The importance of breathing techniques in preventing pulmonary complications after surgery
DOI:
https://doi.org/10.12775/JEHS.2026.95.73502Keywords
postoperative pulmonary complications, breathing exercises, respiratory physiotherapy, incentive spirometry, postoperative rehabilitation, pulmonary prevention after surgeryAbstract
Respiratory physiotherapy is an important element in the prevention and treatment of postoperative respiratory complications, which frequently occur in patients after surgical procedures, particularly in the thoracic and abdominal areas. The aim of this study was to assess the impact of respiratory physiotherapy on reducing the risk of postoperative pulmonary complications and to determine the importance of early mobilization and patient education in the rehabilitation process. The study is based on a review of available scientific literature regarding the use of various respiratory physiotherapy methods in the postoperative period and their effectiveness in preventing pulmonary complications. The analysis of studies indicates that the use of respiratory techniques reduces the incidence of complications such as atelectasis and pneumonia, and the best therapeutic effects are achieved when breathing exercises are combined with early patient mobilization and appropriate preoperative education. The results of the review confirm that a comprehensive approach to respiratory physiotherapy increases its effectiveness in preventing postoperative complications. At the same time, the need for further research of high methodological quality is emphasized to standardize procedures and better determine the effectiveness of individual therapeutic methods.
References
[1] Lusquinhos, J., Tavares, M., & Abelha, F. (2023). Postoperative Pulmonary Complications and Perioperative Strategies: A Systematic Review. Cureus, 15(5), e38786. https://doi.org/10.7759/cureus.38786
[2] Dhillon, G., Buddhavarapu, V. S., Grewal, H., Munjal, R., Verma, R. K., Surani, S., & Kashyap, R. (2023). Evidence-based Practice Interventions for Reducing Postoperative Pulmonary Complications: A Narrative Review. The open respiratory medicine journal, 17, e18743064271499. https://doi.org/10.2174/012210299X247199231128100613
[3] Huang, C., Zhao, X., Geng, S., Sun, S., Mousa, N. M., Xia, H., Xu, X., Deng, J., Lu, X., Xu, D., Zhao, B., Lim, M., Li, Y., Tang, W., Chen, X., Smith, F. G., Tang, C., & Feng, X. (2026). Non-drug perioperative interventions to reduce postoperative pulmonary complications after abdominal surgery: systematic review and meta-analysis. BMJ (Clinical research ed.), 393, e089001. https://doi.org/10.1136/bmj-2025-089001
[4] Chandler, D., Mosieri, C., Kallurkar, A., Pham, A. D., Okada, L. K., Kaye, R. J., Cornett, E. M., Fox, C. J., Urman, R. D., & Kaye, A. D. (2020). Perioperative strategies for the reduction of postoperative pulmonary complications. Best practice & research. Clinical anaesthesiology, 34(2), 153–166. https://doi.org/10.1016/j.bpa.2020.04.011
[5] Odor, P. M., Bampoe, S., Gilhooly, D., Creagh-Brown, B., & Moonesinghe, S. R. (2020). Perioperative interventions for prevention of postoperative pulmonary complications: systematic review and meta-analysis. BMJ (Clinical research ed.), 368, m540. https://doi.org/10.1136/bmj.m540
[6] Boden, I., Reeve, J., Jernås, A., Denehy, L., & Fagevik Olsén, M. (2024). Preoperative physiotherapy prevents postoperative pulmonary complications after major abdominal surgery: a meta-analysis of individual patient data. Journal of physiotherapy, 70(3), 216–223. https://doi.org/10.1016/j.jphys.2024.02.012
