Comparison of Two Methods of Postoperative Respiratory Care

Dohi, Shuji; Gold, Martin I.

doi:10.1097/00132586-197906000-00062

Cited by 3 publications

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“…It was also observed that there was no improvement in the methodological quality of studies over time. Nine (30%) included studies (three in abdominal [34][35][36] , five in cardiac [47][48][49][50][51][52] and one 50 in thoracic surgery) presented PEDro scores below 5, and six of them showed that the use of IS favors the early recovery of lung function or the prevention of PPC. The methodological flaws found in most studies were the lack of a sample size calculation, problems in experimental design and inadequate method of randomization, and this may have generated bias in the interpretation of the results obtained by the treatment with the IS.…”

Section: Discussionmentioning

confidence: 99%

“…Analyzing only the studies [24][25][26][27][28][29][30][31][32][33][34][35][36] that evaluated the effect of IS in patients undergoing abdominal surgery, showed that this technique did not demonstrate to be beneficial in relation to other physical therapy interventions in the prevention of PPC. Some factors can be analyzed to justify these findings: first, the lack of consensus among physical therapists with regards to the gold standard intervention in the postoperative period, including the appropriate number of repetitions, duration of therapy and other postoperative treatments that may influence the results found.…”

Section: Discussionmentioning

confidence: 99%

“…In three of them 32,34,35 the authors showed that the use of IS reduced the incidence of PPC compared with other physical therapy interventions; six studies 13,[24][25][26]30,33 showed no between group differences in the incidence of PCC between IS and other intervention; and two studies 27,29 showed that IS failed to reduce the incidence of PPC when compared to exercises with positive pressure (CPAP or IPPB) (Table 3).…”

Section: Ppc As An Outcomementioning

confidence: 99%

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Incentive spirometry in major surgeries: a systematic review

Carvalho¹,

Paisani²,

Lunardi³

2011

Rev. bras. fisioter.

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Objective: To conduct a systematic review to evaluate the evidence of the use of incentive spirometry (IS) for the prevention of postoperative pulmonary complications and for the recovery of pulmonary function in patients undergoing abdominal, cardiac and thoracic surgeries. Methods: Searches were performed in the following databases: Medline, Embase, Web of Science, PEDro and Scopus to select randomized controlled trials in which IS was used in the pre-and/or post-operative period in order to prevent postoperative pulmonary complications and/or recover lung function after abdominal, cardiac and thoracic surgery. Two reviewers independently assessed all studies. In addition, the study quality was assessed using the PEDro scale. Results: Thirty studies were included (14 abdominal, 13 cardiac and 3 thoracic surgery; n=3,370 patients). In the analysis of the methodological quality, studies achieved a PEDro average score of 5.6, 4.7 and 4.8 points in abdominal, cardiac and thoracic surgeries, respectively. Five studies (3 abdominal, 1 cardiac and 1 thoracic surgery) compared the effect of the IS with a control group (no intervention) and no difference was detected in the evaluated outcomes. Conclusion: There was no evidence to support the use of incentive spirometry in the management of surgical patients. Despite this, the use of incentive spirometry remains widely used without standardization in clinical practice.Keywords: incentive spirometry; surgery; postoperative care; postoperative complication; physical therapy; breathing exercise. ResumoObjetivo: Realizar um levantamento da literatura para avaliar as evidências do uso do incentivador respiratório (IR) na prevenção de complicações pulmonares pós-operatórias (CPPs) e recuperação da função pulmonar em pacientes submetidos a cirurgias abdominal, cardíaca e torácica. Métodos: Esta revisão sistemática utilizou as bases de dados Medline, Embase, Web of Science, PEDro e Scopus para selecionar ensaios clínicos randomizados, nos quais o IR foi utilizado nos período pré e/ou pós-operatório, visando prevenir CPP e/ou recuperar função pulmonar após cirurgias abdominal, cardíaca ou torácica. Dois revisores analisaram independentemente os estudos. Além disso, a qualidade dos estudos foi avaliada segundo a escala PEDro. Resultados: Trinta estudos foram incluídos (14 de cirurgia abdominal, 13 de cardíaca e três de torácica; n=3370 pacientes). Na análise de qualidade, os estudos obtiveram média de 5,6, 4,7 e 4,8 pontos nas cirurgias abdominais, cardíacas e torácicas, respectivamente. Cinco estudos (três de cirurgia abdominal, um de cardíaca e um de torácica) compararam o efeito do IR com grupo controle (sem intervenção) e não se verificou diferença nos desfechos estudados. Conclusão: Não se encontraram evidências que subsidiem o uso do IR no manejo de pacientes cirúrgicos.Apesar disso, o uso do IR continua não-padronizado e amplamente difundido na prática clínica.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Ppc As An Outcomementioning

confidence: 99%

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Incentive spirometry in major surgeries: a systematic review

Carvalho¹,

Paisani²,

Lunardi³

2011

Rev. bras. fisioter.

