The evaluation of the incentive spirometer in the management of postoperative pulmonary complications

Craven, John; Evans, Gwyn A.; Davenport, Patrick; Williams, Rhonda

doi:10.1002/bjs.1800611012

Cited by 89 publications

(34 citation statements)

References 29 publications

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“…Probably, the mechanical consequences of this procedure may explain the augmented incidence of atelectasis (Craven et al 1974;Reines et al 1982) and gasexchange impairment (Huseby et al 1976;Connors et al 1980;McDonnell et al 1986) observed in some clinical studies that evaluated CPT. Thus, TP might be indicated in selected patients and an expansion maneuver could be used after or during the procedure to open up collapsed airspaces, normalizing gas exchange and respiratory mechanics.…”

Section: Discussionmentioning

confidence: 95%

Thoracic percussion yields reversible mechanical changes in healthy subjects

Guimarães

Zin

2008

Eur J Appl Physiol

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In order to characterize the mechanical effects of thoracic percussion per se in lung parenchyma, we analyzed respiratory impedance parameters by impulse oscillometry (12 healthy subjects) and lung mechanics by the least square method (6 healthy subjects) before (PRE-TP) and after (POS-TP) thoracic percussion, and after a deep-breath-maneuver (POS-DB). Pulmonary resistance was similar among PRE-TP, POS-TP and POS-DB while pulmonary dynamic compliance showed a significant reduction after TP (mean +/- SEM: from 0.15 +/- 0.018 L/cmH(2)O to 0.12 +/- 0.016 L/cmH(2)O; P = 0.001), returning to basal values (mean +/- SEM: 0.15 +/- 0.021; P = 0.004) after DB. Reactance parameters (AX and f (0)) evaluated by oscillometry increased significantly after TP, returning to previous values after DB. Total impedance (Z5) and respiratory system resistance at 5 Hz (R5) did not differ significantly among experimental conditions. Our data strongly suggest that thoracic percussion can promote changes in respiratory mechanics compatible with lung collapse and/or pneumoconstriction, which are, however, reversible by deep inspirations.

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Section: Discussionmentioning

confidence: 95%

Thoracic percussion yields reversible mechanical changes in healthy subjects

Guimarães

Zin

2008

Eur J Appl Physiol

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“…Analyzing only the studies [24][25][26][27][28][29][30][31][32][33][34][35][36] that evaluated the effect of IS in patients undergoing abdominal surgery, showed that this technique did not demonstrate to be beneficial in relation to other physical therapy interventions in the prevention of PPC. Some factors can be analyzed to justify these findings: first, the lack of consensus among physical therapists with regards to the gold standard intervention in the postoperative period, including the appropriate number of repetitions, duration of therapy and other postoperative treatments that may influence the results found.…”

Section: Discussionmentioning

confidence: 99%

“…In three of them 32,34,35 the authors showed that the use of IS reduced the incidence of PPC compared with other physical therapy interventions; six studies 13,[24][25][26]30,33 showed no between group differences in the incidence of PCC between IS and other intervention; and two studies 27,29 showed that IS failed to reduce the incidence of PPC when compared to exercises with positive pressure (CPAP or IPPB) (Table 3).…”

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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“…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%

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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The evaluation of the incentive spirometer in the management of postoperative pulmonary complications

Cited by 89 publications

References 29 publications

Thoracic percussion yields reversible mechanical changes in healthy subjects

Thoracic percussion yields reversible mechanical changes in healthy subjects

Incentive spirometry in major surgeries: a systematic review

The Scientific Basis for Postoperative Respiratory Care

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