human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES Little is known about the physiologic and clinical effects of noninvasive positive pressure ventilation ( NPPV ) in patients who have acute respiratory failure ( ARF ) after abdominal surgery . We evaluated our clinical experience with the use of NPPV in the treatment of ARF after abdominal surgery . METHODS We prospect ively evaluated NPPV use during a 2-year period in a medical-surgical ICU of a university hospital . We documented demographic and diagnostic data , gas exchange , and clinical outcomes . We compared patients who were not intubated to those who were intubated after a trial of NPPV . RESULTS Of 72 patients with ARF after abdominal surgery who were treated with NPPV , 48 patients avoided intubation ( 67 % ) . Patients in the intubated and nonintubated groups had similar demographic characteristics , and similar American Society of Anesthesiologists physical status and simplified acute physiology score II scores at admission . The intubated group had a significantly lower Pa(O2)/fraction of inspired oxygen ( Fi(O2 ) ) ratio ( 123 + /- 62 mm Hg vs 194 + /- 76 mm Hg , p < 0.01 ) and more extended bilateral alveolar infiltrates ( 67 % vs 31 % , p < 0.01 ) than the non-intubated group . Within the first NPPV observation period , the Pa(O2)/Fi(O2 ) increased ( + 36 + /- 29 % [ + /- SD ] , p = 0.04 ) and the respiratory rate decreased ( 28.2 + /- 3.4 breaths/min vs 23.1 + /- 3.8 breaths/min , p < 0.01 ) significantly only in the non-intubated group . The non-intubated group had significantly lower length of ICU stay ( 17.3 + /- 10.9 days vs 34.1 + /- 28.5 days , p < 0.01 ) and mortality rate ( 6 % vs 29 % , p < 0.01 ) . CONCLUSION NPPV may be an alternative to conventional ventilation in selected patients with ARF after abdominal surgery who require ventilatory support BACKGROUND Elders undergo approximately 40 % of more than 1 million major abdominal operations annually . Yet evidence about recovery to preoperative levels of functional independence is limited . This study details course and predictors of functional recovery after  elective major abdominal operations in the elderly . STUDY DESIGN This was a prospect i ve cohort of 372 consecutive patients , 60 years old or more , enrolled from surgeons in private practice and two university-affiliated hospitals , assessed preoperatively and postoperatively at 1 , 3 , and 6 weeks , 3 and 6 months , using self-report and performance-based measures ( Activities of Daily Living [ ADL ] , Instrumental Activities of Daily Living [ IADL ] , Medical Outcomes Study Short Form-36 Physical Component and Mental Component Scales [ PCS , MCS ] , Geriatric Depression Scale [ GDS ] , Folstein Mini-Mental State Exam [ MMSE ] , timed walk , functional reach , h and grip strength ) . RESULTS Mean age was 69 + /- 6 years with 56 % men , 47 % nonHispanic Caucasian , and 42 % Mexican American ; hospital distribution was 49 % private , 51 % university-affiliated . Maximum functional declines ( 95 % CI ) occurred 1 week postoperatively : ADL , 2.8 points ( 2.4 to 3.2 ) ; IADL , 7.6 points ( 7 to 8.3 ) ; SF-36 PCS , 6.5 points ( 5.4 to 7.6 ) ; Mini-Mental State Exam , 0.5 points ( 0.2 to 0.7 ) ; timed walk , 6.8 seconds ( 5.2 to 8.4 ) ; functional reach , 1.7 inches ( 1.2 to 2.2 ) ; grip strength , 2 kilograms ( 1.3 to 2.7 ) ( p < 0.001 for all ) . SF-36 mental component scale and Geriatric Depression Scale scores did not worsen . Mean recovery times were : Mini-Mental State Exam , 3 weeks ; timed walk , 6 weeks ; ADL , SF-36 PCS , and functional reach , 3 months ; and IADL , 6 months . Mean grip strength did not return to preoperative status by 6 months . The incidence of persistent disability at 6 months , compared with preoperative status , was : ADL , 9 % ; IADL , 19 % ; PCS , 16 % ; mental component scale , 17 % ; timed walk , 39 % ; functional reach , 58 % ; and grip strength , 52 % . Potentially modifiable independent predictors of ADL and IADL recovery were preoperative physical conditioning and depression plus serious postoperative complications . CONCLUSIONS The clinical course of functional recovery varied