Effects of positive expiratory pressure and breath stacking training on pulmonary function in cardiac surgery patients: a randomized controlled trial

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Published: Aug 9, 2021
Keywords:
Positive expiratory pressure Breath stacking Chest physical therapy Cardiac surgery Pulmonary function

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Porraporn Sriwannawit
Department of Physical Therapy, Faculty of Medicine, Prince of Songkla University, Kho Hong, Hat Yai, Songkhla, Thailand.
Arisa Aimrat
Bangkok Hospital Phuket, Phuket, Thailand.
Phiyakan Piramruk
Betong Hospital, Betong, Yala, Thailand.
Theerathorn Sattayawinich
Theerathorn Physical Therapy Clinic, Songkhla, Thailand.
Kanokporn Pechjaroon
Yala Hospital, Yala, Thailand.
Waraporn Piyatham
Medical Rehabilitation Department, Vachira Phuket Hospital, Phuket, Thailand.
Poondharick Iaopanich
Baankanlapapruek Nursing Home, Bangkok, Thailand.
Korakot Onthet
Ranong Hospital, Ranong, Thailand.
Kotchakorn Kitnantakhun
Taksin Hospital, Surat Thani, Thailand.
Chalalai Damkrabi
Lake Terrace Resort, Satun, Thailand.
Phailin Thaworncheep
Department of Physical Therapy, Faculty of Medicine, Prince of Songkla University, Kho Hong, Hat Yai, Songkhla, Thailand.

Abstract

This study aimed to investigate the effects of adding positive expiratory pressure (PEP) and breath stacking (BS) training to routine chest physical therapy after cardiac surgery on pulmonary function (PF), respiratory muscle strength (RMS), and chest wall expansion (CWE) in comparison to receiving routine chest physical therapy alone. Thirty-four cardiac surgery patients were assigned randomly to either the PEP (n=10), BS (n=12), or control group (CON) (n=12). All participants received routine chest physiotherapy. The PEP training consisted of 5 breaths/set, 6 sets/session, 2 sessions/day for three days postoperatively via a BreathMAX device, while the BS training involved 5 breaths/set, 3 sets/session, 2 sessions/day for three days postoperatively. All participants were assessed for PF, RMS, and CWE. Results showed that after training, all groups showed a significant increase in force vital capacity, vital capacity, total lung capacity, and CWE (p-value < 0.01) compared to postoperative day 2. The PEP and CON groups also exhibited a significant increase in peak expiratory flow rate and forced expiratory volume in one second. Moreover, a significant increase in maximal inspiratory pressure and maximal expiratory pressure on postoperative day 5 was observed in the BS and CON groups compared to postoperative day 2. However, no significant differences between the groups were found. The three protocols were equally efficacious concerning PF recovery during the first 5 postoperative days. When compared with routine therapy, BS tended to yield greater RMS. Meanwhile, PEP tended to produce better PF and CWE than the other two techniques. Therefore, physiotherapists should consider post-operative management as a key role in these patients, especially when using the chest physical therapy technique, since this technique has different method and is beneficial for the reduction in post-operative complications.

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1.
Sriwannawit P, Aimrat A, Piramruk P, Sattayawinich T, Pechjaroon K, Piyatham W, Iaopanich P, Onthet K, Kitnantakhun K, Damkrabi C, Thaworncheep P. Effects of positive expiratory pressure and breath stacking training on pulmonary function in cardiac surgery patients: a randomized controlled trial. Arch AHS [Internet]. 2021 Aug. 9 [cited 2024 Nov. 18];33(3):16-28. Available from: https://he01.tci-thaijo.org/index.php/ams/article/view/249749
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Vol. 33 No. 3 (2021): September - December
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Original article
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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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