This is what we want you to do:

Due to the effects of general anaesthesia on your lungs, there is an increased risk of developing respiratory complications with major surgery. ICOUGH is a respiratory training bundle based on interventions established at Boston Medical Centre shown to reduce respiratory complications. ICOUGH has been designed to help you combat the effects of general anaesthesia on your lungs following surgery.

The ICOUGH structure is explained below:

• I - Incentive spirometry (IS)

  You will be provided with an IS device which trains your lungs before surgery and re-opens the base of your lungs after surgery. You should aim to undertake IS training at least 4 times a day before surgery and on an hourly basis after surgery until you are mobilising normally. For more information on incentive spirometry please click here

• C - Coughing with good pain control

  You must cough effectively after surgery to clear secretions, and open your lungs properly to avoid the risk of secondary infection. Following your surgery, a combination of techniques will be used to ensure your pain is well managed. Your pain control options will be discussed with you closer to your surgery.

• O – Oral healthcare

  Improving oral healthcare before and after surgery can reduce the risk of a chest infection. We recommend you brush your teeth at least twice a day. Start using an antibacterial mouthwash twice a day, 10-15 minutes after brushing your teeth. If you have existing dental problems now is the time to visit your dentist. For more information on improving oral healthcare click here

• U – Understanding ICOUGH

  We will use multiple healthcare interactions to explain about how and why we use ICOUGH to help reduce patient chest complications after major surgery.

• G – Getting out of bed & mobilisation after surgery

  Getting yourself mobile after surgery is key to recovery. We always aim to mobilise you on the first and every subsequent day after surgery

• H – Head of bed elevated to improve breathing technique

  After surgery, be sure to sit up in bed rather than lying flat to give your lungs more room to expand and keep them big.

Recovery

Following your operation it is advised you continue using your incentive spirometry device until you are mobilising comfortably. You will be encouraged to bring your incentive spirometry device with you to hospital so you can continue chest training following your operation during the recovery period to minimise the risk of a chest infection.

It is also important that you maintain good oral healthcare during the 4-6 week period following your operation. Continue brushing your teeth at least twice daily and continue using an antibacterial mouthwash 10-15 minutes after brushing your teeth.

Following your discharge from hospital, if you experience any chest problems please contact your ERAS+ team or GP as soon as possible.