Using an incentive spirometer reduces pulmonary complications in patients with traumatic rib fractures: a randomized controlled trial

Objectives: We aimed to analyze the effects of a tailored rehabilitation nursing care program on functional ability and quality of life in patients with conservative treatment for rib fractures. Design: Randomized controlled trial. Setting: Inpatient rehabilitation hospital. Subjects: Rib fracture patients treated conservatively were randomized into two groups (experimental and control group). Interventions: Patients in control group received Treatment as Usual (TAU) and patients included in experimental group received TAU and an added tailored rehabilitation nursing care program (RNT). Main measures: At baseline, and end of hospitalization treatment, the functional ability was assessed with the Barthel Index, and the quality of life was evaluated with the EuroQol-5D. Additionally, the outcomes were assessed at six-month follow-up. Results: A total of 80 patients were included in the study, whose mean age was 77.19 SD 7.71 in the RNT group and 75.55 SD 9.46 in the TAU group. Our data showed a significant difference in the post-treatment gains in overall quality of life (74.25 SD 20.62 vs 60.28 SD 20.54), and functional ability (71.79 SD 23.85 vs 69.41 SD 24.30) between the RNT group and the TAU group ( P < 0.05). Compared to the TAU group, the RNT group also showed a significant improvement in functional ability and quality of life at six-month follow-up. Conclusions: A tailored rehabilitation nursing care program added to the conservative treatment during hospitalization can improve the functional ability and quality of life of patients after rib fractures at discharge and at six-month follow-up. Trial registration: ClinicalTrial.gov Identifier: NCT04168996

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“…Several studies have reported similar profile in rib fracture patients receiving conservative treatment. 26,27…”

Section: Discussionmentioning

confidence: 99%

Impacts of tailored, rehabilitation nursing care on functional ability and quality of life in hospitalized elderly patients after rib fractures

et al. 2021

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“…This maneuver emphasizes lung inflation, increasing tidal volume, and maintaining patency of the smaller airway [8]. Like other prophylactic measures, such as smoking cessation, administration of antibiotics, bronchodilators, and chest physical therapy, incentive spirometer has been shown to decrease the rate of postoperative lung atelectasis and decrease pulmonary complications after cardiac, lung, or abdominal surgery [8]. It also reduced pulmonary complications, and improved pulmonary function test (PFT) results in patients with rib fractures [8][9][10].…”

Section: Discussionmentioning

confidence: 99%

“…It encourages deep inspiratory and expiratory breathing by having the patient take long, deep breaths with subsequent pauses. This maneuver emphasizes lung inflation, increasing tidal volume, and maintaining patency of the smaller airway [ 8 ]. Like other prophylactic measures, such as smoking cessation, administration of antibiotics, bronchodilators, and chest physical therapy, incentive spirometer has been shown to decrease the rate of postoperative lung atelectasis and decrease pulmonary complications after cardiac, lung, or abdominal surgery [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Incentive Spirometer in Increasing Maximum Inspiratory Volume in an Out-Patient Setting

Toor¹,

Kashyap²,

Yau³

et al. 2021

Cureus

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BackgroundIncentive spirometry (IS) is the mainstay of care in postoperative patients that has been heavily studied in the inpatient setting. Studies have shown that the utilization of IS improves lung volumes and reduces the rate of pneumonia in post-surgical patients. However, the literature is ambiguous on its benefit as many studies also demonstrate no significant benefit, especially in comparison to early ambulation. Our study sought to determine whether a consistent IS regimen can improve lung function in an outpatient setting. MethodsThis prospective cohort study included patients in a physical medicine and rehabilitation clinic setting during the COVID pandemic. Patients with severe respiratory disease, baseline cough, those unable to perform deep breathing, fever greater than 100.4 F due to non-pulmonary on initial evaluation, or inability to fill out the forms and complete the study were excluded. Each participant was given the IS along with hands-on instruction on how to use the device and accurately record measurements. Patients were asked to lie down and inhale and exhale through the tube ten times. They were asked to mark the highest volume during their 10 breaths. Patients were instructed to complete this exercise three times a day for 30 days. Patients were also asked to perform light exercises or walking for 20 minutes per day three times a week and postural drainage. Patients were instructed to call their primary care physician if a 20% or more decrease from their baseline was noted or if they experienced any new coughs, fever, or shortness of breath during the 30 days of exercise. ResultsA total of 48 patients enrolled in the study with a (median) age of 58.0 years (SD 10.2 years), 21 females and 27 males. Baseline maximal inspiration for study participants was 1885.4 mL prior to exercise, with a subsequent increase in lung capacity observed for all participants enrolled in the study. At the end of the study period, week four, the average maximal inspiratory volume was 2235.4 mL. Paired t-test showed a significant difference between baseline (1885.4) and maximum (2235.4) volumes (t=-4.59, p<0.0001). Analysis of variance (ANOVA) showed no significant difference among Week 1-4 averages (F=1.08, p=0.36). None of the participants reported any symptoms (fever, coughing, shortness of breath) or COVID-19 infection during the 30-days period. None of the participants reported contacting primary care physicians. ConclusionWhen prescribed daily breathing exercises with an incentive spirometer, study participants experienced a 16% increase in maximal inspiratory volume over a span of 30 days and did not need to contact their primary care physician during the study period.

