• Serge Baneton, Jérôme E Dauvergne, Charlene Gouillet, Emmanuelle Cartron, Christelle Volteau, Johanna Nicolet, Frederic Corne, and Bertrand Rozec.
• Service de kinésithérapie, hôpital Laënnec, CHU Nantes, Nantes, France.
• J. Cardiothorac. Vasc. Anesth. 2023 Sep 1; 37 (9): 166816761668-1676.

ObjectivesThe authors investigated the effect of active work with positive airway pressure (PAP) in addition to chest physiotherapy (CP) on pulmonary atelectasis (PA) in patients undergoing cardiac surgery with cardiopulmonary bypass.DesignA randomized controlled study.SettingAt a single-center tertiary hospital.ParticipantsEighty adult patients undergoing cardiac surgery (coronary artery bypass grafting, valve surgery, or both), and presenting with PA after tracheal extubation on postoperative days 1 or 2, were randomized from November 2014 to September 2016.InterventionThree days of CP, twice daily, associated with active work with PAP effect (intervention group) versus CP alone (control group). Pulmonary atelectasis was assessed by using the radiologic atelectasis score (RAS) measured from daily chest x-rays. All radiographs were reviewed blindly.Measurements And Main ResultsAmong included patients, 79 (99%) completed the trial. The primary outcome was mean RAS on day 2 after inclusion. It was significantly lower in the intervention group (mean difference and 95% CI: -1.1 [-1.6 to -0.6], p < 0.001). The secondary outcomes were the sniff nasal inspiratory pressure measured before and after CP and clinical variables. Sniff nasal inspiratory pressure was significantly higher in the intervention group on day 2 (7.7 [3.0-12.5] cmH2O, p = 0.002). The respiratory rate was lower in the intervention group (-3.2 [95% CI -4.8 to -1.6] breaths/min, p < 0.001) on day 2. No differences were found between the 2 groups for percutaneous oxygen saturation/oxygen requirement ratio, heart rate, pain, and dyspnea scores.ConclusionsActive work with the PAP effect, combined with CP, significantly decreased the RAS of patients undergoing cardiac surgery after 2 days of CP, with no differences observed in clinically relevant parameters.Copyright © 2023 Elsevier Inc. All rights reserved.

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