across different measures . Protracted disability at 6 months after operation was substantial . Several potentially modifiable factors consistently predicted recovery OBJECTIVE To evaluate inspiratory volume in patients undergoing cardiac surgery and to determine the effects that incentive spirometry ( IS ) and the breath stacking ( BS ) technique have on the recovery of FVC in such patients . METHODS A prospect i ve , controlled , r and omized clinical trial involving 35 patients undergoing cardiac surgery at the Hospital de Força Aérea do Galeão ( HFAG , Galeão Air Force Hospital ) , in the city of Rio de Janeiro , Brazil . The patients , all of whom performed mobilization and cough procedures , were r and omly divided into three groups : exercise control ( EC ) , performing only the abovementioned procedures ; IS , performing the abovementioned procedures and instructed to take long breaths using an incentive spirometer ; and BS , performing the abovementioned procedures , together with successive inspiratory efforts using a facial mask coupled to a unidirectional valve . Forced spirometry was carried out in the preoperative period and on postoperative days 1 to 5 . During the maneuvers , inspiratory volume was measured in the IS and BS groups . RESULTS On postoperative day 1 , FVC significantly decreased in all groups ( EC : 87.1 vs. 32.0 % ; IS : 75.3 vs. 29.5 % ; and BS : 81.9 vs. 33.2 % ; p < 0.001 for all ) , as did inspiratory volume in the IS and BS groups ( 2.29 vs. 0.82 L ; and 2.56 vs. 1.34 L , respectively ; p < 0.001 for both ) . Between postoperative days 1 and 5 , FVC partially normalized in all groups ( EC : 32.0 vs. 51.3 % ; IS : 29.5 vs. 46.7 % ; and BS : 33.3 vs. 54.3 % ; p < 0.001 for all ) . During the postoperative period , inspiratory volume was significantly higher in the BS group than in the IS group . CONCLUSIONS The three protocol s were equivalent concerning the recovery of FVC on the first five postoperative days . When compared with IS , the BS technique promoted higher inspiratory volumes in this sample of postoperative cardiac patients Background : Current knowledge of the risk for  postoperative pulmonary complications ( PPCs  ) rests on studies that narrowly selected patients and procedures . Hypothesizing that PPC occurrence could be predicted from a reduced set of perioperative variables , we aim ed to develop a predictive index for a broad surgical population . Methods : Patients undergoing surgical procedures given general , neuraxial , or regional anesthesia in 59 hospitals were r and omly selected for this prospect i ve , multicenter study . The main outcome was the development of at least one of the following : respiratory infection , respiratory failure , bronchospasm , atelectasis , pleural effusion , pneumothorax , or aspiration pneumonitis . The cohort was r and omly divided into a development sub sample to construct a logistic regression model and a validation sub sample . A PPC predictive index was constructed . Results : Of 2,464 patients studied , 252 events were observed in 123 ( 5 % ) . Thirty-day mortality was higher in patients with a PPC ( 19.5 % ; 95 % [ CI ] , 12.5–26.5 % ) than in those without a PPC ( 0.5 % ; 95 % CI , 0.2–0.8 % ) . Regression modeling identified seven independent risk factors : low preoperative arterial oxygen saturation , acute respiratory infection during the previous month , age , preoperative anemia , upper abdominal or intrathoracic surgery , surgical duration of at least 2 h , and emergency surgery . The area under the receiver operating characteristic curve was 90 % ( 95 % CI , 85–94 % ) for the development sub sample and 88 % ( 95 % CI , 84–93 % ) for the validation sub sample . Conclusion : The risk index based on seven objective , easily assessed factors has excellent discriminative ability . The index can be used to assess individual risk of PPC and focus further research on measures to improve patient care STUDY OBJECTIVES To investigate the effects of deep-breathing exercises on pulmonary function , atelectasis , and arterial blood gas levels after coronary artery bypass graft ( CABG ) surgery . DESIGN , SETTING , AND PATIENTS In a prospect i ve , r and omized trial , patients performing deep-breathing exercises ( n = 48 ) were compared to a control group ( n = 42 ) who performed no breathing exercises postoperatively .  