[7] Chang, P. C., Chen, P. H., Chang, T. H., Chen, K. H., Jhou, H. J., Chou, S. H., & Chang, T. W. (2023). Incentive spirometry is an effective strategy to improve the quality of postoperative care in patients. Asian journal of surgery, 46(9), 3397–3404. https://doi.org/10.1016/j.asjsur.2022.11.030
[8] Piccioni, F., Spagnesi, L., Pelosi, P., Bignami, E., Guarnieri, M., Fumagalli, L., Polati, E., Schweiger, V., Comi, D., D'Andrea, R., DI Marco, P., Spadaro, S., Antonelli, S., Sollazzi, L., Mirabella, L., Schiavoni, M., Laici, C., Marelli, J. A., Fabiani, F., Ball, L., … PPCs Investigators Group (2023). Postoperative pulmonary complications and mortality after major abdominal surgery. An observational multicenter prospective study. Minerva anestesiologica, 89(11), 964–976. https://doi.org/10.23736/S0375-9393.23.17382-2
[9] Junaidi, B., Hawrylak, A., & Kaw, R. (2024). Evaluation and Management of Perioperative Pulmonary Complications. The Medical clinics of North America, 108(6), 1087–1100. https://doi.org/10.1016/j.mcna.2024.04.003
[10] Zeng, C., Lagier, D., Lee, J. W., & Vidal Melo, M. F. (2022). Perioperative Pulmonary Atelectasis: Part I. Biology and Mechanisms. Anesthesiology, 136(1), 181–205. https://doi.org/10.1097/ALN.0000000000003943
[11] Lagier, D., Zeng, C., Fernandez-Bustamante, A., & Vidal Melo, M. F. (2022). Perioperative Pulmonary Atelectasis: Part II. Clinical Implications. Anesthesiology, 136(1), 206–236. https://doi.org/10.1097/ALN.0000000000004009
[12] Tuna, M.E., Akgün, M. Preoperative pulmonary evaluation to prevent postoperative pulmonary complications. APS 1, 34 (2023). https://doi.org/10.1007/s44254-023-00034-2
[13] Palermo, J., Tingey, S., Khanna, A. K., & Segal, S. (2024). Evaluation and Prevention of Perioperative Respiratory Failure. Journal of clinical medicine, 13(17), 5083. https://doi.org/10.3390/jcm13175083
[14] Mazzotta, E., Soghomonyan, S., & Hu, L. Q. (2023). Postoperative sore throat: prophylaxis and treatment. Frontiers in pharmacology, 14, 1284071. https://doi.org/10.3389/fphar.2023.1284071
[15] Wang, J., Li, H., Yan, W., Xue, N., Yin, J., Nawsherwan, & Yin, S. (2024). Prehabilitation Interventions for Cardiac Surgery to Prevent Postoperative Pulmonary Complications: Systematic Review and Meta-Analysis. Iranian journal of public health, 53(10), 2167–2179. https://doi.org/10.18502/ijph.v53i10.16683
[16] Schneider, J. L., Rowe, J. H., Garcia-de-Alba, C., Kim, C. F., Sharpe, A. H., & Haigis, M. C. (2021). The aging lung: Physiology, disease, and immunity. Cell, 184(8), 1990–2019. https://doi.org/10.1016/j.cell.2021.03.005
[17] Turan, A., Mascha, E. J., Roberman, D., Turner, P. L., You, J., Kurz, A., Sessler, D. I., & Saager, L. (2011). Smoking and perioperative outcomes. Anesthesiology, 114(4), 837–846. https://doi.org/10.1097/ALN.0b013e318210f560
[18] Choi, J. Y., Al-Saedy, M. A., & Carlson, B. (2023). Positive end-expiratory pressure and postoperative complications in patients with obesity: a review and meta-analysis. Obesity (Silver Spring, Md.), 31(4), 955–964. https://doi.org/10.1002/oby.23675
[19] Harrogate, S., Barnes, J., Thomas, K., Isted, A., Kunst, G., Gupta, S., Rudd, S., Banerjee, T., Hinchliffe, R., & Mouton, R. (2023). Peri-operative tobacco cessation interventions: a systematic review and meta-analysis. Anaesthesia, 78(11), 1393–1408. https://doi.org/10.1111/anae.16120
[20] Tang, E., Rodriguez, R. M., Srivastava, A., Malhan, R., Laksono, I., Yan, E., Englesakis, M., Wong, J., & Chung, F. (2025). Impact of short duration smoking cessation on post-operative complications: A systematic review and meta-analysis. Journal of clinical anesthesia, 106, 111967. https://doi.org/10.1016/j.jclinane.2025.111967
