title: Outcomes of patients with acute respiratory failure after abdominal surgery treated with noninvasive positive pressure ventilation. Functional independence after major abdominal surgery in the elderly. Three physiotherapy protocols: effects on pulmonary volumes after cardiac surgery. Prediction of Postoperative Pulmonary Complications in a Population-based Surgical Cohort Deep‐Breathing Exercises Reduce Atelectasis And Improve Pulmonary Function After Coronary Artery Bypass Surgery. The effect of incentive spirometry and inspiratory muscle training on pulmonary function after lung resection. Are maximal inspiratory breathing exercises or incentive spirometry better than early mobilization after cardiopulmonary bypass? Effects of periodic positive airway pressure by mask on postoperative pulmonary function. Physiotherapy after coronary artery surgery: are breathing exercises necessary? The effectiveness of incentive spirometry with physical therapy for high-risk patients after coronary artery bypass surgery. [Ineffectiveness of incentive spirometry as coadjuvant of conventional physiotherapy for the prevention of postoperative respiratory complications after thoracic and esophageal surgery]. Preoperative use of incentive spirometry does not affect postoperative lung function in bariatric surgery. Effects of conventional physiotherapy, continuous positive airway pressure and non‐invasive ventilatory support with bilevel positive airway pressure after coronary artery bypass grafting Reliability of the PEDro scale for rating quality of randomized controlled trials. Absence of benefit of incentive spirometry in low-risk patients undergoing elective cholecystectomy. A controlled randomized study. Incentive spirometry does not enhance recovery after thoracic surgery A controlled trial of intermittent positive pressure breathing, incentive spirometry, and deep breathing exercises in preventing pulmonary complications after abdominal surgery. Incentive spirometry versus routine chest physiotherapy for prevention of pulmonary complications after abdominal surgery Comparison of incentive spirometry and intermittent positive pressure breathing after coronary artery bypass graft. Comparison of continuous positive airway pressure, incentive spirometry, and conservative therapy after cardiac operations A comparative study of IPPB, the incentive spirometer, and blow bottles: the prevention of atelectasis following cardiac surgery. Incentive spirometry with expiratory positive airway pressure reduces pulmonary complications, improves pulmonary function and 6-minute walk distance in patients undergoing coronary artery bypass graft surgery. Risk factors for pulmonary complications after emergency abdominal surgery. Influence of incentive spirometry on pulmonary volumes after laparotomy. Effect of Preoperative and Postoperative Incentive Spirometry on Lung Functions After Laparoscopic Cholecystectomy An evaluation of the incentive spirometer to improve lung function after cholecystectomy Prevention of respiratory complications after abdominal surgery: a randomised clinical trial
abstract: OBJECTIVES Little is known about the physiologic and clinical effects of noninvasive positive pressure ventilation ( NPPV ) in patients who have acute respiratory failure ( ARF ) after abdominal surgery . We evaluated our clinical experience with the use of NPPV in the treatment of ARF after abdominal surgery . METHODS We prospect ively evaluated NPPV use during a 2-year period in a medical-surgical ICU of a university hospital . We documented demographic and diagnostic data , gas exchange , and clinical outcomes . We compared patients who were not intubated to those who were intubated after a trial of NPPV . RESULTS Of 72 patients with ARF after abdominal surgery who were treated with NPPV , 48 patients avoided intubation ( 67 % ) . Patients in the intubated and nonintubated groups had similar demographic characteristics , and similar American Society of Anesthesiologists physical status and simplified acute physiology score II scores at admission . The intubated group had a significantly lower Pa(O2)/fraction of inspired oxygen ( Fi(O2 ) ) ratio ( 123 + /- 62 mm Hg vs 194 + /- 76 mm Hg , p < 0.01 ) and more extended bilateral alveolar infiltrates ( 67 % vs 31 % , p < 0.01 ) than the non-intubated group . Within the first NPPV observation period , the Pa(O2)/Fi(O2 ) increased ( + 36 + /- 29 % [ + /- SD ] , p = 0.04 ) and the respiratory rate decreased ( 28.2 + /- 3.4 breaths/min vs 23.1 + /- 3.8 breaths/min , p < 0.01 ) significantly only in the non-intubated group . The non-intubated group had significantly lower length of ICU stay ( 17.3 + /- 10.9 days vs 34.1 + /- 28.5 days , p < 0.01 ) and mortality rate ( 6 % vs 29 % , p < 0.01 ) . CONCLUSION NPPV may be an alternative to conventional ventilation in selected patients with ARF after abdominal surgery who