Overview
Flutter therapy is an oscillating positive expiratory pressure (OPEP) technique that combines positive expiratory pressure with airway oscillations to facilitate mobilization and clearance of respiratory secretions. Conventional chest physiotherapy includes deep breathing exercises, incentive spirometry, airway-clearance techniques, splinted coughing and early mobilization to promote lung expansion and secretion clearance. A total of 94 patients aged 40-70 years with mild-to-moderate COPD undergoing elective coronary artery bypass grafting (CABG) will be enrolled in this randomized controlled trial and will be randomly allocated into two groups, with 47 participants in each group. The intervention group will receive conventional chest physiotherapy combined with Flutter therapy, while the control group will receive conventional chest physiotherapy alone. Both groups will receive supervised treatment for 5 consecutive postoperative days, with 3 sessions per day, resulting in 15 treatment sessions. Baseline assessment will be performed on postoperative day 1 before commencement of the intervention, and post-intervention assessment will be conducted on postoperative day 5. The study will compare the effects of Flutter-assisted conventional chest physiotherapy versus conventional chest physiotherapy alone on postoperative peak expiratory flow rate, chest expansion and airway clearance.
Description
Chronic obstructive pulmonary disease (COPD) is associated with persistent respiratory symptoms, airflow limitation and increased mucus secretion and retention. Patients undergoing coronary artery bypass grafting (CABG) are also at risk of developing postoperative pulmonary complications. The co-existence of COPD may further affect the postoperative respiratory recovery and airway clearance. Conventional chest physiotherapy (CPT) is commonly used in the postoperative management of CABG patients to facilitate lung expansion, improve ventilation and promote Airway clearance. Flutter therapy is an oscillating positive expiratory pressure (OPEP) technique that combines positive expiratory pressure with airway oscillations and is used to facilitate mobilization and airway clearance. The present randomized controlled trial is designed to investigate the additional effects of Flutter therapy when combined with CPT in post-CABG patients with COPD. A total of 84 participants will be included in the study and randomly allocated into two groups. Group A will serve as the control group and will receive CPT alone. Group B will serve as the intervention group and will receive CPT in combination with Flutter therapy. Selection of subjects will be done by using non-probability purposive sampling technique. The sample size was calculated using G\* power software version 3.1. Normality testing will be done by using Shapiro-Wilk Test. Based on the normality test, difference within groups will be determined using paired t-test (Wilcoxon Signed Rank) whereas difference between two groups will be determined using independent t-test (Mann Whitney U). Data will be analyzed using SPSS v. 21.0. The intervention will be administered for five consecutive days during the postoperative period. Three treatment sessions will be provided each day, resulting in a total of 15 treatment sessions for each participant. Participants in the control group will receive CPT according to the study protocol whereas in the intervention group will receive the same CPT program with the addition of Flutter therapy. The treatment procedures will be administered according to the predefined study protocol throughout the intervention period. The study assessments will be performed according to the specified assessment schedule. Assessment will be conducted before the intervention and after completion of the five-day treatment period. The outcome assessor will be blinded to the group allocation. This blinding will be maintained during assessment to minimize potential assessment bias between the control and intervention groups. The study will therefore provide a comparison between CPT alone and CPT with Flutter therapy in post-CABG patients with COPD. The comparison is intended to determine the additional effects associated with incorporating Flutter therapy into CPT during the postoperative treatment period. The study will focus on the changes observed following the specified treatment program and will provide evidence regarding the additional role of Flutter therapy as an adjunct to CPT in this patient population. All study procedures will be conducted in accordance with the predefined study protocol. Data generated during the study will be recorded systematically and analyzed according to the statistical procedures specified in the research protocol.
Eligibility
Inclusion Criteria:
- Adults aged 40-70 years undergoing elective CABG
- Pre-existing COPD (mild- moderate), clinically diagnosed COPD
- Early post-operative (24-72 hrs.), extubated and hemodynamically stable
- No mechanical ventilation beyond 24 hrs., stable vitals (HR: 60-100bpm, SBP :110-130mmhg), no vasopressors.
- Follow commands, provide consent and perform assessments.
Exclusion Criteria:
- Patients undergoing emergency CABG or revision/repeat CABG procedure
- Patients with severe COPD or intersitial lung disease
- Contraindications positive expiratoey pressure (PEP) therapy (e.g, untreated pneumothorax, hemoptysis or recent esophageal surgery).
- Hemodynamically unstable patients post-operatively.
- Patients with neurological, musculoskeletal or cognitive impairments.
- Patients with active infections, malignancy.
- Patients with severe or uncontrolled comorbidities(e.g; renal failure).
- Patients in BiPAP.
