Comparison of Diaphragmatic Breathing Exercise, Volume and Flow Incentive Spirometry, on Diaphragm Excursion and Pulmonary Function in Patients Undergoing Laparoscopic Surgery: A Randomized Controlled Trial

Abstract

Objective. To evaluate the effects of diaphragmatic breathing exercises and flow and volume-oriented incentive spirometry on pulmonary function and diaphragm excursion in patients undergoing laparoscopic abdominal surgery. Methodology. We selected 260 patients posted for laparoscopic abdominal surgery and they were block randomization as follows: 65 patients performed diaphragmatic breathing exercises, 65 patients performed flow incentive spirometry, 65 patients performed volume incentive spirometry, and 65 patients participated as a control group. All of them underwent evaluation of pulmonary function with measurement of Forced Vital Capacity (FVC), Forced Expiratory Volume in the first second (FEV1), Peak Expiratory Flow Rate (PEFR), and diaphragm excursion measurement by ultrasonography before the operation and on the first and second postoperative days. With the level of significance set at p < 0.05. Results. Pulmonary function and diaphragm excursion showed a significant decrease on the first postoperative day in all four groups (p < 0.001) but was evident more in the control group than in the experimental groups. On the second postoperative day pulmonary function (Forced Vital Capacity) and diaphragm excursion were found to be better preserved in volume incentive spirometry and diaphragmatic breathing exercise group than in the flow incentive spirometry group and the control group. Pulmonary function (Forced Vital Capacity) and diaphragm excursion showed statistically significant differences between volume incentive spirometry and diaphragmatic breathing exercise group (p < 0.05) as compared to that flow incentive spirometry group and the control group. Conclusion. Volume incentive spirometry and diaphragmatic breathing exercise can be recommended as an intervention for all patients pre- and postoperatively, over flow-oriented incentive spirometry for the generation and sustenance of pulmonary function and diaphragm excursion in the management of laparoscopic abdominal surgery.

Impact of breathing exercises in subjects with lung cancer undergoing surgical resection: A systematic review and meta‐analysis

“…After IMT and threshold device training, the diaphragmatic activity increased in patients with postoperative diaphragm dysfunction, and the inspiratory muscle strength increased as well (Kodric et al., ). Alaparthi, Augustine, Anand, and Mahale () demonstrated that abdominal breathing exercise and volume incentive spirometry could be used as a preoperative and postoperative intervention for all patients, and the lung function in the intervention groups was preserved better than in the control group.…”

Role and impact of multimodal prehabilitation for gynecologic oncology patients in an Enhanced Recovery After Surgery (ERAS) program

“…27 Inspiratory muscle training involves 15 to 30 min daily sessions using an inspiratory threshold-loading device with a patient-tailored program or daily home breathing exercises through a flow volume incentive spirometer. 28 Lastly, physical intervention can be home-based or can be performed under the supervision of a healthcare provider. Although both types of training have been reported to be beneficial,…”

Incentive spirometry as a way to prevent pulmonary atelectasis development

“…Incentive spirometry (IS) is a lung expansion technique, which stimulates maximum inspiratory effort with the aim of the most complete filling of the alveoli with air providing a slow maximal inspiration. However, there are contradictory data on the use of IS effectiveness for PPCs prevention in patients after upper abdominal surgery [9][10][11][12][13][14][15].…”