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Incentive Spirometry Use Following Abdominal Surger y. James Barry, BS Stacy Marsden, MA Jill Stewart, MBA MSN Clinical Nurse Leader Program, College of Nursing Georgia Regents University . Background.

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incentive spirometry use following abdominal surger y

Incentive Spirometry Use Following Abdominal Surgery

James Barry, BS

Stacy Marsden, MA

Jill Stewart, MBA

MSN Clinical Nurse Leader Program, College of Nursing

Georgia Regents University

background
Background
  • Abdominal surgery is associated with high risk of post-operative pulmonary complications (PPC)
  • Without a therapeutic respiratory regimen, up to 25% of abdominal surgery patients develop PPC (Deodhar, 1991)
  • Post-operative pulmonary complications include:
    • Respiratory failure
    • Atelectasis
    • Pneumonia
    • Bronchospasm
    • Tracheobronchitis
  • Incentive spirometry (IS) and deep-breathing exercises (DBE) can reduce the risk for PPC
purpose
Purpose
  • The literature review was performed to answer the question, “For post-operative abdominal surgery patients does the use of an incentive spirometer reduce the risk of pulmonary complications compared with a regimen of deep breathing exercises?”
  • Determining whether IS or DBE use is more effective could play a significant role in the reduction of morbidity and mortality, improving health outcomes, and reducing health costs following abdominal surgery.
literature search strategy
Literature Search Strategy
  • Databases searched: CINAHL, Cochrane, Google Scholar, Medline, Ovid
  • Key search terms: deep breathing exercises, incentive spirometry, pulmonary complications, post abdominal surgery,
  • Target population: adult patients at risk for pulmonary complications following abdominal surgery
  • Inclusion criteria: studies that compare the effectiveness of DBE versus IS use in the prevention of PPCs in adults
  • Exclusion criteria: pediatric studies, pre-surgical interventions, non-abdominal surgery
  • Articles:20 articles reviewed, nine articles selected ranging from 1984-2011 (paucity of studies in the last five years)
evidence hierarchy
Evidence Hierarchy

Legend: 1a=systematic review of RCTs, 1b=indiv. RCTs, 2a=systematic rev. of cohort studies, 2b=indiv. Cohort studies & poor RCTS, 3a=systematic rev. of case-control studies, 3b=indiv. case-controlled studies, 4=poor quality case-controlled and cohort studies, 5=expert opinion based on clinical experience

limitations
Limitations
  • Inconsistencies across studies in the definition of PPCs, methodology of data analysis
  • Effectiveness of IS and DBE depends on patient selection, treatment dosage, instructions given, supervision during respiratory training, and patient adherence
  • Tidal volumes not measured in all studies
  • Not all trials are randomized
  • The short follow-up period for most patients limits analysis of IS effectiveness
  • The incidence of PPCs varies dramatically depending on the type of surgery and patient’s health status
recommendations for practice
Recommendations for Practice
  • Continuation of current practice is recommended based on analysis of available evidence
  • Implementation of either IS use or DBE following abdominal surgery
  • Incentive spirometry
    • Hourly during waking hours with 10 maximal breaths per session
  • Deep breathing exercises
    • 4 to 5 times daily during waking hours
barriers to implementation
Barriers to Implementation

Barriers

  • Requires education and supervision
  • Ineffective unless performed as instructed
  • Time and cost involved
  • Patient adherence
  • Patient health status and level of consciousness (LOC)

Suggestion to overcome barriers

  • Nurse and patient education
  • Incorporation of IS implementation during hourly rounding
  • Supervision for adherence and proper use
  • Family member assistance
  • Keep IS in patient’s line of sight
conclusion
Conclusion
  • IS and/or DBE are more effective than no respiratory therapy in the prevention of PPCs
  • There is no evidence to support a statistically significant difference between IS use and DBE for the prevention of PPCs in post-operative abdominal surgery patients
  • Additional research with adequate methodological designs is needed to clarify the effect and to justify the use of IS over DBE
references
References

Carvalho, C., Paisani, D.M., & Lunardi, A.C. (2011). Incentive spirometry in major surgeries: a systematic review. Brazilian Journal of Physical Therapy,15, 343-350.

Celli, B.R., Rodriguez, K., & Snider, G.L. (1984). A controlled trial of intermittent positive pressure breathing incentive spirometry and deep breathing exercises in preventing pulmonary complications after abdominal surgery. The American Review of Respiratory Disease, 130, 12-5.

Deodhar, S.D., Mohite, J.D., Shirahatti, R.G., & Joshi, S. (1991). Pulmonary complications of upper abdominal surgery. J Postgrad Med, 37, 88-92.

Guimaraes, M.M., El Dib, R., Smith, R.F., & Matos, D. (2009). Incentive spirometry for prevention of postoperative pulmonary complications in upper abdominal surgery. Cochrane Database System Rev, 3. doi: 10.1002/14651858.CD006058.pub2.

Hall, J.C., Tarala, R.A., Tapper, J., & Hall, J.L. (1996). "Prevention of respiratory complications after abdominal surgery: A randomised clinical trial." BMJ, 312(7024), 148-152.

references1
References

National Guideline Clearinghouse. (2011). Incentive spirometry: 2011. Retrieved from http://www.guidelines.gov/content.aspx?id=34793.

O'Connor, M., Tattersall, M.P., & Carter, J.A. (1988). An evaluation of the incentive spirometer to improve lung function after cholecystectomy. Anaesthesia, 43(9), 785-7.

Schwieger, I., Gamulin, Z., Forster, A., Meyer, P., Gemperle, M., & Suter, P.M. (1986). Absence of benefit of incentive spirometry in low-risk patients undergoing elective cholecystectomy. A controlled randomized study. Chest, 89(5), 652-6.

Thomas, J. A., & McIntosh, J.M. (1994). Are incentive spirometry, intermittent positive pressure breathing, and deep breathing exercises effective in the prevention of postoperative pulmonary complications after upper abdominal surgery? A systematic overview and meta-analysis. Physical Therapy, 74(1), 3-10.