Patient management was similar in the groups in terms of assessment , positioning , and mobility . INTERVENTIONS The patients in the deep-breathing group were instructed to perform breathing exercises hourly during daytime for the first 4 postoperative days . The exercises consisted of 30 slow , deep breaths performed with a positive expiratory pressure blow-bottle device ( + 10 cm H(2)O ) . MEASUREMENTS AND RESULTS Spirometric measurements , spiral CT ( three transverse levels ) , arterial blood gas analysis , and scoring of subjective experience of the breathing exercises were performed on the fourth postoperative day . Atelectasis was only half the size in the deep-breathing group compared to the control group , amounting to 2.6 + /- 2.2 % vs 4.7 + /- 5.7 % ( p = 0.045 ) at the basal level and 0.1 + /- 0.2 % vs 0.3 + /- 0.5 % ( mean + /- SD ) [ p = 0.01 ] at the apical level . Compared to the control subjects , the patients in the deep-breathing group had a significantly smaller reduction in FVC ( to 71 + /- 12 % , vs 64 + /- 13 % of the preoperative values ; p = 0.01 ) and FEV(1 ) ( to 71 + /- 11 % , vs 65 + /- 13 % of the preoperative values ; p = 0.01 ) . Arterial oxygen tension , carbon dioxide tension , fever , or length of ICU or hospital stay did not differ between the groups . In the deep-breathing group , 72 % of the patients experienced a subjective benefit from the exercises . CONCLUSIONS Patients performing deep-breathing exercises after CABG surgery had significantly smaller atelectatic areas and better pulmonary function on the fourth postoperative day compared to a control group performing no exercises BACKGROUND A predicted postoperative forced expiratory volume in 1 second ( FEV1 ) of less than 800 ml or 40 % of predicted is a common criterion for exclusion of patients from lung resection for cancer . Usually , the predicted postoperative lung function is calculated according to a formula based on the number of lung segments that will be resected . Incentive spirometry and specific inspiratory muscle training are two maneuvers that have been used to enhance lung expansion and inspiratory muscle strength in patients with chronic obstructive pulmonary disease and after lung operation . METHODS Thirty-two patients with chronic obstructive pulmonary disease who were c and i date s for lung resection were r and omized into two groups : 17 patients received specific inspiratory muscle training and incentive spirometry , 1 hour per day , six times a week , for 2 weeks before and 3 months after lung resection ( group A ) and 15 patients were assigned to the control group and received no training ( group B ) . RESULTS Inspiratory muscle strength increased significantly in the training group , both before and 3 months after the operation . In group B , the predicted postoperative FEV1 value consistently underestimated the actual postoperative FEV1 by approximately 70 ml in the lobectomy subgroup and by 110 ml in the pneumonectomy subgroup . In group A , the actual postoperative FEV1 was higher than the predicted postoperative FEV1 by 570 ml in the lobectomy subgroup and by 680 ml in the pneumonectomy subgroup of patients . CONCLUSIONS In patients undergoing lung resection the simple calculation of predicted postoperative FEV1 underestimates the actual postoperative FEV1 by a small fraction . Lung functions can be increased significantly when incentive spirometry and specific inspiratory muscle training are used before and after operation Forty-nine adults who had undergone cardiopulmonary bypass surgery were r and omly assigned to one of three exercise programs to determine if either maximal inspiratory breathing exercises or incentive spirometry offered a therapeutic advantage over early mobilization alone . After extubation , the patients started their assigned exercise programs . A physical examination and pulmonary 
    Output:
    
agent
