EBA Incentive Spirometry

The AARC reviewed a total of 54 clinical trials and systemic reviews on incentive spirometry and updated the following recommendations based on the assessment, development, and evaluation (GRADE) scoring system. 1: Incentive spirometry alone is not recommended for routine alone use in the preoperative and postoperative setting to prevent postoperative pulmonary complications. 2: It is recommended that incentive spirometry be used with deep breathing techniques, directed coughing, early mobilization, and optimal analgesia to prevent postoperative pulmonary complications. 3: It is suggested that deep breathing exercises provide the same benefit as incentive spirometry in the preoperative and postoperative setting to prevent postoperative pulmonary complications. 4: Routine use of incentive spirometry to prevent atelectasis in patients after upper-abdominal surgery is not recommended. 5: Routine use of incentive spirometry to prevent atelectasis after coronary artery bypass graft surgery is not recommended. 6: It is suggested that a volume-oriented device be selected as an incentive spirometry device. Respir Care2011;56(10):1600 –1604. © 2011 Daedalus Enterprises]

Preoperative and postoperative incentive spirometery is aimed to prevent atelectasis, pneumonia, and to improve the airway. Upper abdominal surgery has the most complications with preoperative and post-operative respiratory problems. The incentive Spirometer cannot be used alone with this type of post operative care because it will be ineffective. The incentive spirometer prevents complications by decreasing pleural pressure, promoting increased lung expansion and better gas exchange. There is lacking evidence for exactly how frequent the incentive spirometer should be used, although some suggestions have been made in clinical trials such as: Ten breaths every one to two hours while awake, Ten breaths 5 times a day, Fifteen breaths every four hours. Assessment of the outcome shows that correct use of the incentive spirometer Decreases respiratory rate, Absence of fever, Normal pulse rate, Improvement in previously absent or diminished breath sounds, Improved radiographic findings, Improved arterial oxygenation (P_aO2, S_aO2, S_pO2), reduced F_IO2 requirement. In conclusion, incentive spirometery shows ineffective after abdominal surgery and coronary artery bypass surgery when used alone. When the incentive spirometer is indicated, it must be included with deep breathing excercises, directed coughing, early ambulation, and optimal analgesia to be affective in lowering the incidence of pulmonary complications.

 

Ruben D Restrepo, Richard Wettstein, Leo Wittnebel and Michael Tracy

Respiratory Care October 2011, 56 (10) 1600-1604; DOI: http://dx.doi.org/10.4187/respcare.01471

 

http://rc.rcjournal.com/content/56/10/1600/tab-references