Should incentive spirometry be used for a post-operative patient after anatomical repair of an umbilical hernia?

Incentive Spirometry for Post-Operative Umbilical Hernia Repair Patients

Yes, incentive spirometry should be provided to post-operative patients following umbilical hernia repair, especially if they have risk factors for pulmonary complications. 1

Risk Assessment for Pulmonary Complications

Umbilical hernia repair involves abdominal surgery, which places patients at higher risk for postoperative pulmonary complications. According to the American College of Physicians guidelines, the following factors increase risk:

Patient-Related Risk Factors:

• Age >60 years
• Chronic obstructive pulmonary disease (COPD)
• ASA class II or greater
• Functional dependence
• Congestive heart failure
• Low serum albumin (<35 g/L) 1

Procedure-Related Risk Factors:

• Abdominal surgery (which includes umbilical hernia repair)
• Prolonged surgery (>3 hours)
• General anesthesia 1

Implementation of Incentive Spirometry

For patients identified as having risk factors:

1. Timing and Frequency:

   • Begin incentive spirometry immediately post-operation
   • Perform 10 times every hour while awake 2
   • Continue until patient is fully mobile and showing good respiratory function

2. Proper Technique:

   • Take slow, deep breaths through the mouthpiece
   • Hold breath for 3-5 seconds at maximum inspiration
   • Exhale slowly and completely 2

3. Monitoring:

   • Document highest volume achieved
   • Assess for improvement in lung volumes
   • Ensure proper technique is maintained 2

Evidence and Recommendations

The American College of Physicians strongly recommends that "all patients who after preoperative evaluation are found to be at higher risk for postoperative pulmonary complications should receive deep breathing exercises or incentive spirometry" 1. This recommendation is particularly relevant for abdominal surgery patients.

The CDC guidelines also support incentive spirometry as an advantageous maneuver for patients at risk of developing postoperative pulmonary complications 1.

Effectiveness and Limitations

While incentive spirometry is widely recommended, it's important to note:

• Incentive spirometry appears to be most effective when used as part of a multimodal approach to preventing pulmonary complications 3
• Some studies suggest that incentive spirometry alone may not be superior to other chest physiotherapy techniques 4
• A non-randomized pilot study found that incentive spirometry, as part of an intensive post-operative physiotherapy program, decreased pulmonary complications (6% vs 17%) and reduced length of stay in surgical high dependency units 5

Common Pitfalls to Avoid

• Inadequate frequency of use
• Poor technique (breathing too rapidly or shallowly)
• Lack of breath holding at maximum inspiration
• Discontinuing use too early in recovery 2

Conclusion

For umbilical hernia repair patients, incentive spirometry should be implemented as part of standard post-operative care, especially for those with risk factors for pulmonary complications. The evidence suggests that when properly used as part of a comprehensive respiratory care strategy, incentive spirometry can help reduce the risk of post-operative pulmonary complications and potentially shorten hospital stays.