I COUGH UK

We know that when you have major surgery, it puts a big strain on your body. However, there are several ways that you can improve your fitness leading up to your surgery, which will help prepare your body for your operation and its recovery.

Improve your fitness before a major operation
Eat a healthy diet
Stop smoking
I COUGH UK

Improve your fitness before your surgery

Moderate exercise before your operation will help strengthen your muscles and build up stamina. This will allow you to mobilise earlier and reduce your risk of breathing problems such as chest infections which are common after major surgery. Depending upon your general fitness and the effects of other treatments that you may have had recently, you may currently have a limited ability to exercise. If this is the case try and go for a walk twice a day, increasing the distance you walk as you become fitter. Contact your GP or hospital Consultant if you find this brings on any new heart or chest symptoms. If you require a Cardiopulmonary exercise test [CPET] as part of your pre-operative assessment prior to your surgery, the Consultant Anaesthetist that you see will be able to give you further advice regarding exercise dependent upon your CPET results.

Eat a healthy diet

A healthy diet will help improve your recovery from surgery and in particular wound healing. If you have experienced a change in your appetite and particularly if you’ve lost weight, please discuss this with your surgeon and specialist nurse. You can be referred to a specialist dietician for advice to help improve your nutritional health before your operation.

Stop Smoking

It is very important to stop smoking as soon as possible before any major surgery. This will reduce the risk of any breathing problems during and after your operation. There are several ways to stop smoking

CMFT stop smoking Manchester (www.stopsmokingmanchester.co.uk or 0161 205 5998)
Make an appointment at your GP practice or health centre. There is usually a Smoking Cessation Advisor who can help give you advice about stopping smoking
National Smoking Helpline(www.nhs.uk/smokefree or 0800 022 4 332)

I COUGH UK is a collaboration between our hospital, Central Manchester Foundation University Hospitals [CMFT] and another large hospital in America called Boston Medical Centre [BMC]. The medical team at BMC showed a reduction in patient’s lung complications after surgery with a series of simple interventions. We are now employing these interventions or all our patients having major surgery.

Prior to surgery, we will explain the steps of I COUGH. These steps will be supported by INTERNET based resources. We will also want you to concentrate on improving your fitness, eating a healthy diet and stopping smoking as set out above.

I COUGH UK steps

I - Incentive Spirometer Exercises

Deep breathing exercises will help keep your lungs healthy and prevent lung problems after your surgery. You will be issued with an Incentive Spirometer and instructed in its use. Prior to surgery aim to practice this at least 4 times per day [ideally 2-4weeks before your operation]. After your surgery you will be issued with a further spirometer and will be encouraged to do this at least hourly.

Instructions for Incentive Spirometer

Place the mouthpiece in your mouth and seal your lips around the mouthpiece
Breathe in slowly and deeply
Remove the mouthpiece from your mouth and breathe out

C - Cough and Deep Breathing

After surgery taking deep breaths and coughing helps to clear your lungs.

This helps the lungs do the vital job of delivering oxygen to the tissues in your body.

O - Oral Care

Good oral health care reduces risk of lung complications after major surgery and improves your overall general health.

We want you to concentrate on optimal dental care leading up to your surgery by focussing on:

Brushing your teeth twice per day for 2 minutes. Make sure you brush the sides of your teeth and along the gumline, especially on the inside surfaces next to your tongue and the roof of your mouth.
Brush the top of your tongue, as far back as you can comfortably manage.
Cleaning in between the teeth with either dental floss or bottle brushes.
Use mouthwash once a day to help control the dental plaque. Also gargle with the mouthwash, to clean the back of your tongue and mouth.
Consider getting a scale and polish from your dentist

This process of good dental healthcare will continue in hospital after your surgery.

U - Understanding I COUGH

It is important for you and your family to take an active part in your recovery from surgery.

We want your pain to be controlled to help you take deep breaths and cough, do breathing exercises and make sure you get out of bed, sit in a chair and walk.

G - Get out of bed

Getting out of bed and mobilising early after surgery is extremely important and will help prevent numerous complications. It will help clear secretions from your lungs and reduce your risk of lung infection, improve your circulation so that you may regain your strength and improve your gut’s function. However, there is often patient concern about doing harm by moving soon after surgery, and anxiety about how sore the pain from surgery will be. Steps to getting out of bed:

It is safe and very important-we will reassure and support you
We will aim to mobilise you into your own chair at least twice per day
Manage your pain – Pain management is very important to us and we have a specialised pain team to help us manage your pain.

H - Head of Bed Elevated

It is important to keep the head of the bed elevated between 30-45 degrees. Being in an upright position after surgery will help your breathing.