title: [Incentive spirometry with expiratory positive airway pressure brings benefits after myocardial revascularization]. Comparison between deep breathing exercises and incentive spirometry after CABG surgery. The efficacy of postoperative incentive spirometry is influenced by the device-specific imposed work of breathing. Three physiotherapy protocols: effects on pulmonary volumes after cardiac surgery. Intrapulmonary percussive ventilation vs incentive spirometry for children with neuromuscular disease. The Effect of Abdominal Binders on Postoperative Pulmonary Function 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. Short-Term Respiratory Physical Therapy Treatment in the PACU and Influence on Postoperative Lung Function in Obese Adults Postoperative pulmonary complications and lung function in high‐risk patients: a comparison of three physiotherapy regimens after upper abdominal surgery in general anesthesia The effectiveness of incentive spirometry with physical therapy for high-risk patients after coronary artery bypass surgery. Positive expiratory pressure device acceptance by hospitalized children with sickle cell disease is comparable to incentive spirometry. Preoperative use of incentive spirometry does not affect postoperative lung function in bariatric surgery. The effect of incentive spirometry on chest expansion and breathing work in patients with chronic obstructive airway diseases: comparison of two methods. Absence of benefit of incentive spirometry in low-risk patients undergoing elective cholecystectomy. A controlled randomized study. Incentive spirometry to prevent acute pulmonary complications in sickle cell diseases. Postoperative pulmonary complications after gynecologic surgery. Incentive spirometry does not enhance recovery after thoracic surgery Incentive spirometry versus routine chest physiotherapy for prevention of pulmonary complications after abdominal surgery Postthoracotomy respiratory muscle mechanics during incentive spirometry using respiratory inductance plethysmography. 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. Incentive spirometry decreases respiratory complications following major abdominal surgery. Effect of Preoperative and Postoperative Incentive Spirometry on Lung Functions After Laparoscopic Cholecystectomy
abstract: BACKGROUND Patients undergoing coronary artery bypass graft ( CABG ) surgery  have higher risk to develop pulmonary complications ( PCs ) such as atelectasis , pneumonia and pleural effusion . These complications could increase the length of hospital stay , re sources utilization and also are associated with reduced quality of life and functional capacity a long term . OBJECTIVE To test if the use of incentive spirometry ( IS ) associated with expiratory positive airway pressure ( EPAP ) , after CABG surgery improves dyspnea , effort perceived and quality of life 18 months after CABG . METHODS Sixteen patients su bmi tted to a CABG , were r and omized to a control group ( n=8 ) or IS+EPAP group ( n=8 ) . The protocol of IS+EPAP was applied in the immediate postoperative period and following for more 4 weeks in the patient 's home . Eighteen months after CABG , the strength of the respiratory muscle , the functional capacity , the lung function , the quality of life and the level of physical activity were evaluated . RESULTS After six minute walk test ( 6-MWT ) , the score of the dyspnea ( 1.6+/-0.6 vs 0.6+/-0.3 , P<0.05 ) and the perceived effort ( 13.4+/-1.2 vs 9.1+/-0.7 , P<0.05 ) were higher in the control group , when compared with the IS+EPAP group . In quality of life evaluation , the domain related to the physical aspects limitations was better in IS+EPAP group ( 93.7+/-4.1 vs 50+/-17 , P<0.02 ) . CONCLUSION Patients that were su bmi tted to IS+EPAP present reduction of dyspnea and lower effort sensation after the 6-MWT , and also a better quality of life 18 months after CABG OBJECTIVE To compare the effects of deep breathing exercises ( DBE ) and the flow-oriented incentive spirometry ( IS ) in patients undergone coronary artery bypass grafting ( CABG ) through the following variables : forced vital capacity - FVC , forced expiratory volume in 1 second - FEV(1 ) , maximal respiratory pressures and oxygen saturation . METHODS Thirty six patients in CABG postoperative period underwent thirty minutes of non-invasive ventilation  during the first 24 hours after extubation and were r and omly shared into two groups as following : DBE ( n=18 ) and IS ( n=18 ) . The spirometric variables were assessed on the preoperative period and seventh postoperative day ( POD ) . The respiratory muscle strength and oxygen saturation were assessed on the preoperative period , first , second and seventh POD . RESULTS The