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: BACKGROUND Patients undergoing coronary artery bypass graft ( CABG ) surgery  have higher risk to develop pulmonary complications ( PCs ) such as atelectasis , pneumonia and pleural effusion . These complications could increase the length of hospital stay , re sources utilization and also are associated with reduced quality of life and functional capacity a long term . OBJECTIVE To test if the use of incentive spirometry ( IS ) associated with expiratory positive airway pressure ( EPAP ) , after CABG surgery improves dyspnea , effort perceived and quality of life 18 months after CABG . METHODS Sixteen patients su bmi tted to a CABG , were r and omized to a control group ( n=8 ) or IS+EPAP group ( n=8 ) . The protocol of IS+EPAP was applied in the immediate postoperative period and following for more 4 weeks in the patient 's home . Eighteen months after CABG , the strength of the respiratory muscle , the functional capacity , the lung function , the quality of life and the level of physical activity were evaluated . RESULTS After six minute walk test ( 6-MWT ) , the score of the dyspnea ( 1.6+/-0.6 vs 0.6+/-0.3 , P<0.05 ) and the perceived effort ( 13.4+/-1.2 vs 9.1+/-0.7 , P<0.05 ) were higher in the control group , when compared with the IS+EPAP group . In quality of life evaluation , the domain related to the physical aspects limitations was better in IS+EPAP group ( 93.7+/-4.1 vs 50+/-17 , P<0.02 ) . CONCLUSION Patients that were su bmi tted to IS+EPAP present reduction of dyspnea and lower effort sensation after the 6-MWT , and also a better quality of life 18 months after CABG OBJECTIVE To compare the effects of deep breathing exercises ( DBE ) and the flow-oriented incentive spirometry ( IS ) in patients undergone coronary artery bypass grafting ( CABG ) through the following variables : forced vital capacity - FVC , forced expiratory volume in 1 second - FEV(1 ) , maximal respiratory pressures and oxygen saturation . METHODS Thirty six patients in CABG postoperative period underwent thirty minutes of non-invasive ventilation  during the first 24 hours after extubation and were r and omly shared into two groups as following : DBE ( n=18 ) and IS ( n=18 ) . The spirometric variables were assessed on the preoperative period and seventh postoperative day ( POD ) . The respiratory muscle strength and oxygen saturation were assessed on the preoperative period , first , second and seventh POD . RESULTS The groups were considered homogeneous in relation to the demographic and surgical variables . It has been noted fall in the values of FVC and FEV(1 ) between the preoperative period and the seventh POD , but without significant differences between groups . The maximal respiratory pressures showed drop in the first POD but with and partial recovery until the seventh POD , also without significant differences between groups . The oxygen saturation was the only variable that was completely recovered on the seventh POD , also without significant differences between groups . CONCLUSION There were not observed significant differences in maximal respiratory pressures , spirometric variables and oxygen saturation in patients undergone deep breathing exercises and flow-oriented incentive spirometry after coronary artery bypass grafting STUDY OBJECTIVES The study evaluated the impact of the additional imposed work of breathing ( WBimp ) generated by two different spirometers on postoperative incentive spirometry performance in patients at high risk and moderate risk for postoperative pulmonary complications ( PPCs ) . Additionally , we investigated whether maximal inspiratory pressure ( PImax ) is an easy estimate of the WBimp imposed by incentive spirometers . DESIGN Prospect i ve , r and omized , single-blind clinical trial . SETTING ICU of a university hospital . INTERVENTIONS AND MEASUREMENTS Thirty male patients were assigned to a group at high risk for PPCs ( group A ; inspiratory capacity [ IC ] , < 1.6 L ) or to a group at moderate risk for PPCs ( group B ; IC , 1.6 to 2.5 L ) after upper-abdominal , thoracic , or two-cavity surgery . On the first or second postoperative day WBimp , IC , and PImax were recorded without spirometers ( baseline ) and during incentive spirometry with the Mediflo spirometer ( Medimex ; Hamburg , Germany ) ( high WBimp ) and the Coach spirometer ( Kendall ; Neustadt , Germany ) ( low WBimp ) using a pneumotachograph . In group A , the baseline and the ICs for both spirometers only differed slightly . In group B , the IC was significantly reduced for the Mediflo ( p < 0.05 ) , which imposed a WBimp twice as high as the Coach ( p < 0.01 ) . PImax was significantly increased for both the Mediflo and the Coach ( p < 0.01 ) . PImax was positively correlated with WBimp ( r = 0.8 ) . CONCLUSIONS Incentive spirometers differ considerably in their additional Wbimp with a potential impact on the efficacy of postoperative incentive spirometry performance . PImax might be an easy clinical estimate for the WBimp during incentive spirometry . Incentive spirometers with low WBimp permit increased maximal sustained inspiration and , thus , enhanced incentive spirometry performance , and , therefore , it might be more suitable for use in postoperative respiratory care 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 Pulmonary infections can be life threatening for children with neuromuscular diseases who have impaired ability to clear secretions .  Intrapulmonary percussive ventilation ( IPV ) is a pneumatic device that delivers air and aerosol to the lungs at frequencies of 200 to 300 cycles per minute at peak pressures from 20 to 40 cm H(2)O. Anecdotal reports and pilot studies show its safety and effectiveness in mobilizing secretions in patients with cystic fibrosis . OBJECTIVE To test the hypothesis that IPV used in a pulmonary program for adolescents with neuromuscular disease would reduce the number of days of antibiotic use for pulmonary infection . METHODS A r and omized , controlled study was conducted to compare efficacy of IPV with incentive spirometry ( IS ) in reducing number of days of antibiotic use in adolescents with neuromuscular disease . The secondary endpoints were the number of respiratory infections , hospitalizations , and school days missed . RESULTS A total of 18 patients were enrolled ( 9 IPV , 9 IS ) .  Antibiotic use was significantly higher with IS ( 24/1000 patient-days ) compared with IPV ( 0/1000 patient-days ) , ( incidence rate ratio , 43 ; 95 % confidence interval , 6 - 333 ) . The IS group spent more days hospitalized ( 4.4/1000 patient-days vs 0/1000 patient-days ) than the IPV group ( incidence rate ratio , 8.5 ; 95 % confidence interval , 1.1 - 67 ) . The IPV group had 0 episodes of pneumonia or bacterial bronchitis compared with 3 events in the IS group , although this did not meet statistical significance . CONCLUSION Intrapulmonary percussive ventilation as part of a preventive pulmonary regimen reduced days of antibiotic use and hospitalization for respiratory illness in adolescents with neuromuscular disease Abdominal binders are ordered by some surgeons postoperatively for patient comfort and to prevent wound complications . There has been some question as to the compressive effect that an abdominal binder has on pulmonary function . We prospect ively r and omized 54 patients undergoing a midline laparotomy incision to two groups : a “ binder ” group and a “ no binder ” group .  Preoperative pulmonary function tests ( vital capacity and incentive spirometry ) were measured . Postoperatively , pulmonary function tests , pulse oximetry , oxygen requirement , pulmonary and wound complications , pain control , time to ambulation , and hospital length of stay were examined . Vital capacity as a per cent of preoperative values on postoperative Day 1 for the binder and nonbinder groups were 64.7 and 54.6 per cent , respectively , but this was not statistically significant . Average level of pain using the visual analog pain scale on postoperative Days 1 through 3 in the binder versus nonbinder groups was 4 versus 8 , 3 vs 6 , and 3 versus 7 , respectively . Time to ambulation was 18.6 hours in the binder group and 16.7 hours in the nonbinder group . Hospital length of stay in the binder and nonbinder groups was 3.9 days and 3.7 days , respectively . We conclude that abdominal binders in our patients with midline abdominal incisions had no significant effect on postoperative pulmonary function , but seemed to help with pain control 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 res 
    Output:
    
agent
3 : It is suggested that deep breathing exercises provide the same benefit as incentive spirometry in the preoperative and postoperative setting to prevent postoperative pulmonary complications .
