Absence of Benefit of Incentive Spirometry in Low-Risk Patients Undergoing Elective Cholecystectomy

Schwieger, Ian M.; Gamulin, Z.; Forster, A.; Meyer, P; Gemperle, M.; Suter, Peter M.

doi:10.1378/chest.89.5.652

Cited by 74 publications

(38 citation statements)

References 21 publications

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“…1,29 In the ensuing 40 years a litany of studies evaluating incentive spirometry for preventing PPC have been published. Two main areas of investigation have been pursued: incentive spirometry for PPC prevention following upper abdominal surgery, [30][31][32][33][34][35][36][37][38][39][40][41][42][43] and incentive spirometry for PPC prevention following cardiac/thoracic surgery. [44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60] Comparison of these studies is difficult, owing to the various study designs (randomized controlled trials and prospective trials), the comparators (none, chest physical therapy [CPT], CPAP, expiratory airway pressure), the frequency of interventions (eg, hourly, every 4 hours), the duration of each intervention (number of maneuvers, minutes of therapy), and the outcomes (radiographic atelectasis, gas exchange, pneumonia, pulmonary function).…”

Section: Incentive Spirometrymentioning

confidence: 99%

“…Of the studies that used PPCs as an outcome, 3 compared incentive spirometry with a control group of no intervention following upper abdominal surgery. 31,34,37 While the most recent of these trials is 25 years old, none showed any advantage for incentive spirometry over no intervention. Incentive spirometry was compared to other interventions in 11 trials following upper abdominal surgery, and included incentive spirometry versus deep breathing exercises, intermittent positive-pressure breathing (IPPB), postural drainage, CPAP, PEP, and early ambulation.…”

Section: Incentive Spirometrymentioning

confidence: 99%

“…In those trials, 6 studies found no differences between the groups, 30-33,37,40 3 found incen- 43 Schwieger et al compared incentive spirometry to no intervention in a group of low risk patients following laparoscopic cholecystectomy and found no differences in lung function. 37 Minschaert and colleagues compared incentive spirometry to conventional physical therapy and found that incentive spirometry was associated with a faster recovery of tidal volume. 43 Stock et al compared CPAP, incentive spirometry, and conservative therapy following upper abdominal surgery, and found that CPAP improved gas exchange and lung volumes, compared to incentive spirometry.…”

Section: Incentive Spirometrymentioning

confidence: 99%

“…38 Other studies in this category showed no advantage of incentive spirometry over other techniques with respect to restoration of lung volumes. [31][32][33]35,37,40 Studies comparing incentive spirometry for PPC prevention after cardiac/thoracic surgery also include a trial with no intervention as the control, 48 and studies that compared incentive spirometry to other techniques. 44,45,47,48,51,52,54,55,58,60 The majority of these trials reported no difference between incentive spirometry and the comparator.…”

Section: Incentive Spirometrymentioning

confidence: 99%

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The Scientific Basis for Postoperative Respiratory Care

Branson

2013

Respir Care

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Postoperative pulmonary complications (PPCs) are common and expensive. Costs, morbidity, and mortality are higher with PPCs than with cardiac or thromboembolic complications. Preventing and treating PPCs is a major focus of respiratory therapists, using a wide variety of techniques and devices, including incentive spirometry, CPAP, positive expiratory pressure, intrapulmonary percussive ventilation, and chest physical therapy. The scientific evidence for these techniques is lacking. CPAP has some evidence of benefit in high risk patients with hypoxemia. Incentive spirometry is used frequently, but the evidence suggests that incentive spirometry alone has no impact on PPC. Chest physical therapy, which includes mechanical clapping and postural drainage, appears to worsen atelectasis secondary to pain and splinting. As with many past respiratory therapy techniques, the profession needs to take a hard look at these techniques and work to provide only practices based on good evidence. The idea of a PPC bundle has merit and should be studied in larger, multicenter trials. Additionally, intraoperative ventilation may play a key role in the development of PPCs and should receive greater attention.

