Can Postoperative Pulmonary Conditions Be Improved by Treatment with the Bartlett-Edwards Incentive Spirometer after Upper Abdominal Surgery?

Postoperative pulmonary complications and lung function in high‐risk patients: a comparison of three physiotherapy regimens after upper abdominal surgery in general anesthesia

“…From our department a clinical controlled study comparing the conventionally used chest physiotherapy to treatment with the Bartlett-Edwards incentive spirometer did not show any beneficial efTect of the instrument (20). They found a low frequency, 3%, of severe PPC and ascribed this to the effectiveness of conventional pre-and postoperative chest physiotherapy.…”

“…Most studies concerning PPC after upper abdominal and thoracic surgery have been made to elucidate the effect of various forms of standardized chest physiotherapy on large inhomogeneous groups or smaller groups of otherwise low-risk patients. There seems to be agreement concerning the benefit of early mobilization and chest physiotherapy (3, 4, 17, 19,20), but controversy still exists concerning the benefits of the various mechanical devices, blow-bottles, incentive spirometer, CPAP and PEP, with respect to prevention of PPC in non-selected patient groups (4, 6 , 7,17,19,20).…”

Perspectives on Incentive Spirometry Utility and Patient Protocols

“…Although 2 studies found beneficial effects of IS on postoperative pulmonary complications compared to intermittent positive-pressure breathing 39 which has been proven ineffective 55 -and physiotherapy 37 for upper abdominal surgery patients, most show no differences 11,12,26,44,47,48,56 or inferior effects (vs intermittent positive-pressure breathing 14 and CPAP 50 ). In 1 investigation, IS appeared to facilitate faster tidal volume recovery to preoperative baseline versus conventional physical therapy, 57 whereas most other studies have demonstrated no advantages 11,12,26,46,47,56 or inferior 40 pulmonary function improvement compared to other respiratory therapies. Past investigations have also reported no difference between IS and other respiratory techniques in reducing postoperative pulmonary complications 6,24,40,43,52,53,[58][59][60] or improving pulmonary function in cardiothoracic surgical patients.…”

“…24,45,52,53,60 Further clinical research is required to determine optimal IS protocols. Previous investigators have recommended that IS usage occur hourly, 26,36,37 45 12 times per day, 11 every 4 h, 46 4 times per hour, 47 3 times per hour, 48 10 times per hour, 49 30 times per hour, 50 or every 10 min. 51 Past studies set subjects' target inspiratory volume at 50 -70% of preoperative vital capacity, 14 1,400 - 40 or at maximal inspiration above residual volume.…”

“…Furthermore, there are few outcome-based data supporting precisely how IS should be used. Previous investigations themselves have used widely variable procedural parameters with respect to the optimal frequency of sessions, 8,11,14,26,[36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51] target inspiratory volume, 14,40,43,44 whether the target is static or dynamic, 11,14,40,42 when to start IS postoperatively, 11,37,39,40,43,44,47,50 the number of breaths per session, 8,14,26,[36][37][38]42,43,45,46,49,52,53 and duration of breath holds.…”