Prevention of postoperative respiratory complications

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Pulmonary complications are the most common cause of morbidity and mortality in the postoperative period; they occur in from 20% to 40% of patients after major abdominal or thoracic operations.1–3 The sequence of postoperative hypoventilation leading to atelectasis, bronchiolar or bronchial plugging with secretions, alveolar collapse, hypoxia, tachypnea, fever, and pneumonitis is familiar to all who care for patients during the postoperative period. The measures used to prevent or to lessen the threat of these complications vary. They include careful preoperative evaluation of pulmonary function and recognition of existing bronchopulmonary disease; discouragement of cigarette smoking during the preoperative period; training in deep breathing and coughing exercises; careful choice of anesthetic techniques; avoidance of excessive use of atropine or other sputum drying agents during the operative period; and a variety of measures employed during the postoperative period to encourage deep breathing, coughing, and the liquefaction of inspirated secretions.

For many years, one of us (R.E.H.) has employed “blow bottles” as a breathing device for use by patients during the postoperative period to encourage deep inspirations and alveolar expansion. Recently, a nursing directive ordered the replacement of “blow bottles” with balloons as a simpler and cheaper way to accomplish the same goals. This prospective change in hospital procedure challenged us to question the superiority of either device and the role of other measures in preventing postoperative respiratory complications.


Three types of postoperative respiratory measures were selected for study and comparison: (1) chest physiotherapy, (2) the use of “blow bottles,” or. . .



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