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Clinical Evidence



Clinical Evidence in Anaesthesia

Clinical Evidence is a monthly, updated directory of evidence on the effects of common clinical interventions, published by the BMJ Publishing Group. It provides a concise account of the current state of knowledge, ignorance, and uncertainty about the prevention and treatment of a wide range of clinical conditions based on thorough searches of the literature. It deliberately does not make recommendations. It summarises the best available evidence, and where there is no good evidence, it says so. 

 would like to thank Clinical Evidence for granting permission for the display of a synopsis of their findings in Perioperative Care. For comprehensive details and explanations about the above findings, please refer to the Clinical Evidence site. This section will be updated as new findings are released from Clinical Evidence.

© BMJ Publishing Group Ltd 2003
Click here for PDA version

Clinical evidence topic on Postoperative Pulmonary Infections

Summary of Interventions

Beneficial
Postoperative chest physiotherapy (deep breathing exercises)                        
Epidural anaesthesia

Likely to be beneficial
Postoperative chest physiotherapy (incentive spirometry and intermittent positive pressure breathing)

Unknown effectiveness
Advice to stop smoking preoperatively

Key Messages  

Postoperative chest physiotherapy (deep breathing exercises) One systematic review and one subsequent RCT have found that deep breathing exercises reduce postoperative pulmonary infections compared with control.

References

1.  Celli BR et al. A controlled trial of intermittent positive pressure breathing, incentive spirometry, and deep breathing exercises in preventing pulmonary complications after abdominal surgery. Am Rev Respir Dis 1984;130:12–15. 
 
2.Thomas JA et al. Are incentive spirometry, intermittent positive pressure breathing and deep breathing exercises effective in the prevention of postoperative pulmonary complications after upper abdominal surgery? A systematic overview and meta-analysis. Phys Ther 1994;74:3–16. 
 
3.  Overend TJ et al The effect of incentive spirometry on postoperative pulmonary complications: a systematic review. Chest 2001;120:971–978.  

4.  Fagevik-Olsen M et al. Randomized controlled trial of prophylactic chest physiotherapy in major abdominal surgery. Br J Surg 1997;84:1535–1538. 

5.  Stiller K et al. Efficacy of breathing and coughing exercises in the prevention of pulmonary complications after coronary artery surgery. Chest 1994;105:741–747.

Epidural anaesthesia Two systematic reviews have found that epidural anaesthesia with or without postoperative epidural analgesia reduces postoperative pulmonary infections compared with general anaesthesia with or without postoperative systemic analgesia. Neither review sought data on adverse effects. Subsequent and additional RCTs found inconsistent results.

References

1.  Rodgers A et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ 2000;321:1493–1497.  

2.  Ballantyne JC et al. The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analyses of randomized controlled trials. Anesth Analg 1998;86:598–612
 
3.  Jayr C et al. Postoperative pulmonary complication: epidural analgesia using bupivacaine and opioids versus parenteral opioids. Anesthesiology 1993;78:666–676

4.  Logas W et al. Continuous thoracic epidural analgesia for postoperative pain relief following thoracotomy: a randomized prospective study. Anesthesiology 1987;67:787–791

5.  Auroy Y et al. Serious complications related to regional anesthesia. Anesthesiology 1997;87:479–486

6.  Scott DA et al. Postoperative analgesia using epidural infusions of fentanyl with bupivacaine. Anesthesiology 1995;83:727–737

7.  Shah JL. Postoperative pressure sores after epidural anaesthesia

Postoperative chest physiotherapy (incentive spirometry and intermittent positive pressure breathing) Two RCTs found that incentive spirometry reduced pulmonary complications compared with control. One RCT found that intermittent positive pressure breathing reduced postoperative pulmonary complications compared with control.

References

1.  Celli BR, Rodriguez KS, Snider GL. A controlled trial of intermittent positive pressure breathing, incentive spirometry, and deep breathing exercises in preventing pulmonary complications after abdominal surgery. Am Rev Respir Dis 1984;130:12–15

2.  Thomas JA, McIntosh JM. Are incentive spirometry, intermittent positive pressure breathing and deep breathing exercises effective in the prevention of postoperative pulmonary complications after upper abdominal surgery? A systematic overview and meta-analysis. Phys Ther 1994;74:3–16.

25.  Overend TJ, Anderson C, Lucy, SD, et al The effect of incentive spirometry on postoperative pulmonary complications: a systematic review. Chest 2001;120:971–978

26.  Fagevik-Olsen M, Hahn I, Nordgren S, et al. Randomized controlled trial of prophylactic chest physiotherapy in major abdominal surgery. Br J Surg 1997;84:1535–1538

27.  Stiller K, Montarello J, Wallace M, et al. Efficacy of breathing and coughing exercises in the prevention of pulmonary complications after coronary artery surgery. Chest 1994;105:741–747.

Advice to stop smoking preoperatively We found no RCTs about the effects of preoperative advice to stop cigarette smoking on postoperative pulmonary infections. Two observational studies found that people who smoked were more likely to develop postoperative pulmonary complications of all kinds than those who did not. One study suggested that people who had stopped smoking 6 months preoperatively reverted to the risk of those who had never smoked.

References

1.  Hall JC, Tarala RA, Hall JL, et al. A multivariate analysis of the risk of pulmonary complications after laparotomy. Chest 1991;99:923–927

2.  Møller A, Villebro N, Pedersen T. Interventions for preoperative smoking cessation. In: The Cochrane Library, Issue 1, 2002. Oxford: Update Software. 

3.  Warner MA, Offord KP, Warner ME, et al. Role of preoperative cessation of smoking and other factors in postoperative pulmonary complications: a blinded prospective study of coronary artery bypass patients. Mayo Clin Proc 1989;64:609–616

4.  Bluman LG, Mosca L, Newman N, et al. Preoperative smoking habits and postoperative pulmonary complications. Chest 1998;113:148–152.




                                                                                                       




 






 
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