Breathing Exercises for Pulmonary Function of Post-laparotomy Patients .
Condition: Laparotomy Patients
Study type: Interventional

Summary: 
      The study is designed to compare the effects of blow bottle technique and interdigital
      exercises on the pulmonary functions of the post laparotomy patients where there is sudden
      decline in lung function and increased rate of complications after the surgery. A randomized
      control trial was conducted including post laparotomy patients, randomly allocated to
      interventional and control groups. Both the groups received breathing exercises along with
      conventional treatment during phase I rehabilitation. Data was collected at baseline, before
      and after every session and after 6 sessions before patient discharge from hospital. Outcome
      measures include assessment of lung volumes and capacities, oxygen saturation and vitals of
      the post laparotomy patients
    

Detailed description: 
      Pulmonary complications are common in post laparotomy patients because of multiple pre
      operative, intra operative and post operative factors. To manage these complications many
      interventions and breathing techniques are used. These complications alter the pulmonary
      function leading to decreased chest expansion, oxygen saturation and post operative
      atelectasis. Anesthetic drugs that also cause cardiac depression along with hemodynamic
      instability of the patient. Incision given to the chest or abdominal wall during procedure
      causes to lose the integrity of respiratory muscles which effects the functions of the muscle
      directly. Respiratory muscles are compromised, normal lung volumes are depressed. More than
      75% of patients who are receiving neuromuscular blocking agent develops atelectasis. The
      estimated time after surgery for patient to return to its preoperative health status is
      approximately 6 weeks. These complications increase the hospital length of stay and cost
      associated with it as well as increase the morbidity and mortality.

      Lung expansion techniques (LETs) are widely used to prevent postoperative pulmonary
      complications (PPCs). However, the effects of each of these techniques on thoraco-abdominal
      mechanics and PPC incidence after abdominal surgery remain unclear. Active Cycle of Breathing
      Techniques (ACBT) has shown to be effective in mobilizing and clearing the excess bronchial
      secretions and to improve lung function. It neither causes nor increases hypoxemia or
      increases airflow obstruction. Chest physiotherapy and breathing exercises are often
      prescribed to patients undergoing cardiac surgery and abdominal surgery in order to prevent
      or reduce post-operative pulmonary complications. There are different breathing techniques
      with and without mechanical devices after the surgery, but there is controversy regarding
      which breathing techniques are the most effective.

      Researches have proved change in pulmonary functions by the use of various breathing
      exercises. Depressed pulmonary functions i.e. decreased forced vital capacity (FVC) ,
      decreased forced expiratory volume (FEV1), Peak Expiratory Flow Rate (PEFR) are seen as
      result of disturbed lung function. Alteration in function of diaphragm contributes in
      postoperatively pulmonary function disturbances. Chest physiotherapy is implied for
      minimizing the altered lung functions and complications. This includes multiple breathing
      exercises, percussion , vibrations, huffing, coughing techniques, postural drainage and
      mobilization.

      The current study is conducted to compare two respiratory techniques for the improvement in
      post operative pulmonary function; because of incisional pain, patients find the inspiratory
      exercises difficult to perform, therefore, the study is conducted to assess if easy-to
      -perform expiratory techniques are similar in effect to the inspiratory techniques and for
      the said purpose comparison of blow bottle technique and interdigital breathing on post
      laparotomy patients is made for the improvement of pulmonary function and vitals of these
      patients.

      .
    

Intervention name(s): Interdigital exercise; Blow-Bottle technique
Intervention type(s): Other; Other
Intervention description(s): Patient asked to sit in upright position interlocking their fingers with inhaling deeply bringing the arms up and exhaling through mouth while bring the arm down.; For blow bottle 20cm of bottle filled with 10cm of water in which a tube of length 35- 40cm inserted with the inner diameter of ≥8mm(21).Patient is asked to form bubbles in bottle by exhaling in bottle performing Forced Expiratory Techniques.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Pulmonary function; Chest expansion; Laparotomy; Spirometry