require ventilatory support BACKGROUND Elders undergo approximately 40 % of more than 1 million major abdominal operations annually . Yet evidence about recovery to preoperative levels of functional independence is limited . This study details course and predictors of functional recovery after  elective major abdominal operations in the elderly . STUDY DESIGN This was a prospect i ve cohort of 372 consecutive patients , 60 years old or more , enrolled from surgeons in private practice and two university-affiliated hospitals , assessed preoperatively and postoperatively at 1 , 3 , and 6 weeks , 3 and 6 months , using self-report and performance-based measures ( Activities of Daily Living [ ADL ] , Instrumental Activities of Daily Living [ IADL ] , Medical Outcomes Study Short Form-36 Physical Component and Mental Component Scales [ PCS , MCS ] , Geriatric Depression Scale [ GDS ] , Folstein Mini-Mental State Exam [ MMSE ] , timed walk , functional reach , h and grip strength ) . RESULTS Mean age was 69 + /- 6 years with 56 % men , 47 % nonHispanic Caucasian , and 42 % Mexican American ; hospital distribution was 49 % private , 51 % university-affiliated . Maximum functional declines ( 95 % CI ) occurred 1 week postoperatively : ADL , 2.8 points ( 2.4 to 3.2 ) ; IADL , 7.6 points ( 7 to 8.3 ) ; SF-36 PCS , 6.5 points ( 5.4 to 7.6 ) ; Mini-Mental State Exam , 0.5 points ( 0.2 to 0.7 ) ; timed walk , 6.8 seconds ( 5.2 to 8.4 ) ; functional reach , 1.7 inches ( 1.2 to 2.2 ) ; grip strength , 2 kilograms ( 1.3 to 2.7 ) ( p < 0.001 for all ) . SF-36 mental component scale and Geriatric Depression Scale scores did not worsen . Mean recovery times were : Mini-Mental State Exam , 3 weeks ; timed walk , 6 weeks ; ADL , SF-36 PCS , and functional reach , 3 months ; and IADL , 6 months . Mean grip strength did not return to preoperative status by 6 months . The incidence of persistent disability at 6 months , compared with preoperative status , was : ADL , 9 % ; IADL , 19 % ; PCS , 16 % ; mental component scale , 17 % ; timed walk , 39 % ; functional reach , 58 % ; and grip strength , 52 % . Potentially modifiable independent predictors of ADL and IADL recovery were preoperative physical conditioning and depression plus serious postoperative complications . CONCLUSIONS The clinical course of functional recovery varied across different measures . Protracted disability at 6 months after operation was substantial . Several potentially modifiable factors consistently predicted recovery OBJECTIVE To evaluate inspiratory volume in patients undergoing cardiac surgery and to determine the effects that incentive spirometry ( IS ) and the breath stacking ( BS ) technique have on the recovery of FVC in such patients . METHODS A prospect i ve , controlled , r and omized clinical trial involving 35 patients undergoing cardiac surgery at the Hospital de Força Aérea do Galeão ( HFAG , Galeão Air Force Hospital ) , in the city of Rio de Janeiro , Brazil . The patients , all of whom performed mobilization and cough procedures , were r and omly divided into three groups : exercise control ( EC ) , performing only the abovementioned procedures ; IS , performing the abovementioned procedures and instructed to take long breaths using an incentive spirometer ; and BS , performing the abovementioned procedures , together with successive inspiratory efforts using a facial mask coupled to a unidirectional valve . Forced spirometry was carried out in the preoperative period and on postoperative days 1 to 5 . During the maneuvers , inspiratory volume was measured in the IS and BS groups . RESULTS On postoperative day 1 , FVC significantly decreased in all groups ( EC : 87.1 vs. 32.0 % ; IS : 75.3 vs. 29.5 % ; and BS : 81.9 vs. 33.2 % ; p < 0.001 for all ) , as did inspiratory volume in the IS and BS groups ( 2.29 vs. 0.82 L ; and 2.56 vs. 1.34 L , respectively ; p < 0.001 for both ) . Between postoperative days 1 and 5 , FVC partially normalized in all groups ( EC : 32.0 vs. 51.3 % ; IS : 29.5 vs. 46.7 % ; and BS : 33.3 vs. 54.3 % ; p < 0.001 for all ) . During the postoperative period , inspiratory volume was significantly higher in the BS group than in the IS group . CONCLUSIONS The three protocol s were equivalent concerning the recovery of FVC on the first five postoperative days . When compared with IS , the BS technique promoted higher inspiratory volumes in this sample of postoperative cardiac patients Background : Current knowledge of the risk for  postoperative pulmonary complications ( PPCs  ) rests on studies that narrowly selected patients and procedures . Hypothesizing that PPC occurrence could be predicted from a reduced set of perioperative variables , we aim ed to develop a predictive index for a broad surgical population . Methods : Patients undergoing surgical procedures given general , neuraxial , or regional anesthesia in 59 hospitals were r and omly