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Section: Incentive Spirometrymentioning

confidence: 99%

Section: Incentive Spirometrymentioning

confidence: 99%

Section: Incentive Spirometrymentioning

confidence: 99%

Section: Incentive Spirometrymentioning

confidence: 99%

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The Scientific Basis for Postoperative Respiratory Care

Branson

2013

Respir Care

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“…Control group without treatment vs. IS: Three studies compared the effect of IS with a control group without intervention 24,27,30 , and no between-group differences were found.…”

Section: Ppc As An Outcomementioning

confidence: 99%

Incentive spirometry in major surgeries: a systematic review

Carvalho¹,

Paisani²,

Lunardi³

2011

Rev. bras. fisioter.

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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. Methods: Searches were performed in the following databases: Medline, Embase, Web of Science, PEDro and Scopus to select randomized controlled trials in which IS was used in the pre-and/or post-operative period in order to prevent postoperative pulmonary complications and/or recover lung function after abdominal, cardiac and thoracic surgery. Two reviewers independently assessed all studies. In addition, the study quality was assessed using the PEDro scale. Results: Thirty studies were included (14 abdominal, 13 cardiac and 3 thoracic surgery; n=3,370 patients). In the analysis of the methodological quality, studies achieved a PEDro average score of 5.6, 4.7 and 4.8 points in abdominal, cardiac and thoracic surgeries, respectively. Five studies (3 abdominal, 1 cardiac and 1 thoracic surgery) compared the effect of the IS with a control group (no intervention) and no difference was detected in the evaluated outcomes. Conclusion: There was no evidence to support the use of incentive spirometry in the management of surgical patients. Despite this, the use of incentive spirometry remains widely used without standardization in clinical practice.Keywords: incentive spirometry; surgery; postoperative care; postoperative complication; physical therapy; breathing exercise. ResumoObjetivo: Realizar um levantamento da literatura para avaliar as evidências do uso do incentivador respiratório (IR) na prevenção de complicações pulmonares pós-operatórias (CPPs) e recuperação da função pulmonar em pacientes submetidos a cirurgias abdominal, cardíaca e torácica. Métodos: Esta revisão sistemática utilizou as bases de dados Medline, Embase, Web of Science, PEDro e Scopus para selecionar ensaios clínicos randomizados, nos quais o IR foi utilizado nos período pré e/ou pós-operatório, visando prevenir CPP e/ou recuperar função pulmonar após cirurgias abdominal, cardíaca ou torácica. Dois revisores analisaram independentemente os estudos. Além disso, a qualidade dos estudos foi avaliada segundo a escala PEDro. Resultados: Trinta estudos foram incluídos (14 de cirurgia abdominal, 13 de cardíaca e três de torácica; n=3370 pacientes). Na análise de qualidade, os estudos obtiveram média de 5,6, 4,7 e 4,8 pontos nas cirurgias abdominais, cardíacas e torácicas, respectivamente. Cinco estudos (três de cirurgia abdominal, um de cardíaca e um de torácica) compararam o efeito do IR com grupo controle (sem intervenção) e não se verificou diferença nos desfechos estudados. Conclusão: Não se encontraram evidências que subsidiem o uso do IR no manejo de pacientes cirúrgicos.Apesar disso, o uso do IR continua não-padronizado e amplamente difundido na prática clínica.

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Preoperative Pulmonary Evaluation

Jackson¹

1988

Arch Intern Med

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Absence of Benefit of Incentive Spirometry in Low-Risk Patients Undergoing Elective Cholecystectomy

Cited by 74 publications

References 21 publications

The Scientific Basis for Postoperative Respiratory Care

The Scientific Basis for Postoperative Respiratory Care

Incentive spirometry in major surgeries: a systematic review

Preoperative Pulmonary Evaluation

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