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ORIGINAL PAPER
Directed cough manoeuvres in the early period after open abdominal surgery
1
Faculty of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
2
Department of General Surgery, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
Submission date: 2020-05-23
Acceptance date: 2020-08-31
Publication date: 2022-09-26
Physiother Quart. 2022;30(3):39-43
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Postoperative pulmonary complications are a common cause for morbidity and mortality after open abdominal surgery (OAS). Incisional pain and restrictive lung dysfunction may impair cough effectiveness, leading to secretion retention. Ineffective cough is a most important factor in the development of postoperative pulmonary complications. The aim of this study was to determine the most effective directed cough manoeuvre early after OAS.
Methods:
The study involved 41 patients (19 females, 22 males; median age: 44.0 years) who underwent OAS. Cough effectiveness was assessed by measuring peak cough flow on the 1st postoperative day with a portable flow meter in 4 different cough manoeuvres: (1) baseline cough 1: patients were asked to cough as effectively as possible; (2) supported cough; (3) supported cough after maximum inspiration; (4) baseline cough 2. Pain intensity during the measurements was evaluated with the Visual Numeric Scale (0–10).
Results:
When the 4 cough conditions were compared, peak cough flow was significantly different (p < 0.001). This difference was due to the superiority of supported cough after maximum inspiration in comparison with the other 3 manoeuvres (p < 0.001). Pain did not significantly differ among the 4 measurements (p = 0.869).
Conclusions:
Coughing with abdominal support after maximum inspiration in a semi-recumbent position provides the most effective cough flow after OAS, without increasing incisional pain intensity. Patients who underwent OAS should be encouraged to practise this manoeuvre in the early postoperative period in order to help bronchial drainage and prevent postoperative pulmonary complications.
Postoperative pulmonary complications are a common cause for morbidity and mortality after open abdominal surgery (OAS). Incisional pain and restrictive lung dysfunction may impair cough effectiveness, leading to secretion retention. Ineffective cough is a most important factor in the development of postoperative pulmonary complications. The aim of this study was to determine the most effective directed cough manoeuvre early after OAS.
Methods:
The study involved 41 patients (19 females, 22 males; median age: 44.0 years) who underwent OAS. Cough effectiveness was assessed by measuring peak cough flow on the 1st postoperative day with a portable flow meter in 4 different cough manoeuvres: (1) baseline cough 1: patients were asked to cough as effectively as possible; (2) supported cough; (3) supported cough after maximum inspiration; (4) baseline cough 2. Pain intensity during the measurements was evaluated with the Visual Numeric Scale (0–10).
Results:
When the 4 cough conditions were compared, peak cough flow was significantly different (p < 0.001). This difference was due to the superiority of supported cough after maximum inspiration in comparison with the other 3 manoeuvres (p < 0.001). Pain did not significantly differ among the 4 measurements (p = 0.869).
Conclusions:
Coughing with abdominal support after maximum inspiration in a semi-recumbent position provides the most effective cough flow after OAS, without increasing incisional pain intensity. Patients who underwent OAS should be encouraged to practise this manoeuvre in the early postoperative period in order to help bronchial drainage and prevent postoperative pulmonary complications.
REFERENCES (19)
1.
Haines KJ, Skinner EH, Berney S. Association of postoperative pulmonary complications with delayed mobilisation following major abdominal surgery: an observational cohort study. Physiotherapy. 2013;99(2):119–125; doi: 10.1016/j.physio.2012.05.013.
2.
Colucci DBB, Fiore JF Jr, Paisani DM, Risso TT, Colucci M, Chiavegato LD, et al. Cough impairment and risk of postoperative pulmonary complications after open upper abdominal surgery. Respir Care. 2015;60(5):673–678; doi: 10.4187/respcare.03600.
3.
Smith MCL, Ellis ER. Is retained mucus a risk factor for the development of postoperative atelectasis and pneumonia? – Implications for the physiotherapist. Physiother Theory Pract. 2000;16(2):69–80; doi: 10.1080/095939800407268.