groups were considered homogeneous in relation to the demographic and surgical variables . It has been noted fall in the values of FVC and FEV(1 ) between the preoperative period and the seventh POD , but without significant differences between groups . The maximal respiratory pressures showed drop in the first POD but with and partial recovery until the seventh POD , also without significant differences between groups . The oxygen saturation was the only variable that was completely recovered on the seventh POD , also without significant differences between groups . CONCLUSION There were not observed significant differences in maximal respiratory pressures , spirometric variables and oxygen saturation in patients undergone deep breathing exercises and flow-oriented incentive spirometry after coronary artery bypass grafting STUDY OBJECTIVES The study evaluated the impact of the additional imposed work of breathing ( WBimp ) generated by two different spirometers on postoperative incentive spirometry performance in patients at high risk and moderate risk for postoperative pulmonary complications ( PPCs ) . Additionally , we investigated whether maximal inspiratory pressure ( PImax ) is an easy estimate of the WBimp imposed by incentive spirometers . DESIGN Prospect i ve , r and omized , single-blind clinical trial . SETTING ICU of a university hospital . INTERVENTIONS AND MEASUREMENTS Thirty male patients were assigned to a group at high risk for PPCs ( group A ; inspiratory capacity [ IC ] , < 1.6 L ) or to a group at moderate risk for PPCs ( group B ; IC , 1.6 to 2.5 L ) after upper-abdominal , thoracic , or two-cavity surgery . On the first or second postoperative day WBimp , IC , and PImax were recorded without spirometers ( baseline ) and during incentive spirometry with the Mediflo spirometer ( Medimex ; Hamburg , Germany ) ( high WBimp ) and the Coach spirometer ( Kendall ; Neustadt , Germany ) ( low WBimp ) using a pneumotachograph . In group A , the baseline and the ICs for both spirometers only differed slightly . In group B , the IC was significantly reduced for the Mediflo ( p < 0.05 ) , which imposed a WBimp twice as high as the Coach ( p < 0.01 ) . PImax was significantly increased for both the Mediflo and the Coach ( p < 0.01 ) . PImax was positively correlated with WBimp ( r = 0.8 ) . CONCLUSIONS Incentive spirometers differ considerably in their additional Wbimp with a potential impact on the efficacy of postoperative incentive spirometry performance . PImax might be an easy clinical estimate for the WBimp during incentive spirometry . Incentive spirometers with low WBimp permit increased maximal sustained inspiration and , thus , enhanced incentive spirometry performance , and , therefore , it might be more suitable for use in postoperative respiratory care 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 Pulmonary infections can be life threatening for children with neuromuscular diseases who have impaired ability to clear secretions .  Intrapulmonary percussive ventilation ( IPV ) is a pneumatic device that delivers air and aerosol to the lungs at frequencies of 200 to 300 cycles per minute at peak pressures from 20 to 40 cm H(2)O. Anecdotal reports and pilot studies show its safety and effectiveness in mobilizing secretions in patients with cystic fibrosis . OBJECTIVE To test the hypothesis that IPV used in a pulmonary program for adolescents with neuromuscular disease would reduce the number of days of antibiotic use for pulmonary infection . METHODS A r and omized , controlled study was conducted to compare efficacy of IPV with incentive spirometry ( IS ) in reducing number of days of antibiotic use in adolescents with neuromuscular disease . The secondary endpoints were the number of respiratory infections , hospitalizations , and school days missed . RESULTS A total of 18 patients were enrolled ( 9 IPV , 9 IS ) .  Antibiotic use was significantly higher with IS ( 24/1000 patient-days ) compared with IPV ( 0/1000 patient-days ) , ( incidence rate ratio , 43 ; 95 % confidence interval , 6 - 333 ) . The IS group spent more days hospitalized ( 4.4/1000 patient-days vs 0/1000 patient-days ) than the IPV group ( incidence rate ratio , 8.5 ; 95 % confidence interval , 1.1 - 67 ) . The IPV group had 0 episodes of pneumonia or bacterial bronchitis compared with 3 events in the IS group , although this did not meet statistical significance . CONCLUSION Intrapulmonary percussive ventilation as part of a preventive pulmonary regimen reduced days of antibiotic use and hospitalization for respiratory illness in adolescents with neuromuscular disease Abdominal binders are ordered by some surgeons postoperatively for patient comfort and to prevent wound complications . There has been some question as to the compressive effect that an abdominal binder has on pulmonary function . We prospect ively r and omized 54 patients undergoing a midline laparotomy incision to two groups : a “ binder ” group and a “ no binder ” group .  