics, McMaster University, and Quality Manager, Physiotherapy Department, Chedoke-McMaster Hospitals, Hamilton, Ontario, Canada L8N 3Z5.

Background and Purpose. The purpose of this meta-analysis was to quantitatively assess the conflicting body of literature concerning the efficacy of incentive spirometry (IS), intermittent positive pressure breathing (IPPB), and deep breathing exercises (DBEX) in the prevention of postoperative pulmonary complications in patients undergoing upper abdominal surgery. Methods. Computerized searches of MEDLINE and the Cumulative Index to Nursing and Allied Health databases were performed for the years 1966 through 1992. Citations were selected based on the following relevance criteria: (1) patients undergoing any type of upper abdominal surgery; (2) any combination of IS, IPPB, and DBEX; (3) an outcome of pulmonary complications; and (4) randomized trials. Review of 116 citations yielded 55 potential trials and 10 review articles. Of these, 14 citations were included in the overview based on relevance criteria requirements. Study validity was assessed by two independent observers, and data were extracted. Results. The common odds ratio (COR) for the occurrence of pulmonary complications for IS versus no physical therapy was 0.44 in favor of IS. The COR for DBEX versus no physical therapy was 0.43 in favor of DBEX. Both findings were statistically significant. The CORs for IS versus IPPB, IS versus DBEX, and IPPB versus DBEX were 0.76 (95% confidence interval [CI]=0.39–1.4), 0.91 (95% CI=0.57–1.4), and 0.94 (95% CI=0.28–3.17), respectively. None of these comparisons reached statistical significance. Conclusion and Discussion. Incentive spirometry and DBEX appear to be more effective than no physical therapy intervention in the prevention of postoperative pulmonary complications. There is no evidence to support a significant difference between any of the three modalities.

Key Words: Meta-analysis • Physical therapy • Upper abdominal surgery

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