POSTOPERATIVE PHYSICAL THERAPY AFTER CORONARY-ARTERY BYPASS-SURGERY

Coronary artery bypass surgery is frequently complicated by postoperat ive atelectasis. Although routinely prescribed, the efficacy of any sp ecific chest physical therapy is not well established. We studied pati ents at a university center undergoing elective coronary artery bypass surgery. Based upon chest X-ray criteria at extubation, patients (n = 228) were classified as demonstrating greater or lesser degrees of at electasis. Those with a lesser degree of atelectasis were randomized t o receive either early mobilization or sustained maximal inflations (S MI). Those with greater a degree of atelectasis were separately random ized to receive either SMI or single-handed percussions (SSP). We foun d the extent of atelectasis at extubation did not predict the risk of developing pneumonia. Hospital stays and intensive care unit stays wer e similar regardless of treatment. Physical therapy costs were highest in the most labor-intensive therapy group (SSP). We conclude that pos toperative respiratory dysfunction is common but does not commonly cau se significant morbidity or prolong hospital stay. Adding SMI to patie nts with minimal atelectasis at extubation does not improve clinical o utcomes. Similarly, adding SSP to patients with marked atelectasis doe s not improve outcomes over those obtained with SMI and early ambulati on.