[21] Buonanno, P., Marra, A., Iacovazzo, C., Vargas, M., Coviello, A., Squillacioti, F., Nappi, S., de Siena, A. U., & Servillo, G. (2023). Impact of ventilation strategies on pulmonary and cardiovascular complications in patients undergoing general anaesthesia for elective surgery: a systematic review and meta-analysis. British journal of anaesthesia, 131(6), 1093–1101. https://doi.org/10.1016/j.bja.2023.09.011
[22] Hu, J., Guo, R., Li, H., Wen, H., & Wang, Y. (2024). Perioperative Diaphragm Dysfunction. Journal of clinical medicine, 13(2), 519. https://doi.org/10.3390/jcm13020519
[23] Nørskov, J., Skaarup, S.H., Bendixen, M. et al. Diaphragmatic dysfunction is associated with postoperative pulmonary complications and phrenic nerve paresis in patients undergoing thoracic surgery. J Anesth 38, 386–397 (2024). https://doi.org/10.1007/s00540-024-03325-5
[24] Liu, HM., Yu, H., Zuo, YD. et al. Postoperative pulmonary complications after sugammadex reversal of neuromuscular blockade: a systematic review and meta-analysis with trial sequential analysis. BMC Anesthesiol 23, 130 (2023). https://doi.org/10.1186/s12871-023-02094-0
[25] Ababneh, Q. M., Abdelrahman, H., & Abdelhameed, M. E. (2025). Effectiveness of Incentive Spirometry Versus Deep Breathing Exercises in Preventing Postoperative Pulmonary Complications After Abdominal Surgery: A Comprehensive Review. Cureus, 17(3), e80149. https://doi.org/10.7759/cureus.80149
[26] Liao, B., Liao, W., Yin, S., Liu, S., & Wu, X. (2024). Effect of ultrasound-guided lung recruitment to reduce pulmonary atelectasis after non-cardiac surgery under general anesthesia: a systematic review and meta-analysis of randomized controlled trials. Perioperative medicine (London, England), 13(1), 23. https://doi.org/10.1186/s13741-024-00379-7
[27] Li, X., Li, X., Zhang, W., Liu, Q., Gao, Y., Chang, R., & Zhang, C. (2021). Factors and potential treatments of cough after pulmonary resection: A systematic review. Asian journal of surgery, 44(8), 1029–1036. https://doi.org/10.1016/j.asjsur.2021.01.001
[28] Wu, Y., Song, W., Zhu, D., Wang, Y., & Che, G. (2023). Risk factors for cough after pulmonary resection. World journal of surgical oncology, 21(1), 348. https://doi.org/10.1186/s12957-023-03235-y
[29] McGarvey, L., Rubin, B. K., Ebihara, S., Hegland, K., Rivet, A., Irwin, R. S., Bolser, D. C., Chang, A. B., Gibson, P. G., Mazzone, S. B., & CHEST Expert Cough Panel (2021). Global Physiology and Pathophysiology of Cough: Part 2. Demographic and Clinical Considerations: CHEST Expert Panel Report. Chest, 160(4), 1413–1423. https://doi.org/10.1016/j.chest.2021.04.039
[30] Hill, D. B., Button, B., Rubinstein, M., & Boucher, R. C. (2022). Physiology and pathophysiology of human airway mucus. Physiological reviews, 102(4), 1757–1836. https://doi.org/10.1152/physrev.00004.2021
[31] Singh, V., Agumbe Pai, S., & Hosmath, V. (2023). Clinical outcome of patients undergoing preoperative chest physiotherapy in elective upper abdominal surgeries. Journal of perioperative practice, 33(6), 182–189. https://doi.org/10.1177/17504589211045225
[32] Ko, E., Yoo, K. Y., Lim, C. H., Jun, S., Lee, K., & Kim, Y. H. (2023). Is atelectasis related to the development of postoperative pneumonia? a retrospective single center study. BMC anesthesiology, 23(1), 77. https://doi.org/10.1186/s12871-023-02020-4
[33] Franklin E, Anjum F. Incentive Spirometer and Inspiratory Muscle Training. [Updated 2023 Apr 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/sites/books/NBK572114/?utm_source=chatgpt.com