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“…e lack of clear quality control indicators and the difficulty of self-assessment in the traditional respiratory function exercise process have a relationship with the patient's understanding and compliance, thus significantly reducing the efficiency of training. e Incentive Spirometer (IS) mimics sighing and yawning movements to help patients take an active approach to rhythmic deep breathing, increase tidal volume by promoting diaphragm respiration and alveolar opening, basal ventilation, penetrating pulmonary pressure, and in turn improve respiratory muscle status, promote airway secretion discharge, and assist to maximize lung expansion to prevent and reverse lung atelectasis [10][11][12][13][14][15][16][17]. An excitatory spirometer, also known as a sustained maximum inhalator, encourages patients to maximize inhalation and maintain >3 s by monitoring the flow or volume of breath.…”

Section: Is-enhanced Pulmonary Training and Its Role In Perioperative...mentioning

confidence: 99%

A Cross-Sectional Study on the Application of IS in Perioperative Pulmonary Function Training in Spine and Orthopedics

Qiu

Zhang

et al. 2022

Computational Intelligence and Neuroscience

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Background. The incentive spirometer (IS) is a mechanical device that promotes lung expansion and can be used to prevent and treat postoperative pulmonary complications. In this study, the preventive effect of pulmonary function training with IS on the improvement of pulmonary function and pulmonary complications was observed. Methods. From May 2019 to April 2021, 69 scoliosis patients with impaired moderate and severe lung function were divided into the traditional pulmonary training group (n = 32) and IS-enhanced pulmonary training group (n = 35). The patient underwent lung function testing after admission and one week after the start of training and chest CT on the third day after surgery. Results. The average age was 13.47 and 15.66, respectively ( p = 0.223). The Cobb angles were 83.84 and 83.97 ( p = 0.756), respectively, and no statistical difference between the parameters of lung function was detected. After 1 week of respiratory function training, significant improvement in lung function testing parameters including VC%, FVC%, FEV1%, FEV1/FVC, FEV1/VC, and MVV% was found in both groups. Analysis of covariance showed more significant improvement in IS-enhanced group compared to the conventional training group ( p < 0.05). The incidence of postoperative pulmonary atelectasis was lower in IS-enhanced group than in traditional groups (2.9% vs. 21.9%, p = 0.043) with no difference in the overall incidence of pulmonary complications ( p = 0.164) and shorter preoperative and total hospitalization in the IS-enhanced group. Conclusion. Compared to traditional pulmonary function training, IS-enhanced training can significantly accelerate the improvement of pulmonary function testing parameters, shorten the preoperative pulmonary function training time, reduce the incidence of postoperative pulmonary tension complications, and accelerate postoperative rehabilitation.

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“…1,29 In the ensuing 40 years a litany of studies evaluating incentive spirometry for preventing PPC have been published. 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).…”

Section: Incentive Spirometrymentioning

confidence: 99%

The Scientific Basis for Postoperative Respiratory Care

Branson

2013

Respir Care

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Postoperative pulmonary complications (PPCs) are common and expensive. Costs, morbidity, and mortality are higher with PPCs than with cardiac or thromboembolic complications. Preventing and treating PPCs is a major focus of respiratory therapists, using a wide variety of techniques and devices, including incentive spirometry, CPAP, positive expiratory pressure, intrapulmonary percussive ventilation, and chest physical therapy. The scientific evidence for these techniques is lacking. CPAP has some evidence of benefit in high risk patients with hypoxemia. Incentive spirometry is used frequently, but the evidence suggests that incentive spirometry alone has no impact on PPC. Chest physical therapy, which includes mechanical clapping and postural drainage, appears to worsen atelectasis secondary to pain and splinting. As with many past respiratory therapy techniques, the profession needs to take a hard look at these techniques and work to provide only practices based on good evidence. The idea of a PPC bundle has merit and should be studied in larger, multicenter trials. Additionally, intraoperative ventilation may play a key role in the development of PPCs and should receive greater attention.

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Comparison of Two Methods of Postoperative Respiratory Care

Cited by 3 publications

References 0 publications

Incentive spirometry in major surgeries: a systematic review

Incentive spirometry in major surgeries: a systematic review

A Cross-Sectional Study on the Application of IS in Perioperative Pulmonary Function Training in Spine and Orthopedics

The Scientific Basis for Postoperative Respiratory Care

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