A Surgeon Orders Lung Expansion Therapy for an Obtunded 68-Year-Old

A surgeon orders lung expansion therapy for an obtunded 68-year-old, 170-lb man who has developed atelectasis after thoracic surgery. On baseline assessment, the patient cannot perform an IC or VC maneuver, but has no evidence of retained secretions. Which of the following would you recommend?

A) intermittent positive-pressure breathing (IPPB) at 6 to 8 breaths/min at 10 to 15 ml/kg
B) continuous positive airway pressure therapy at 12 cm H₂O for 24 hours
C) positive end-expiratory pressure therapy with bronchodilator and bronchial hygiene
D) incentive spirometry 10 times an hour at an initial volume of 600 to 800 ml