***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: BACKGROUND Patients undergoing coronary artery bypass graft ( CABG ) surgery  have higher risk to develop pulmonary complications ( PCs ) such as atelectasis , pneumonia and pleural effusion . These complications could increase the length of hospital stay , re sources utilization and also are associated with reduced quality of life and functional capacity a long term . OBJECTIVE To test if the use of incentive spirometry ( IS ) associated with expiratory positive airway pressure ( EPAP ) , after CABG surgery improves dyspnea , effort perceived and quality of life 18 months after CABG . METHODS Sixteen patients su bmi tted to a CABG , were r and omized to a control group ( n=8 ) or IS+EPAP group ( n=8 ) . The protocol of IS+EPAP was applied in the immediate postoperative period and following for more 4 weeks in the patient 's home . Eighteen months after CABG , the strength of the respiratory muscle , the functional capacity , the lung function , the quality of life and the level of physical activity were evaluated . RESULTS After six minute walk test ( 6-MWT ) , the score of the dyspnea ( 1.6+/-0.6 vs 0.6+/-0.3 , P<0.05 ) and the perceived effort ( 13.4+/-1.2 vs 9.1+/-0.7 , P<0.05 ) were higher in the control group , when compared with the IS+EPAP group . In quality of life evaluation , the domain related to the physical aspects limitations was better in IS+EPAP group ( 93.7+/-4.1 vs 50+/-17 , P<0.02 ) . CONCLUSION Patients that were su bmi tted to IS+EPAP present reduction of dyspnea and lower effort sensation after the 6-MWT , and also a better quality of life 18 months after CABG OBJECTIVE To compare the effects of deep breathing exercises ( DBE ) and the flow-oriented incentive spirometry ( IS ) in patients undergone coronary artery bypass grafting ( CABG ) through the following variables : forced vital capacity - FVC , forced expiratory volume in 1 second - FEV(1 ) , maximal respiratory pressures and oxygen saturation . METHODS Thirty six patients in CABG postoperative period underwent thirty minutes of non-invasive ventilation  during the first 24 hours after extubation and were r and omly shared into two groups as following : DBE ( n=18 ) and IS ( n=18 ) . The spirometric variables were assessed on the preoperative period and seventh postoperative day ( POD ) . The respiratory muscle strength and oxygen saturation were assessed on the preoperative period , first , second and seventh POD . RESULTS The groups were considered homogeneous in relation to the demographic and surgical variables . It has been noted fall in the values of FVC and FEV(1 ) between the preoperative period and the seventh POD , but without significant differences between groups . The maximal respiratory pressures showed drop in the first POD but with and partial recovery until the seventh POD , also without significant differences between groups . The oxygen saturation was the only variable that was completely recovered on the seventh POD , also without significant differences between groups . CONCLUSION There were not observed significant differences in maximal respiratory pressures , spirometric variables and oxygen saturation in patients undergone deep breathing exercises and flow-oriented incentive spirometry after coronary artery bypass grafting STUDY OBJECTIVES The study evaluated the impact of the additional imposed work of breathing ( WBimp ) generated by two different spirometers on postoperative incentive spirometry performance in patients at high risk and moderate risk for postoperative pulmonary complications ( PPCs ) . Additionally , we investigated whether maximal inspiratory pressure ( PImax ) is an easy estimate of the WBimp imposed by incentive spirometers . DESIGN Prospect i ve , r and omized , single-blind clinical trial . SETTING ICU of a university hospital . INTERVENTIONS AND MEASUREMENTS Thirty male patients were assigned to a group at high risk for PPCs ( group A ; inspiratory capacity [ IC ] , < 1.6 L ) or to a group at moderate risk for PPCs ( group B ; IC , 1.6 to 2.5 L ) after upper-abdominal , thoracic , or two-cavity surgery . On the first or second postoperative day WBimp , IC , and PImax were recorded without spirometers ( baseline ) and during incentive spirometry with the Mediflo spirometer ( Medimex ; Hamburg , Germany ) ( high WBimp ) and the Coach spirometer ( Kendall ; Neustadt , Germany ) ( low WBimp ) using a pneumotachograph . In group A , the baseline and the ICs for both spirometers only differed slightly . In group B , the IC was significantly reduced for the Mediflo ( p < 0.05 ) , which imposed a WBimp twice as high as the Coach ( p < 0.01 ) . PImax was significantly increased for both the Mediflo and the Coach ( p < 0.01 ) . PImax was positively correlated with WBimp ( r = 0.8 ) . CONCLUSIONS Incentive spirometers differ considerably in their additional Wbimp with a potential impact on the efficacy of postoperative incentive spirometry performance . PImax might be an easy clinical estimate for the WBimp during incentive spirometry . Incentive spirometers with low WBimp permit increased maximal sustained inspiration and , thus , enhanced incentive spirometry performance , and , therefore , it might be more suitable for use in postoperative respiratory care 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 Pulmonary infections can be life threatening for children with neuromuscular diseases who have impaired ability to clear secretions .  Intrapulmonary percussive ventilation ( IPV ) is a pneumatic device that delivers air and aerosol to the lungs at frequencies of 200 to 300 cycles per minute at peak pressures from 20 to 40 cm H(2)O. Anecdotal reports and pilot studies show its safety and effectiveness in mobilizing secretions in patients with cystic fibrosis . OBJECTIVE To test the hypothesis that IPV used in a pulmonary program for adolescents with neuromuscular disease would reduce the number of days of antibiotic use for pulmonary infection . METHODS A r and omized , controlled study was conducted to compare efficacy of IPV with incentive spirometry ( IS ) in reducing number of days of antibiotic use in adolescents with neuromuscular disease . The secondary endpoints were the number of respiratory infections , hospitalizations , and school days missed . RESULTS A total of 18 patients were enrolled ( 9 IPV , 9 IS ) .  Antibiotic use was significantly higher with IS ( 24/1000 patient-days ) compared with IPV ( 0/1000 patient-days ) , ( incidence rate ratio , 43 ; 95 % confidence interval , 6 - 333 ) . The IS group spent more days hospitalized ( 4.4/1000 patient-days vs 0/1000 patient-days ) than the IPV group ( incidence rate ratio , 8.5 ; 95 % confidence interval , 1.1 - 67 ) . The IPV group had 0 episodes of pneumonia or bacterial bronchitis compared with 3 events in the IS group , although this did not meet statistical significance . CONCLUSION Intrapulmonary percussive ventilation as part of a preventive pulmonary regimen reduced days of antibiotic use and hospitalization for respiratory illness in adolescents with neuromuscular disease Abdominal binders are ordered by some surgeons postoperatively for patient comfort and to prevent wound complications . There has been some question as to the compressive effect that an abdominal binder has on pulmonary function . We prospect ively r and omized 54 patients undergoing a midline laparotomy incision to two groups : a “ binder ” group and a “ no binder ” group .  Preoperative pulmonary function tests ( vital capacity and incentive spirometry ) were measured . Postoperatively , pulmonary function tests , pulse oximetry , oxygen requirement , pulmonary and wound complications , pain control , time to ambulation , and hospital length of stay were examined . Vital capacity as a per cent of preoperative values on postoperative Day 1 for the binder and nonbinder groups were 64.7 and 54.6 per cent , respectively , but this was not statistically significant . Average level of pain using the visual analog pain scale on postoperative Days 1 through 3 in the binder versus nonbinder groups was 4 versus 8 , 3 vs 6 , and 3 versus 7 , respectively . Time to ambulation was 18.6 hours in the binder group and 16.7 hours in the nonbinder group . Hospital length of stay in the binder and nonbinder groups was 3.9 days and 3.7 days , respectively . We conclude that abdominal binders in our patients with midline abdominal incisions had no significant effect on postoperative pulmonary function , but seemed to help with pain control 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 res 
    Output:
    