selected for this prospect i ve , multicenter study . The main outcome was the development of at least one of the following : respiratory infection , respiratory failure , bronchospasm , atelectasis , pleural effusion , pneumothorax , or aspiration pneumonitis . The cohort was r and omly divided into a development sub sample to construct a logistic regression model and a validation sub sample . A PPC predictive index was constructed . Results : Of 2,464 patients studied , 252 events were observed in 123 ( 5 % ) . Thirty-day mortality was higher in patients with a PPC ( 19.5 % ; 95 % [ CI ] , 12.5–26.5 % ) than in those without a PPC ( 0.5 % ; 95 % CI , 0.2–0.8 % ) . Regression modeling identified seven independent risk factors : low preoperative arterial oxygen saturation , acute respiratory infection during the previous month , age , preoperative anemia , upper abdominal or intrathoracic surgery , surgical duration of at least 2 h , and emergency surgery . The area under the receiver operating characteristic curve was 90 % ( 95 % CI , 85–94 % ) for the development sub sample and 88 % ( 95 % CI , 84–93 % ) for the validation sub sample . Conclusion : The risk index based on seven objective , easily assessed factors has excellent discriminative ability . The index can be used to assess individual risk of PPC and focus further research on measures to improve patient care STUDY OBJECTIVES To investigate the effects of deep-breathing exercises on pulmonary function , atelectasis , and arterial blood gas levels after coronary artery bypass graft ( CABG ) surgery . DESIGN , SETTING , AND PATIENTS In a prospect i ve , r and omized trial , patients performing deep-breathing exercises ( n = 48 ) were compared to a control group ( n = 42 ) who performed no breathing exercises postoperatively .  Patient management was similar in the groups in terms of assessment , positioning , and mobility . INTERVENTIONS The patients in the deep-breathing group were instructed to perform breathing exercises hourly during daytime for the first 4 postoperative days . The exercises consisted of 30 slow , deep breaths performed with a positive expiratory pressure blow-bottle device ( + 10 cm H(2)O ) . MEASUREMENTS AND RESULTS Spirometric measurements , spiral CT ( three transverse levels ) , arterial blood gas analysis , and scoring of subjective experience of the breathing exercises were performed on the fourth postoperative day . Atelectasis was only half the size in the deep-breathing group compared to the control group , amounting to 2.6 + /- 2.2 % vs 4.7 + /- 5.7 % ( p = 0.045 ) at the basal level and 0.1 + /- 0.2 % vs 0.3 + /- 0.5 % ( mean + /- SD ) [ p = 0.01 ] at the apical level . Compared to the control subjects , the patients in the deep-breathing group had a significantly smaller reduction in FVC ( to 71 + /- 12 % , vs 64 + /- 13 % of the preoperative values ; p = 0.01 ) and FEV(1 ) ( to 71 + /- 11 % , vs 65 + /- 13 % of the preoperative values ; p = 0.01 ) . Arterial oxygen tension , carbon dioxide tension , fever , or length of ICU or hospital stay did not differ between the groups . In the deep-breathing group , 72 % of the patients experienced a subjective benefit from the exercises . CONCLUSIONS Patients performing deep-breathing exercises after CABG surgery had significantly smaller atelectatic areas and better pulmonary function on the fourth postoperative day compared to a control group performing no exercises BACKGROUND A predicted postoperative forced expiratory volume in 1 second ( FEV1 ) of less than 800 ml or 40 % of predicted is a common criterion for exclusion of patients from lung resection for cancer . Usually , the predicted postoperative lung function is calculated according to a formula based on the number of lung segments that will be resected . Incentive spirometry and specific inspiratory muscle training are two maneuvers that have been used to enhance lung expansion and inspiratory muscle strength in patients with chronic obstructive pulmonary disease and after lung operation . METHODS Thirty-two patients with chronic obstructive pulmonary disease who were c and i date s for lung resection were r and omized into two groups : 17 patients received specific inspiratory muscle training and incentive spirometry , 1 hour per day , six times a week , for 2 weeks before and 3 months after lung resection ( group A ) and 15 patients were assigned to the control group and received no training ( group B ) . RESULTS Inspiratory muscle strength increased significantly in the training group , both before and 3 months after the operation . In group B , the predicted postoperative FEV1 value consistently underestimated the actual postoperative FEV1 by approximately 70 ml in the lobectomy subgroup and by 110 ml in the pneumonectomy subgroup . In group A , the actual postoperative FEV1 was higher than the predicted postoperative FEV1 by 570 