Introduction:
Postoperative pulmonary complications are a common cause for morbidity and mortality after open abdominal surgery (OAS). Incisional pain and restrictive lung dysfunction may impair cough effectiveness, leading to secretion retention. Ineffective cough is a most important factor in the development of postoperative pulmonary complications. The aim of this study was to determine the most effective directed cough manoeuvre early after OAS.

Methods:
The study involved 41 patients (19 females, 22 males; median age: 44.0 years) who underwent OAS. Cough effectiveness was assessed by measuring peak cough flow on the 1st postoperative day with a portable flow meter in 4 different cough manoeuvres: (1) baseline cough 1: patients were asked to cough as effectively as possible; (2) supported cough; (3) supported cough after maximum inspiration; (4) baseline cough 2. Pain intensity during the measurements was evaluated with the Visual Numeric Scale (0–10).

Results:
When the 4 cough conditions were compared, peak cough flow was significantly different (p < 0.001). This difference was due to the superiority of supported cough after maximum inspiration in comparison with the other 3 manoeuvres (p < 0.001). Pain did not significantly differ among the 4 measurements (p = 0.869).

Conclusions:
Coughing with abdominal support after maximum inspiration in a semi-recumbent position provides the most effective cough flow after OAS, without increasing incisional pain intensity. Patients who underwent OAS should be encouraged to practise this manoeuvre in the early postoperative period in order to help bronchial drainage and prevent postoperative pulmonary complications.