When is incentive spirometry (IS) recommended?

From the Guidelines

Incentive spirometry is recommended for patients at higher risk for postoperative pulmonary complications, particularly those undergoing prolonged surgery, abdominal surgery, thoracic surgery, neurosurgery, head and neck surgery, vascular surgery, aortic aneurysm repair, emergency surgery, and general anesthesia, as stated in the guidelines from the American College of Physicians 1. The use of incentive spirometry is beneficial in preventing postoperative pulmonary complications, such as atelectasis, pneumonia, and respiratory failure, by encouraging deep breathing and improving lung expansion.

• The typical regimen involves taking 10 slow, deep breaths with the device every hour while awake, holding each breath for 3-5 seconds before exhaling slowly.
• Proper technique requires sitting upright at 90 degrees if possible, taking normal breaths before using the device, then inhaling slowly through the mouthpiece to raise the indicator to the prescribed level. The available evidence suggests that for patients undergoing abdominal surgery, any type of lung expansion intervention, including incentive spirometry, is better than no prophylaxis at all, as noted in the guidelines 1. While incentive spirometry may be the least labor-intensive option, it is most effective when combined with early mobilization, coughing exercises, and adequate pain control.
• Incentive spirometry should be used cautiously in patients with severe respiratory distress, untreated pneumothorax, or those unable to cooperate with the procedure. The guidelines emphasize the importance of evaluating patients for concomitant risk factors and implementing pre- and postoperative interventions to reduce pulmonary complications, including the use of incentive spirometry 1.

From the Research

Incentive Spirometry Recommendations

Incentive spirometry (IS) is recommended for patients undergoing certain types of surgery, particularly those at high risk for developing pulmonary complications. The following points highlight when IS is recommended:

• Patients undergoing thoracic surgery, such as pulmonary resection, may benefit from IS to reduce postoperative pulmonary complications (PPCs) and shorten hospital stay 2.
• IS may be beneficial for patients with preoperative predicted FEV1 of <80%, as it has been shown to reduce PPCs in a linear fashion with decreasing FEV1 2.
• However, the effectiveness of IS in preventing pulmonary complications after upper abdominal surgery is unclear, with some studies showing no significant difference between IS and no respiratory treatment or other physiotherapy 3, 4.
• IS may not be effective in preventing pulmonary complications after coronary artery bypass graft (CABG) surgery, with some studies showing no difference between IS and other prophylactic physiotherapy 5.
• For patients at high risk for developing PPCs, such as those with chronic obstructive pulmonary disease (COPD) or current/recent ex-smokers, IS may be beneficial in reducing the frequency of PPCs, although further research is needed to confirm this 6.

Key Considerations

When considering the use of IS, the following factors should be taken into account:

• The type of surgery and the patient's individual risk factors for developing pulmonary complications.
• The patient's preoperative lung function, including FEV1.
• The availability of other prophylactic physiotherapy options, such as deep breathing exercises or positive pressure breathing techniques.
• The need for further research to confirm the effectiveness of IS in certain patient populations, such as those at high risk for developing PPCs.