Denehy 2001.
| Methods | RCT done at Austin and Repatriation Medical Centre, Melbourne, Australia | |
| Participants | Adult patients undergoing upper abdominal surgery. Inclusion criteria: incision above the umbilicus; FEV1 greater than 50% predicted | |
| Interventions | All participants received preoperative education on effects of surgery on lung function and were instructed on deep breathing exercises, including sustained maximal inspiration Post surgery, all participants received physiotherapy twice daily for 3 days, for a minimum of 10 minutes each session. This traditional physiotherapy consisted of deep breathing exercises, forced expiration technique and supported cough. Early ambulation was encouraged, and physiotherapy was done in the sitting position on bed or chair Control group: received the above traditional physiotherapy Intervention groups (CPAP, 15 minutes; CPAP, 30 minutes): nasal mask for CPAP, PEEP set at 10 cm H2O. 30% O2 was used for CPAP. This was given 4 times each day, following traditional physiotherapy Control group: 18 participants; male/female: 15:3; age, years: 73.3 ± 5.8; no data on BMI Intervention group (2 groups combined): 17 and 15 participants; male/female: 12:5 and 12:3; age, years: 72.5 ± 6.5 and 70.5 ± 6.3; no data on BMI |
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| Outcomes | Duration of intervention: 3 postoperative days Duration of follow‐up: at least 5 days No differences in pain scores between groups All‐cause mortality: 1 participant died after 32 days, but no details of surgical complications are given Major respiratory complications as defined in individual studies: Postoperative pulmonary complications: control, 4/18; intervention, 2/17 and 1/15 Significant atelectasis: not reported Pneumonia: not reported ("chest radiograph changes" reported but not significant (88% control group, 58.5% intervention group)) Respiratory failure: not reported Severe hypoxia: not reported Severe delirium: not reported Need for tracheal intubation and invasive ventilation: not reported Readmission to ICU/IMC: intervention group: not reported Length of stay in hospital, days: control group, 12.3 ± 4.8; intervention group, 11.5 ± 4.1 and 12.5 ± 4.8 Cardiovascular complications (myocardial infarction, unstable angina, acute cardiac failure, arrhythmia): none reported Cardiac arrest: not reported Other postoperative complications (wound infection, anastomotic leak, renal failure): not reported Adverse effects of the intervention (pulmonary aspiration, upper airway or facial injury): not reported |
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| Notes | BMI = body mass index CPAP = continuous positive airway pressure FEV1 = forced expiratory volume in 1 second ICU = intensive care unit IMC = intermediate care unit PEEP = positive end‐expiratory pressure RCT = randomized controlled trial |
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| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Randomly allocated into 3 groups with use of sealed envelopes |
| Allocation concealment (selection bias) | Low risk | Randomly allocated into 3 groups with use of sealed envelopes, but no details of allocation concealment provided |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | Not discussed, but physiotherapists blinded to FRC (functional residual capacity) values, so only partially blinded |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | Only radiologist possibly blinded (partial blinding only) |
| Incomplete outcome data (attrition bias) All outcomes | Unclear risk | Not described, but only those who completed 5 days of lung volume measurements (40/50) were included in FRC and VC (vital capacity) analyses |
| Selective reporting (reporting bias) | High risk | Poor reporting of participant demographics (no weight) and no details on complications |
| Other bias | Unclear risk | Not sure |