ml in the lobectomy subgroup and by 680 ml in the pneumonectomy subgroup of patients . CONCLUSIONS In patients undergoing lung resection the simple calculation of predicted postoperative FEV1 underestimates the actual postoperative FEV1 by a small fraction . Lung functions can be increased significantly when incentive spirometry and specific inspiratory muscle training are used before and after operation Forty-nine adults who had undergone cardiopulmonary bypass surgery were r and omly 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 Postoperative pulmonary complications , alveolar-arteriolar oxygen difference ( [A-a]O2-diff ) , peak expiratory flow ( PEF ) and forced vital capacity ( FVC ) were compared in patients using continuous positive airway pressure ( CPAP ) and positive expiratory pressure ( PEP ) administered  by face mask  against those of a control  group using  a deep-breathing device ( Triflo ) .  Forty-three consecutive , r and omized patients undergoing elective upper abdominal surgery were included .  CPAP , PEP and Triflo were administered for 30 consecutive breaths in every waking hour for three days postoperatively . The (A-a)O2-difference increased equally and significantly in the three groups after surgery , reaching a maximum on the first postoperative day . After this day , however , (A-a)O2-diff decreased in the CPAP and PEP groups , being significantly lower in the PEP group compared to the control group , two days postoperatively ( p less than 0.05 ) and significantly lower in both the PEP and CPAP groups three days postoperatively ( p less than 0.001 and p less than 0.05 , respectively . ) PEF did not differ significantly between the groups before or after surgery , while FVC was significantly higher in the PEP and CPAP groups , compared to control , on the third postoperative day ( p less than 0.05 ) . Atelectatic consolidation was observed in six of 15 patients in the control group three days postoperatively , the incidence being significantly lower in both the PEP group ( 0 of 15 , p less than 0.001 ) and the CPAP group ( one of 13 , p less than 0.05 ) . We concluded that periodic face mask administration of CPAP and PEP are superior to deep breathing exercises with respect to gas exchange , preservation of lung volumes and development of atelectasis after upper abdominal surgery . We also conclude that the simple and commercially available PEP mask is as effective as the more complicated CPAP system One hundred and ten men undergoing coronary artery bypass grafting took part in a prospect i ve r and omised study comparing three physiotherapy protocol s. All patients were taught self supported huffing and coughing by a physiotherapist and encouraged to move about . This comprised the sole treatment for the 37 control patients ( group 3 ) . Additional physiotherapy included breathing exercises for the 35 patients in group 1 and use of an incentive spirometer for the 38 patients in group 2 . Functional residual capacity ( FRC ) was measured daily at the bedside until the fifth postoperative day and arterial blood gas tensions were measured on the second and fourth postoperative days . After surgery patients developed a severe restrictive ventilatory defect and profound arterial hypoxaemia . There were no differences between the three groups . Mean FRC on day 2 was 1.90 litres ( 61 % of the preoperative value ) , increasing to 2.32 1 by day 5 ( 76 % of the preoperative value ) . The mean arterial oxygen tension was 7.37 kPa on day 2 and 8.58 kPa on day 4 . Four patients in group 1 , two in group 2 , and five in group 3 developed a chest infection . It is concluded that the addition of breathing exercises or incentive spirometry to a regimen of early mobilisation and huffing and coughing confers no extra benefit after uncomplicated coronary artery bypass grafting BACKGROUND AND PURPOSE 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 setting s. SUBJECTS Patients with chronic airflow limitation following CABG ( N = 185 ) participated . METHODS Subjects were r and omly assigned to receive either postoperative pulmonary physical therapy ( breathing exercises , secretion removal , mobility ) or physical therapy combined with IS . RESULTS No difference was found between the two groups in atelectasis , spirometry , oxygen saturation , pulmonary infection , or hospital stay . CONCLUSION AND DISCUSSION 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 can not be fully evaluated We have studied the efficacy of routine use of incentive spirometry ( IS ) in two groups of patients : group 1 ( n = 18 ) with IS , and group 2 ( n = 19 ) , no IS . All patients suffered from lung or esophagus neoplasm and received respiratory physiotherapy before and after the operation . They underwent high chest and abdomen surgery .  