Short-term respiratory physical therapy treatment in the PACU and influence on postoperative lung function in obese adults.

BACKGROUND: Even several days after surgery, obese patients exhibit a measureable amount of atelectasis and thus are predisposed to postoperative pulmonary complications. Particularly in ambulatory surgery, rapid recovery of pulmonary function is desired to ensure early discharge of the obese patient. In this study, we wanted to evaluate intensive short-term respiratory physical therapy treatment (incentive spirometry) in the postanesthesia care unit (PACU) and its impact on pulmonary function in the obese. METHODS: After ethics committee approval and informed consent, we prospectively studied 60 obese patients (BMI 30-40) undergoing minor peripheral surgery, half of which were randomly assigned to receive respiratory physiotherapy during their PACU stay, while the others received routine treatment. Premedication, general anesthesia, and respiratory settings were standardized. We measured arterial oxygen saturation by pulse oximetry on air breathing. Inspiratory and expiratory lung functions were measured preoperatively (baseline) and at 10 min, 1, 2, 6, and 24 h after extubation, with the patient supine, in a 30 degrees head-up position. The two groups were compared using repeated-measure analysis of variance and t test analysis. Statistical significance was considered to be P < 0.05. RESULTS: There were no differences at the first assessment, but, during the PACU stay, pulmonary function in the physiotherapy group was significantly better than the controls' (p < 0.0001), an effect which persisted for at least 24 h after surgery (p < 0.009). CONCLUSION: Short-term respiratory physiotherapy during the PACU stay promotes more rapid recovery of postoperative lung function in the obese during the first 24 h.