Proper method for preoperative chest preparation of patients listed for cardiac surgery

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Postoperative pulmonary complication (PCCs) after cardiac surgery are a major source of morbidity and mortality, and increase length of hospital stay and resource utilization. The preoperative including prehospitlization period before CARDIAC surgery maybe used to improve a patients pulmonary condition. The efficacy of preoperative non-invasive CPAP and BIPAP machine use, chest physiotherapy (CPT) and postural drainage, frequent nebulization plus inspiratory muscle training (IMT) in reducing the incidence of PPCs in high-risk patients undergoing CARDIAC surgery has not yet been determined. To evaluate the prophylactic efficacy of our new preoperative chest preparation strategy (strategy A) on the incidence of PPCs in high risk patients scheduled for elective CARDIAC surgery compared with classic routinely used one (Strategy B). A single blind, randomized clinical trial conducted at the Cardiac Center of Kind Fahad Armed forces Hospital, Jeddah, Saudi Arabia, with the enrollment between November 2011 and October 2012. Of 500 patients referred for elective CARDIAC surgery, 100 (20%) met criteria for high risk of developing PPCs, of whom were enrolled and followed up until discharge from hospital after dividing him to two groups, our new preoperative chest preparation strategy group (group A) and classic routinely used group (group B). Patients were randomly assigned to receive either preoperative strategy (n = 50) or usual care B strategy (n = 50). Both groups received the postoperative physical therapy. Incidence of PPCs especially pneumonia, duration of postoperative intubation and invasive ventilation, Intensive Care Unit (ICU) stay and hospitalization incidence of requiring re-intubation and impact of both strategies on postoperative patient compliance to respiratory therapy. Both groups were comparable at baseline. After CARDIAC surgery, PPCs were present in 10 (20%) of patients in the A group and 25 (50%) of patients B group. Pneumonia occurred in 5 (10%) of patients in the A group and in 7 (14%) of patients in the B (OR 95% CI). Median days range 6–18 days in the B group. Finally, postoperative patients compliance to respiratory therapy was significantly improved. Preoperative A strategy reduced the incidence of PPCs an duration of postoperative hospitalization in patients at high risk of developing pulmonary complication undergoing CARDIAC surgery. Also, postoperative patient compliance to respirartory therapy was significantly improved.