The incidence of alterations of pulmonary auscultation , roentgenologic abnormalities and alterations of the alveolar-arterial difference of oxygen ( D[A-a]O2 ) as well as postoperative complications were similar in both groups . Patients undergoing digestive surgery  presented a higher frequency of pleural effusion ( p less than 0.05 ) and of them , the subgroup with IS stayed at the hospital for a longer time ( 47.2 + /- 32 days ) than the subgroup undergoing digestive surgery not su bmi tted to IS ( p less than 0.01 ) probably because of the higher incidence of neoplasms of the mean third of the esophagus in such group . In our study and in the context of the type of surgery studied , the routine use of IS does not decrease the frequency of clinical and roentgenologic alterations neither improves the efficacy of postoperative gas interchange Morbidly obese patients undergoing general anesthesia for laparoscopic bariatric surgery are considered at increased risk of a postoperative decrease in lung function . The purpose of this study was to determine whether a systematic use of incentive spirometry ( IS ) prior to surgery could help patients to preserve their respiratory function better in the postoperative period . Forty-one morbidly obese ( body mass index [ BMI ] > 40 kg/m² ) c and i date s for laparoscopic bariatric surgery were consented in the study . All patients were taught how to use an incentive spirometer but then were r and omized blindly into 2 groups . The control group was instructed to use the incentive spirometer for 3 breaths , once per day . The treatment group was requested to use the incentive spirometer for 10 breaths , 5 times per day . Twenty experimental ( mean BMI of 48.9 ± 5.67 kg/m² ) and 21 control patients ( mean BMI of 48.3 ± 6.96 kg/m² ) were studied . The initial mean inspiratory capacity ( IC ) was 2155 ± 650.08 ( SD ) cc and 2171 ± 762.98 cc in the experimental and control groups , respectively . On the day of surgery , the mean IC was 2275 ± 777.56 cc versus 2254.76 ± 808.84 cc , respectively . On postoperative day 1 , both groups experienced a significant drop of their IC , with volumes of 1458 ± 613.87 cc ( t test P < 0.001 ) and 1557.89 ± 814.67 cc ( t test P < 0.010 ) , respectively . Our results suggest that preoperative use of the IS does not lead to significant improvements of inspiratory capacity and that it is a not a useful re source to prevent postoperative decrease in lung function Background : Coronary artery bypass graft ( CABG ) surgery with the use of mammary arteries is associated with severe alteration of lung function parameters . The purpose of the present study was to compare the effect on lung function tests of conventional physiotherapy using incentive spirometry ( IS ) with non‐invasive ventilation on continuous positive airway pressure ( CPAP ) and with non‐invasive ventilation on bilevel positive airway pressure ( BiPAP or NIV‐2P ) BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . 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 r and omly 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 Objective : To investigate the additional effect of incentive spirometry to chest physiotherapy to prevent postoperative pulmonary complications after thoracic surgery for lung and esophageal resections . Design : R and omized controlled trial . Setting : University hospital , intensive care unit , and surgical department . Patients : Sixty‐seven patients ( age , 59 ± 13 yrs ; forced expiratory volume in 1 sec , 93 % ± 22 % predicted ) undergoing elective thoracic surgery for lung ( n = 40 ) or esophagus ( n = 27 ) resection . Interventions : Physiotherapy ( breathing exercises , huffing , and coughing ) ( PT ) plus incentive spirometry ( IS ) was compared with PT alone . Measurements and Main Results : Lung function , body temperature , chest radiograph , white blood cell count , and number of hospital and intensive care unit days were all measured . Pulmonary function was significantly reduced after surgery ( 55 % of the initial value ) and improved significantly in the postoperative period in both groups . However , no differences were observed in the recovery of pulmonary function between the groups . The overall score of the chest radiograph , based on the presence of atelectasis , was similar in both treatment groups . Eight patients ( 12 % ) ( three patients with lobectomy and five with esophagus resection ) developed a pulmonary complication ( abnormal chest radiograph , elevated body temperature and white blood cell count ) , four in each treatment group . Adding IS to regular PT did not reduce hospital or intensive care unit stay . Conclusions : Pulmonary complications after lung and esophagus surgery were relatively low . The addition of IS to PT did not further reduce pulmonary complications or hospital stay . Although we can not rule out beneficial effects in a subgroup of high‐risk patients , routine use of IS after thoracic surgery seems to be ineffective Controversy exists regarding the routine use of aids to lung expansion in the prevention of pulmonary complications after abdominal surgery . We prospect ively r and omized 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 entered 876 patients into a clinical trial aim ed 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 Fifty-two patients were r and omized to receive either incentive spirometry ( IS ) or intermittent positive pressure breathing ( IPPB ) in addition to conventional chest physical therapy following coronary artery bypass grafting .  