An Assessment of Balloon Spirometer as an Aid in Chest Physiotherapy

Dr. S.K. Dwivedi¹*, Kiran Patel², Somashekar Uday³ and Adile S.L.⁴

¹Assistant Professor and H.O.D. Physiology, Govt. Medical College, Jagdalpur

²Associate Professor, Physiology, NSCB Medical College, Jabalpur

³Associate Professor, Surgery, NSCB Medical College, Jabalpur

⁴Dean, Govt. Medical College, Jagdalpur (Bastar)

*Corresponding Author E-mail: drskd05@rediffmail.com

ABSTRACT:

Objective: To assess the role of balloon spirometer as an aid for providing chest physiotherapy.

Material and method: Data was collected from sixty cases of 18 to 60 years of age of both sexes, who underwent major abdominal surgery in a predrawn and pretested proforma.

Findings and interpretation: On analysis it was recorded that in control group chest complications were in 60 % of cases in comparison to only in 13 % of cases in incentive spirometry group. At probability of 0.05 these complication rate was highly significant (p = 0.0001). Thus incentive chest physiotherapy proved beneficial in comparison to no physiotherapy.

Recommendation: Authors recommend that in developing countries like India routine prophylactic Balloon type of chest physiotherapy can be used as an aid in preventing post pulmonary complications.

KEYWORDS: Balloon Spirometry (B.S.), Chest Physiotherapy.

INTRODUCTION:

There is little evidence to suggest that mucus production or ciliary action is altered significantly after operation. Normal expiration with an occasional forced expiration is sufficient to clean all the mucus produced in the bronchial mucosa in the normal condition and also in the days following an operation. Expiratory maneuvers include coughing, induced coughing with a tracheal catheter, blowing in to a balloon, glove or tube, blowing out against resistance and breathe holding. During any expiratory maneuver, the pleural pressure is higher than the airway pressure and alveoli must deflate, just the opposite of desired effect. Most of the description on the use of expiratory maneuvers in the postoperative period is subjective.

By taking in to consideration the above points and as per recommendations of the World Health Organization (W.H.O.) study group in 1957, that in order to get a comprehensive picture of any disease or health problem, more and more such studies have to be done, Garg Narenra K. (1) and Garg Narenra K. and Sharma A.B. (2), the authors have under taken the present study with the objective to assess the impact of Balloon spirometer (B.S.) as an aid in chest physiotherapy for patients undergone major abdominal surgeries.

MATERIALS AND METHOD:

Present study was organized in NSCB Medical College and Hospital, Jabalpur (M.P.) from May 2006 to June 2007. Over all 60 cases (45 put on Balloon Spirometer and 15 as controlled group) belong between 18 and 60 years of age and of both sexes, who underwent major abdominal surgery, taken as sample. Historically a centre of the Kalchuri and Gond dynasties, Jabalpur developed a synchronic culture influenced by the intermittent reigns of the Maratha and Mughal empires. In the early 19^th centuries, it was gradually annexed in British India as Jubbulpore and incorporated as major cantonment town. Jabalpur is known for its picturesque marble rock formations (Bhedaghat) on the bank of river Narmada.

Table – I. Comparison of true value of lung function between Balloon and Controlled group (Recording – 1, II and III)

	Recording – 1st		Recording – IInd		Recording – IIIrd
	B.S. N=45	Controlled N=15	B.S. N=45	Controlled N=15	B.S. N=45	Controlled N=15
FVC(liters)	1.26 ± 0.54	1.05 ± 0.26	1.55 ± 0.66	1.07±0.24	1.98 ± 0.72	1.09 ± 0.27
FEV1(liters)	1.10 ± 0.53	0.90 ± 0.18	1.32 ± 0.53	0.90±0.19	1.73 ± 0.64	0.93 ± 0.22
PEF (liters/sec.)	1.77 ± 0.70	1.44 ± 0.27	1.93 ± 0.55	1.51± 0.33	2.29 ± 0.78	1.71 ± 0.44
FEV1/FVC%	87.42 ± 10.23	86.77 ± 9.78	86.11± 7.57	84.52±13.92	89.12 ± 6.39	86.35 ± 10.91
MVV (liters/min.)	48.29 ± 5.54	42.05 ± 4.70	56.70 ± 10.76	46.96±4.79	61.71 ± 11.21	45.89 ± 4.45

Several important federal and state institutions including Government NSCB Medical College and Hospital are located in Jabalpur.

