Effect of Incentive Spirometry on Postoperative Hypoxemia and Pulmonary Complications After Bariatric Surgery

Pantel, Haddon; Hwang, J.; Brams, David M.; Schnelldorfer, Thomas; Nepomnayshy, Dmitry

doi:10.1001/jamasurg.2016.4981

Cited by 43 publications

(33 citation statements)

References 26 publications

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“…In 2017, Pantel et al 38 reported the results of a randomized clinical trial that compared the use of postoperative IS to no use of IS after bariatric surgery. Postoperative IS did not demonstrate any effect on postoperative hypoxemia or postoperative pulmonary complications.…”

Section: Systematic Reviewsmentioning

confidence: 99%

Clinical Effectiveness of Incentive Spirometry for the Prevention of Postoperative Pulmonary Complications

et al. 2017

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Incentive spirometry (IS) is commonly prescribed to reduce pulmonary complications, despite limited evidence to support its benefits and a lack of consensus on optimal protocols for its use. Although numerous studies and meta-analyses have examined the effects of IS on patient outcomes, there is no clear evidence establishing its benefit to prevent postoperative pulmonary complications. Clinical practice guidelines advise against the routine use of IS in postoperative care. Until evidence of benefit from well-designed clinical trials becomes available, the routine use of IS in postoperative care is not supported by high levels of evidence.

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Section: Systematic Reviewsmentioning

confidence: 99%

Clinical Effectiveness of Incentive Spirometry for the Prevention of Postoperative Pulmonary Complications

et al. 2017

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“…A 2017 singlecenter randomized controlled trial that compared IS to no IS found no difference in the development of postoperative hypoxemia and pulmonary complications after bariatric surgery. 17 A systematic review of PEP therapy administered after abdominal surgery identified only 4 randomized controlled trials, all published before 1993, conducted with PEP therapy in subjects who had abdom-inal surgery. 18 One study revealed positive differences; a higher P aO 2 on days 2 and 3, and a lower incidence of atelectasis at day 3.…”

Section: Discussionmentioning

confidence: 99%

A Randomized Controlled Trial Comparing Two Lung Expansion Therapies After Upper Abdominal Surgery

et al. 2019

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BACKGROUND: Lung expansion therapy is often ordered after surgery to improve alveolar ventilation and reduce risks of postoperative pulmonary complications. The impact of lung expansion therapy at altering ventilation in patients who are not intubated has not been described. The primary purpose of this study was to determine if there is a difference in dorsal redistribution of ventilation and incidences of postoperative pulmonary complications when comparing incentive spirometry (IS) with Ez-PAP lung expansion therapy after upper abdominal surgery. Our a priori null hypothesis was that there are no differences. METHODS: This randomized controlled trial enrolled adult human subjects after upper-abdominal surgery from January 2017 to November 2018. The subjects were allocated to receive IS or EzPAP 3 times a day on postoperative days 1-5. An electrical impedance tomography device was connected to the subjects for a single lung expansion therapy session on postoperative days 1, 3, and 5 to measure the change in post-lung expansion therapy dorsal end-expiratory lung impedance (⌬EELI%). Lung expansion therapy sessions with electrical impedance tomography included 2 min of normal breathing, 3 cycles of 10 breaths, and 2 min of normal breathing after cycle 3. Postoperative pulmonary complications were screened until hospital discharge. Mann-Whitney, chi-square, and Fisher exact tests were applied. Data were reported as count (n), percentage, and median (interquartile range) for primary and secondary outcomes. Alpha (2-tailed) was < 0.05. RESULTS: A total of 112 subjects were enrolled to receive IS (n ‫؍‬ 56) or EzPAP (n ‫؍‬ 56). Baseline characteristics were equal. Post-lung expansion therapy dorsal ⌬EELI% increased for both groups, but the dorsal ⌬EELI% for IS versus EzPAP on postoperative day 1 (16% versus 12%, P ‫؍‬ .39), postoperative day 3 (6% versus 6%, P ‫؍‬ .68), and postoperative day 5 (9% versus 6%, P ‫؍‬ .46) was not significantly different. Hospital length of stay (4 d; P ‫؍‬ .30) and incidence of postoperative pulmonary complications (3.6% versus 7.1%, P ‫؍‬ .19) were similar. CONCLUSIONS: There was no significant post-lung expansion therapy dorsal ⌬EELI% or postoperative pulmonary complications among the adults who received IS or EzPAP 3 times a day after upper abdominal surgery. (ClinicalTrials.gov registration NCT02892773.)Dräger provided an electrical impedance tomography device and electrode belts.

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“…In addition, incentive spirometers are easy to use and there is the possibility of using it independently after the previous training as well as a visual feedback that allows a patient to record obtained LIC indicators yourself. Howe ver, there is another opinion on the effectiveness of the IS, as Pantel H. et al (2017) [12] did not reveal any influence of the IS on the postoperative pulmonary complications development in patients after bariatric surgery, therefore its use is not recommended for this category of patients. Paulo do Nascimento Junior et al (2014) [13] reviewed the data from 12 studies published before August 2013 and concluded that there was low quality evidence regarding the lack of effectiveness of incentive spirometry for prevention of postoperative pulmonary complications in patients after upper abdominal surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Incentive spirometry (IS) is a lung expansion technique, which stimulates maximum inspiratory effort with the aim of the most complete filling of the alveoli with air providing a slow maximal inspiration. However, there are contradictory data on the use of IS effectiveness for PPCs prevention in patients after upper abdominal surgery [9][10][11][12][13][14][15].…”

Section: ключові словаmentioning

confidence: 99%

Incentive spirometry as a way to prevent pulmonary atelectasis development

Kuzmenko

Vorotyntsev

2019

ZMJ

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Цель работы-оценить эффективность побудительной спирометрии (ПС) как способа предупреждения развития ателектазов легких у пациентов с умеренным или высоким риском развития послеоперационных легочных осложнений (ПЛО) после оперативных вмешательств на верхнем этаже брюшной полости. Материалы и методы. Исследование состояло из двух этапов. Первый, ретроспективный этап, заключался в анализе данных историй болезни 51 стационарного больного (группа сравнения). Группу исследования составили 39 пациентов проспективной части исследования, которым в первые 7 дней послеоперационного периода проводили сеансы ПС. Пациенты обеих групп прооперированы открытым способом на органах верхнего этажа брюшной полости продолжительностью

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Effect of Incentive Spirometry on Postoperative Hypoxemia and Pulmonary Complications After Bariatric Surgery

Abstract: clinicaltrials.gov Identifier: NCT02431455.

Cited by 43 publications

References 26 publications

Clinical Effectiveness of Incentive Spirometry for the Prevention of Postoperative Pulmonary Complications

Clinical Effectiveness of Incentive Spirometry for the Prevention of Postoperative Pulmonary Complications

A Randomized Controlled Trial Comparing Two Lung Expansion Therapies After Upper Abdominal Surgery

Incentive spirometry as a way to prevent pulmonary atelectasis development

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