Absence of benefit of incentive spirometry in low-risk patients undergoing elective cholecystectomy. A controlled randomized study. Can postoperative pulmonary conditions be improved by treatment with the Bartlett-Edwards incentive spirometer after upper abdominal surgery? The effectiveness of incentive spirometry with physical therapy for high-risk patients after coronary artery bypass surgery. Comparison of three methods of respiratory care following upper abdominal surgery. Incentive spirometry versus routine chest physiotherapy for prevention of pulmonary complications after abdominal surgery. An evaluation of the incentive spirometer to improve lung function after cholecystectomy. Prevention of postoperative pulmonary complications with CPAP, incentive spirometry, and conservative therapy. Are maximal inspiratory breathing exercises or incentive spirometry better than early mobilization after cardiopulmonary bypass? A controlled trial of intermittent positive pressure breathing, incentive spirometry, and deep breathing exercises in preventing pulmonary complications after abdominal surgery.
To determine the potential benefit of incentive spirometry, which has been advocated to prevent pulmonary complications after upper-abdominal surgery, we compared a group of patients receiving incentive spirometry to another group receiving no specialized postoperative respiratory care. Forty patients in the American Society of Anesthesiologists' class 1 and 2 who were undergoing cholecystectomy (through right subcostal incision) were included in the study and were randomly allocated to one of the two groups. Patients receiving incentive spirometry were encouraged by a specialized respiratory physiotherapist to breathe deeply for five minutes hourly, 12 times daily, for three postoperative days. No statistically significant difference between the two groups was found in the radiologic evidence of postoperative pulmonary complications, arterial oxygen pressure, spirometric measurement, and clinical evaluation at the second or fourth postoperative day (or both). In particular, deterioration on the chest x-ray film at the fourth postoperative day was observed in eight of 20 patients in the group receiving incentive spirometry and in six of 20 in the control group. Our study confirms the postoperative deterioration of respiratory function after upper-abdominal surgery and demonstrates the lack of therapeutic values of incentive spirometry in these patients at low risk for pulmonary complications. During the immediate postoperative course after upper abdominal surgery, pulmonary complications often occur, caused, inter alia, by reduced regional ventilation and by atelectases as a result of: (1) narrowing of the small peripheral bronchi, and (2) impaired respiratory function. Based on these pathophysiological mechanisms, an instrument (Bartlett-Edwards Incentive Spirometer) has been devised, which aims at giving the patient an opportunity of sustained maximal inspiration under standardized and controlled conditions. The use of this instrument has been followed by reports of a considerable reduction in postoperative pulmonary complications. In a controlled clinical investigation of the pre- and postoperative condition of the lungs, we were unable to show any beneficial effect of the instrument. In general, we have a low frequency of severe postoperative pulmonary complications, as compared with the results reported in the literature. We ascribe this to our very effective pre- and postoperative respiratory therapy. The purpose of this study was to determine whether the addition of incentive spirometry (IS) to postoperative pulmonary physical therapy is more effective than physical therapy alone in reducing postoperative pulmonary complications in high-risk patients after coronary artery bypass grafting (CABG). Patients were given the spirometer and instructed in its use, as often occurs in clinical settings.
                Patients with chronic airflow limitation following CABG (N = 185) participated.
                Subjects were randomly assigned to receive either postoperative pulmonary physical therapy (breathing exercises, secretion removal, mobility) or physical therapy combined with IS.
                No difference was found between the two groups in atelectasis, spirometry, oxygen saturation, pulmonary infection, or hospital stay.
