Effectiveness of Preoperative Chest Physiotherapy in Patients Undergoing Elective Cardiac Surgery, a Systematic Review and Meta-Analysis

Abstract

Background and Objectives: Patients undergoing cardiac surgery are particularly vulnerable for developing postoperative pulmonary complications (PPCs). This systematic review and meta-analysis aimed to evaluate the role of preoperative chest physiotherapy in such patients. Materials and Methods: All original articles that assessed patients undergoing elective cardiac surgery, with preoperative chest physiotherapy, and compared them to patients undergoing elective cardiac surgery, without preoperative chest physiotherapy, were included. Animal studies, studies conducted prior to the year 2000, commentaries, or general discussion papers whose authors did not present original data were excluded. Studies assessing physiotherapy regimens other than chest physiotherapy were also excluded. The search was performed using the following electronic resources: the Cochrane Central Register of Controlled Trials, the PubMed central database, and Embase. The included studies were assessed for potential bias using the Cochrane Collaboration's tool for assessing the risk of bias. Each article was read carefully, and any relevant data were extracted. The extracted data were registered, tabulated, and analyzed using Review Manager software. Results: A total of 10 articles investigating 1458 patients were included in the study. The studies were published from 2006 to 2019. The populations were patients scheduled for elective CABG/cardiac surgery, and they were classified into two groups: the interventional (I) group, involving 651 patients, and the control (C) group, involving 807 patients. The meta-analysis demonstrated no significant differences between the interventional and control groups in surgery time and ICU duration, but a significant difference was found in the time of mechanical ventilation and the length of hospital stay, favoring the interventional group. A significant difference was shown in the forced expiratory volume in 1s (FEV1% _predicted), forced vital capacity (FVC% _predicted), and maximum inspiratory pressure (Pi-max), favoring the interventional group. Conclusions: This study is limited by the fact that one of the included ten studies was not an RCT. Moreover, due to lack of the assessment of certain variables in some studies, the highest number of studies included in a meta-analysis was the hospital stay length (eight studies), and the other variables were analyzed in a fewer number of studies. The data obtained can be considered as initial results until more inclusive RCTs are conducted involving a larger meta-analysis. However, in the present study, the intervention was proved to be protective against the occurrence of PPCs. The current work concluded that preoperative chest physiotherapy can yield better outcomes in patients undergoing elective cardiac surgery.

Keywords: elective cardiac surgery; postoperative pulmonary complications; preoperative chest physiotherapy; pulmonary functions.

Figure 1

PRISMA study selection flow chart.

Figure 2

Forest plot evaluating surgery time in the included studies.

Figure 3

Forest plot evaluating ICU duration stay in the included studies.

Figure 4

Forest plot evaluating mechanical ventilation duration in the included studies.

Figure 5

Forest plot evaluating hospital stay length in the included studies.

Figure 6

Forest plot evaluating FEV1% _predicted in the included studies.

Figure 7

Forest plot evaluating FVC% _predicted in the included studies.

Figure 8

Forest plot evaluating Pi-max in the included studies.

Figure 9

Forest plot evaluating PPCs in the included studies.

Figure 10

Funnel plot for the PPCs incidences reported by the studies.

Figure 11

Risk of bias graph for the included studies.

Figure 12

Risk of bias summary for the included studies. A square with a green circle means low risk, a square with a red circle means high risk, and an empty square indicates unclear risk.