THE EFFECT OF PHYSICAL THERAPY ON RESPIRATORY COMPLICATIONS FOLLOWINGCARDIAC-VALVE SURGERY

Study objective: To determine whether higher personnel intensive chest physical therapy can prevent the atelectasis that routinely follows c ardiac valve surgery. Design: Randomized, controlled trial. Setting: T ertiary care hospital. Patients: Seventy-eight patients undergoing ele ctive cardiac valve surgery between October 1991 and April 1993 were e nrolled. Interventions: Patients were randomized in an unmasked fashio n to receive early mobilization and sustained maximal inflations (lowe r-intensity treatment) or to receive early mobilization, sustained max imal inflations, and single-handed percussions (higher-intensity treat ment). Measurements and results: Clinical efficacy was determined by e xtent of atelectasis, length of ICU stay, total length of hospital sta y, and personnel costs. The extent of postoperative atelectasis was si milar in both groups on the fifth postoperative day, Postoperative val ues of FVC and FEV(1) were reduced to a similar extent in both groups, Hospital stays and ICU stays were similar regardless of treatment, Ph ysical therapy costs were highest in the higher-intensity therapy grou p. Conclusions: Postoperative respiratory dysfunction is common but do es not usually cause significant morbidity or prolong hospital stay, T he routine prescription of high-intensity physical therapy does not im prove patient outcomes but does add significantly to patient costs.