Slow vital capacity and peak expiratory flow readings decreased rapidly and to an equal extent in both groups after surgery , and partly recovered by the sixth postoperative day ( POP ) . Arterial PO2 values were similar for the groups on the first three POPs . On the POPs 2 , 3 , and 6 , the number of chest films showing atelectases as well as the number of individual patients having atelectases revealed no statistically significant differences between the two groups . Based on the three variables studied , we consider both devices equal in efficiency after coronary surgery Of 38 patients undergoing median sternotomy for cardiac operations all developed profound restrictive defects in pulmonary function during the first 72 h after tracheal extubation . Although decreased lung volumes were refractory to correction by vigorous , aggressive pulmonary therapy during this period , frequent and supervised treatment may prevent further deterioration in pulmonary function . The overall incidence of pneumonia was only 3 % ( 1/38 ) . Continuous positive airway pressure delivered by mask proved to be a nearly effortless form of postoperative respiratory therapy that was less painful than incentive spirometry or coughing and deep breathing , and therefore may be preferable Following cardiac operations , 145 patients were treated with either intermittent positive-pressure breathing ( IPPB ) , blod bottles , or an incentive spirometer in an attempt to alter the incidence of atelectasis . Pulmonary complications occurred in 30 % of the patients receiving IPPB , 15 % of those using an incentive spirometer , and 8 % of those using blow bottles .  Gastrointestinal side-effects occurred in 20 % of the IPPB group and were rare in other groups . The cost of IPPB is also considerably greater than either incentive spirometry or blow bottles . IPPB is not essential to prevention of atelectasis in postoperative cardiac surgical patients and may be inferior to other methods BACKGROUND The use of the incentive spirometry ( IS ) with expiratory positive airway pressure ( EPAP ) to prevent postoperative pulmonary complications ( PPC ) after coronary artery bypass graft ( CABG ) is not well established . This study sought to determine the effects of IS+EPAP after CABG . METHODS Thirty-four patients undergoing CABG were r and omly assigned to a control group or IS+EPAP group . Maximal respiratory pressures , pulmonary function test , 6-minute walk test and chest x-ray were performed at baseline as well as 1 week and 1 month after CABG . RESULTS Maximal inspiratory pressure was significantly higher in the IS+EPAP group compared to controls at both 1 week and 1 month ( P<.001 ) . Maximal expiratory pressure was significantly higher at 1 month compared to 1 week in IS+EPAP group ( P<.01 ) . At 1 month , forced vital capacity and forced expiratory volume in 1 second was significantly higher in IS+EPAP compared to controls ( P<.05 ) . Inspiratory capacity was higher at 1 month in IS+EPAP group compared to controls ( P<.05 ) . The distance walked in 6-minute walk test was higher at 1 month in IS+EPAP group ( P<.001 ) compared to controls . Lastly , radiological injury score at 1 week was lower in IS+EPAP compared to controls ( P<.004 ) . CONCLUSIONS In patients undergoing CABG , IS+EPAP results in improved pulmonary function and 6-minute walk distance as well as a reduction in PPC OBJECTIVE Pulmonary complications are common after abdominal surgery .  Although a variety of risk factors have been described for these complications , studies so far have focused on elective interventions . The aim of this study was to determine the incidence and predictors of pulmonary complications following  emergency abdominal surgery .  