A Prospective Comparison of Three Procedures Used in Attempts To Prevent Postoperative Pulmonary Complications

The treatments used for prevention of postoperative pulmonary complications have included many respiratory therapy maneuvers designed to help a patient attain intermittent deep breaths. Three methods advocated to achieve these deep breaths are volume-oriented intermittent positive-pressure breathing (IPPB), incentive spirometry (IS), and a turn, cough, hyperventilate (TCH) procedure. We devised a study comparing these three techniques, with 100 surgical patients preoperatively assigned at random to each of the three methods. Pulmonary complications were defined by abnormal chest radiographs obtained 72 hours postoperatively. Of the variables monitored during the study, only three were related to the development of complications: a surgical site near the diaphragm, a positive smoking history, and a marked decrease in forced vital capacity after surgery. Compared to the other two therapy procedures, IS was associated with a lower incidence of postoperative complications, but the difference was nonsignificant (P > .05).