ORIGINAL RESEARCH—HEAD AND NECK CANCER Effect of deep breathing exercises on oxygenation after major head and neck surgery Arzu Genç, PhD, PT, Ahmet Omer Ikiz, MD, MSc, Enis Alpin Güneri, MD, MSc, and Ali Günerli, MD, Izmir, Turkey OBJECTIVES: To investigate respiratory and hemodynamic re- sponses to deep breathing exercise (DBE) during the follow-up period in the intensive care unit after major head and neck surgery. STUDY DESIGN: Prospective study. SUBJECTS AND METHODS: Thirty-five patients were in- structed to perform DBE every hour for 3 consecutive hours during the first postoperative day. The ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO 2 /FiO 2 ), oxygen saturation (SpO 2 ), respiratory rate (RR), heart rate (HR), and mean arterial pressure (MAP) was recorded. RESULTS: DBE increased the PaO 2 /FiO 2 ratio from 416.7  143.6 to 453.4  141.4 mm Hg and increased SpO 2 from 97.4  1.9 to 99.2  0.9. DBE decreased the RR from 24.1  3.3 to 21.8  2.9 breaths/min (P  0.05). No statistically significant difference in HR or MAP was observed after DBE (P  0.05). CONCLUSION: DBE improves oxygenation after major head and neck surgery, without causing additional harmful hemody- namic effects. © 2008 American Academy of Otolaryngology–Head and Neck Surgery Foundation. All rights reserved. S urgery to treat cancers of the head and neck carries substantial risk in terms of peri- and postoperative com- plications. These patients often have preexisting comorbidi- ties that must be recognized to optimize postoperative care. For example, smoking may compromise the patient’s respi- ratory condition, and the pulmonary system is the leading source of postoperative systemic complications. The most important and serious postoperative pulmonary complica- tions include atelectasis, pneumonia, respiratory failure, and the exacerbation of underlying lung disease, which arise in approximately 10% to 15% of cases. 1-5 Pulmonary complications can be reduced via the optimi- zation of pulmonary function, intensive pulmonary hygiene, and early ambulation. 1 Chest physiotherapy plays an impor- tant role in the treatment of atelectasis and preventing its progression to more significant pulmonary complications following major surgeries. Physiotherapists use various techniques to improve lung volume and to clear pulmonary secretion in postoperative patients. 6,7 Although numerous studies have investigated the effects of chest physiotherapy in abdominal and thoracic surgery patients, only one publication to our knowledge has ad- dressed this topic in head and neck surgery patients. 7-11 Therefore, we investigated the respiratory and hemody- namic effects of deep breathing exercise (DBE) during recuperation in the intensive care unit (ICU) after major head and neck surgery. SUBJECTS AND METHODS This study included 35 patients who underwent major head and neck surgery and were monitored in the ICU from December 1999 to January 2002. The patients ranged in age from 40 to 75 years, with a mean  standard deviation (SD) of 58.8  8.9 years. The group consisted of 34 men (97.1%) and one woman (2.9%). The study was approved by the Ethics and Human Research Committee of Dokuz Eylül University Hospital (Izmir, Turkey). Exclusion criteria included active pulmonary pathology (eg, exacerbation of chronic obstructive pulmonary disease [COPD]) and unstable cardiovascular condition. A mean arterial pressure (MAP) of less than 65 mm Hg, arterial pressure fluctuation of 15 mm Hg with position change, and a heart rate (HR) exceeding 130/min were used as indicators of unstable cardiovascular condition. One patient with post- operative exacerbation of COPD had to be excluded from the study. As a result, we gathered data for 35 of the 36 patients initially enrolled. Eighteen patients showed no underlying conditions. Of the remaining 17 patients, 11 had cardiovascular conditions, four had pulmonary conditions, one patient had a neurolog- ical condition, and one patient had diabetes mellitus. Thirty of 35 patients were smokers with a mean  SD pack-year history of 42.5  23.0. Thirty-four patients belonged to the American Society of Anesthesiologists (ASA) Class I and one to Class II. The mean duration of anesthesia was 8.4  2.3 hours and the mean time spent in the ICU was 22.8  8.8 hours. Received November 4, 2007; revised April 10, 2008; accepted April 21, 2008. Otolaryngology–Head and Neck Surgery (2008) 139, 281-285 0194-5998/$34.00 © 2008 American Academy of Otolaryngology–Head and Neck Surgery Foundation. All rights reserved. doi:10.1016/j.otohns.2008.04.025