Incentive spirometry for tracheostomy and laryngectomy patients. Incentive spirometry decreases respiratory complications following major abdominal surgery. Absence of benefit of incentive spirometry in low-risk patients undergoing elective cholecystectomy. A controlled randomized study. The effectiveness of incentive spirometry with physical therapy for high-risk patients after coronary artery bypass surgery. An evaluation of the incentive spirometer to improve lung function after cholecystectomy Incentive spirometry does not enhance recovery after thoracic surgery The efficacy of postoperative incentive spirometry is influenced by the device-specific imposed work of breathing. Incentive spirometry versus routine chest physiotherapy for prevention of pulmonary complications after abdominal surgery Influence of incentive spirometry on pulmonary volumes after laparotomy. [Ineffectiveness of incentive spirometry as coadjuvant of conventional physiotherapy for the prevention of postoperative respiratory complications after thoracic and esophageal surgery]. Postthoracotomy respiratory muscle mechanics during incentive spirometry using respiratory inductance plethysmography. Comparison of continuous positive airway pressure, incentive spirometry, and conservative therapy after cardiac operations Incentive spirometry to prevent acute pulmonary complications in sickle cell diseases. Preoperative use of incentive spirometry does not affect postoperative lung function in bariatric surgery. Prevention of respiratory complications after abdominal surgery: a randomised clinical trial Effectiveness of spirometry as a motivational tool for smoking cessation: a clinical trial, the ESPIMOAT study Effect of Preoperative and Postoperative Incentive Spirometry on Lung Functions After Laparoscopic Cholecystectomy
Sustained maximal inspiration ( incentive spirometry ) is used for the prevention and management of atelectasis in major abdominal and thoracic surgery . Patients with head and neck surgery are predisposed to postoperative disturbances in lung function after extensive surgical resection , immobilization , or significant chest wall deformity from various reconstructive procedures . The patient often requires tracheostomy or permanent laryngeal stoma . A prospect i ve clinical study on patients with major head and neck surgery was conducted to evaluate the use of incentive spirometry to improve postoperative lung function . An adaptor was first design ed to allow patients with tracheostomy tubes to use the spirometers . Parameters studied include vital signs , arterial blood gases ( A-a gradient ) , and pulmonary function test . Significant improvement of lung function and lack of complication warrant the use of incentive spirometry in postoperative head and neck surgery patients Pulmonary complications are the leading cause of morbidity and mortality following major abdominal surgery . Chest physiotherapy aims to decrease the likelihood of these complications and hasten recovery . Exercises aim ed at maximising inspiratory effort are the most beneficial for the patients . The incentive spirometer is a h and held device that patients use to achieve effective inspiration . In a nonr and omised pilot study of 263 patients we have found that the addition of the incentive spirometer , as part of an intensive post-operative physiotherapy programme , decreased the occurrence of pulmonary complications ( 6 vs 17 % , p = 0.01 ) and length of stay on the surgical high dependency unit ( 3.1 vs 4 days p = 0.03 ) . The two groups were comparable when age , sex , smoking history , the need for emergency surgery and post-operative analgesia were compared To determine the potential benefit of incentive spirometry , which has been advocated to prevent pulmonary complications after upper-abdominal surgery , we compared a group of patients receiving incentive spirometry  to another group receiving no specialized postoperative respiratory care . Forty patients in the American Society of Anesthesiologists ' class 1 and 2 who were undergoing cholecystectomy ( through right subcostal incision ) were included in the study and were r and omly allocated to one of the two groups . Patients receiving incentive spirometry were encouraged by a specialized respiratory physiotherapist to breathe deeply for five minutes hourly , 12 times daily , for three postoperative days . No statistically significant difference between the two groups was found in the radiologic evidence of postoperative pulmonary complications , arterial oxygen pressure , spirometric measurement , and clinical evaluation at the second or fourth postoperative day ( or both ) . In particular , deterioration on the chest x-ray film at the fourth postoperative day was observed in eight of 20 patients in the group receiving incentive spirometry and in six of 20 in the control group . Our study confirms the postoperative deterioration of respiratory function after upper-abdominal surgery and demonstrates the lack of therapeutic values of  incentive spirometry  in these patients at low risk for pulmonary complications BACKGROUND