Implementation of A Perioperative Respiratory Care Bundle to Improve Respiratory Outcomes Following Major Abdominal Surgery

Abstract

Postoperative pulmonary complications (PPCs) commonly occur following major abdominal surgery. There are different approaches to manage and minimise PPCs of which is respiratory physiotherapy. Enhanced Recovery After Surgery (ERAS) approached is currently considered within perioperative practice to enhance recovery and decrease postoperative complications in general. However, there a few interventions targeting PPCs in particular within ERAS. Therefore, the aim of this thesis is to implement a perioperative respiratory care bundle that improves postoperative respiratory outcomes following major abdominal surgery.

Three studies were conducted in this thesis in order to find best respiratory care interventions that would be included within the bundle by a systematic review and meta-analysis (chapter 2), investigate the need for improvement in perioperative practice by an observational study (chapter 3) and investigate the success of the implemented bundle by a quality improvement study (chapter 4). The incidence of PPCs was extremely high in local hospital and was associated with increased morbidities and length of stay. The proposed perioperative respiratory care bundle to be implemented, being called I-COUGH Plus, includes Incentive Spirometry (IS) plus Inspiratory Muscle Trainer (IMT), coughing and deep breathing, oral hygiene, understanding, get out of bed, head of bed elevated. The I-COUGH Plus was proposed aiming to improve respiratory muscle strength and patient outcomes postoperatively. Preliminary results showed that I-COUGH Plus has no effect on improving respiratory muscles and decreasing PPCs. However, I-COUGH Plus is still considered within perioperative practice hoping to show its effectiveness after recruiting sufficient number of patients.