Effectiveness of Incentive Spirometer and Diaphragmatic Breathing Exercise on ABG Measures in Post-CABG Patients
Condition: Post Coronary Artery Bypass Grafting
MeSH terms: Respiratory Aspiration
Study type: Interventional

Summary: 
      The rate of pulmonary complications following Coronary artery bypass graft (CABG) is high.
      Early pulmonary exercises are important in preventing this complication following cardiac
      surgery. This study aimed to investigate the effectiveness of incentive spirometer (IS) and
      diaphragmatic breathing exercise (DBE) on the alteration of arterial blood gas (ABG)
      measures. The study was based on a two-arm, parallel-group, randomized comparative design.
      Thirty patients who underwent CABG enrolled in the study based on inclusion and exclusion
      criteria, randomly allocated into either of the groups, IS Group or DBE Group. IS Group and
      DBE Group underwent chest physiotherapy with IS and DBE, respectively. ABG measures,
      including PH of blood, partial pressure of arterial oxygen molecule (PaO2), and partial
      pressure of arterial carbon dioxide (PaCO2), was assessed using an ABG analyzer at baseline
      (pre-operation), day1 post-operation, and day2 post-operation. The significance level was
      kept constant for all statistical analyses at 95%.
    

Detailed description: 
      Coronary artery bypass graft (CABG) is one of common treatment procedures performed
      worldwide. Evidence suggest that every year more than 1 million CABG procedure has been
      performed. Pulmonary complications are one of the most common consequence post CABG.

      The incidence of atelectasis after heart operation with cardiopulmonary bypass is still
      80-84% in spite of careful fluid & respiratory management. The basic problem in respiratory
      care of post-surgical patient is atelectasis leading to hypoxemia causing alteration in
      arterial blood gases (ABGs). Associated with atelectasis are widening alveolar - arterial O2
      gradient (as right to left intrapulmonary shunting increases) decrease ventilation perfusion
      ratio, decrease functional residual capacity and decrease compliance. Chest physiotherapy is
      routinely used after major abdominal & cardiothoracic surgery to prevent these pulmonary
      complications following operation.

      To date, there is a variable view about the effectiveness of these two primary breathing
      exercise techniques (incentive spirometer and diaphragmatic breathing exercise). 10-12 Hence
      an effort to systematically study the effectiveness of these is attempted. Thus, the current
      study aimed to determine the efficacy of incentive spirometer and diaphragmatic breathing
      exercises in addition to conventional chest physiotherapy on alteration of ABG measures in
      patients with post CABG. This study hypothesized that there will be a significant difference
      between the effect of the IS and DBE on ABG alteration in post CABG patients.
    

Intervention name(s): Incentive spirometer plus Chest physiotherapy; Diaphragmatic breathing exercise plus Chest physiotherapy
Intervention type(s): Other; Other
Intervention description(s): Incentive spirometer was given to IS group. However, a conventional chest physiotherapy was given to both groups in the optimal position.; Diaphragmatic breathing exercise was given to DBE group. In addition, a conventional chest physiotherapy was given in the optimal position.
Other intervention name(s): Huffing, Coughing, Upper and lower limbs active exercises; Huffing, Coughing, Upper and lower limbs active exercises
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Chest Physiotherapy; Incentive spirometer; Diaphragmatic breathing