Is an incentive spirometer used for pneumothorax?

From the Guidelines

Incentive spirometers are not recommended for patients with pneumothorax, as they may worsen the condition by increasing intrathoracic pressure and expanding the air leak. Pneumothorax is a condition where air collects in the pleural space between the lung and chest wall, causing partial or complete lung collapse. The primary treatment for pneumothorax typically includes oxygen therapy, observation for small pneumothoraces, needle aspiration, or chest tube insertion for larger ones. According to the British Thoracic Society guideline for pleural disease 1, the management of pneumothorax should focus on addressing the underlying cause and relieving symptoms.

Some key points to consider in the management of pneumothorax include:

• Oxygen therapy to reduce the total pressure of gases in pleural capillaries and increase the pressure gradient between the pleural capillaries and the pleural cavity, thereby increasing absorption of air from the pleural cavity 1
• Observation for small pneumothoraces, with supplemental high flow oxygen therapy where feasible
• Needle aspiration or chest tube insertion for larger pneumothoraces
• Avoidance of activities that increase intrathoracic pressure, including forceful breathing exercises, during the acute phase of pneumothorax

Once the pneumothorax has fully resolved and the patient has been cleared by their healthcare provider, breathing exercises including incentive spirometry may be incorporated into the recovery plan to help re-expand the lung and prevent atelectasis. However, the use of incentive spirometry should be individualized and based on the patient's specific needs and condition, as noted in the guidelines on enhanced recovery after pulmonary lobectomy 1.

It is essential to prioritize the patient's safety and well-being, and to avoid any interventions that may exacerbate the condition. The management of pneumothorax should always be directed by a healthcare provider who can monitor the patient's condition and adjust treatments accordingly.

From the Research

Incentive Spirometer for Pneumothorax

• The use of an incentive spirometer in patients with pneumothorax has been explored in various studies 2, 3, 4, 5.
• A case study published in 2016 found that noninvasive treatment with incentive spirometry can be effective in patients with minimal symptoms and no signs of life-threatening respiratory distress 2.
• However, another study published in 2013 reported a case of pneumothorax caused by aggressive use of an incentive spirometer in a patient with emphysema, highlighting the potential risks of using this device in certain patients 3.
• A survey of healthcare professionals found that the majority believed incentive spirometry to be essential to patient care and effective in improving pulmonary function, although there was a lack of standardization in its use 4.
• A systematic review and meta-analysis published in 2023 found that incentive spirometry was an effective strategy to improve the quality of postoperative care in patients, reducing the length of hospital stay and the risk of postoperative pulmonary complications 5.
• In contrast, a review of traumatic pneumothorax management published in 2021 did not mention the use of incentive spirometry as a treatment option, instead focusing on diagnostic practices and evolving management strategies such as lung ultrasound and conservative approaches 6.

Potential Benefits and Risks

• The potential benefits of using an incentive spirometer in patients with pneumothorax include improved pulmonary function and reduced risk of postoperative complications 2, 5.
• However, the potential risks include the development of pneumothorax or exacerbation of existing lung disease, particularly in patients with emphysema or other underlying conditions 3.
• Healthcare professionals should carefully consider the individual patient's condition and medical history before recommending the use of an incentive spirometer 4.

Clinical Applications

• Incentive spirometry may be used as a noninvasive treatment option for patients with minimal symptoms and no signs of life-threatening respiratory distress 2.
• It may also be used as a preventive measure to reduce the risk of postoperative pulmonary complications in patients undergoing surgery 5.
• However, its use should be carefully monitored and adjusted according to the individual patient's response and medical condition 3, 4.