Effect of incentive spirometry after cardiac surgery: protocol for a systematic review

Abstract

Introduction: Patients receiving cardiac surgeries present high risk of developing postoperative complications. Incentive spirometry (IS) is used for the prevention and treatment of postoperative pulmonary complications in patients undergoing cardiac surgeries. Publications have suggested that IS is ineffective. In contrast, some studies have shown that when IS is adequately used, it may lead to beneficial outcomes. Objectives: To assess the effect of IS in patients undergoing cardiac surgeries. Methods/design: Systematic Reviews with randomised and quasi-randomised trials with adult patients undergoing cardiac surgeries, evaluating the effect of flow or volume-oriented IS. Outcome measures: postoperative pulmonary complications; adverse events; mortality; length of hospital stay; length of intensive care unit stay; reintubation rate; pulmonary function; antibiotic use; oxygenation; and respiratory muscle strength. Search: MEDLINE, EMBASE, CENTRAL, PEDro, CINAHL, LILACS, SCIELO, Allied, AMED, Scopus, Open Grey database, the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP), ClinicalTrials.gov, clinicaltrialsregister.eu, and ReBec. Two authors will independently extract data. PEDro scale will be used to evaluate the methodological quality of the studies. Meta-analysis will be performed using the inverse variance method and the random effects model in RevMan 5.3. We will use the I2 statistic to estimate the amount of heterogeneity across studies in each meta-analysis. Ethics and dissemination: The approval of an ethical committee is not required. Only clinical trials that have complied with ethical guidelines and followed the Declaration of Helsinki, will be included in this systematic review. The findings of this study will help clarify uncertainties about the effects of incentive spirometry in the postoperative period of cardiac surgery and may be disseminated to clinicians, assisting in decision making and including the best evidence in the treatment of their patients. Discussion: This review will clarify the uncertainty over whether IS is a useful technique for patients undergoing cardiac surgeries. While good quality studies have shown IS is an effective prophylactic technique, other studies have suggested that there is no evidence to support IS utilization.Keywords: incentive spirometry, cardiac surgery, postoperative.

Is Incentive Spirometry Superior to Standard Care in Postoperative Cardiac Surgery on Clinical Outcomes and Length of Hospital and Intensive Care Unit Stay? A Systematic Review with Meta-Analysis

“…With respect to the secondary outcomes analysis, four trials reported LOS [ 33 , 40 , 43 , 45 ] , two reported ICU LOS [ 36 , 43 ] , eight reported parameters of lung function [ 24 , 29 , 30 , 33 , 34 , 36 , 41 , 47 ] , ten reported PaO 2 , nine reported SO 2 , and one reported reintubation rate. No trials evaluated the use of antibiotics (which was an outcome of interest for this review [ 16 ] ).…”

“…We conducted a systematic review following the reporting recommendations proposed by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (or PRISMA) [ 15 ] . The protocol was registered in the International Prospective Register of Systematic Reviews (or PROSPERO) (#CRD42020161009), is available online at https://www.crd.york.ac.uk/prospero/export_record_pdf.php ), and was previously published [ 16 ] .…”

“…The search strategy was sensitive ( Supplement 1 ) to capture all potentially qualifying studies through the Medical Literature Analysis and Retrieval System Online (or MEDLINE®), Embase®, Cochrane Central Register of Controlled Trials (or CENTRAL), Physiotherapy Evidence Database (PEDro), Cumulative Index of Nursing and Allied Health (or CINAHL®), Latin American and Caribbean Health Sciences Literature (or LILACS), Scientific Electronic Library Online (or SciELO), and Scopus® databases, as well as in the OpenGrey database, the main clinical trial registration sites, conferences, congresses, and symposiums in the area described in the protocol [ 16 ] . When necessary, we contacted the authors of the clinical trials to request additional data.…”