AND PURPOSE The purpose of this study was to determine whether the addition of incentive spirometry ( IS ) to postoperative pulmonary physical therapy is more effective than physical therapy alone in reducing postoperative pulmonary complications in high-risk patients after coronary artery bypass grafting ( CABG ) . Patients were given the spirometer and instructed in its use , as often occurs in clinical setting s. SUBJECTS Patients with chronic airflow limitation following CABG ( N = 185 ) participated . METHODS Subjects were r and omly assigned to receive either postoperative pulmonary physical therapy ( breathing exercises , secretion removal , mobility ) or physical therapy combined with IS . RESULTS No difference was found between the two groups in atelectasis , spirometry , oxygen saturation , pulmonary infection , or hospital stay . CONCLUSION AND DISCUSSION Incentive spirometry combined with physical therapy is no more effective than postoperative physical therapy alone in reducing atelectasis for this population . Use of the spirometer , however , was not monitored , and although the study mimicked practice as it often occurs , the effectiveness of the spirometer can not be fully evaluated Forty patients who underwent elective cholecystectomy were allocated r and omly to one of two groups . Patients in one group used an incentive spirometer as part of their postoperative chest physiotherapy ; those in the other received routine postoperative physiotherapy as dictated by their needs . Each group contained equal numbers of smokers and nonsmokers , and the data from each group were analysed separately . The use of the incentive spirometer  did not confer any benefits as judged by clinical evidence of pulmonary complications , pulmonary function tests or length of hospital stay Objective : To investigate the additional effect of incentive spirometry to chest physiotherapy to prevent postoperative pulmonary complications after thoracic surgery for lung and esophageal resections . Design : R and omized controlled trial . Setting : University hospital , intensive care unit , and surgical department . Patients : Sixty‐seven patients ( age , 59 ± 13 yrs ; forced expiratory volume in 1 sec , 93 % ± 22 % predicted ) undergoing elective thoracic surgery for lung ( n = 40 ) or esophagus ( n = 27 ) resection . Interventions : Physiotherapy ( breathing exercises , huffing , and coughing ) ( PT ) plus incentive spirometry ( IS ) was compared with PT alone . Measurements and Main Results : Lung function , body temperature , chest radiograph , white blood cell count , and number of hospital and intensive care unit days were all measured . Pulmonary function was significantly reduced after surgery ( 55 % of the initial value ) and improved significantly in the postoperative period in both groups . However , no differences were observed in the recovery of pulmonary function between the groups . The overall score of the chest radiograph , based on the presence of atelectasis , was similar in both treatment groups . Eight patients ( 12 % ) ( three patients with lobectomy and five with esophagus resection ) developed a pulmonary complication ( abnormal chest radiograph , elevated body temperature and white blood cell count ) , four in each treatment group . Adding IS to regular PT did not reduce hospital or intensive care unit stay . Conclusions : Pulmonary complications after lung and esophagus surgery were relatively low . The addition of IS to PT did not further reduce pulmonary complications or hospital stay . Although we can not rule out beneficial effects in a subgroup of high‐risk patients , routine use of IS after thoracic surgery seems to be ineffective STUDY OBJECTIVES The study evaluated the impact of the additional imposed work of breathing ( WBimp ) generated by two different spirometers on postoperative incentive spirometry performance in patients at high risk and moderate risk for postoperative pulmonary complications ( PPCs ) . Additionally , we investigated whether maximal inspiratory pressure ( PImax ) is an easy estimate of the WBimp imposed by incentive spirometers . DESIGN Prospect i ve , r and omized , single-blind clinical trial . SETTING ICU of a university hospital . INTERVENTIONS AND MEASUREMENTS Thirty male patients were assigned to a group at high risk for PPCs ( group A ; inspiratory capacity [ IC ] , < 1.6 L ) or to a group at moderate risk for PPCs ( group B ; IC , 1.6 to 2.5 L ) after upper-abdominal , thoracic , or two-cavity surgery . On the first or second postoperative day WBimp , IC , and PImax were recorded without spirometers ( baseline ) and during incentive spirometry with the Mediflo spirometer ( Medimex ; Hamburg , Germany ) ( high WBimp ) and the Coach spirometer ( Kendall ; Neustadt , Germany ) ( low WBimp ) using a pneumotachograph . In group A , the baseline and the ICs for both spirometers only differed slightly . In group B , the IC was significantly reduced for the Mediflo ( p < 0.05 ) , which imposed a WBimp twice as high as the Coach ( p < 0.01 ) . PImax was significantly increased for both the Mediflo and the