Preoperative pulmonary function tests ( vital capacity and incentive spirometry ) were measured . Postoperatively , pulmonary function tests , pulse oximetry , oxygen requirement , pulmonary and wound complications , pain control , time to ambulation , and hospital length of stay were examined . Vital capacity as a per cent of preoperative values on postoperative Day 1 for the binder and nonbinder groups were 64.7 and 54.6 per cent , respectively , but this was not statistically significant . Average level of pain using the visual analog pain scale on postoperative Days 1 through 3 in the binder versus nonbinder groups was 4 versus 8 , 3 vs 6 , and 3 versus 7 , respectively . Time to ambulation was 18.6 hours in the binder group and 16.7 hours in the nonbinder group . Hospital length of stay in the binder and nonbinder groups was 3.9 days and 3.7 days , respectively . We conclude that abdominal binders in our patients with midline abdominal incisions had no significant effect on postoperative pulmonary function , but seemed to help with pain control 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 Background Even several days after surgery , obese patients exhibit a measureable amount of atelectasis and thus are predisposed to postoperative pulmonary complications . Particularly in ambulatory surgery , rapid recovery of pulmonary function is desired to ensure early discharge of the obese patient . In this study , we wanted to evaluate intensive short-term respiratory physical therapy treatment ( incentive spirometry ) in the postanesthesia care unit ( PACU ) and its impact on pulmonary function in the obese . Methods After ethics committee approval and informed consent , we prospect ively studied 60 obese patients ( BMI 30–40 ) undergoing minor peripheral surgery  , half of which were r and omly assigned to receive  respiratory physiotherapy  during their PACU stay , while the others received routine treatment . Premedication , general anesthesia , and respiratory setting s were st and ardized . We measured arterial oxygen saturation by pulse oximetry on air breathing . Inspiratory and expiratory lung functions were measured preoperatively ( baseline ) and at 10 min , 1 , 2 , 6 , and 24 h after extubation , with the patient supine , in a 30 ° head-up position . The two groups were compared using repeated-measure analysis of variance and t test analysis . Statistical significance was considered to be P < 0.05 . Results There were no differences at the first assessment , but , during the PACU stay , pulmonary function in the physiotherapy group was significantly better than the controls ’ ( p < 0.0001 ) , an effect which persisted for at least 24 h after surgery ( p < 0.009 ) . ConclusionS hort-term respiratory physiotherapy during the PACU stay promotes more rapid recovery of postoperative lung function in the obese during the first 24 The effect of three postoperative regimes of respiratory therapy on  pulmonary complications and lung function was compared in high‐risk patients . Fifty‐one patients were r and omized to : 1 ) conventional chest physiotherapy alone ( PHYS ) , 2 ) chest physiotherapy and positive expiratory pressure ( PEP ) , or 3 ) chest physiotherapy with both positive expiratory pressure and inspiratory resistance ( RMT ) . Treatments were given twice daily by a physiotherapist and self‐administered . The incidence of postoperative pulmonary complications ( PPC ) was respectively , 71 % , 76 % and 65 % in the PHYS‐ , PEP‐ and RMT‐groups . The incidence of PPC requiring treatment with antibiotic , bronchodilator or supplementary oxygen according to the existing clinical practice was 47 % , 47 % and 29 % . The incidence of atelectasis was 65 % , 64 % and 60 % and of pneumonia 29 % , 35 % and 6 % . There was no difference between the groups , except for a tendency to a lower frequency of pneumonia in the RMT‐group . Postoperatively forced vital capacity ( FVC ) decreased to mean 54 % , forced expired volume in 1 s to 48 % and functional residual capacity to 76 % of preoperative values . Arterial oxygen tension ( Pao2 ) declined to mean 8.1 kPa and arterial saturation ( Sao2 ) to 89 % . There was no difference between the groups except for FVC , Pao2 and Sao2 ( P = 0.008 , P = 0.008 and P = 0.002 ) , which showed the least decrease in the RMT‐group . None of the regimens could be considered as satisfactory concerning the prevention of PPC , but RMT seemed to be the most efficient . Insufficient self‐administration of treatment was probably one of the causes of the overall high incidence of PPC in this study 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 BACKGROUND The pulmonary complication in sickle cell disease known as acute chest syndrome ( ACS ) has potential for high morbidity and mortality . A r and omized trial demonstrated that incentive spirometry ( IS ) reduces the rate of ACS , leading to a role for respiratory therapy in hospital management of sickle cell pain . However , use of IS can be limited by chest wall pain , or by difficulty with the coordinated inspiration in a young child .  