The goal of this quasi-experimental clinical trial is to learn if position management combined with the Active Cycle of Breathing Techniques (ACBT) works to reduce postoperative pulmonary complications in adult patients undergoing elective cardiac surgery. It will also evaluate the individual effects of each technique compared to routine care.
The main questions it aims to answer are:
Does the combination of positioning and ACBT significantly lower the incidence and severity of postoperative pulmonary complications (like atelectasis, pneumonia, and respiratory failure) within the first 7 days after surgery? Does the combination of these techniques reduce the length of hospital stay compared to using each technique alone or routine care? Does the application of ACBT alone lower the rate of respiratory infections? Does position management alone improve oxygenation parameters (such as SpO\_{2} and PaO\_{2})?
Researchers will compare four groups of patients to determine the most effective nursing approach:
Group 1 (Control Group): Participants will receive routine postoperative hospital care only.
Group 2 (ACBT Group): Participants will perform the Active Cycle of Breathing Techniques (breathing control, thoracic expansion, and huffing) three times daily for 10-15 minutes over 5 postoperative days.
Group 3 (Positioning Group): Participants will receive structured position management exclusively, shifting from head elevation (30-45) early after surgery to a semi-recumbent position (approx60) during waking hours, alongside other positions like lateral or forward-leaning as tolerated.
Group 4 (Combined Group): Participants will receive both structured position management and perform the ACBT sessions according to the same schedules.
All participants will undergo daily respiratory assessments using a standardized scoring system for 7 days post-surgery or until hospital discharge.
Adult patients (aged from 20 years to 65 years old).
Undergoing elective cardiac surgery (Coronary Artery bypass Grafting (CABG) or valves surgeries) via median sternotomy.
Hemodynamically stable postoperatively (no high-dose vasopressor support).
Fully conscious and capable of following complex verbal instructions.
• Patients undergoing emergency cardiac surgery.
History of chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD), bronchial asthma, or bronchiectasis
Pre-existing pulmonary complications (e.g., pneumonia, atelectasis, pleural effusion) prior to surgery
Neuromuscular disorders affecting respiratory muscles
Parallel
Structured Position Management Protocol
BehavioralA systematic nursing-driven positioning protocol designed to utilize gravitational forces to optimize lung volumes and minimize pulmonary secretions. In the early postoperative phase (0-6 hours or until extubation), patients are managed with head elevation at 30-45 and the head turned to one side. Post-extubation/after 6 hours, patients are maintained in a semi-recumbent position (approx60during waking hours and 15-30 during sleep. Additional positions including lateral rotations, forward-leaning, postural drainage, and prone positioning are integrated throughout the stay as clinically tolerated
Active Cycle of Breathing Techniques (ACBT)
BehavioralA structured airway clearance regimen performed independently by the patient following specialized nursing instruction. The technique integrates breathing control (normal relaxed breathing), thoracic expansion exercises (deep breathing), and the forced expiration technique (huffing) to mobilize peripheral pulmonary secretions. Once the patient is clinically stable on postoperative day 1 (POD 1), the cycle is performed three times daily for 10-15 minutes, continuing across 5 postoperative days.
Incidence and Severity of Postoperative Pulmonary Complications (PPCs)
Postoperative pulmonary complications (PPCs) will be evaluated using the Modified Kroenke Scoring System. This tool assesses respiratory outcomes on a scale from Grade 0 (no complications) to Grade 5 (death before discharge). \* Grades 1 \& 2: Indicate mild to moderate complications (e.g., cough, micro-atelectasis, bronchospasm, or hypoxemia). \* Grades 3 \& 4: Indicate severe to very severe clinically significant complications (e.g., pneumonia, pleural effusion requiring intervention, or mechanical ventilation/re-intubation). Metric: The highest (worst) recorded score within the first 7 postoperative days will be analyzed. A cut-off score of ≥ 3 defines the presence of clinically significant PPCs.
Length of Hospital Stay
The total number of days the patient remains hospitalized following cardiac surgery. Lower lengths of stay indicate a faster functional recovery.
Click on the lead sponsor to view all of their trials.
This trial is not recruiting at the moment. You can still explore other options:
