Reducing lung complications after surgery

[Music]

[Text on screen: Enhanced Recovery After Surgery (ERAS) Surgery School]

[Text on screen: Traditional Custodians of Country - The Health Service Partnership would like to acknowledge the many Traditional Custodians of Country throughout Australia, with the filming of this video taking place on the Wurundjeri and Boonwurrung land of the Kulin Nation. We honour their Elders past, present and emerging, and extend that respect to any First Nations, Aboriginal and Torres Strait Islander people joining us today. First Nations Peoples should be aware that these videos may contain images or names of people who have died.]

[Artwork on screen: Possum Skin Cloak, Marcus Lee Design 2025]

[Text on screen: ACOUGH]

[On screen: Catherine Sinton, Clinical Nurse Consultant]

Today, you're going to hear about A-COUGH. 

A-COUGH is a program designed to improve lung function and reduce chest infections and even pneumonia, which may occur after surgery. 

The reason some people develop chest infections is that general anaesthesia administered during surgery can prevent your lungs from expanding properly. 

As a result, parts of your lungs may collapse, allowing infection to set in. Surgery and anaesthesia also reduce the movement of the cilia, which normally sweeps bacteria and debris from your lungs. This puts you at a greater risk of lung infection. 

So, what can you do to prevent lung infections and pneumonia after surgery? 

Although there may be a one in five chance of pneumonia occurring, researchers have found that breathing exercises using the A-COUGH technique decreases the chance of lung complications after surgery by as much as 50%. The exercises and steps you will now be taught is the A-COUGH program. The program consists of the following components:

• A: Active cycle of breathing technique.
• C: Cycle - this technique must be repeated in a systematic way. 
• O: Oral hygiene - reducing the bacteria that are responsible for most lung infections.
• U: Understanding and remembering the concepts. 
• G: Getting out of bed - this is done with the help of your nurses and physiotherapists. 
• H: Head elevation - keeping the head elevated helps your lungs expand. 

We'll begin with the active cycle of breathing technique, or ACBT, which represents the A in A-COUGH. 

This breathing exercise consists of four phases: breathing control, deep breathing, the huff, and the cough. After surgery, you'll be asked to perform these exercises every 2 to 4 hours daily. 

The first phase of the ACBT is the blue phase: breathing control. This phase is to ensure your airways are relaxed. Sit as upright as possible, relax your shoulders and upper chest, 

Place your hands across your tummy. Take a slow, normal breath in through your nose. 

Feel your tummy rising under your hand. Breathe out gently. 

Let's practise breathing control together. Place your hands across your tummy. Take a slow, normal breath in through your nose to feel your tummy rising and make sure you fill your lungs as fully as you can. Relax your shoulders when breathing out. 

The second phase is the purple phase: deep breathing. Sit as upright as possible, relax your shoulders and upper chest. Place your hands across the side of your chest, then take a slow, deep breath in through your nose. Feel your ribs moving out under your hands. Take the biggest breath in that you can. Hold your breath for 2 to 3 seconds. 

Relax your shoulders while breathing out. Let's practise deep breathing together. 

Place your hands across your chest, take a slow, deep breath in through your nose to feel your chest rising. Hold your breath for 2 to 3 seconds. Now breathe out slowly. 

The third phase is the yellow phase: the huff. The huff helps shift secretions from the bottom of your lungs to your larger breathing passages. 

Breathe out the air from your lungs as quickly as possible, like you're trying to steam up a mirror or clear your reading glasses. Let's practise the huff together. Take a medium-sized breath in. Hold your hand in front of your mouth and blow out with some force. 

The fourth phase of the ACBT is the green phase: the cough. The cough clears phlegm from your upper breathing tubes. You may need to practise supported coughing with a pillow or a folded towel placed over the area of your operation. This will help ease the discomfort from the area post-surgery.

Let's practise the cough together. Place a pillow or folded towel over the area, take a deep breath in and cough out as hard as you can. Repeat the cough two to three times until your cough sounds dry. You now have practised each of the 4 components of the ACBT, which is the A in A-COUGH.

The C in A-COUGH stands for cycle. The whole ACBT cycle must be repeated in a systematic way. Start with 4 breathing control breaths, then 4 deep breaths, then 4 breathing control breaths, one huff, 4 breathing control breaths, finish with one cough. Practice this cycle twice in the morning and night, every day until your surgery.

This will ensure that you are an expert at doing it after your operation. We have now covered the A and C of ACOUGH.

Time for O, which is oral hygiene. It is often mouth bacteria that causes lung infections.

In order to minimise this risk, we recommend that you: brush twice a day every day, use antiseptic mouth wash to gargle and rinse out your mouth at a different time to brushing twice a day every day, see a dentist so that any source of infection in your teeth or gums can be cleared before you have your surgery.

The U A-COUGH stands for understanding. Providing you with this information will help you understand just how important it is for you to follow the A-COUGH program.

The G in A-COUGH stands for getting out of bed. You will be encouraged to get out of bed soon after your surgery. Lung volumes can increase by 20% just by sitting in a chair, and walking is one of the best exercises for breathing and recovery. Sitting out of bed or walking is recommended for 4 hours the day after your surgery and for 6 hours every day after that.

Your nurse or physiotherapist will help you sit and walk until you are safe to do so yourself.

Finally, the H in A-COUGH stands for head elevation. When in bed, make sure you sit up or have your head elevated by pillows, or by elevating the top section of your bed so that your lungs can function more effectively, especially while you're doing your exercises.

Do not lie flat in bed after surgery unless instructed. So now you know all about A-COUGH. A printed or digital brochure with the ACBT exercises is available on request. Keep practising the program to support your wellbeing and recovery after surgery.

And remember: exercise is medicine too.

[Text on screen: Acknowledgements - Source material for this video has been provided by the Centre for Prehabilitation and Perioperative Care, Peter MacCallum Cancer Centre

• Prof. Bernhard Riedel, Head of Department
• Hilmy Ismail, Anaesthetic Consultant
• Ms Catherine Sinton, ERAS Clinical Nurse Consultant

West Metro Health Services Partnership: Mercy Health, Peter Mac, The Royal Children's Hospital, The Royal Melbourne Hospital, Western Health, The Women's, North Western Primary Health Network]

[Text on screen: Disclaimer - The information contained in this video is for your general information and use only, and is not intended to be a substitute for independent professional advice and should not be used or relied on as an alternative to professional health care.

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