The Efficacy of Postoperative Incentive Spirometry Is Influenced by the Device-Specific Imposed Work of Breathing

Weindler, J.; Kiefer, Ralph-Thomas

doi:10.1378/chest.119.6.1858

Cited by 68 publications

(61 citation statements)

References 16 publications

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“…In healthy adults, previous studies have reported that VIS induced greater chest wall expansion and abdominal displacement 10,11,19 and lower inspiratory muscle activity 9,11,20 and work of breathing 21,22 than FIS. However, to the best of our knowledge the advice to use incentive spirometry has never been investigated in elderly subjects.…”

Section: Discussionmentioning

confidence: 90%

Effect of Volume-Oriented Versus Flow-Oriented Incentive Spirometry on Chest Wall Volumes, Inspiratory Muscle Activity, and Thoracoabdominal Synchrony in the Elderly

et al. 2013

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BACKGROUND: Aging causes physiological and functional changes that impair pulmonary function. Incentive spirometry is widely used for lung expansion, but the effects of volume-oriented incentive spirometry (VIS) versus flow-oriented incentive spirometry (FIS) on chest wall volumes, inspiratory muscle activity, and thoracoabdominal synchrony in the elderly are poorly understood. We compared VIS and FIS in elderly subjects and healthy adult subjects. METHODS: Sixteen elderly subjects (9 women, mean ؎ SD age 70.6 ؎ 3.9 y, mean ؎ SD body mass index 23.8 ؎ 2.5 kg/ m 2 ) and 16 healthy adults (8 women, mean ؎ age 25.9 ؎ 4.3 y, mean ؎ body mass index 23.6 ؎ 2.4 kg/ m 2 ) performed quiet breathing, VIS, and FIS in randomized sequence. Chest wall kinematics (via optoelectronic plethysmography) and inspiratory muscle activity (via surface electromyography) were assessed simultaneously. Synchrony between the superior thorax and abdominal motion was calculated (phase angle). RESULTS: In the elderly subjects both types of incentive spirometry increased chest wall volumes similarly, whereas in the healthy adult subjects VIS increased the chest wall volume more than did FIS. FIS and VIS triggered similar lower thoracoabdominal synchrony in the elderly subjects, whereas in the healthy adults FIS induced lower synchrony than did VIS. FIS required more muscle activity in the elderly subjects to create an increase in chest wall volume. CONCLUSIONS: Incentive spirometry performance is influenced by age, and the differences between elderly and healthy adults response should be considered in clinical practice.

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Section: Discussionmentioning

confidence: 90%

Effect of Volume-Oriented Versus Flow-Oriented Incentive Spirometry on Chest Wall Volumes, Inspiratory Muscle Activity, and Thoracoabdominal Synchrony in the Elderly

et al. 2013

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“…Some studies have shown differences between the different types of incentive spirometers in terms of respiratory pattern, thoracoabdominal motion, respiratory effort, and accessory muscle recruitment. (8)(9)(10) In the present study, diaphragmatic mobility was measured via ultrasound during the use of incentive spirometers. Our results showed that diaphragmatic mobility was significantly greater during ISVOD and during DB than during ISFOD.…”

Section: Resultsmentioning

confidence: 99%

“…(8) Other authors have observed that there is greater abdominal motion, lower accessory respiratory muscle recruitment, and higher tidal volume during the use of ISVOD than during the use of ISFOD. (9,10) In addition to the evaluation parameters mentioned above, diaphragmatic mobility during the use of different types of incentive spirometers has not been quantified in previous studies, and such quantification could contribute to a better understanding of the mechanical effects of the devices and of their indications in clinical practice.…”

Section: Introductionmentioning

confidence: 93%

Mobilidade diafragmática durante espirometria de incentivo orientada a fluxo e a volume em indivíduos sadios