Method of exercise

B.S. was used 5minutes hourly at least 12 times per day for 1^st 7 days between 8am to 7pm. 150 to 200 expiration per day assisted coughing and vibration of chest wall done. Saline nabulation 3 times a day was performed. Five parameters were selected viz. FVC, FEV1, PEF, FEV/FVC and MVV recorded by flow based computerized spirometer on immediate post operative day-1^st and subsequently 3^rd, 7^th and 10^th day. The outcome of surgery was assessed on the basis of postoperative pulmonary complications. Chest radiograph were the most commonly used measure. Physical examination was used as a secondary outcome measure if it was not possible to separate chest radiograph findings. Definition of positive outcome usually includes a combination of physical signs such as chest auscultation, temperature and sputum production.

OBSERVATIONS AND DISCUSSION:

On analysis of the collected data it was found that the mean Forced Vital Capacity (FVC) was 1.26 ±0.54 ( t value-0.40 and p value-> 0.05) on day first recording. Second recording which was taken 7^th postoperative day was 1.55 ±0.66 (t value- 1.86 and p value > 0.05) statistically in significant. Third recording was taken on 10^th post operative day was 1.98 ± 0.72 (t value-2.41 and p value <0.05) which was found significant.

FEV1:

Mean value for FEV1 was on 1^st recording 1.10 ± 0.53 (t value- 0.96 and p value- <0.05) and found insignificant. On second recording i.e. on 7^th day 1.32 ± 053. On third recording i.e. 10^th day 1.73 ±0.64.

PEFR (Peak Expiratory Flow Rate):

Mean value for PEF was on 1^st recording 1.77 ± 0.70 (t value- 0.96 and p value- <0.05) and found insignificant. On second recording i.e. on 7^th day 1.93 ± 0.55 on third recording i.e. 10^th day 2.29 ± 0.78.

FEV1/FVC PERCENTAGE:

Mean value for FEV1/FVC was on 1^st recording 86.11 ± 7.57 (t value- 0.96 and p value-<0.05) and found insignificant. On second recording i.e. on 7^th day 91.37 ± 8.23. On third recording i.e. 10^th day 89.12 ± 6.39.

Maximum Voluntary Ventilation (MVM)-

Mean value for MVM was on 1^st recording 48.29 ± 5.54. On second recording i.e. on 7^th day 56.70 ± 10.76. On third recording i.e. 10^th day 61.71 ± 11.21.

Chest Complications Rate –

On further analysis it was recorded that in control group chest complications were in 60 % of cases in comparison to only in 15.5 percent of cases in B.S.group so highly significant at 5 % level. (p=0.0008). Thus B.S. physiotherapy proved beneficial in comparison to without chest physiotherapy. Jung R et al (3) noted in their study that post operative complications in B.S.group were less than control group. Fagevike M.O.et al (4) found that chest complications rate was 6 % in treatment group in comparison to 27 % in control group. Roukema JA et al (5) in their study observed that postoperative complications were 19 % in treatment group in comparison to 60 % in control group. Bartlett RH (6) studied in controlled series of unselected patients and noticed that have been consistently decrease pulmonary complications in treatment group i.e. chest physiotherapy group than no treatment group.

CONCLUSION AND RECOMMENDATION:

Thus the authors found that the findings of the present study were more or less similar to the findings of various studies conducted by different researchers throughout the globe.

From above observations and discussion the authors reached to the conclusion that in developing countries like India routine prophylactic Balloon type of chest physiotherapy can be recommended as an aid in preventing post pulmonary complications.

REFERENCES:

1. Garg Narendra K.: Evaluation of the impact of emesis and emesis plus purgation Therapy; Research J Pharmacology and Pharmacodynamics:2 (2) March-April;2010:201-202.

2. Garg Narendra K and Sharma A.B. : Epidemiological profile of patients attending a tertiary care hospital, Muktsar, Punjab (India); Research J Pharmacology and Pharmacodynamics:3 (6) November-December; 2011:311-317

3. Jung R, Wright J, Nusser R, Rosoff L. Comparison of three methods of respiratory care following upper abdominal surgery chest (1980) : 78: 31-35

4. Fagevike M.O, Hahn I, Nordgren S, Lonroth H and Lundholm, Randomized controlled trial of prophylactic chest physiotherapy in major abdominal Surgery (1997) :84:1535-1538

5. Roukema JA, Carol EJ, Parins JG, The prevention of pulmonary complications after abdominal surgery in patients with non compromised pulmonary status, Arch. Surg. (1988) :123: 30-34

6. Bartlett RH, Gazzzaniga AB, Geraghty TR, Respiratory Maneuvers to prevent post operative pulmonary complications; JAMA (1973) ; 224: 1017-21

Received on 06.04.2014 Modified on 15.07.2014

Res. J. Pharmacology & P’dynamics. 7(1): Jan.-Mar. 2015; Page 27-28

DOI: 10.5958/2321-5836.2015.00006.3