Perspectives on Incentive Spirometry Utility and Patient Protocols

Eltorai, Adam E.M.; Baird, Grayson L.; Eltorai, Ashley Szabo; Pangborn, Joshua; Antoci, Valentin; Cullen, H. Allethaire; Paquette, Katherine; Connors, Kevin; Barbaria, Jacqueline; Smeals, Kimberly J; Agarwal, Saurabh; Healey, Terrance T.; Ventetuolo, Corey E.; Sellke, Frank W.; Daniels, Alan H.

doi:10.4187/respcare.05872

Cited by 19 publications

(24 citation statements)

References 58 publications

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“…Monitoring of vital signs in the post-anesthetic setting is essential to identify patients at potential risk of postoperative respiratory failure [156]. Incentive spirometry is widely used to prevent PPCs, although clinical effectiveness data are limited, and standardized protocols are lacking [157,158].…”

Section: Strength Of Recommendationmentioning

confidence: 99%

Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus

et al. 2020

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Background Surgical outcomes in geriatric patients may be complicated by factors such as multiple comorbidities, low functional performance, frailty, reduced homeostatic capacity, and cognitive impairment. An integrated multidisciplinary approach to management is, therefore, essential in this population, but at present, the use of such an approach is uncommon. The Perioperative Management of Elderly patients (PriME) project has been established to address this issue. Aims To develop evidence-based recommendations for the integrated care of geriatric surgical patients. Methods A 14-member Expert Task Force of surgeons, anesthetists, and geriatricians was established to develop evidence-based recommendations for the pre-, intra-, and postoperative care of hospitalized older patients (≥ 65 years) undergoing elective surgery. A modified Delphi approach was used to achieve consensus, and the strength of recommendations and quality of evidence was rated using the U.S. Preventative Services Task Force criteria. Results A total of 81 recommendations were proposed, covering preoperative evaluation and care (30 items), intraoperative management (19 items), and postoperative care and discharge (32 items). Conclusions These recommendations should facilitate the multidisciplinary management of older surgical patients, integrating the expertise of the surgeon, the anesthetist, the geriatrician, and other specialists and health care professionals (where available) as needed. These roles may vary according to the phase and setting of care and the patient’s conditions.

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Section: Strength Of Recommendationmentioning

confidence: 99%

Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus

et al. 2020

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“…Responses were received from 1,681 unique nurses and RTs from the 4 national organizations with various educational backgrounds, years of experience, and primary practice locations. Respondent characteristics and survey completion rates are fully detailed in Eltorai et al 30 The clear majority of providers agreed that patient adherence with IS is poor (86.0%; 1,416 of 1,647 respon-…”

Section: Resultsmentioning

confidence: 99%

“…Given the lack of standardized protocols for IS use and, therefore, the lack of adherence to such protocols, adherence was deliberately left undefined in the survey to assess providers' real-life perspectives in their own practices. 30 In so doing, the meaning of adherence is standardized to what is actually practiced by providers. An operational definition of adherence is that of a patient acting in accordance with provider advice.…”

Section: Methodsmentioning

confidence: 99%

Incentive Spirometry Adherence: A National Survey of Provider Perspectives

et al. 2018

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“…Freitas, et al [12] also revealed no evidence of a difference between groups in the incidence of PPCs with IS and treatment with physical therapy, positivepressure breathing techniques, active cycle of breathing, or preoperative patient education and worse pulmonary function and arterial oxygenation. Eltorai et al [24] investigated the clinical effectiveness of incentive spirometry and found that there was narrow evidence to support its advantages and an absence of harmonized protocol for its use. In addition, Overend,et al [20] conducted a systematic review study and concluded that evidence does not support the use of IS for decreasing the incidence of PPCs.…”

Section: Discussionmentioning

confidence: 99%

“…Freitas, et al, Carvalho et al, Eltorai et al, and Overend et al, have declared that, to date, there is no evidence to support the practice of IS to decrease PPCs. although IS is still usually requested to reduce PPCs, despite the narrow evidence to support its advantages and the absence of a harmonized protocol and they recommend that additional research is necessary to clarify this issue [12,19,20,24]. Agostini and Singh, differ from this opinion and have stated that this practice can improve pulmonary function [25].…”

Section: Introductionmentioning

confidence: 99%

Preoperative Incentive Spirometry for Preventing Postoperative Pulmonary Complications in Patients Undergoing Coronary Artery Bypass Graft Surgery: A Prospective, Randomized Controlled Trial

Sweity

Alkaissi

Othman

et al. 2021

Preprint

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Background: Postoperative pulmonary complications (PPCs) often occur after cardiac operations, and are a leading cause of morbidity, inhibit oxygenation, and increase hospital length of stay, and mortality. Although clinical evidence for PPCs prevention is often unclear and crucial, measures take place to reduce PPCs. One device usually used for this reason is the incentive spirometry (IS). The Aim of the study is to evaluate the effect of preoperative incentive spirometry to prevent postoperative pulmonary complications, improve postoperative oxygenation, and decrease hospital stay following coronary artery bypass graft (CABG) surgery patients. Methods: This was a clinical randomized prospective study. A total of 80 patients were selected as candidates for CABG at An-Najah National University Hospital, Nablus-Palestine. Patients had been randomly assigned into two groups: incentive spirometry group (IS), SI performed before surgery (study group) and control group, preoperative spirometry was not performed. The 40 patients in each group received the same protocol of anesthesia and ventilation in the operating room. Result: The study findings showed that there was a significant difference between the IS group and control group in the incidence of postoperative atelectasis, there were 8 patients (20.0%) in IS group and 17 patients (42.5 %) in the control group (p= 0.03). Mechanical ventilation duration was significantly less in group IS group, the median was four hours versus six hours in the control group (p < 0.001). Hospital length of stay was significantly less in group IS group, the median was six days versus seven days in the control group (p < 0.001). Median of the amount of arterial blood oxygen and oxygen saturation was significantly effective improvement in IS group with (p < 0.005). Conclusion: Preoperative incentive spirometry for 2 days along with exercises of deep breathing, encouraged coughing and early ambulation following CABG are in connection with prevention and decrease incidence of atelectasis, hospital stay, mechanical ventilation duration and improved postoperative oxygenation with better pain control. A difference that can be considered both significant and clinically relevant.Trial registration Thai Clinical Trials Registry: TCTR20201020005. Registered 17 October 2020 - Retrospectively registered.

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Perspectives on Incentive Spirometry Utility and Patient Protocols

Cited by 19 publications

References 58 publications

Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus

Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus

Incentive Spirometry Adherence: A National Survey of Provider Perspectives

Preoperative Incentive Spirometry for Preventing Postoperative Pulmonary Complications in Patients Undergoing Coronary Artery Bypass Graft Surgery: A Prospective, Randomized Controlled Trial

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