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Comparison of continuous positive airway pressure, incentive spirometry, and conservative therapy after cardiac operations
Stock MC, Downs JB, Cooper RB, Lebenson IM, Cleveland J, Weaver DE, Alster JM, Imrey PB
Critical Care Medicine 1984 Nov;12(11):969-972
clinical trial
5/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

Of 38 patients undergoing median sternotomy for cardiac operations all developed profound restrictive defects in pulmonary function during the first 72 h after tracheal extubation. Although decreased lung volumes were refractory to correction by vigorous, aggressive pulmonary therapy during this period, frequent and supervised treatment may prevent further deterioration in pulmonary function. The overall incidence of pneumonia was only 3% (1/38). Continuous positive airway pressure delivered by mask proved to be a nearly effortless form of postoperative respiratory therapy that was less painful than incentive spirometry or coughing and deep breathing, and therefore may be preferable.

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