Intermittent positive expiratory pressure ( PEP ) therapy may be easier for a child 's coordination and more comfortable than IS for a child with chest wall pain . PURPOSE To compare PEP therapy with conventional IS for children hospitalized for sickle cell pain with respect to patient satisfaction , length of hospital stay , and progression to ACS . METHODS This pilot study enrolled 20 children upon hospitalization for sickle cell pain in the thorax , r and omly assigning them to either PEP ( n = 11 ) or IS ( n = 9 ) therapy , administered by a therapist hourly while awake . RESULTS The r and omization assigned an older distribution to PEP than IS ( 12.3 vs 8.8 y ) . Patient satisfaction was high for both respiratory care devices , and there was no difference between the PEP and IS groups ( 4.5 vs 4.4 , p = 0.81 ) . Length of hospital stay was similar ( 5 vs 4.3 d , p = 0.56 ) . No children in either group progressed to ACS . CONCLUSION These preliminary results show no difference in the primary outcomes in the 2 groups . Intermittent PEP therapy warrants further study as an alternative to IS for sickle cell patients at high risk for ACS , as effective preventive respiratory therapy 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 Chronic obstructive airway diseases ( COAD ) , characterized by mucus hypersecretion , lead to exercise intolerance . Incentive spirometry has been used to prevent postoperative pulmonary atelectasis . METHODS To compare the efficacy of two incentive spirometers , Coach ( volume-oriented ) and Triflo ( flow-oriented ) , in the work of breathing in COAD patients , 22 patients were r and omized in this study : 12 patients ( Triflo-II group ) initially used Triflo-II for 10 minutes and then Coach for the same period . In contrast , the Coach group , including 10 patients , started with Coach followed by Triflo-II . After receiving incentive spirometry , lung expansion and work of breathing were assessed . RESULTS Patients in the Coach group significantly increased chest wall expansion ( p = 0.041 ) , as compared with patients using Triflo-II . Similarly , there was also a significantly increased abdominal wall expansion in the Coach group ( p = 0.0056 ) , compared with that in the Triflo-II group . The need of accessory muscle assistance for breathing in the Coach group was significantly less than in the Triflo-II group ( p = 0.047 ) . It was easier for patients in the Coach group to start a breath ( p = 0.0058 ) than for those in the Triflo-II group . For the entire group , 17 patients ( 77.3 % ) preferred Coach to assist their breathing , and only 4 patients ( 18.2 % ) favored Triflo-II . CONCLUSION COAD patients achieved a larger expansion of the chest and abdomen with a Coach device . Our data provide a good rationale for an outcome study on the use of incentive spirometer in COAD patients 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 BACKGROUND This study was design ed to determine the incidence of thoracic bone infa rct ion in patients with sickle cell diseases who were hospitalized with acute chest or back pain above the diaphragm and to test the hypothesis that incentive spirometry can decrease the incidence of atelectasis and pulmonary infiltrates . METHODS We conducted a prospect i ve , r and omized trial in 29 patients between 8 and 21 years of age with sickle cell diseases who had 38 episodes of acute chest or back pain above the diaphragm and were hospitalized . Each episode of pain was considered to be an independent event . At each hospitalization , patients with normal or unchanged chest radiographs on admission were r and omly assigned to treatment with spirometry or to a control nonspirometry group . Each patient in the spirometry group took 10 maximal inspirations using an incentive spirometer every two hours between 8 a.m. and 10 p.m. and while awake during the night until the chest pain subsided . A second radiograph was obtained three or more days after admission , or sooner if clinical ly necessary , to determine the incidence of pulmonary complications . Bone scanning was performed no sooner than two days after hospital admission