The Application of Pursed-Lip Breathing to Increase Tidal Volume in Patients with Pleural Effusion in the High Care Unit (HCU)

Abstract

Pleural effusion is characterized by fluid accumulation in the pleural cavity, resulting in reduced lung expansion, decreased tidal volume, increased work of breathing, and impaired gas exchange. This condition requires evidence-based nursing interventions to optimize pulmonary ventilation. Pursed-Lip Breathing (PLB) is a non-pharmacological breathing exercise that generates positive end-expiratory pressure, helping maintain airway patency and improve ventilation. To describe the implementation of PLB in improving tidal volume among patients with pleural effusion in the High Care Unit (HCU). A descriptive case study involved two patients with pleural effusion secondary to metastatic breast carcinoma and bilateral pleural effusion associated with stage V Chronic Kidney Disease, Hypertensive Heart Disease, and severe anemia. Data were collected through interviews, observation, physical examination, and medical and nursing record review. Tidal volume was measured using spirometry, while respiratory rate, oxygen saturation, accessory muscle use, and dyspnea were assessed before and after the intervention. PLB was administered twice daily for three consecutive days, with each session lasting 5–10 minutes. Data were analyzed descriptively by comparing patients' conditions before and after the intervention. Mrs. Y's tidal volume increased from 340 mL to 430 mL, while Mrs. M's increased from 360 mL to 470 mL. Both patients demonstrated improved oxygen saturation, reduced respiratory rate, decreased accessory muscle use, reduced dyspnea, and greater breathing comfort. PLB improved tidal volume and respiratory status in patients with pleural effusion and may serve as a supportive nursing intervention to optimize pulmonary ventilation.