Coach ( p < 0.01 ) . PImax was positively correlated with WBimp ( r = 0.8 ) . CONCLUSIONS Incentive spirometers differ considerably in their additional Wbimp with a potential impact on the efficacy of postoperative incentive spirometry performance . PImax might be an easy clinical estimate for the WBimp during incentive spirometry . Incentive spirometers with low WBimp permit increased maximal sustained inspiration and , thus , enhanced incentive spirometry performance , and , therefore , it might be more suitable for use in postoperative respiratory care We entered 876 patients into a clinical trial aim ed at preventing pulmonary complications after abdominal surgery . Patients either received conventional chest physiotherapy or were encouraged to perform maximal inspiratory manoeuvres for 5 min during each hour while awake , using an incentive spirometer . The incidence of pulmonary complications did not differ significantly between the groups : incentive spirometry 68 of 431 ( 15.8 % , 95 % CI 14.0 - 17.6 % ) , and chest physiotherapy 68 of 445 ( 15.3 % , CI 13.6 - 17.0 % ) . Nor was there a difference between the groups in the incidence of positive clinical signs , pyrexia , abnormal chest radiographs , pathogens in sputum , respiratory failure ( PO2 less than 60 mm Hg ) , or length of stay in hospital . We conclude that prophylactic incentive spirometry and chest physiotherapy are of equivalent clinical efficacy in the general management of patients undergoing abdominal surgery Twenty patients undergoing an upper abdominal procedure were r and omly assigned in two groups . One group was treated with both chest physical therapy and incentive spirometry and the other was treated with chest physical therapy alone .  Spirometric values , respiratory rate , tidal volume and vital capacity were determined during the postoperative course . We observed that patients treated with incentive spirometry bad a faster return to preoperative pulmonary volumes . This observation confirms the prophylactic role of incentive spirometry in the prevention of pulmonary complications after laparotomy We have studied the efficacy of routine use of incentive spirometry ( IS ) in two groups of patients : group 1 ( n = 18 ) with IS , and group 2 ( n = 19 ) , no IS . All patients suffered from lung or esophagus neoplasm and received respiratory physiotherapy before and after the operation . They underwent high chest and abdomen surgery .  The incidence of alterations of pulmonary auscultation , roentgenologic abnormalities and alterations of the alveolar-arterial difference of oxygen ( D[A-a]O2 ) as well as postoperative complications were similar in both groups . Patients undergoing digestive surgery  presented a higher frequency of pleural effusion ( p less than 0.05 ) and of them , the subgroup with IS stayed at the hospital for a longer time ( 47.2 + /- 32 days ) than the subgroup undergoing digestive surgery not su bmi tted to IS ( p less than 0.01 ) probably because of the higher incidence of neoplasms of the mean third of the esophagus in such group . In our study and in the context of the type of surgery studied , the routine use of IS does not decrease the frequency of clinical and roentgenologic alterations neither improves the efficacy of postoperative gas interchange We undertook this study to characterize the postthoracotomy compartmental displacement and respiratory mechanical changes occurring during and after the performance of the incentive spirometry maneuver . We also evaluated the effect of recumbency angle on compartmental recruitment .  Sixteen patients were r and omized to perform incentive spirometry either at 30 degrees or 60 degrees recumbency angle . They were studied using respiratory inductance plethysmography  to measure tidal volume , respiratory frequency , inspiratory time , rib cage motion/tidal volume ratio , inspiratory duty cycle , and inspiratory flow . Patients were studied before surgery and on postoperative days 1 and 3 . Statistical analysis was accomplished using multiple measures ANOVA with post-hoc Student 's t-tests when appropriate . Preoperative incentive spirometry augmented VT by increasing both VT/TI and TI . Postoperatively , the incentive recruitment of VT was reduced , a result of a decrease in TI and TI/TTOT ; VT/TI was unchanged . There was postoperative decrease of AB and AB/VT during incentive spirometry , greatest in the 60 degrees group . Our results characterize the nature of the respiratory recruitment afforded by incentive spirometry , before and after thoracotomy . We also found evidence of postthoracotomy diaphragmatic derecruitment during incentive spirometry exacerbated by a high recumbency angle Of 38 patients undergoing median sternotomy for cardiac operations all developed profound restrictive defects in pulmonary function during the first 72 h after tracheal extubation . Although decreased lung volumes were refractory to correction by vigorous , aggressive pulmonary therapy during this period , frequent and supervised treatment may prevent further deterioration in pulmonary function . The overall incidence