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“…Kemampuan cough atau batuk yang menurun juga merupakan salah satu penyebab ARDS. [5][6][7][8] Pain, incentive spirometry, cough (PIC core) secara original yang dibuat oleh Wellspan York Hospital, York, Pennsylvania, USA digunakan untuk mengevaluasi dan memonitor pasien selama perawatan. 9 Berdasarkan latar belakang yang telah dipaparkan maka dilakukan penelitian ini yang bertujuan untuk menilai spesifisitas dan sensitivitas PIC score dalam memrediksi terjadinya ARDS pada pasien patah tulang iga akibat trauma tumpul toraks.…”

Section: Pendahuluanunclassified

Sensitivitas dan Spesifisitas Pain, Incentive Spirometry, Cough Score sebagai Prediktor Acute Respiratory Distress Syndrome pada Pasien dengan Patah Tulang Iga akibat Trauma Tumpul Toraks

Rustandi

Tangkilisan

Sukanto

et al. 2021

eCL

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Thoracic trauma is one of the most common causes of death in trauma cases due to acute respiratory distress syndrome (ARDS). Definitive diagnosis and rapid identification are challenges in ARDS due to blunt thoracic trauma. The PIC score (pain, incentive spirometry, cough) is used to evaluate and monitor patients during treatment. This study was aimed to assess the specificity and sensitivity of the PIC Score in predicting the occurrence of ARDS in patients with rib fractures due to blunt thoracic trauma. This study used a prospective cohort design with a correlation analysis using data of dependency modeling via R-line copula, ROC curve analysis, and regression analysis. The results showed a total of 25 patients with an average age of 52 years, male sex was predominant (84% vs 16%). On admission, most patients had fractures of three ribs (40%). The PIC score tended to be lower in patients with higher number of rib fractures. The relationship between the PIC score and the PaO2/FiO2 ratio on day 7th of treatment showed a positive correlation, supporting the possibility of using the PIC score to predict ARDS. The sensitivity and specificity of the PIC score in predicting ARDS in blunt thoracic trauma were quite high (sensitivity 80.2% and specificity 80.9%) with an accuracy of 80.9%. In conclusion, the PIC score can predict accurately the occurrence of ARDS in patients with rib fractures due to blunt thoracic trauma.Keywords: blunt thoracic trauma; ARDS; PIC score Abstrak: Trauma toraks merupakan salah satu penyebab kematian terbanyak dalam kasus trauma acute respiratory distress syndrome (ARDS). Diagnosis pasti dan identifikasi segera merupakan tantangan dalam penanganan ARDS akibat trauma tumpul toraks. PIC score (pain, incentive spirometry, cough) digunakan untuk mengevaluasi dan memonitor pasien selama perawatan. Penelitian ini bertujuan untuk menilai spesifisitas dan sensitivitas PIC score dalam memrediksi terjadinya ARDS pada pasien patah tulang iga akibat trauma tumpul toraks. Pada penelitian ini digunakan rancangan prospective cohort dengan penilaian korelasi analisis menggunakan data hasil pemodelan dependensi via R-line copula, analisis kurva ROC, dan analisis regresi. Hasil penelitian mendapatkan total 25 pasien dengan rerata usia 52 tahun, didominasi oleh laki-laki (84% vs 16%). Saat masuk kebanyakan pasien mengalami patah tulang pada tiga tulang iga (40%). PIC score cenderung lebih rendah pada pasien dengan jumlah patah tulang iga yang lebih banyak. Hubungan antara PIC score dan rasio PaO2/FiO2 pada hari ke-7 perawatan menunjukkan adanya korelasi positif; hal ini mendukung kemungkinan penggunaan PIC score untuk memrediksi ARDS. Sensitivitas dan spesifisitas PIC score dalam memrediksi ARDS pada trauma tumpul toraks cukup tinggi (sensitivitas 80,2% dan spesifisitas 80,9%) dengan akurasi 80,9%. Simpulan penelitian ini ialah PIC score dapat memrediksi terjadinya ARDS secara akurat pada pasien patah tulang iga akibat trauma tumpul toraks.Kata kunci: trauma tumpul toraks; ARDS; PIC score

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Using an incentive spirometer reduces pulmonary complications in patients with traumatic rib fractures: a randomized controlled trial

Cited by 46 publications

References 36 publications

Impacts of tailored, rehabilitation nursing care on functional ability and quality of life in hospitalized elderly patients after rib fractures

Impacts of tailored, rehabilitation nursing care on functional ability and quality of life in hospitalized elderly patients after rib fractures

Efficacy of Incentive Spirometer in Increasing Maximum Inspiratory Volume in an Out-Patient Setting

Sensitivitas dan Spesifisitas Pain, Incentive Spirometry, Cough Score sebagai Prediktor Acute Respiratory Distress Syndrome pada Pasien dengan Patah Tulang Iga akibat Trauma Tumpul Toraks

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