4.
McCool FD. Global physiology and pathophysiology of cough: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1 Suppl.):48S–53S; doi: 10.1378/chest.129.1_suppl.48S.
5.
Fink JB. Forced expiratory technique, directed cough, and autogenic drainage. Respir Care. 2007;52(9):1210–1221.
6.
AARC clinical practice guideline. Directed cough. American Association for Respiratory Care. Respir Care. 1993;38(5):495–499.
7.
Fiore JF Jr, Chiavegato LD, Denehy L, Paisani DM, Faresin SM. Do directed cough maneuvers improve cough effectiveness in the early period after open heart surgery? Effect of thoracic support and maximal inspiration on cough peak expiratory flow, cough expiratory volume, and thoracic pain. Respir Care. 2008;53(8):1027–1034.
8.
Torres-Castro R, Monge G, Vera R, Puppo H, Céspedes J, Vilaró J. Therapeutic strategies to increase the effectiveness of cough [in Spanish]. Rev Med Chil. 2014;142(2):.
10.
Niimi A, Matsumoto H, Ueda T, Takemura M, Suzuki K, Tanaka E, et al. Impaired cough reflex in patients with recurrent pneumonia. Thorax. 2003;58(2):152–153; doi: 10.1136/thorax.58.2.152.
11.
Dilworth JP, Pounsford JC, White RJ. Cough threshold after upper abdominal surgery. Thorax. 1990;45(3):207–209; doi: 10.1136/thx.45.3.207.
12.
Gayat E, Lecarpentier E, Retout S, Bedairia E, Batallan A, Bonay M, et al. Cough reflex sensitivity after elective Caesarean section under spinal anaesthesia and after vaginal delivery. Br J Anaesth. 2007;99(5):694–698; doi: 10.1093/bja/aem228.
13.
Fry DL, Hyatt RE. Pulmonary mechanics. A unified analysis of the relationship between pressure, volume and gasflow in the lungs of normal and diseased human subjects. Am J Med. 1960;29:672–689; doi: 10.1016/0002-9343(60)90100-5.
14.
Mahajan RP, Singh P, Murty GE, Aitkenhead AR. Relationship between expired lung volume, peak flow rate and peak velocity time during a voluntary cough manoeuvre. Br J Anaesth. 1994;72(3):298–301; doi: 10.1093/bja/72.3.298.
15.
Sivasothy P, Brown L, Smith IE, Shneerson JM. Effect of manually assisted cough and mechanical insufflation on cough flow of normal subjects, patients with chronic obstructive pulmonary disease (COPD), and patients with respiratory muscle weakness. Thorax. 2001;56(6):438–444; doi: 10.1136/thorax.56.6.438.
16.
Cheifetz O, Lucy SD, Overend TJ, Crowe J. The effect of abdominal support on functional outcomes in patients following major abdominal surgery: a randomized controlled trial. Physiother Can. 2010;62(3):242–253; doi: 10.3138/physio.62.3.242.
17.
Arici E, Tastan S, Can MF. The effect of using an abdominal binder on postoperative gastrointestinal function, mobilization, pulmonary function, and pain in patients undergoing major abdominal surgery: a randomized controlled trial. Int J Nurs Stud. 2016;62:108–117; doi: 10.1016/j.ijnurstu.2016.07.017.
18.
Saeed S, Rage KA, Memon AS, Kazi S, Samo KA, Shahid S, et al. Use of abdominal binders after a major abdominal surgery: a randomized controlled trial. Cureus. 2019;11(10):e5832; doi: 10.7759/cureus.5832.
19.
Cachemaille M, Grass F, Fournier N, Suter MR, Demartines N, Hübner M, et al. Pain intensity in the first 96 hours after abdominal surgery: a prospective cohort study. Pain Med. 2020;21(4):803–813; doi: 10.1093/pm/pnz156.
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