What are the specific procedures for deep breathing exercises to prevent postoperative pulmonary complications?

Specific Procedures for Deep Breathing Exercises to Prevent Postoperative Pulmonary Complications

Deep breathing exercises should be performed hourly while awake with a frequency of 30 deep breaths per hour to effectively prevent postoperative pulmonary complications, particularly in high-risk patients. 1

Patient Risk Assessment

• Patients at higher risk for postoperative pulmonary complications who would benefit most from deep breathing exercises include those with chronic obstructive pulmonary disease, age >60 years, ASA class II or greater, functional dependence, congestive heart failure, and low serum albumin (<35 g/L). 2
• Certain surgical procedures increase risk, including prolonged surgery (>3 hours), abdominal surgery, thoracic surgery, neurosurgery, head and neck surgery, vascular surgery, aortic aneurysm repair, emergency surgery, and procedures under general anesthesia. 2

Proper Deep Breathing Exercise Technique

• Instruct the patient to sit upright in bed or in a chair if possible, as this position allows for optimal lung expansion. 1, 3
• Have the patient place hands on the lower ribs or abdomen to feel the movement during breathing. 3
• Instruct the patient to inhale slowly and deeply through the nose, focusing on expanding the lower chest and abdomen rather than the upper chest. 1, 3
• Ask the patient to hold the breath for 2-3 seconds at maximum inspiration. 3
• Direct the patient to exhale slowly through pursed lips, taking about twice as long to exhale as to inhale. 3
• Repeat this cycle for a total of 30 deep breaths per hour while awake. 1

Implementation Schedule

• Begin deep breathing exercises as soon as possible after surgery, ideally within the first few hours of recovery. 1, 4
• Perform exercises hourly while awake for the first 24-72 hours post-surgery, depending on risk factors and recovery progress. 1
• Continue exercises until the patient is fully mobile and respiratory status has normalized. 4

Supportive Techniques

• Teach supported coughing technique: instruct the patient to splint the incision site with a pillow or folded blanket before coughing to minimize pain and improve effectiveness. 1
• Combine deep breathing exercises with early mobilization, progressing from moving in bed to sitting, standing, and walking as soon as medically indicated. 1, 5
• Consider using incentive spirometry in addition to deep breathing exercises, particularly for high-risk patients. 6, 7
• Ensure adequate pain management to facilitate effective deep breathing and coughing. 1

Common Pitfalls to Avoid

• Avoid relying solely on one intervention (e.g., incentive spirometry alone) instead of a multimodal approach. 1
• Do not delay mobilization, as early movement complements breathing exercises. 1, 5
• Ensure proper technique through demonstration and supervision rather than just verbal instruction. 1
• Avoid inadequate pain control, which can limit the patient's ability to take deep breaths. 1
• Do not routinely use nasogastric tubes unless specifically indicated for postoperative nausea, vomiting, or abdominal distention. 2

Special Considerations

• For patients with thoracic or upper abdominal incisions, provide additional support with pillows or splinting techniques to reduce pain during breathing exercises. 1, 5
• Consider positive expiratory pressure (PEP) devices on a case-by-case basis for patients with significant atelectasis or secretion retention. 1
• For patients with sickle cell disease, combine deep breathing exercises with incentive spirometry, chest physiotherapy, and early mobilization to prevent pulmonary complications. 2