Yamaguti¹,

Sakamoto

Panazzolo

et al. 2010

J. bras. pneumol.

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Objective: To compare the diaphragmatic mobility of healthy subjects during incentive spirometry with a volumeoriented device, during incentive spirometry with a flow-oriented device, and during diaphragmatic breathing. To compare men and women in terms of diaphragmatic mobility during these three types of breathing exercises. Methods:We evaluated the pulmonary function and diaphragmatic mobility of 17 adult healthy volunteers (9 women and 8 men). Diaphragmatic mobility was measured via ultrasound during diaphragmatic breathing and during the use of the two types of incentive spirometers. Results: Diaphragmatic mobility was significantly greater during the use of the volume-oriented incentive spirometer than during the use of the flow-oriented incentive spirometer (70.16 ± 12.83 mm vs. 63.66 ± 10.82 mm; p = 0.02). Diaphragmatic breathing led to a greater diaphragmatic mobility than did the use of the flow-oriented incentive spirometer (69.62 ± 11.83 mm vs. 63.66 ± 10.82 mm; p = 0.02). During all three types of breathing exercises, the women showed a higher mobility/ FVC ratio than did the men. Conclusions: Incentive spirometry with a volume-oriented device and diaphragmatic breathing promoted greater diaphragmatic mobility than did incentive spirometry with a flow-oriented device. Women performed better on the three types of breathing exercises than did men. ResumoObjetivo: Comparar a mobilidade diafragmática de indivíduos sadios durante a espirometria de incentivo orientada a volume, durante a espirometria de incentivo orientada a fluxo e durante exercícios diafragmáticos. Comparar a mobilidade diafragmática entre homens e mulheres durante esses três tipos de exercícios respiratórios. Métodos: Foram avaliadas a função pulmonar e a mobilidade diafragmática de 17 voluntários sadios adultos (9 mulheres e 8 homens). A avaliação da mobilidade do diafragma foi realizada durante a execução de exercícios diafragmáticos e durante o uso dos dois tipos de espirômetros de incentivo, por meio de um método ultrassonográfico. Resultados: A mobilidade diafragmática avaliada durante a utilização do espirômetro orientado a volume foi significativamente maior que aquela durante o uso do espirômetro orientado a fluxo (70,16 ± 12,83 mm vs. 63,66 ± 10,82 mm; p = 0,02). Os exercícios diafragmáticos promoveram maior mobilidade diafragmática do que o uso do espirômetro orientado a fluxo (69,62 ± 11,83 mm vs. 63,66 ± 10,82 mm; p = 0,02). Durante os três tipos de exercícios respiratórios, a relação mobilidade/CVF foi significativamente maior nas mulheres do que nos homens. Conclusões: A espirometria de incentivo orientada a volume e o exercício diafragmático promoveram maior mobilidade diafragmática do que a espirometria de incentivo orientada a fluxo. As mulheres apresentaram um melhor desempenho nos três tipos de exercícios respiratórios avaliados do que os homens. Original ArticleDiaphragmatic mobility in healthy subjects during incentive spirometry with a flow-oriented device and with a volume-oriented device J Bras Pneumol...

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“…Several types of medical intervention are employed to decrease the risk of atelectasis [18][19][20][21][22][23][24]. currently the most widespread used method is incentive spirometry, although the majority of studies do not show it to have a significant effect (21).…”

Section: Introductionmentioning

confidence: 99%

Single or repetitive lung recruitment manoeuvres after cardiac valve replacement surgery

Riachy¹,

Ibrahim²,

Sleilaty³

et al. 2017

Lung Breath J

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Cardiopulmonary bypass surgery has been implicated in causing atelectasis; a major cause of intrapulmonary shunting and hypoxemia postoperatively. This study investigated if repetitive lung recruitment manoeuvres (RRM), before and after extubation, could reduce intrapulmonary shunting for a longer period post-extubation than only one standardized recruitment manoeuvre (SRM), Forty cardiac valve replacement patients were randomised after SRM into two groups: RRM group (n=20): Total vital capacity manoeuvre at surgery end and repeated every 4 hours until extubation; SC group (n=20): Standard care with SRM. Intrapulmonary shunts (Qs/Qt) were measured after anaesthesia induction, at surgery termination and every 4 hours until 24 hours post-extubation. Time to extubation was recorded. Lung function was measured every 12 hours until discharge.A 24 hour post-extubation ANOVA showed no Qs/Qt significant differences between RRM and SC group (4.5 ± 3.3% and 5.3 ± 2.4%). At surgery end, Qs/Qt increased in RRM group (7.3 ± 3.2% to 13.5 ± 3.7%; p<10-3) but was significantly less (p<0.02) compared to SC group (7.3 ± 3.7% to 16.1 ± 6%; p<10-3). Time to extubation was 8.8 ± 4.2 h in RRM group versus 10.4 ± 4.3 h SC group (p<0.2, ns). No significant difference in vital capacity was seen in the RRM group (3.17 ± 1.2 to 1.9 ± 1 l) compared to SC group (3.4 ± 0.8 to 2.1 ± 0.9 l).In valve replacement surgery, RRM is only beneficial in the short-term period and does not assure a better intrapulmonary shunt benefit than one SRM applied at the end of surgery.

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The Efficacy of Postoperative Incentive Spirometry Is Influenced by the Device-Specific Imposed Work of Breathing

Cited by 68 publications

References 16 publications

Effect of Volume-Oriented Versus Flow-Oriented Incentive Spirometry on Chest Wall Volumes, Inspiratory Muscle Activity, and Thoracoabdominal Synchrony in the Elderly

Effect of Volume-Oriented Versus Flow-Oriented Incentive Spirometry on Chest Wall Volumes, Inspiratory Muscle Activity, and Thoracoabdominal Synchrony in the Elderly

Mobilidade diafragmática durante espirometria de incentivo orientada a fluxo e a volume em indivíduos sadios

Single or repetitive lung recruitment manoeuvres after cardiac valve replacement surgery

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