Incentive spirometry for prevention of postoperative pulmonary complications in upper abdominal surgery

BackgroundThis is an update of a Cochrane Review first published in The Cochrane Library 2008, Issue 3.Upper abdominal surgical procedures are associated with a high risk of postoperative pulmonary complications. The risk and severity of postoperative pulmonary complications can be reduced by the judicious use of therapeutic manoeuvres that increase lung volume. Our objective was to assess the effect of incentive spirometry compared to no therapy or physiotherapy, including coughing and deep breathing, on all-cause postoperative pulmonary complications andmortality in adult patients admitted to hospital for upper abdominal surgery.ObjectivesOur primary objective was to assess the effect of incentive spirometry (IS), compared to no such therapy or other therapy, on postoperative pulmonary complications and mortality in adults undergoing upper abdominal surgery.Our secondary objectives were to evaluate the effects of IS, compared to no therapy or other therapy, on other postoperative complications, adverse events, and spirometric parameters.Search methodsWe searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 8), MEDLINE, EMBASE, and LILACS (from inception to August 2013). There were no language restrictions. The date of the most recent search was 12 August 2013. The original search was performed in June 2006.Selection criteriaWe included randomized controlled trials (RCTs) of IS in adult patients admitted for any type of upper abdominal surgery, including patients undergoing laparoscopic procedures.Data collection and analysisTwo authors independently assessed trial quality and extracted data.Main resultsWe included 12 studies with a total of 1834 participants in this updated review. The methodological quality of the included studies was difficult to assess as it was poorly reported, so the predominant classification of bias was 'unclear'; the studies did not report on compliance with the prescribed therapy. We were able to include data from only 1160 patients in the meta-analysis. Four trials (152 patients) compared the effects of IS with no respiratory treatment. We found no statistically significant difference between the participants receiving IS and those who had no respiratory treatment for clinical complications (relative risk (RR) 0.59, 95% confidence interval (CI) 0.30 to 1.18). Two trials (194 patients) IS compared incentive spirometry with deep breathing exercises (DBE). We found no statistically significant differences between the participants receiving IS and those receiving DBE in the meta-analysis for respiratory failure (RR 0.67, 95% CI 0.04 to 10.50). Two trials (946 patients) compared IS with other chest physiotherapy. We found no statistically significant differences between the participants receiving IS compared to those receiving physiotherapy in the risk of developing a pulmonary condition or the type of complication. There was no evidence that IS is effective in the prevention of pulmonary complications.Authors' conclusionsThere is low quality evidence regarding the lack of effectiveness of incentive spirometry for prevention of postoperative pulmonary complications in patients after upper abdominal surgery. This review underlines the urgent need to conduct well-designed trials in this field. There is a case for large RCTs with high methodological rigour in order to define any benefit from the use of incentive spirometry regarding mortality.

A new species of milk frog of the genus trachycephalus tschudi (anura, hylidae) from the amazonian rainforest

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

A new genus and two new species of Opilioacaridae (Acari: Parasitiformes) from Amazonia, Brazil with a key to world genera

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Pollen morphology of Fridericia Mart. (Bignoniaceae) from Brazilian forest fragments

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

On the shock performance of a nonlinear vibration isolator with high-static-low-dynamic-stiffness

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Two levels of the inspired oxygen fraction in propofol-anesthetized dogs with high intracranial pressure: cardiopulmonary function

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

CT study of the performance of reciprocating and oscillatory motions in flattened root canal areas

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Leaf and inflorescence peduncle anatomy: a contribution to the taxonomy of Rapateaceae

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Structural and optical properties of Cu2O crystalline electrodeposited films

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Mapeamento geológico, caracterização litoquímica e potencial econômico do corpo de cromitito de Cedrolina, Santa Terezinha de Goiás - GO

Studies of mafic-ultramafic bodies have been carried out through the years due to their great use on the interpretation of geochemical and geotectonic processes that took place in Earth's history. Amongst them, chromitites are notably recognized for being excellent indicators of their parental magma chemistry and of different geotectonic environments, as well for frequently containing associated noble metals mineralization. Thus the investigation of one of this ultramafic bodies that occurs inside the Pilar de Goiás Greenstone Belt was proposed, resulting in a detailed map of the chromitites and country rocks, as well as innumerous new data on the chemistry of chromite and associated matrix and accessory minerals. These studies were based upon geological field observations, optic and Scanning Electron Microscope (SEM), besides electron microprobe and cathodoluminescence analysis performed at the “Eugen F. Stumpfl Laboratory” of the Montanuniversität Institute of Resource Mineralogy, University of Leoben - Leoben, Austria. The chromitites are composed of 40-70% in volume of chromite (~50% on average), 14-55% of talc (~30% on average), 3-60% of chromium rich chlorite (~20% on average), traces to 4% of iron hydroxides and traces to 3% of rutile (1,5% on average). The chromite occurs as large spherical aggregates or as fine grained subhedral crystals disseminated in the matrix. This aggregates have diameters of 0.3-1.5 cm (1 cm on average) and are extremely well rounded, massive to intensively fractured, and commonly deformed to ellipsoids. When observed under the microscope, these aggregates show well rounded to slightly irregular borders, but on their interiors, these structures are represented by fine to medium grained euhedral to subhedral chromite crystals that have sharp contacts between themselves. The rock's matrix is basically made of chlorite and talc that define a metamorphic foliation (Sn), being the talc an alteration product ...

Efeito de Técnicas Osteopáticas Estruturais na Postura e Flexibilidade de Individuos com Escoliose Idiopática do Adolescente

Pós-graduação em Fisioterapia - FCT

Metodologia para identificação de áreas de risco e prioritárias para conservação da avifauna na bacia hidrográfica do rio Una, Ibiúna/SP

Pós-graduação em Ciências Ambientais - Sorocaba

Morfologia do primeiro estágio juvenil de quatro espécies de caranguejos Leucosioidea (Crustacea: Decapoda: Brachyura), com proposta de padronização para as descrições dos estágios iniciais em Decapoda

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Distribution and systematics of the freshwater genus Sirodotia (Batrachospermales, Rhodophyta) in North America

Multivariate morphometrics and image analysis were used to determine the number of well-delineated infrageneric taxa of Sirodotia in North America. Three groupings were distinguished from 25 populations examined from Newfoundland and Quebec in the north to central Mexico in the south. These groupings were statistically related to 10 type specimens, and the following species were recognized: Sirodotia huillensis (Welwitsch ex W. et G. S. West) Skuja (syn. S. ateleia Skuja), S. suecica Kylin (syn. S. acuminata Skuja ex Flint and S. fennica Skuja), and S. tenuissima (Collins) Skuja ex Flint. These species are differentiated on the basis of whorl shape and degree of separation at maturity (S. suecica, rounded and appressed; S. huillensis and S. tenuissima, truncated apex and separated), the density of spermatangia (S. huillensis, dense clusters, S. suecica and S. tenuissima, sparsely aggregated), and the mode of germination of the gonimoblast initial (S. suecica and S. tenuissima,from the nonprotuberant side of the fertilized carpogonium; S. huillensis from the protuberant side). Sirodotia huillensis was found only in the desert-chaparral, whereas S. suecica and S. tenuissima occurred from south-temperate to boreal regions in cool (temperature 8-18-degrees-C), low ion (specific conductance 10-99 muS.cm-1), and mildly acidic to neutral (pH 5.7-7.3) waters.

Níveis de lisina em dietas para reprodutores de Rhamdia voulezi em tanques-rede

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)