METHODS This was a prospect i ve cohort study . Pre and intra-operative data were collected through interview and chart review and their association with the occurrence of postoperative pulmonary complications ( PPC ) were analyzed . RESULTS Two hundred and sixty-six consecutive adult patients were included and seventy-five ( 28.2 % ) developed PPC . Age > 50 years ( adjusted OR=3.86 ; P<0.001 ) , body mass index ( BMI ) < 21 kg/m(2 ) or 30 kg/m(2 ) ( adjusted OR=2.43 ; P=0.007 ) and upper or upper/lower abdominal incision ( adjusted OR=2.57 ; P=0.027 ) were independently associated with PPC . Patients su bmi tted to multiple procedures tended to be at a higher risk for PPC ( adjusted OR=1.73 ; P=0.079 ) . The development of PPC was associated with prolonged hospital stay ( P<0.001 ) and increased death rate ( P<0.001 ) . CONCLUSIONS Pulmonary complications are frequent among patients undergoing abdominal emergency surgery  and lead to increased length of hospital stay and death rate . Older age , abnormal BMI , upper or upper/lower abdominal incision and multiple procedures are predictors of PPC in this setting Twenty patients undergoing an upper abdominal procedure were r and omly assigned in two groups . One group was treated with both chest physical therapy and incentive spirometry and the other was treated with chest physical therapy alone .  Spirometric values , respiratory rate , tidal volume and vital capacity were determined during the postoperative course . We observed that patients treated with incentive spirometry bad a faster return to preoperative pulmonary volumes . This observation confirms the prophylactic role of incentive spirometry in the prevention of pulmonary complications after laparotomy This study was design ed to compare the effects of preoperative and postoperative incentive spirometry on lung functions after laparoscopic cholecystectomy in 50 otherwise normal healthy adults . Patients were r and omized into a control group ( group PO , n=25 ) and a study group ( group PR , n=25 ) . Patients in group PR were instructed to carry out incentive spirometry before the surgery 15 times , every fourth hourly , for 1 week whereas in group PO , incentive spirometry was carried out during the postoperative period . Lung functions were recorded at the time of preanesthetic evaluation , on the day before the surgery , postoperatively at 6 , 24 , and 48 hours , and at discharge . Significant improvement in the lung functions was seen after preoperative incentive spirometry ( group PR ) , P<0.05 . The lung functions were significantly reduced till the time of discharge in both the groups . However , lung functions were better preserved in group PR at all times when compared with group PO ; P<0.05 . To conclude , lung functions are better preserved with preoperative than postoperative incentive spirometry Forty patients who underwent elective cholecystectomy were allocated r and omly 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 Abstract Objective : To evaluate the prevention of respiratory complications after abdominal surgery by a comparison of a global policy of incentive spirometry with a regimen consisting of deep breathing exercises for low risk patients and incentive spirometry plus physiotherapy  for high risk patients . Design : Stratified r and omised trial . Setting : General surgical service of an urban teaching hospital . Patients : 456 patients undergoing abdominal surgery . Patients less than 60 years of age with an American Society of Anesthesia classification of 1 were considered to be at low risk . Outcome measures : Respiratory complications were defined as clinical features consistent with collapse or consolidation , a temperature above 38 ° C , plus either confirmatory chest radiology or positive results on sputum microbiology . We also recorded the time that staff devoted to prophylactic respiratory therapy . Results : There was good baseline equivalence between the groups . The incidence of respiratory complications was 15 % ( 35/231 ) for patients in the incentive spirometry group and 12 % ( 28/225 ) for patients in the mixed therapy group ( P=0.40 ; 95 % confidence interval -3.6 % to 9.0 % ) . It required similar amounts of staff time to provide incentive spirometry and deep breathing exercises for low risk patients . The inclusion of physiotherapy for high risk patients , however , result ed in the utilisation of an extra 30 minutes of staff time per patient . Conclusions : When the use of re sources is taken into account , the most efficient regimen of prophylaxis against respiratory complications after abdominal surgery is deep breathing exercises for low risk patients and incentive spirometry for high risk patients . Key messages Key messages Most postoperative respiratory complications were due to atelectasis : less than 1 % of the patients developed pneumonia An American Society of Anesthesia classification > 1 and an age > /=60 years is a simple way of defining patients at high risk of respiratory complications and other adverse events after abdominal surgery A regimen consisting of deep breathing exercises ( low risk patients ) and incentive spirometry ( high risk patients ) is an efficient way of providing prophylaxis against respiratory complications after abdominal
target: CONCLUSION There was no evidence to support the use of incentive spirometry in the management of surgical patients .
background: 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 .