                Incentive spirometry combined with physical therapy is no more effective than postoperative physical therapy alone in reducing atelectasis for this population. Use of the spirometer, however, was not monitored, and although the study mimicked practice as it often occurs, the effectiveness of the spirometer cannot be fully evaluated. Incentive spirometry, as a method for preventing postoperative atelectasis, was compared with intermittent positive-pressure breathing (IPPB) and resistance breathing in 126 patients undergoing upper-abdominal surgery, most of whom had cholecystectomy. There was no statistically significant difference in the incidence of atelectasis among the three groups, who were matched for age, sex, smoking history, previous respiratory disease, and duration of surgery. There was a significantly higher incidence of atelectasis in patients over the age of 50 years (P = 0.004) than in younger subjects, where the incidence was not different among the three groups. Incentive spirometric therapy, as used in this study, offered no advantage over the other methods of treatment. We entered 876 patients into a clinical trial aimed at preventing pulmonary complications after abdominal surgery. Patients either received conventional chest physiotherapy or were encouraged to perform maximal inspiratory manoeuvres for 5 min during each hour while awake, using an incentive spirometer. The incidence of pulmonary complications did not differ significantly between the groups: incentive spirometry 68 of 431 (15.8%, 95% CI 14.0-17.6%), and chest physiotherapy 68 of 445 (15.3%, CI 13.6-17.0%). Nor was there a difference between the groups in the incidence of positive clinical signs, pyrexia, abnormal chest radiographs, pathogens in sputum, respiratory failure (PO2 less than 60 mm Hg), or length of stay in hospital. We conclude that prophylactic incentive spirometry and chest physiotherapy are of equivalent clinical efficacy in the general management of patients undergoing abdominal surgery. Forty patients who underwent elective cholecystectomy were allocated randomly to one of two groups. Patients in one group used an incentive spirometer as part of their postoperative chest physiotherapy; those in the other received routine postoperative physiotherapy as dictated by their needs. Each group contained equal numbers of smokers and nonsmokers, and the data from each group were analysed separately. The use of the incentive spirometer did not confer any benefits as judged by clinical evidence of pulmonary complications, pulmonary function tests or length of hospital stay. Continuous positive airway pressure (CPAP) administered at intervals with a mask and incentive spirometry (IS) were compared with a regimen of coughing and deep breathing (CDB) to determine which promoted the most rapid recovery of pulmonary function after upper abdominal operations in 65 adults. Postoperatively, FRC of patients in all groups was similar relative to preoperative values. However, mean FRC of patients who received CPAP increased more rapidly than did mean FRC of those receiving CDB when compared to the values obtained following operation (p less than 0.05). Incentive spirometry did not increase FRC to a greater extent than did CDB. Roentgenographic evidence of atelectasis 72 hours postoperatively was observed in 23 percent of CPAP patients (five of 22) and 42 percent and 41 percent of patients who received CDB (eight of 19) and IS (nine of 22). Two patients (3 percent) developed pneumonia. The low incidence of pneumonia regardless of the type of therapy may be attributable to vigorous, vigilant respiratory care in a population at high risk for developing pneumonia. Frequency and supervision of respiratory therapy may be more important than the type of therapy delivered after upper abdominal operations. Mask CPAP offers advantages because it requires no effort from the patient, and therapy is not painful. Forty-nine adults who had undergone cardiopulmonary bypass surgery were randomly assigned to one of three exercise programs to determine if either maximal inspiratory breathing exercises or incentive spirometry offered a therapeutic advantage over early mobilization alone. After extubation, the patients started their assigned exercise programs. A physical examination and pulmonary function tests were performed preoperatively, at the start of the exercise program, and 24 and 48 hours after the start of the program. The results showed a significant decrease (approximately 50%) in lung volumes but no airflow obstruction in patients who had coronary artery bypass graft. In those patients who had valve replacement, lung volumes fell, and in addition, mild airflow obstruction occurred. A majority of patients had postoperative pulmonary complications. There were no significant differences among the exercise programs in improving lung volumes and airflow or in preventing postoperative complications. We conclude that maximal inspiratory breathing exercises or incentive spirometry, when used in addition to early mobilization, offers no therapeutic advantage over early mobilization alone after cardiopulmonary bypass surgery. Controversy exists regarding the routine use of aids to lung expansion in the prevention of pulmonary complications after abdominal surgery. We prospectively randomized 172 patients into 1 of 4 groups: the control group (44 patients) received no respiratory treatment, the IPPB group (45 patients) received intermittent positive pressure breathing therapy for 15 min 4 times daily, the IS group (42 patients) was treated with incentive spirometry 4 times daily, and the DBE group (41 patients) carried out deep breathing exercises under supervision for 15 min 4 times daily. Roentgenographic changes, observed 24 h after surgery, were comparable in the 4 groups (20.5 to 36.6%). Pulmonary complications were defined as the development of 3 or more of 6 new findings: cough, phlegm, dyspnea, chest pain, temperature greater than 38 degrees C, pulse rate more than 100 beats/min. The frequency of development of pulmonary complications was 48% in the control group, 22% in the IPPB group (p less than 0.05), 21% in the IS group (p less than 0.05), and 22% in the DBE group (p less than 0.05). Side effects of respiratory treatment were observed only in the IPPB group (18%; p less than 0.05). Hospital stay in patients undergoing upper abdominal surgery was significantly shorter in the IS group (mean +/- SD, 8.6 +/- 3 days) than in the control group (13 +/- 5 days). This difference was not observed for the other 2 treatment groups.(ABSTRACT TRUNCATED AT 250 WORDS)
We found no evidence regarding the effectiveness of the use of incentive spirometry for prevention of postoperative pulmonary complications in upper abdominal surgery. This review underlines the urgent need to conduct well-designed trials in this field. There is a case for large randomized trials of high methodological rigour in order to define any benefit from the use of incentive spirometry regarding mortality.