of pneumonia was only 3 % ( 1/38 ) . Continuous positive airway pressure delivered by mask proved to be a nearly effortless form of postoperative respiratory therapy that was less painful than incentive spirometry or coughing and deep breathing , and therefore may be preferable BACKGROUND This study was design ed to determine the incidence of thoracic bone infa rct ion in patients with sickle cell diseases who were hospitalized with acute chest or back pain above the diaphragm and to test the hypothesis that incentive spirometry can decrease the incidence of atelectasis and pulmonary infiltrates . METHODS We conducted a prospect i ve , r and omized trial in 29 patients between 8 and 21 years of age with sickle cell diseases who had 38 episodes of acute chest or back pain above the diaphragm and were hospitalized . Each episode of pain was considered to be an independent event . At each hospitalization , patients with normal or unchanged chest radiographs on admission were r and omly assigned to treatment with spirometry or to a control nonspirometry group . Each patient in the spirometry group took 10 maximal inspirations using an incentive spirometer every two hours between 8 a.m. and 10 p.m. and while awake during the night until the chest pain subsided . A second radiograph was obtained three or more days after admission , or sooner if clinical ly necessary , to determine the incidence of pulmonary complications . Bone scanning was performed no sooner than two days after hospital admission to determine the incidence of thoracic bone infa rct ion . RESULTS The incidence of thoracic bone infa rct ion was 39.5 percent ( 15 of 38 hospitalizations ) . Pulmonary complications ( atelectasis or infiltrates ) developed during only 1 of 19 hospitalizations of patients assigned to the spirometry group , as compared with 8 of 19 hospitalizations of patients in the nonspirometry group ( P = 0.019 ) . Among patients with thoracic bone infa rct ion , no pulmonary complications developed in those assigned to the spirometry group during a total of seven hospitalizations , whereas they developed during five of eight hospitalizations in the nonspirometry group ( P = 0.025 ) . CONCLUSIONS Thoracic bone infa rct ion is common in patients with sickle cell diseases who are hospitalized with acute chest pain .  Incentive spirometry can prevent the pulmonary complications ( atelectasis and infiltrates ) associated with the acute chest syndrome in patients with sickle cell diseases who are hospitalized with chest or back pain above the diaphragm Morbidly obese patients undergoing general anesthesia for laparoscopic bariatric surgery are considered at increased risk of a postoperative decrease in lung function . The purpose of this study was to determine whether a systematic use of incentive spirometry ( IS ) prior to surgery could help patients to preserve their respiratory function better in the postoperative period . Forty-one morbidly obese ( body mass index [ BMI ] > 40 kg/m² ) c and i date s for laparoscopic bariatric surgery were consented in the study . All patients were taught how to use an incentive spirometer but then were r and omized blindly into 2 groups . The control group was instructed to use the incentive spirometer for 3 breaths , once per day . The treatment group was requested to use the incentive spirometer for 10 breaths , 5 times per day . Twenty experimental ( mean BMI of 48.9 ± 5.67 kg/m² ) and 21 control patients ( mean BMI of 48.3 ± 6.96 kg/m² ) were studied . The initial mean inspiratory capacity ( IC ) was 2155 ± 650.08 ( SD ) cc and 2171 ± 762.98 cc in the experimental and control groups , respectively . On the day of surgery , the mean IC was 2275 ± 777.56 cc versus 2254.76 ± 808.84 cc , respectively . On postoperative day 1 , both groups experienced a significant drop of their IC , with volumes of 1458 ± 613.87 cc ( t test P < 0.001 ) and 1557.89 ± 814.67 cc ( t test P < 0.010 ) , respectively . Our results suggest that preoperative use of the IS does not lead to significant improvements of inspiratory capacity and that it is a not a useful re source to prevent postoperative decrease in lung function Abstract Objective : To evaluate the prevention of respiratory complications after abdominal surgery by a comparison of a global policy of incentive spirometry with a regimen consisting of deep breathing exercises for low risk patients and incentive spirometry plus physiotherapy  for high risk patients . Design : Stratified r and omised trial . Setting : General surgical service of an urban teaching hospital . Patients : 456 patients undergoing abdominal surgery . Patients less than 60 years of age with an American Society of Anesthesia classification of 1 were considered to be at low risk . Outcome measures : Respiratory complications were defined as clinical features consistent with collapse or consolidation , a temperature above 38 ° C , plus either confirmatory chest radiology or positive results on sputum microbiology . We also recorded the time that staff devoted to prophylactic respiratory therapy . Results : There was good baseline