CONCLUSION There was no evidence to support the use of incentive spirometry in the management of surgical patients .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES Little is known about the physiologic and clinical effects of noninvasive positive pressure ventilation ( NPPV ) in patients who have acute respiratory failure ( ARF ) after abdominal surgery . We evaluated our clinical experience with the use of NPPV in the treatment of ARF after abdominal surgery . METHODS We prospect ively evaluated NPPV use during a 2-year period in a medical-surgical ICU of a university hospital . We documented demographic and diagnostic data , gas exchange , and clinical outcomes . We compared patients who were not intubated to those who were intubated after a trial of NPPV . RESULTS Of 72 patients with ARF after abdominal surgery who were treated with NPPV , 48 patients avoided intubation ( 67 % ) . Patients in the intubated and nonintubated groups had similar demographic characteristics , and similar American Society of Anesthesiologists physical status and simplified acute physiology score II scores at admission . The intubated group had a significantly lower Pa(O2)/fraction of inspired oxygen ( Fi(O2 ) ) ratio ( 123 + /- 62 mm Hg vs 194 + /- 76 mm Hg , p < 0.01 ) and more extended bilateral alveolar infiltrates ( 67 % vs 31 % , p < 0.01 ) than the non-intubated group . Within the first NPPV observation period , the Pa(O2)/Fi(O2 ) increased ( + 36 + /- 29 % [ + /- SD ] , p = 0.04 ) and the respiratory rate decreased ( 28.2 + /- 3.4 breaths/min vs 23.1 + /- 3.8 breaths/min , p < 0.01 ) significantly only in the non-intubated group . The non-intubated group had significantly lower length of ICU stay ( 17.3 + /- 10.9 days vs 34.1 + /- 28.5 days , p < 0.01 ) and mortality rate ( 6 % vs 29 % , p < 0.01 ) . CONCLUSION NPPV may be an alternative to conventional ventilation in selected patients with ARF after abdominal surgery who require ventilatory support BACKGROUND Elders undergo approximately 40 % of more than 1 million major abdominal operations annually . Yet evidence about recovery to preoperative levels of functional independence is limited . This study details course and predictors of functional recovery after  elective major abdominal operations in the elderly . STUDY DESIGN This was a prospect i ve cohort of 372 consecutive patients , 60 years old or more , enrolled from surgeons in private practice and two university-affiliated hospitals , assessed preoperatively and postoperatively at 1 , 3 , and 6 weeks , 3 and 6 months , using self-report and performance-based measures ( Activities of Daily Living [ ADL ] , Instrumental Activities of Daily Living [ IADL ] , Medical Outcomes Study Short Form-36 Physical Component and Mental Component Scales [ PCS , MCS ] , Geriatric Depression Scale [ GDS ] , Folstein Mini-Mental State Exam [ MMSE ] , timed walk , functional reach , h and grip strength ) . RESULTS Mean age was 69 + /- 6 years with 56 % men , 47 % nonHispanic Caucasian , and 42 % Mexican American ; hospital distribution was 49 % private , 51 % university-affiliated . Maximum functional declines ( 95 % CI ) occurred 1 week postoperatively : ADL , 2.8 points ( 2.4 to 3.2 ) ; IADL , 7.6 points ( 7 to 8.3 ) ; SF-36 PCS , 6.5 points ( 5.4 to 7.6 ) ; Mini-Mental State Exam , 0.5 points ( 0.2 to 0.7 ) ; timed walk , 6.8 seconds ( 5.2 to 8.4 ) ; functional reach , 1.7 inches ( 1.2 to 2.2 ) ; grip strength , 2 kilograms ( 1.3 to 2.7 ) ( p < 0.001 for all ) . SF-36 mental component scale and Geriatric Depression Scale scores did not worsen . Mean recovery times were : Mini-Mental State Exam , 3 weeks ; timed walk , 6 weeks ; ADL , SF-36 PCS , and functional reach , 3 months ; and IADL , 6 months . Mean grip strength did not return to preoperative status by 6 months . The incidence of persistent disability at 6 months , compared with preoperative status , was : ADL , 9 % ; IADL , 19 % ; PCS , 16 % ; mental component scale , 17 % ; timed walk , 39 % ; functional reach , 58 % ; and grip strength , 52 % . Potentially modifiable independent predictors of ADL and IADL recovery were preoperative physical conditioning and depression plus serious postoperative complications . CONCLUSIONS The clinical course of functional recovery varied across different measures . Protracted disability at 6 months after operation was substantial . Several potentially modifiable factors consistently predicted recovery OBJECTIVE To evaluate inspiratory volume in patients undergoing cardiac surgery and to determine the effects that incentive spirometry ( IS ) and the breath stacking ( BS ) technique have on the recovery of FVC in such patients . METHODS A prospect i ve , controlled , r and omized clinical trial involving 35 patients undergoing cardiac surgery at the Hospital de Força Aérea do Galeão ( HFAG , Galeão Air Force Hospital ) , in the city of Rio de Janeiro , Brazil . The patients , all of whom performed mobilization and cough procedures , were r and omly divided into three groups : exercise control ( EC ) , performing only the abovementioned procedures ; IS , performing the abovementioned procedures and instructed to take long breaths using an incentive spirometer ; and BS , performing the abovementioned procedures , together with successive inspiratory efforts using a facial mask coupled to a unidirectional valve . Forced spirometry was carried out in the preoperative period and on postoperative days 1 to 5 . During the maneuvers , inspiratory volume was measured in the IS and BS groups . RESULTS On postoperative day 1 , FVC significantly decreased in all groups ( EC : 87.1 vs. 32.0 % ; IS : 75.3 vs. 29.5 % ; and BS : 81.9 vs. 33.2 % ; p < 0.001 for all ) , as did inspiratory volume in the IS and BS groups ( 2.29 vs. 0.82 L ; and 2.56 vs. 1.34 L , respectively ; p < 0.001 for both ) . Between postoperative days 1 and 5 , FVC partially normalized in all groups ( EC : 32.0 vs. 51.3 % ; IS : 29.5 vs. 46.7 % ; and BS : 33.3 vs. 54.3 % ; p < 0.001 for all ) . During the postoperative period , inspiratory volume was significantly higher in the BS group than in the IS group . CONCLUSIONS The three protocol s were equivalent concerning the recovery of FVC on the first five postoperative days . When compared with IS , the BS technique promoted higher inspiratory volumes in this sample of postoperative cardiac patients Background : Current knowledge of the risk for  postoperative pulmonary complications ( PPCs  ) rests on studies that narrowly selected patients and procedures . Hypothesizing that PPC occurrence could be predicted from a reduced set of perioperative variables , we aim ed to develop a predictive index for a broad surgical population . Methods : Patients undergoing surgical procedures given general , neuraxial , or regional anesthesia in 59 hospitals were r and omly selected for this prospect i ve , multicenter study . The main outcome was the development of at least one of the following : respiratory infection , respiratory failure , bronchospasm , atelectasis , pleural effusion , pneumothorax , or aspiration pneumonitis . The cohort was r and omly divided into a development sub sample to construct a logistic regression model and a validation sub sample . A PPC predictive index was constructed . Results : Of 2,464 patients studied , 252 events were observed in 123 ( 5 % ) . Thirty-day mortality was higher in patients with a PPC ( 19.5 % ; 95 % [ CI ] , 12.5–26.5 % ) than in those without a PPC ( 0.5 % ; 95 % CI , 0.2–0.8 % ) . Regression modeling identified seven independent risk factors : low preoperative arterial oxygen saturation , acute respiratory infection during the previous month , age , preoperative anemia , upper abdominal or intrathoracic surgery , surgical duration of at least 2 h , and emergency surgery . The area under the receiver operating characteristic curve was 90 % ( 95 % CI , 85–94 % ) for the development sub sample and 88 % ( 95 % CI , 84–93 % ) for the validation sub sample . Conclusion : The risk index based on seven objective , easily assessed factors has excellent discriminative ability . The index can be used to assess individual risk of PPC and focus further research on measures to improve patient care STUDY OBJECTIVES To investigate the effects of deep-breathing exercises on pulmonary function , atelectasis , and arterial blood gas levels after coronary artery bypass graft ( CABG ) surgery . DESIGN , SETTING , AND PATIENTS In a prospect i ve , r and omized trial , patients performing deep-breathing exercises ( n = 48 ) were compared to a control group ( n = 42 ) who performed no breathing exercises postoperatively .  