to determine the incidence of thoracic bone infa rct ion . RESULTS The incidence of thoracic bone infa rct ion was 39.5 percent ( 15 of 38 hospitalizations ) . Pulmonary complications ( atelectasis or infiltrates ) developed during only 1 of 19 hospitalizations of patients assigned to the spirometry group , as compared with 8 of 19 hospitalizations of patients in the nonspirometry group ( P = 0.019 ) . Among patients with thoracic bone infa rct ion , no pulmonary complications developed in those assigned to the spirometry group during a total of seven hospitalizations , whereas they developed during five of eight hospitalizations in the nonspirometry group ( P = 0.025 ) . CONCLUSIONS Thoracic bone infa rct ion is common in patients with sickle cell diseases who are hospitalized with acute chest pain .  Incentive spirometry can prevent the pulmonary complications ( atelectasis and infiltrates ) associated with the acute chest syndrome in patients with sickle cell diseases who are hospitalized with chest or back pain above the diaphragm OBJECTIVE Investigate the frequency of , and risks for postoperative  pulmonary complications after surgery for non-malignant gynecologic disorders . METHOD A retrospective component included medical record data for one year . A prospect i ve component enrolled 300 patients consecutively who were scheduled for gynecologic surgeries .  RESULT Postoperative pulmonary complications occurred in 1.22 % of 328 open abdominal procedures in the retrospective study , and 2.16 % of 232 in the prospect i ve study . Pooling the data yielded a frequency estimate of 1.61 % . Mean hospital length of stay ( pooled data ) increased 1.75 days in those with postoperative pulmonary complications . Smoking was the only significant risk factor ( relative risk=3.9 using pooled data ) . CONCLUSION Postoperative pulmonary complications after surgery for non-malignant gynecologic disorders are infrequent but increase hospital length of stay . Smokers are at increased risk 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 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 We undertook this study to characterize the postthoracotomy compartmental displacement and respiratory mechanical changes occurring during and after the performance of the incentive spirometry maneuver . We also evaluated the effect of recumbency angle on compartmental recruitment .  Sixteen patients were r and omized to perform incentive spirometry either at 30 degrees or 60 degrees recumbency angle . They were studied using respiratory inductance plethysmography  to measure tidal volume , respiratory frequency , inspiratory time , rib cage motion/tidal volume ratio , inspiratory duty cycle , and inspiratory flow . Patients were studied before surgery and on postoperative days 1 and 3 . Statistical analysis was accomplished using multiple measures ANOVA with post-hoc Student 's t-tests when appropriate . Preoperative incentive spirometry augmented VT by increasing both VT/TI and TI . Postoperatively , the incentive recruitment of VT was reduced , a result of a decrease in TI and TI/TTOT ; VT/TI was unchanged . There was postoperative decrease of AB and AB/VT during incentive spirometry , greatest in the 60 degrees group . Our results characterize the nature of the respiratory recruitment afforded by incentive spirometry , before and after thoracotomy . We also found evidence of postthoracotomy diaphragmatic derecruitment during incentive spirometry exacerbated by a high recumbency angle 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 Pulmonary complications are the leading cause of morbidity and mortality following major abdominal surgery . Chest physiotherapy aims to decrease the likelihood of these complications and hasten recovery . Exercises aim ed at maximising inspiratory effort are the most beneficial for the patients . The incentive spirometer is a h and held device that patients use to achieve effective inspiration . In a nonr and omised pilot study of 263 patients we have found that the addition of the incentive spirometer , as part of an intensive post-operative physiotherapy programme , decreased the occurrence of pulmonary complications ( 6 vs 17 % , p = 0.01 ) and length of stay on the surgical high dependency unit ( 3.1 vs 4 days p = 0.03 ) . The two groups were comparable when age , sex , smoking history , the need for emergency surgery and post-operative analgesia were compared 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
target: 3 : It is suggested that deep breathing exercises provide the same benefit as incentive spirometry in the preoperative and postoperative setting to prevent postoperative pulmonary complications .
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