Postoperative atelectasis: Intermittent positive pressure breathing, incentive spirometry, and face-mask positive end-expiratory pressure
W. L. Paul and J. B. Downs
Postoperative atelectasis has been treated with inspiratory maneuvers in an
attempt to increase functional residual capacity. We compared the effect of
intermittent positive pressure breathing (IPPB), incentive spirometry, and
5-cm H2O positive end-expiratory pressure (PEEP) applied with a face mask
on the transpulmonary pressure (PL) at the end of expiration of eight
patients 24 to 34 hours after aortocoronary bypass graft insertion.
Intermittent positive pressure breathing and PEEP increased expiratory PL
during therapy. After IPPB, expiratory PL fell below control values and
then returned toward, but did not reach, control values After PEEP was
discontinued, expiratory PL returned to control values within the next 30
minutes. The results suggest that face-mask PEEP will increase functional
residual capacity, that incentive spirometry has little or effect, and that
IPPB may decrease lung volume after treatment.
