This study examines the effects of coughing exercises and incentive spirometry (IS) on lung function and recovery in children who undergo heart surgery. The main goals are to see:
How coughing exercises and IS affect breathing and lung function after surgery? How these exercises influence overall recovery after surgery? Children who participate will be randomly assigned to one of three groups: coughing exercises, IS, or standard care. Those in the exercise groups will perform their assigned breathing exercises every 3 hours for the first 3 days after surgery. Daily check-ups will be conducted to monitor their progress, lung function, and oxygen levels.
The study will measure breathing ability, oxygen levels, and recovery milestones to find out which method is most effective in preventing lung complications and helping children recover faster.
Children aged 6 to 18 years scheduled for elective cardiac surgery.
Postoperative extubation within 24 hours and judged clinically stable to begin respiratory therapy.
Hemodynamically stable.
Pre-existing moderate-to-severe chronic lung disease requiring baseline oxygen therapy.
Neuromuscular disorders significantly impairing cough/inspiratory effort.
Emergency surgery, ongoing major bleeding.
Prolonged mechanical ventilation >72 hours or tracheostomy on admission.
Parallel
Coughing Exercises
Behavioralparticipants will receive structured postoperative coughing exercises supervised by trained healthcare professionals. The intervention includes instruction on effective deep breathing followed by directed coughing to enhance airway clearance and prevent secretion retention. Exercises will be performed every 3 hours for three consecutive days after cardiac surgery, in addition to standard postoperative care.
Incentive Spirometry
Deviceparticipants will perform postoperative incentive spirometry using a standard incentive spirometer under professional supervision. Children will be instructed to perform slow, deep inspirations with visual feedback to promote lung expansion and alveolar recruitment. The intervention will be conducted 15 times every 3 hours for three days after surgery, alongside standard postoperative care.
Standard Postoperative Care
Other interventionParticipants will receive routine postoperative care according to institutional protocols following cardiac surgery. This includes standard medical and nursing management such as oxygen therapy, pain control, monitoring of vital signs, and mobilization as tolerated, without additional structured respiratory physiotherapy interventions.
Respiratory Function Score.
A composite postoperative respiratory function score assessed using standardized pediatric respiratory severity score, including respiratory rate (breaths/min), oxygen saturation measured by pulse oximetry (SpO₂, %), presence of wheezing (yes/no), use of accessory respiratory muscles (yes/no), and feeding tolerance. Higher scores indicate better respiratory function.
Postoperative Recovery Indicators Assessed by Clinical and Functional Parameters
Postoperative quality of recovery assessed using the Pediatric Quality of Recovery (PQoR) scale, which evaluates postoperative pain, comfort, emotional status, physical activity, and feeding tolerance through age-appropriate assessment and caregiver reporting. Higher scores indicate better postoperative recovery.
Length of Intensive Care Unit (ICU) Stay
The duration of stay in the pediatric intensive care unit following cardiac surgery, calculated in days from ICU admission to ICU discharge based on hospital medical records..
Arterial Blood Gas (ABG) Parameters
Arterial blood gas analysis will be used to evaluate changes in oxygenation and ventilation status following the cough exercise and incentive spirometry intervention. The measured parameters include partial pressure of oxygen (PaO₂), partial pressure of carbon dioxide (PaCO₂), bicarbonate (HCO₃-), and oxygen saturation (SaO₂). Measurements will be obtained using standard arterial sampling procedures and analyzed according to hospital laboratory protocols.
postoperative complications
Assessment of postoperative complications among pediatric patients following cardiac surgery, including atelectasis, pneumonia, pleural effusion, pneumothorax, respiratory distress, and others during the postoperative period.
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