Difference between continuous positive airway pressure via mask therapy and incentive spirometry to treat or prevent post-surgical atelectasis

OBJECTIVE: To assess the effect of early use of continuous positive airway pressure (CPAP) therapy to treat or prevent acute atelectasis in post-operative cardiac patients particularly smokers and elderly patients.

METHODS: A pilot study suggested enrolling at least 32 participants in each group to be significant. One hundred and eight patients from King Fahd Armed Forces Hospital, Jeddah, Kingdom of Saudi Arabia who met the inclusion criteria participated in this study conducted between March 2010 and March 2011. The participants were divided randomly into 3 groups, incentive spirometry (IS) therapy, and CPAP therapy every 2 (CPAP2hrs), or 4 hours (CPAP4hrs). Inspiratory capacity (IC) was used to compare the 3 therapy regimes. Simultaneously, respiratory rate (RR), heart rate (HR) and oxygen saturation (SpO2) were measured for all groups. Failure was defined as requiring intubation, bi-level positive airway pressure, or added chest physiotherapy.

RESULTS: Thirty-six patients participated in each group (98 male and 10 female, with a mean age of 62+/-9.3 years). The IC increased significantly in the CPAP2hrs group when compared with the control group or the CPAP4hrs group. The SpO2 decreased significantly in the control group and the CPAP4hrs groups when compared with the CPAP2hrs group. Also, there were no significant differences in RR and HR between all groups.

CONCLUSION: Early use of CPAP via mask therapy for half an hour every 2 hours had better outcomes to re-open collapsed alveoli after cardiac surgery.