Incentive Spirometry After Lung Resection: A Randomized Controlled Trial

Malík, Peter; Fahim, Christine; Vernon, Jordyn; Thomas, Priya; Schieman, Colin; Finley, Christian; Agzarian, John; Shargall, Yaron; Farrokhyar, Forough; Hanna, Waël C.

doi:10.1016/j.athoracsur.2018.03.051

Cited by 29 publications

(40 citation statements)

References 13 publications

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“…The literatures did not recommend to routinely use IS for prevention of postoperative collapse [14, 15, 17, 27–29]. The current study showed 65.5% of patients with lung cancers to use the IS undergoing surgical resection.…”

Section: Discussionmentioning

confidence: 58%

Is incentive spirometry beneficial for patients with lung cancer receiving video-assisted thoracic surgery?

et al. 2019

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Background The effectiveness of Incentive spirometry (IS) in patients undergoing video-assisted thoracic surgery (VATS) remains lacking. We conducted a population-based study to investigate the effectiveness of IS on patients with lung cancers following VATS. Methods We identified patients newly diagnosed with lung cancer who underwent surgical resection by VATS or thoracotomy from the years 2000 to 2008 in the Longitudinal Health Insurance Database. Exposure variable was the use of IS during admission for surgical resection by VATS or thoracotomy. Primary outcomes included hospitalization cost, incidence of pneumonia, and length of hospital stay. Secondary outcomes included the frequency of emergency department (ED) visits and hospitalizations at 3-month, 6-month, and 12-month follow-ups after thoracic surgery. Results We analyzed 7549 patients with lung cancer undergoing surgical resection by VATS and thoracotomy. The proportion of patients who were subjected to IS was significantly higher in those who underwent thoracotomy than in those who underwent VATS (68.4% vs. 53.1%, P < 0.0001). After we controlled for potential covariates, the IS group significantly reduced hospitalization costs (− 524.5 USD, 95% confidence interval [CI] = − 982.6 USD – -66.4 USD) and the risk of pneumonia (odds ratio = 0.55, 95% CI = 0.32–0.95) compared to the non-IS group following VATS. No difference in ED visit frequency and hospitalization frequency at 3-month, 6-month, and 1-year follow-up was noted between the IS and the non-IS groups following VATS. Conclusions The use of IS in patients with lung cancers undergoing VATS may reduce hospitalization cost and the risk of pneumonia.

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Section: Discussionmentioning

confidence: 58%

Is incentive spirometry beneficial for patients with lung cancer receiving video-assisted thoracic surgery?

et al. 2019

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“…They identified a need for more adequately powered studies with well-defined outcome measures to better evaluate the treatment benefit of IS in thoracic surgery patients. Since the publication of this review, there have been 4 further studies [13][14][15][16] with 8,166 subjects investigating the clinical effectiveness of IS in the postoperative management of thoracic surgery patients. Three were RCTs, and one was a population-based observational study ( T1,AQ:E Table 1).…”

Section: Is Devices and Theorymentioning

confidence: 99%

“…Malik et al 14 performed an RCT with 387 subjects undergoing lung resection in Canada between 2014 and 2017. They investigated whether any incremental benefit was conferred by the addition of IS to standard physiotherapy.…”

Section: Is Devices and Theorymentioning

confidence: 99%

“…However, several studies hint at a treatment benefit conferred by IS in high-risk patients, such as those with COPD. 14,16,21 Despite these generally neutral results, IS remains widely used, which suggests that thoracic surgical teams have some confidence in their ability to encourage patients to undertake breathing exercises. It is possible that trials struggle to demonstrate a benefit because subjects within these trials receive enhanced physiotherapy compared to what is normally available outside of a trial setting, perhaps due to the Hawthorne effect.…”

Section: Should We Persevere With Is In Postoperativementioning

confidence: 99%

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Incentive Spirometry for Prevention of Postoperative Pulmonary Complications After Thoracic Surgery

