POSTOPERATIVE INTERMITTENT POSITIVE-PRESSURE BREATHING TREATMENTS PHYSIOLOGICAL CONSIDERATIONS

Abstract

Comment: There are many factors involved in the development of postoperative pulmonary complications, but only 2 schools of thought have been generally adopted in their prevention and treatment. In the United Kingdom, the chest physiotherapist is intimately involved with the patient prior to and immediately after surgery. They teach and gently persuade the patient to breathe deeply and cough, and with percussion secretions are mobilized into the major bronchi and trachea and thus are more readily expectorated. This all takes a great deal of time, and success is to a great extent dependent, not only on the skill of the therapist, but also on the rapport she is able to establish with the patient. A bright and understanding personality, combined with firmness and encouraging patter, are desirable. The patient welcomes the attention and a significant relationship develops. Often valuable information is confided to the physiotherapist that has eluded the nursing and medical staff. IPPB or inhalational therapy has not on the whole gained the widespread popularity and acceptance in the United Kingdom as in the United States. The visitor to a U. S. Hospital is impressed with the size of the organization, the equipment available, and the number of treatments carried out daily. The enthusiasm of the therapists and patient for this form of treatment appear to be unchallengeable. McConnell et al. have tried to compare both techniques, using changes in transpulmonary “pressure to indicate effectiveness. Interestingly enough, they found no appreciable difference in a small series. Results achieved using an incentive spirometer were more impressive. In view of these results, the authors question the enormous financial costs of a form of therapy which is no more effective than simple encouragement or incentive spirometry, with considerable financial savings. I cannot fault the rationale of the physiologic considerations, but before accepting these radical conclusions I should like the 3 techniques to be assessed on a pathologic basis. Perhaps to satisfy the chemotherapeutic enthusiasts, respiratory stimulants such as doxapram should also be considered.