Incentive spirometry does not enhance recovery after thoracic surgery

Respiratory Rehabilitation and Respiratory Division, University Hospitals, Katholieke Universiteit Leuven, and the Faculty of Physical Education and Physiotherapy, Belgium.
Critical Care Medicine (Impact Factor: 6.31). 04/2000; 28(3):679-83. DOI: 10.1097/00003246-200003000-00013
Source: PubMed


To investigate the additional effect of incentive spirometry to chest physiotherapy to prevent postoperative pulmonary complications after thoracic surgery for lung and esophageal resections.
Randomized controlled trial.
University hospital, intensive care unit, and surgical department.
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.
Physiotherapy (breathing exercises, huffing, and coughing) (PT) plus incentive spirometry (IS) was compared with PT alone.
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.
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 cannot rule out beneficial effects in a subgroup of high-risk patients, routine use of IS after thoracic surgery seems to be ineffective.

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    • "Preoperative inspiratory muscle training (IMT) for a period of at least 2 weeks has been shown to significantly improve respiratory muscle and lung function in the early postoperative period following cardiothoracic or upper abdominal surgery, significantly reducing the risk of PPC [8]. Randomized controlled trials after pulmonary resection via thoracotomy have so far failed to detect the effects of postoperative respiratory physiotherapy in reducing PPC [9] [10] [11], although Agostini et al. [11] described a trend towards lower frequency of PPC in a high-risk subgroup of patients. There is a scarcity of studies investigating the effects of postoperative IMT on respiratory muscle strength after lung cancer surgery, and potential effects have not been adequately documented in a randomized controlled setting. "
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    ABSTRACT: Objectives: The aim was to investigate whether 2 weeks of inspiratory muscle training (IMT) could preserve respiratory muscle strength in high-risk patients referred for pulmonary resection on the suspicion of or confirmed lung cancer. Secondarily, we investigated the effect of the intervention on the incidence of postoperative pulmonary complications. Methods: The study was a single-centre, parallel-group, randomized trial with assessor blinding and intention-to-treat analysis. The intervention group (IG, n = 34) underwent 2 weeks of postoperative IMT twice daily with 2 × 30 breaths on a target intensity of 30% of maximal inspiratory pressure, in addition to standard postoperative physiotherapy. Standard physiotherapy in the control group (CG, n = 34) consisted of breathing exercises, coughing techniques and early mobilization. We measured respiratory muscle strength (maximal inspiratory/expiratory pressure, MIP/MEP), functional performance (6-min walk test), spirometry and peripheral oxygen saturation (SpO2), assessed the day before surgery and again 3-5 days and 2 weeks postoperatively. Postoperative pulmonary complications were evaluated 2 weeks after surgery. Results: The mean age was 70 ± 8 years and 57.5% were males. Thoracotomy was performed in 48.5% (n = 33) of cases. No effect of the intervention was found regarding MIP, MEP, lung volumes or functional performance at any time point. The overall incidence of pneumonia was 13% (n = 9), with no significant difference between groups [IG 6% (n = 2), CG 21% (n = 7), P = 0.14]. An improved SpO2 was found in the IG on the third and fourth postoperative days (Day 3: IG 93.8 ± 3.4 vs CG 91.9 ± 4.1%, P = 0.058; Day 4: IG 93.5 ± 3.5 vs CG 91 ± 3.9%, P = 0.02). We found no association between surgical procedure (thoracotomy versus thoracoscopy) and respiratory muscle strength, which was recovered in both groups 2 weeks after surgery. Conclusions: Two weeks of additional postoperative IMT, compared with standard physiotherapy alone, did not preserve respiratory muscle strength but improved oxygenation in high-risk patients after lung cancer surgery. Respiratory muscle strength recovered in both groups 2 weeks after surgery. Clinical trialsgov id: NCT01793155.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 10/2015; DOI:10.1093/ejcts/ezv359 · 3.30 Impact Factor
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    • "Both these techniques are dependent on specialized equipment and therefore costly to the patient. Two systematic reviews reported no added benefit to deep breathing exercises [13,14,35]. In addition, IPPB would be the last choice because abdominal distention has been reported as potentially harmful and the technique is therapist dependent [14,18]. "
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    ABSTRACT: Postoperative pulmonary complications remain the most significant cause of morbidity following open upper abdominal surgery despite advances in perioperative care. However, due to the poor quality primary research uncertainty surrounding the value of prophylactic physiotherapy intervention in the management of patients following abdominal surgery persists. The Delphi process has been proposed as a pragmatic methodology to guide clinical practice when evidence is equivocal. The objective was to develop a clinical management algorithm for the post operative management of abdominal surgery patients. Eleven draft algorithm statements extracted from the extant literature by the primary research team were verified and rated by scientist clinicians (n=5) in an electronic three round Delphi process. Algorithm statements which reached a priori defined consensus-semi-interquartile range (SIQR)<0.5-were collated into the algorithm. The five panelists allocated to the abdominal surgery Delphi panel were from Australia, Canada, Sweden, and South Africa. The 11 draft algorithm statements were edited and 5 additional statements were formulated. The panel reached consensus on the rating of all statements. Four statements were rated essential. An expert Delphi panel interpreted the equivocal evidence for the physiotherapeutic management of patients following upper abdominal surgery. Through a process of consensus a clinical management algorithm was formulated. This algorithm can now be used by clinicians to guide clinical practice in this population.
    BMC Medical Informatics and Decision Making 02/2012; 12(1):5. DOI:10.1186/1472-6947-12-5 · 1.83 Impact Factor
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    • "The assessment of criteria for the BBS and GS was performed as described in the papers by Brooks-Brunn [8] and Gosselink et al [9]. Further clarification regarding the GS was needed in order to confirm how microbiology results contribute to the score as it was unclear as described in the paper by Gosselink et al [9]; a positive sputum microbiology report constituted a positive second criteria, even if white cell count (WCC) is negative (personal communication with author), see Table 1. Detailed information/instruction regarding the application of the MGS [11] was used to facilitate its application, and where necessary advice was sought (personal communication with author). "
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    ABSTRACT: To evaluate the recognition of postoperative pulmonary complications (PPC) following thoracotomy and lung resection using three PPC scoring tools. Prospective observational study. Regional thoracic centre. One hundred and twenty-nine consecutive thoracotomy and lung resection patients (October 2007 and April 2008). PPC assessment was performed on a daily basis using three sets of criteria described by Brooks-Brunn, Gosselink et al. and Reeve et al.: the Brooks-Brunn Score (BBS), Gosselink Score (GS) and Melbourne Group Scale (MGS), respectively. The results were compared with treatment for PPC and clinical outcomes including mortality, postoperative length of stay and high dependency unit length of stay. PPC frequency was 13% (17/129) with the MGS, 6% (8/129) with the GS and 40% (51/129) with the BBS. The clinically observed incidence of treated (requiring antibiotic therapy or bronchoscopy) PPC was 12% (16/129). PPC treatment following thoracotomy is common. Of the three scoring tools, the MGS outperforms the BBS and the GS in terms of PPC recognition following thoracotomy and lung resection. Patients with a PPC-positive MGS score have a worse outcome as defined by mortality, high dependency unit length of stay and postoperative length of stay. The MGS is an easy-to-use multidisciplinary scoring tool, but further work is required into its use in minimally invasive surgery and in targeting high-risk groups for therapy.
    Physiotherapy 12/2011; 97(4):278-83. DOI:10.1016/ · 1.91 Impact Factor
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