Patient management was similar in the groups in terms of assessment , positioning , and mobility . INTERVENTIONS The patients in the deep-breathing group were instructed to perform breathing exercises hourly during daytime for the first 4 postoperative days . The exercises consisted of 30 slow , deep breaths performed with a positive expiratory pressure blow-bottle device ( + 10 cm H(2)O ) . MEASUREMENTS AND RESULTS Spirometric measurements , spiral CT ( three transverse levels ) , arterial blood gas analysis , and scoring of subjective experience of the breathing exercises were performed on the fourth postoperative day . Atelectasis was only half the size in the deep-breathing group compared to the control group , amounting to 2.6 + /- 2.2 % vs 4.7 + /- 5.7 % ( p = 0.045 ) at the basal level and 0.1 + /- 0.2 % vs 0.3 + /- 0.5 % ( mean + /- SD ) [ p = 0.01 ] at the apical level . Compared to the control subjects , the patients in the deep-breathing group had a significantly smaller reduction in FVC ( to 71 + /- 12 % , vs 64 + /- 13 % of the preoperative values ; p = 0.01 ) and FEV(1 ) ( to 71 + /- 11 % , vs 65 + /- 13 % of the preoperative values ; p = 0.01 ) . Arterial oxygen tension , carbon dioxide tension , fever , or length of ICU or hospital stay did not differ between the groups . In the deep-breathing group , 72 % of the patients experienced a subjective benefit from the exercises . CONCLUSIONS Patients performing deep-breathing exercises after CABG surgery had significantly smaller atelectatic areas and better pulmonary function on the fourth postoperative day compared to a control group performing no exercises BACKGROUND A predicted postoperative forced expiratory volume in 1 second ( FEV1 ) of less than 800 ml or 40 % of predicted is a common criterion for exclusion of patients from lung resection for cancer . Usually , the predicted postoperative lung function is calculated according to a formula based on the number of lung segments that will be resected . Incentive spirometry and specific inspiratory muscle training are two maneuvers that have been used to enhance lung expansion and inspiratory muscle strength in patients with chronic obstructive pulmonary disease and after lung operation . METHODS Thirty-two patients with chronic obstructive pulmonary disease who were c and i date s for lung resection were r and omized into two groups : 17 patients received specific inspiratory muscle training and incentive spirometry , 1 hour per day , six times a week , for 2 weeks before and 3 months after lung resection ( group A ) and 15 patients were assigned to the control group and received no training ( group B ) . RESULTS Inspiratory muscle strength increased significantly in the training group , both before and 3 months after the operation . In group B , the predicted postoperative FEV1 value consistently underestimated the actual postoperative FEV1 by approximately 70 ml in the lobectomy subgroup and by 110 ml in the pneumonectomy subgroup . In group A , the actual postoperative FEV1 was higher than the predicted postoperative FEV1 by 570 ml in the lobectomy subgroup and by 680 ml in the pneumonectomy subgroup of patients . CONCLUSIONS In patients undergoing lung resection the simple calculation of predicted postoperative FEV1 underestimates the actual postoperative FEV1 by a small fraction . Lung functions can be increased significantly when incentive spirometry and specific inspiratory muscle training are used before and after operation Forty-nine adults who had undergone cardiopulmonary bypass surgery were r and omly assigned to one of three exercise programs to determine if either maximal inspiratory breathing exercises or incentive spirometry offered a therapeutic advantage over early mobilization alone . After extubation , the patients started their assigned exercise programs . A physical examination and pulmonary 
    Output:
    