Effect of Nurse-Guided Respiratory Interventions (Incentive Spirometry vs. Coughing Exercises) for Postoperative Recovery in Children following Cardiac Surgery: Randomized Controlled Trial

Abstract

Objective: To evaluate and compare the effectiveness of incentive spirometry versus coughing exercises on the recovery level in children after cardiac surgery.

Methods: A prospective, randomized, single-blind controlled trial posttest design was conducted among children in the intensive care unit at cardiac hospitals in Iraq between December 2025 and March 2026. A total of 105 children aged 6–18 years who underwent cardiac surgery were randomly allocated into three groups: incentive spirometry (n = 35), coughing exercises (n = 35), and control (n = 35). Interventions were initiated within 24 hours after extubation and continued for 5 days. Recovery was assessed using the QoR-15 scale. Secondary outcomes included ICU length of stay. Data were analyzed using SPSS version 27.  

Results: Both intervention groups showed significantly higher recovery scores compared with the control group on the first and seventh postoperative day (p < 0.001). Incentive spirometry shows greater initial improvement in the recovery level. No significant improvement was observed in the control group.

Conclusion: Incentive spirometry and coughing exercises significantly enhance postoperative recovery in children after cardiac surgery compared with routine care. They are low-cost, safe, and effective, and can be integrated into routine care to improve clinical outcomes.

Recommendation: The study recommended provide educational programs and practice training for nursing staff in cardiac hospitals in Iraq to improve their knowledge and skills regarding the appropriate use of the IS and coughing exercises techniques in practice.