ROLE OF INTERMITTENT POSITIVE PRESSURE BREATHING POSTOPERATIVELY

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Abstract
The frequency of pulmonary complications after surgery has been such as to indicate strongly the need of prophylactic measures, especially against postoperative atelectasis. Among etiological factors to be watched for are narcotics that suppress the cough reflex, dehydration, prolonged immobilization, and constricting dressings. These should be eliminated where possible; additional measures to be taken include chemotherapy, tracheal or bronchoscopic aspiration if necessary, and intermittent positive-pressure breathing (IPPB). For best results, IPPB should be started on the first postoperative day. Three or four treatments daily, each lasting approximately 15 minutes, are recommended. The gas recommended is 40% oxygen with either 60% helium or 60% air. It is delivered under a positive pressure of 15 to 20 cm. water in adults and 10 to 12 cm. water in children, at the rate of 8 to 10 respirations per minute. Adjuvant medication (bronchodilators, antibiotics, expectorants, detergents) can be added as aerosols to the gas. Good results in the prevention of postoperative pulmonary complications are reported in a series of 372 surgical patients, of which 144 underwent thoracic operations.

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