Effects of pre- and post-operative active cycle of breathing technique as an add-on to routine chest physical therapy on respiratory parameters in coronary artery bypass graft patients

Abstract

Background & Objective: When someone has coronary artery disease, surgeons may perform a coronary artery bypass graft (CABG) to create a new route for blood to reach the narrowed heart arteries. CABG procedures may increase the risk of patients having pulmonary issues after surgery. The usefulness of active cycle of breathing technique (ACBT) in patients who undergo CABG to lower the risk of lung problems has not been widely recognized or experienced in Pakistan. Therefore, the purpose was to determine the effects of pre and postoperative ACBT on oxygen saturation (SpO₂), arterial blood gas (ABG), and respiratory rate (RR) after coronary artery bypass graft surgery (CABG).

Methodology: The randomized controlled trial took place from March to May 2024 at the Faisalabad Institute of Cardiology (FIC) in Faisalabad. The elected 72 patients both men and women of ages 35 to 65 were randomized using lottery method to place equal numbers of participants in each group (n = 36 each). ACBT was applied in addition to routine chest physical therapy in the intervention group, while the control group received only routine chest therapy. Both patient groups had their arterial blood gases (ABG), oxygen saturation (SpO₂) and respiratory rate (RR) checked at baseline and upto five days after surgery (daily).

Results: There were significant differences between the groups for RR, SpO₂ and PaCO₂ over all the postoperative days (p < 0.001). Nevertheless, there was no noticeable difference in PaO₂ on Day 3 (P = 0.977), in HCO₃ on Day 3 (P = 0.145) and 4 (P = 0.84), nor in pH on Days 2 (P = 0.158) and 3 (P = 0.017). SpO₂ in the control group was 95 (95–96) at the start, climbed to 99 (98–99.4) on Day 1, then dropped to 95 (95–96) by Day 5. RR went up to 28 (27.25–30) on Day 5. For the intervention group, the SpO₂ went from 95 (95–96.75) at the beginning to 99 (98.25–100) by Day 5 and the RR was reduced from 30 (19–31) on Day 1 down to 22 (20–24) on Day 5. Within the control group, SpO₂ went down to 81% and RR went up to 36 ± 3.75 on Day 3 which indicates the respiratory system had not returned to normal as fast as the intervention group.

Conclusion: The findings of our study suggest that ‘active cycle of breathing technique’ is more effective than the routine chest physical therapy alone for improving hemodynamic and respiratory parameters including ABG, RR, and SpO₂ after CABG.

Abbreviations: ABG: arterial blood gas, ACBT: Active cycle breathing technique, CABG: Coronary artery bypass graft, RR: respiratory rate

Keywords: Active cycle breathing technique; Arterial blood gasses; Coronary artery bypass graft; Oxygen saturation; postoperative; pulmonary complications; Respiratory rate

Citation: Bukhari SB, Ashraf HS, Abbas ZU, Zulfiqar N, Nawaz MA, Sharif Z. Effects of pre- and post-operative active cycle of breathing technique as an add-on to routine chest physical therapy on respiratory parameters in coronary artery bypass graft patients. Anaesth. pain intensive care 2025;29 (8):962-970. DOI: 10.35975/apic.v29i8.3026

Received: May 09, 2025; Revised: October 26, 2025; Accepted: January 01, 2025