Richard A. Tarala

Prevention of respiratory complications after abdominal surgery: a randomised clinical trial.

Abstract Objective: To evaluate the prevention of respiratory complications after abdominal surgery by a comparison of a global policy of incentive spirometry with a regimen consisting of deep breathing exercises for low risk patients and incentive spirometry plus physiotherapy for high risk patients. Design: Stratified randomised trial. Setting: General surgical service of an urban teaching hospital. Patients: 456 patients undergoing abdominal surgery. Patients less than 60 years of age with an American Society of Anesthesia classification of 1 were considered to be at low risk. Outcome measures: Respiratory complications were defined as clinical features consistent with collapse or consolidation, a temperature above 38°C, plus either confirmatory chest radiology or positive results on sputum microbiology. We also recorded the time that staff devoted to prophylactic respiratory therapy. Results: There was good baseline equivalence between the groups. The incidence of respiratory complications was 15% (35/231) for patients in the incentive spirometry group and 12% (28/225) for patients in the mixed therapy group (P=0.40; 95% confidence interval -3.6% to 9.0%). It required similar amounts of staff time to provide incentive spirometry and deep breathing exercises for low risk patients. The inclusion of physiotherapy for high risk patients, however, resulted in the utilisation of an extra 30 minutes of staff time per patient. Conclusions: When the use of resources is taken into account, the most efficient regimen of prophylaxis against respiratory complications after abdominal surgery is deep breathing exercises for low risk patients and incentive spirometry for high risk patients. Key messages Key messages Most postoperative respiratory complications were due to atelectasis: less than 1% of the patients developed pneumonia An American Society of Anesthesia classification >1 and an age >/=60 years is a simple way of defining patients at high risk of respiratory complications and other adverse events after abdominal surgery A regimen consisting of deep breathing exercises (low risk patients) and incentive spirometry (high risk patients) is an efficient way of providing prophylaxis against respiratory complications after abdominal surgery

Incentive spirometry versus routine chest physiotherapy for prevention of pulmonary complications after abdominal surgery

We entered 876 patients into a clinical trial aimed at preventing pulmonary complications after abdominal surgery. Patients either received conventional chest physiotherapy or were encouraged to perform maximal inspiratory manoeuvres for 5 min during each hour while awake, using an incentive spirometer. The incidence of pulmonary complications did not differ significantly between the groups: incentive spirometry 68 of 431 (15.8%, 95% CI 14.0-17.6%), and chest physiotherapy 68 of 445 (15.3%, CI 13.6-17.0%). Nor was there a difference between the groups in the incidence of positive clinical signs, pyrexia, abnormal chest radiographs, pathogens in sputum, respiratory failure (PO2 less than 60 mm Hg), or length of stay in hospital. We conclude that prophylactic incentive spirometry and chest physiotherapy are of equivalent clinical efficacy in the general management of patients undergoing abdominal surgery.

Respiratory insufficiency after abdominal surgery

Abstract The objective of this study was to define the relationship between respiratory insufficiency (RI) and various putative risk factors for patients undergoing abdominal surgery. A review of 1332 adults undergoing abdominal surgery was undertaken. Information was collected in a unbiased, prospective and uniform manner with regard to baseline characteristics, perioperative events and adverse outcomes after surgery. Respiratory insufficiency was defined as either: a PO2 < 60 mm Hg, the performance of a tracheotomy, or endotracheal intubation for more than 24 h. The incidence of RI was 3% (40/1332). A logistic regression analysis only identified an American Society of Anesthesia (ASA) classification > 2 (P < 0.001) and the presence of chronic bronchitis (P= < 0.05) as significant risk factors. In addition, 33% (8/24) of the patients who developed postoperative intraperitoneal sepsis and 30% (14/47) of the patients who underwent a reoperation developed RI. It was concluded that patients with a significant systemic disease (ASA > 2), as well as patients with chronic bronchitis, should be the recipients of intense efforts to prevent pulmonary complications after abdominal surgery.

Abuse of Drugs “for Kicks”: A Review of 252 Admissions

Abuse of drugs “for kicks” is becoming more common in Great Britain. This article reviews 252 consecutive cases of drug abuse admitted to the Regional Poisoning Treatment Centre, Royal Infirmary, Edinburgh, during 1971 and 1972. Of the 189 patients (146 males and 43 females; mean age 20 years) 72% of admissions occurred between 6 p.m. and 8 a.m., and Saturday was the most common day for admissions. The commonest source of referral was via the police or ambulance service. Barbiturates were the drugs most often abused, followed by LSD (lysergide) and Mandrax (methaqualone and diphenhydramine). Sixty-five per cent. of patients had previously abused drugs. Medical care was required in 45% of the admissions. Sixty per cent. were in social class 4 or 5 and psychiatric and social support was required in only a small minority of patients.

The Cost-Efficiency of Incentive Spirometry After Abdominal Surgery

This report gives the results of a cost-efficiency analysis of a prospective longitudinal study evaluating two forms of prophylaxis against postoperative pulmonary complications in 876 patients undergoing abdominal surgery. It cost

A Multivariate Analysis of the Risk of Pulmonary Complications After Laparotomy

12.19 per patient for conventional chest physiotherapy, and equivalent costs accrue when incentive spirometers are recycled and used on average 2.3 times (in the Royal Perth Hospital, incentive spirometers are recycled an average of 4.7 times). Maximum cost-containment can be achieved by carefully selecting patients for physical chest care and then instigating a programme of perioperative chest care utilizing recycled incentive spirometers. This approach does not compromise the clinical benefits of prophylactic chest care and allows physiotherapy resources to be directed toward patients with established pulmonary problems.