[34] Kotta, P. A., & Ali, J. M. (2021). Incentive Spirometry for Prevention of Postoperative Pulmonary Complications After Thoracic Surgery. Respiratory care, 66(2), 327–333. https://doi.org/10.4187/respcare.07972
[35] Silva, H. V. C., Lunardi, A. C., Pinto, A. C. P. N., Macedo, J. R. F. F., & Santos, E. D. C. D. (2024). Is Incentive Spirometry Superior to Standard Care in Postoperative Cardiac Surgery on Clinical Outcomes and Length of Hospital and Intensive Care Unit Stay? A Systematic Review with Meta-Analysis. Brazilian journal of cardiovascular surgery, 39(3), e20220319. https://doi.org/10.21470/1678-9741-2022-0319
[36] Zorrilla-Vaca, A., Grant, M. C., Urman, R. D., & Frendl, G. (2022). Individualised positive end-expiratory pressure in abdominal surgery: a systematic review and meta-analysis. British journal of anaesthesia, 129(5), 815–825. https://doi.org/10.1016/j.bja.2022.07.009
[37] Coppolo, D.P., Schloss, J., Suggett, J.A. et al. Non-Pharmaceutical Techniques for Obstructive Airway Clearance Focusing on the Role of Oscillating Positive Expiratory Pressure (OPEP): A Narrative Review. Pulm Ther 8, 1–41 (2022). https://doi.org/10.1007/s41030-021-00178-1
[38] Xu, Z., Han, Z. & Ma, D. Efficacy and safety of long-term use of a positive expiratory pressure device in chronic obstructive pulmonary disease patients, a randomized controlled trial. BMC Pulm Med 23, 17 (2023). https://doi.org/10.1186/s12890-023-02319-5
[39] Rocamora-Pérez, P., Benzo-Iglesias, M. J., Valverde-Martínez, M. L. Á., García-Luengo, A. V., Aguilar-Parra, J. M., Trigueros, R., & López-Liria, R. (2022). Effectiveness of positive expiratory pressure on patients over 16 years of age with cystic fibrosis: systematic review and meta-analysis. Therapeutic advances in respiratory disease, 16, 17534666221089467. https://doi.org/10.1177/17534666221089467
[40] You, J., Jiang, B., Dai, N., Lu, B., Zhao, C., & Zheng, Z. (2024). Effects of oscillatory positive expiratory pressure therapy in patients undergoing thoracic or upper abdominal surgery: A systematic review and meta-analysis. Heliyon, 10(18), e37798. https://doi.org/10.1016/j.heliyon.2024.e37798
[41] Zisi, D., Chryssanthopoulos, C., Nanas, S., & Philippou, A. (2022). The effectiveness of the active cycle of breathing technique in patients with chronic respiratory diseases: A systematic review. Heart & lung : the journal of critical care, 53, 89–98. https://doi.org/10.1016/j.hrtlng.2022.02.006
[42] Zhong, J., Zhang, S., Li, C., Hu, Y., Wei, W., Liu, L., Wang, M., Hong, Z., Long, H., Rong, T., Yang, H., & Su, X. (2022). Active cycle of breathing technique may reduce pulmonary complications after esophagectomy: A randomized clinical trial. Thoracic cancer, 13(1), 76–83. https://doi.org/10.1111/1759-7714.14227
[43] Ning, G., Sihan, C., Daihong, J., Zhilong, Z., Aihua, Z., Liting, L., & Heling, G. (2025). Effect of position management combined with active cycle of breathing techniques on reducing postoperative pulmonary complications in lung cancer patients. BMC cancer, 25(1), 1780. https://doi.org/10.1186/s12885-025-15029-4
[44] Kokotovic, D., Berkfors, A., Gögenur, I., Ekeloef, S., & Burcharth, J. (2021). The effect of postoperative respiratory and mobilization interventions on postoperative complications following abdominal surgery: a systematic review and meta-analysis. European Journal of Trauma and Emergency Surgery, 47, 975–990. https://doi.org/10.1007/s00068-020-01522-x
[45] Sullivan, K. A., Churchill, I. F., Hylton, D. A., & Hanna, W. C. (2021). Use of Incentive Spirometry in Adults following Cardiac, Thoracic, and Upper Abdominal Surgery to Prevent Post-Operative Pulmonary Complications: A Systematic Review and Meta-Analysis. Respiration; international review of thoracic diseases, 100(11), 1114–1127. https://doi.org/10.1159/000517012
