An Early Rehabilitation Intervention for Enhancing Oxygenation and Recovery From Lung Cancer Surgery

Friday, 28 July 2017

Tsae-Jyy Wang, PhD, RN, ARNP
School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
Wei-Ling Hsiao, MSN, RN, NP
Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan

Purpose: The purpose of this study is to test the effects of an early rehabilitation intervention on oxygenation, postoperative complications, and recovery from lung cancer surgery.

Methods:  The study uses an experimental design. Ninety patients scheduled for lung cancer surgeries was recruited from thoracic surgery units of a medical center in Taiwan. Patients were randomly assigned to the intervention or the control group. The intervention includes a 5-day preoperative home-based rehabilitation and a 5-day postoperative in-hospital rehabilitation. The main components of the rehabilitation were aerobic and strength exercises as well as breathing training by using an incentive spirometry. Peripheral capillary oxygen saturation (SpO2) was measured in the morning of the preoperative day and of the 4 consecutive days from postoperative day one to four by using the Nellcor™ OxiMax N-65 Portable Pulse Oximeter. The SpO2/FiO2 (S/F) ratio was then calculated to assess patients’ oxygenation. Data on postoperative pulmonary compilations and durations of chest tube drainage were collected from the patients’ charts.

Results: The patients’ demographics and baseline measures were equivalent between groups. Results of GEE showed a significant group by time interaction effect on S/F ratio. As for the parameter estimates, from postoperative day 1 to day 4, the S/F ratio improvement in the intervention group was 74.49 (Wald X2 = 46.42, p<0.001) more than in the control group. Result of Chi-square test showed that the number of postoperative lung complications in the intervention group (n =1) was significantly less (X2 = 8.39, p = 0.004) than it in the control group (n =10). Result of t- test showed that the duration of chest tube drainage in the intervention group (2.00±1.00 days) was significantly shorter (t =-2.32, p = 0.022) than it in the control group (2.56±1.25 days).

Conclusion:  The study results support the effects of the early rehabilitation intervention on enhancing oxygenation, preventing complications, and promoting recovery from lung cancer surgery as indicated by shortened the duration of chest tube drainage. Surgery to remove the cancer is one of the primary treatment options for non-small cell lung cancer. However, lung cancer surgery may result in decreasing lung capacity and expansion; therefore, increase risks for postoperative pulmonary complications. Pulmonary rehabilitation designed to enhance lung expansion and ventilation may help to reduce postoperative lung complications and promote patients’ recovery from lung cancer surgery.