Nursing Practices for Respiratory Therapy After Cardiac Surgery: A Bibliometric Analysis and Systematic Review

Background and Aims: This two-stage study mapped scientific output on nursing practices for respiratory therapy after cardiac surgery and synthesized the effects of these interventions on patient outcomes.
Methods: The systematic review was reported according to PRISMA 2020. PubMed, Web of Science, and Scopus were searched through July 30, 2026, without start-year or language restrictions. Of 117 records, 87 remained after duplicate removal and were included in the bibliometric analysis using bibliometrix/Biblioshiny. Eleven studies meeting the PICOS criteria were included in the systematic review. Risk of bias was assessed using RoB 2, Joanna Briggs Institute checklists, and the Newcastle-Ottawa Scale. Owing to clinical and methodological heterogeneity, the findings were synthesized narratively.
Results: Scientific production increased markedly after 2023 and peaked in 2025; breathing exercises were central to the field’s conceptual structure. The systematic review included seven randomized controlled trials, two quasi-experimental studies, one retrospective cohort study, and one case series. The most frequently studied interventions were incentive spirometry, deep breathing and coughing exercises, and slow deep-breathing relaxation. Nurse-guided and preoperatively initiated respiratory therapy reduced postoperative pulmonary complications, improved oxygenation, and shortened the duration of mechanical ventilation and intensive care and hospital stays. Improvements in pain, anxiety, depression, sleep quality, and comfort were also reported.
Conclusion: Nurse-led respiratory therapy is a feasible, low-cost approach that may improve pulmonary and psychosocial outcomes after cardiac surgery. However, intervention heterogeneity and limited blinding indicate a need for well-designed, adequately powered randomized controlled trials using standardized protocols.