Ali

2020

Respir Care

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Incentive spirometry is frequently used after thoracic surgery as an adjunct to physiotherapy. Despite its widespread use, it has remained challenging to demonstrate a clinical benefit in terms of either incidence of postoperative pulmonary complications or hospital stay. In this literature review, we have observed that, although there is no study supporting clinical benefit in the thoracic surgical patient population generally, there is now emerging evidence of benefit in higherrisk patient populations such as those with COPD. There is an indication that incentive spirometry can lead to a reduction in the incidence of postoperative pulmonary complications in these patients. The problem with studies published to date is that there are many limitations, not least of which is the challenge of achieving patient adherence with performing incentive spirometry as prescribed. Despite the lack of evidence, there remains an appetite for persevering with incentive spirometry in the postoperative thoracic surgical patient because it is a relatively inexpensive intervention that motivates many patients to perform regular breathing exercises long after the therapist has moved on to the next patient.

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“…The IS is used for the prevention of atelectasis, hypoxemia, pneumonia, respiratory dysfunction, and pleural effusion [3,4]. However, IS utilization has remained the same since its initial development in the 1960s, and the usage protocol has not been standardized [5-8].…”

Section: Introductionmentioning

confidence: 99%

A Mobile Phone–Based Self-Monitoring Tool for Perioperative Gastric Cancer Patients With Incentive Spirometer: Randomized Controlled Trial

Soh

Lee

Yoon³

et al. 2019

JMIR Mhealth Uhealth

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Background An incentive spirometer (IS) is a medical device used to help patients improve the functioning of their lungs. It is provided to patients who have had any surgery that might jeopardize respiratory function. An incentive spirometer plays a key role in the prevention of postoperative complications, and the appropriate use of an IS is especially well known for the prevention of respiratory complications. However, IS utilization depends on the patient’s engagement, and information and communication technology (ICT) can help in this area. Objective This study aimed to determine the effect of mobile ICT on the usage of an IS (Go-breath) app by postoperative patients after general anesthesia. Methods For this study, we recruited patients from April to May 2018, who used the Go-breath app at a single tertiary hospital in South Korea. The patients were randomly classified into either a test or control group. The main function of the Go-breath app was to allow for self-reporting and frequency monitoring of IS use, deep breathing, and active coughing in real time. The Go-breath app was identical for both the test and control groups, except for the presence of the alarm function. The test group heard an alarm every 60 min from 9 am to 9 pm for 2 days. For the test group alone, a dashboard was established in the nurse’s station through which a nurse could rapidly assess the performance of multiple patients. To evaluate the number of performances per group, we constructed an incentive spirometer index (ISI). Results A total of 44 patients were recruited, and 42 of them completed the study protocol. ISI in the test group was 20.2 points higher than that in the control group (113.5 points in the test group and 93.2 points in the control group, P =.22). The system usability scale generally showed almost the same score in the 2 groups (79.3 points in the test group and 79.4 points in the control group, P =.94). We observed that the performance rates of IS count, active coughing, and deep breathing were also higher in the test group but with no statistically significant difference between the groups. For the usefulness “yes or no” question, over 90% (38/42) of patients answered “yes” and wanted more functional options and information. Conclusions The use of the Go-breath app resulted in considerable differences between the test group and control group but with no statistically significant differences. Trial Registration ClinicalTrials.gov NCT03569332; https://clinicaltrials.gov/ct2/show/NCT03569332 (Archived by WebCite at http://www.webcitation.org/74ihKmQIX).

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Incentive Spirometry After Lung Resection: A Randomized Controlled Trial

Abstract: The addition of IS to routine postoperative physiotherapy does not reduce the incidence of PPC after lung resection.

Cited by 29 publications

References 13 publications

Is incentive spirometry beneficial for patients with lung cancer receiving video-assisted thoracic surgery?

Is incentive spirometry beneficial for patients with lung cancer receiving video-assisted thoracic surgery?

Incentive Spirometry for Prevention of Postoperative Pulmonary Complications After Thoracic Surgery

A Mobile Phone–Based Self-Monitoring Tool for Perioperative Gastric Cancer Patients With Incentive Spirometer: Randomized Controlled Trial

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