Effect of Acapella versus Incentive Spirometry on Partial Pressure of Carbon Dioxide in Arterial Blood after Coronary Artery Bypass Graft Surgery: A Randomized Controlled Trial.

Abstract

Background: Patients undergoing coronary artery bypass grafting (CABG) are at increased risk for postoperative pulmonary complications, which may include pneumonia, atelectasis, bronchospasm, exacerbation of chronic obstructive pulmonary disease (COPD), pneumothorax, pleural effusion, and various upper respiratory tract conditions. (1) The Acapella method is used to improve lung volume and airway patency in the early postoperative period in patients who have undergone coronary artery bypass grafting (CABG).
Objectives: to evaluate and compare the effect of acapella and incentive spirometry on Partial Pressure of Carbon Dioxide (PaCO2) after coronary artery bypass graft.
Method: In a randomized controlled study, the effects of acapella versus incentive spirometry were compared in two cardiac centers (the Iraqi center of heart disease and Ibn Al-Bitar Specialized Center) from December 8th, 2025, to June 23rd 3, 2026. after getting the Ethical Approval Committee under No:37 on March 25, 2025.informed written agreement was gotten from all participant were involved in the study. The researchers’ recruited volunteers who had undergone coronary artery bypass grafting (CABG) and randomly separated them into two groups: a study group and a control group. A total of 85 patients take part in the study. The main outcomes were measurements of PaCO2, were extracted from the patients' clinical records (ABGs), with the mean value calculated when the tests being conducted numerous times daily. PaCO2 measured 10 hours after extubation when patient is stable, one day after extubation, and day three after extubation after the procedure. The data were analyzed and interpreted by means of the statistical software SPSS (version 26.0). Qualitative variables such as age, sex, level of education, occupation, and place of residence were statistically analyzed using frequencies and percentages. Numerical variables were statistically analyzed using mean and standard deviation. A p-value below 0.05 was measured statistically significant.
Results: The findings demonstrate significant reduction in PaCO2 levels over the three measurement periods in the control group (χ2= 15.630, p= 0.000) with moderate effect size (0.289); Incentive Spirometry group (χ2= 19.513, p= 0.000) with moderate effect size (0.325), and Acapella group (χ2= 27.214, p= 0.000) with large effect size (0.486).
Conclusions: our study results showed that both Acapella and Incentive spirometry were associated with improved PaCo2 after Coronary Artery Bypass Graft, with Acapella showing the largest within-group effect.
Recommendation: Join the acapella as adjunctive therapy with nursing practice care and rehabilitation of dyspnea for patients after coronary artery bypass grafting Surgery and conduct a clinical study to examine acapella with deep breathing and cough trials in patients who will undergo coronary artery bypass grafting surgery with lung problems such as chronic obstructive pulmonary disease and asthma.