equivalence between the groups . The incidence of respiratory complications was 15 % ( 35/231 ) for patients in the incentive spirometry group and 12 % ( 28/225 ) for patients in the mixed therapy group ( P=0.40 ; 95 % confidence interval -3.6 % to 9.0 % ) . It required similar amounts of staff time to provide incentive spirometry and deep breathing exercises for low risk patients . The inclusion of physiotherapy for high risk patients , however , result ed in the utilisation of an extra 30 minutes of staff time per patient . Conclusions : When the use of re sources is taken into account , the most efficient regimen of prophylaxis against respiratory complications after abdominal surgery is deep breathing exercises for low risk patients and incentive spirometry for high risk patients . Key messages Key messages Most postoperative respiratory complications were due to atelectasis : less than 1 % of the patients developed pneumonia An American Society of Anesthesia classification > 1 and an age > /=60 years is a simple way of defining patients at high risk of respiratory complications and other adverse events after abdominal surgery A regimen consisting of deep breathing exercises ( low risk patients ) and incentive spirometry ( high risk patients ) is an efficient way of providing prophylaxis against respiratory complications after abdominal Background Smoking is the main preventable cause of morbidity and mortality in our region , it being the main causative agent of chronic obstructive pulmonary disease . There still is no consensus on the use of spirometry as a strategy for smoking cessation , given that there is insufficient scientific evidence from high quality studies to recommend the use of this technique . Methods / Design This is to be a r and omized , multicentre , open-label clinical trial . A total of 444 smokers over 40 years of age will be recruited by 39 general practitioners from 22 health centers . Primary objective of this study is to assess the effectiveness of spirometry  together with information regarding the test for smoking cessation after 1 year in smokers over 40 years of age with a more than 10 pack-year history and no previous diagnosis of chronic obstructive pulmonary disease . Groups of 45 patients who smoke will be r and omly selected from the lists of the participating doctors . The names will be sent to the corresponding doctors who will contact c and i date patients and assess whether they meet the selection criteria . Patients who meet these criteria will be r and omly allocated to an intervention or control group . For patients in both groups , a nurse will conduct an interview and perform a spirometry test to measure  forced vital capacity . Then , all patients will be referred for an appointment with their doctor for brief anti-smoking intervention , patients from the intervention group additionally being informed about the result of the spirometry test . After 1 year , smoking status will be assessed and , in those who report that they have quit smoking , abstinence will be confirmed by co-oximetry . Data will be analyzed on an intention-to-treat basis using the chi-squared test for outcomes and binary logistic regression if it is considered to be necessary to adjust for confounding variables . Discussion Performing a spirometry test and providing information on pulmonary function may increase awareness of the effect of smoking among smokers who are asymptomatic or have few symptoms and make them decide to quit . Specifically , in patients with chronic obstructive pulmonary disease it might increase levels of motivation to quit smoking in early stages of the disease . If this strategy were to be effective , it could be included in the health promotion activities offered in primary care . Trial registration Clinical Trials.gov Identifier : This study was design ed to compare the effects of preoperative and postoperative incentive spirometry on lung functions after laparoscopic cholecystectomy in 50 otherwise normal healthy adults . Patients were r and omized into a control group ( group PO , n=25 ) and a study group ( group PR , n=25 ) . Patients in group PR were instructed to carry out incentive spirometry before the surgery 15 times , every fourth hourly , for 1 week whereas in group PO , incentive spirometry was carried out during the postoperative period . Lung functions were recorded at the time of preanesthetic evaluation , on the day before the surgery , postoperatively at 6 , 24 , and 48 hours , and at discharge . Significant improvement in the lung functions was seen after preoperative incentive spirometry ( group PR ) , P<0.05 . The lung functions were significantly reduced till the time of discharge in both the groups . However , lung functions were better preserved in group PR at all times when compared with group PO ; P<0.05 . To conclude , lung functions are better preserved with preoperative than postoperative incentive spirometry
CONCLUSION There was no evidence to support the use of incentive spirometry in the management of surgical patients .
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 .