Analysis of the Clinical Effects of Pulmonary Rehabilitation Combined With Noninvasive Ventilation in Patients After Chest Surgery

Abstract

Background:

Pulmonary rehabilitation (PR) is a comprehensive intervention to help the patient to improve sputum clearance, promote lung expansion. Despite PR has been clinically applied to patients after surgery, the deep inspiration and cough are inhibited by postoperative pain. Furthermore, it may result in sputum retention and atelectasis and lead to pneumonia, delay the chest tube removal, and prolong hospitalization. Recently, some studies found noninvasive ventilation (NIV) use for patients after thoracic surgery was able to facilitate lung function recovery, decrease the duration of chest tube insertion, and shorten hospitalization. However, the effect of combination of PR and NIV for the patients after thoracic surgery remains unknown. Our study aimed to evaluate the clinical outcome of the patients who received PR and NIV compared to the patient receiving only PR after thoracic surgery.

Methods:

Our retrospective study enrolled totally 182 patients after thoracic surgery during 2015-2018. In all of the 182 patients, 97 patients received PR and others received both PR and NIV. In the patients receiving PR and NIV, we applied NIV twice daily since the second day after surgery. The duration of chest tube insertion and the days of hospitalization were assessed as clinical outcomes.

Results:

As for the duration of chest tube insertion due to thoracic diseases (including those related to the lungs and esophagus), there was no statistically difference between the two groups (6.64 ± 4.46 vs. 5.74 ± 2.75 days, P = .11). In the patients with only pulmonary diseases (excluding esophagus-related diseases), the average duration of chest tube insertion was significantly lower in the PR + NIV group, than the PR group (5.43 ± 2.30 vs. 6.62 ± 4.58 days, P = .03). In the days of hospitalization, there was no statistically difference between the PR group and the PR + NIV group (10.11 ± 6.32 vs. 8.60 ± 4.58 days, P = .07). When esophagus-related diseases were excluded, the days of hospitalization was significantly lower in the PR + NIV group than the PR group (7.75 ± 3.36 vs. 9.86 ± 6.48 days, P = .01).

Conclusions:

Our study found that the combination of PR and NIV did help to reduce the duration of chest tube insertion and shorten the days of hospitalization after pulmonary surgery. According to our study, patients after pulmonary surgery should receive PR and NIV as standard postoperative rehabilitation.