Comparison of Incentive Spirometry and Intermittent Positive Pressure Breathing after Coronary Artery Bypass Graft

The Scientific Basis for Postoperative Respiratory Care

“…Two main areas of investigation have been pursued: incentive spirometry for PPC prevention following upper abdominal surgery, [30][31][32][33][34][35][36][37][38][39][40][41][42][43] and incentive spirometry for PPC prevention following cardiac/thoracic surgery. [44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60] Comparison of these studies is difficult, owing to the various study designs (randomized controlled trials and prospective trials), the comparators (none, chest physical therapy [CPT], CPAP, expiratory airway pressure), the frequency of interventions (eg, hourly, every 4 hours), the duration of each intervention (number of maneuvers, minutes of therapy), and the outcomes (radiographic atelectasis, gas exchange, pneumonia, pulmonary function). Of the studies that used PPCs as an outcome, 3 compared incentive spirometry with a control group of no intervention following upper abdominal surgery.…”

“…[31][32][33]35,37,40 Studies comparing incentive spirometry for PPC prevention after cardiac/thoracic surgery also include a trial with no intervention as the control, 48 and studies that compared incentive spirometry to other techniques. 44,45,47,48,51,52,54,55,58,60 The majority of these trials reported no difference between incentive spirometry and the comparator. 44,47,48,51,52,54,58,60 This creates one of the challenges in evaluating the evidence on incentive spirometry in PPC prevention.…”

“…44,45,47,48,51,52,54,55,58,60 The majority of these trials reported no difference between incentive spirometry and the comparator. 44,47,48,51,52,54,58,60 This creates one of the challenges in evaluating the evidence on incentive spirometry in PPC prevention. A randomized controlled trial with sufficient numbers should compare any of the techniques to a standard regimen of up and out of bed and early ambulation.…”

“…Similar findings were seen in studies evaluating the impact on postoperative lung volumes; that is, the most common finding was no difference between incentive spirometry and the other intervention or no intervention. 44,47,51,59,60 A recent paper by Agostini and colleagues compared incentive spirometry to "thoracic expansion exercises" in 180 patients following lung resection. 60 All patients received postoperative breathing exercises, airway clearance, and early mobilization.…”

Prevention of Postoperative Atelectasis in the Post-Cardiac Surgical Patient with Poor Left Ventricular Function: A Study of the Efficacy of Bi-Level Positive Airway Pressure

“…These all combined together lead to high incidence of postoperative pulmonary complications, which includes retention of tracheobronchial secretions, atelectasis and pneumonia [2].These complications produces secondary hypoxemia, prolonged ventilator use and ventilator associated pneumonia with subsequent increased Intensive care unit (ICU) and hospital stays as well as increased morbidity and mortality [3]. Conventional chest physiotherapy, incentive spirometry (IS) and intermittent positive pressure breathing (IPBB), used in an attempt to improve post operative pulmonary functions, may have a beneficial effect in post operative pulmonary impairement [4,5]. Continuous positive airway pressure (CPAP) can restore functional residual capacity (FRC) to pre-operative value, [6].…”