Incentive spirometry: Its value after cardiac surgery

Gale, G. D.; Sanders, Douglas E.

doi:10.1007/bf03007047

Cited by 36 publications

(31 citation statements)

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“…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.…”

Section: Incentive Spirometrymentioning

confidence: 99%

“…[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.…”

Section: Incentive Spirometrymentioning

confidence: 99%

“…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.…”

Section: Incentive Spirometrymentioning

confidence: 99%

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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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Section: Incentive Spirometrymentioning

confidence: 99%

Section: Incentive Spirometrymentioning

confidence: 99%

Section: Incentive Spirometrymentioning

confidence: 99%

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The Scientific Basis for Postoperative Respiratory Care

Branson

2013

Respir Care

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“…Another intervention vs. IS: Nine studies evaluated the incidence of PPC 37,38,40,41,44,45,47,48,51 . One study 38 showed that the use of IS associated to exercises with positive pressure (EPAP) reduced the incidence of PPC in patients undergoing surgery for myocardial revascularization when compared with deep breathing (Table 4).…”

Section: Ppc As An Outcomementioning

confidence: 99%

“…Another intervention vs. IS: Eight studies evaluated the lung function as an outcome 37,39,40,[43][44][45]47,52 , being two studies 44,47 , the IS improved the lung function when compared to other physical therapy interventions. One study 39 showed that the IS did not restore the lung function after surgery when compared to the use of exercises with positive pressure.…”

Section: Lung Function As An Outcomementioning

confidence: 99%

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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Incentive spirometry for preventing pulmonary complications after coronary artery bypass graft

Freitas¹,

Soares²,

Cardoso³

et al. 2007

Cochrane Database of Systematic Reviews

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Individual small trials suggest that there is no evidence of benefit from incentive spirometry in reducing pulmonary complications and in decreasing the negative effects on pulmonary function in patients undergoing CABG. In view of the modest number of patients studied, methodological shortcomings and poor reporting of the included trials, these results should be interpreted cautiously. An appropriately powered trial of high methodological rigour is needed to determine those patients who may derive benefit from incentive spirometry following CABG.

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Incentive spirometry: Its value after cardiac surgery

Abstract: Treatment with intermittent positive pressure breathing (1PPB) and incentive spirometry (I.S.) was compared in 109 patients after heart surgery with cardiopulmonary bypass. Assessment was done by measurement of vital capacity, arterial oxygen tension and identifica-

Cited by 36 publications

References 11 publications

The Scientific Basis for Postoperative Respiratory Care

The Scientific Basis for Postoperative Respiratory Care

Incentive spirometry in major surgeries: a systematic review

Incentive spirometry for preventing pulmonary complications after coronary artery bypass graft

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