[46] Xiang, Y., Zhao, Q., Luo, T., & Zeng, L. (2023). Inspiratory muscle training to reduce risk of pulmonary complications after coronary artery bypass grafting: a systematic review and meta-analysis. Frontiers in cardiovascular medicine, 10, 1223619. https://doi.org/10.3389/fcvm.2023.1223619
[47] Bingül, E. S., Şentürk, N. M., & Kaynar, A. M. (2023). Prehabilitation: a narrative review focused on exercise therapy for the prevention of postoperative pulmonary complications following lung resection. Frontiers in medicine, 10, 1196981. https://doi.org/10.3389/fmed.2023.1196981
[48] Assouline, B., Cools, E., Schorer, R., Kayser, B., Elia, N., & Licker, M. (2021). Preoperative Exercise Training to Prevent Postoperative Pulmonary Complications in Adults Undergoing Major Surgery. A Systematic Review and Meta-analysis with Trial Sequential Analysis. Annals of the American Thoracic Society, 18(4), 678–688. https://doi.org/10.1513/AnnalsATS.202002-183OC
[49] Cook, A., Smith, L., Anderson, C., Ewing, N., Gammack, A., Pecover, M., Sime, N., & Galley, H. F. (2023). The effect of Preoperative threshold inspiratory muscle training in adults undergoing cardiac surgery on postoperative hospital stay: a systematic review. Physiotherapy theory and practice, 39(4), 690–703. https://doi.org/10.1080/09593985.2022.2025548
[50] Huang, Y. T., Lin, Y. J., Hung, C. H., Cheng, H. C., Yang, H. L., Kuo, Y. L., Chu, P. M., Tsai, Y. F., & Tsai, K. L. (2022). The fully engaged inspiratory muscle training reduces postoperative pulmonary complications rate and increased respiratory muscle function in patients with upper abdominal surgery: a randomized controlled trial. Annals of medicine, 54(1), 2222–2232. https://doi.org/10.1080/07853890.2022.2106511
[51] Dolic, D., & Salvitti, S. (2026). Efficacy of positive expiratory pressure in the prevention and treatment of postoperative pulmonary complications following thoracic and abdominal surgery. A systematic review and meta-analysis. Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace, 96(2), 10.4081/monaldi.2026.3735. https://doi.org/10.4081/monaldi.2026.3735
[52] Zhao, C. H., Sun, Y. H., & Mao, X. M. (2023). Volume Incentive Spirometry Reduces Pulmonary Complications in Patients After Open Abdominal Surgery: A Randomized Clinical Trial. International journal of general medicine, 16, 793–801. https://doi.org/10.2147/IJGM.S400030
[53] Xu, X., Cheung, D. S. T., Smith, R., Lai, A. Y. K., & Lin, C. C. (2022). The effectiveness of pre- and post-operative rehabilitation for lung cancer: A systematic review and meta-analysis on postoperative pulmonary complications and length of hospital stay. Clinical rehabilitation, 36(2), 172–189. https://doi.org/10.1177/02692155211043267
[54] Reychler, G., Piraux, E., Beaumont, M., Caty, G., & Liistro, G. (2022). Telerehabilitation as a Form of Pulmonary Rehabilitation in Chronic Lung Disease: A Systematic Review. Healthcare (Basel, Switzerland), 10(9), 1795. https://doi.org/10.3390/healthcare10091795
[55] Uzzaman, M. N., Agarwal, D., Chan, S. C., Patrick Engkasan, J., Habib, G. M. M., Hanafi, N. S., Jackson, T., Jebaraj, P., Khoo, E. M., Mirza, F. T., Pinnock, H., Shunmugam, R. H., & Rabinovich, R. A. (2022). Effectiveness of home-based pulmonary rehabilitation: systematic review and meta-analysis. European respiratory review : an official journal of the European Respiratory Society, 31(165), 220076. https://doi.org/10.1183/16000617.0076-2022
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