Cough dynamics in the post-thoracotomy state.

A series of 24 adult male patients undergoing thoracotomy were found to have a reduction in their cough pressures in the immediate postoperative period to 29 percent of their preoperative values. Cough pressures still averaged only 50 percent of control values one week following surgery, with slow return toward normal over the ensuing three weeks. Pain associated with the surgical wound appeared to be primary factor in the patients' inability to cough effectively. The degree of impairment appeared to be related to the extent of the procedure, pressures being altered less in those with limited incision thoracotomies. Ultrasonically nebulized water mist was found to be effective in all but one patient in inducing significantly higher cough pressures and more effective sputum expectoration. Its use should be considered as a simple method of inducing more effective coughs in the postoperative patient.