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.
    Full-text · Article · Oct 2015 · European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery
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    • "Moreover, the MDT group showed a tendency for shorter durations of postoperative intubation and ICU hospitalization after operation. Patients who underwent esophagectomy experienced a high incidence rate of PPCs with the range of 20 to 35%19202122232425. Previous studies demonstrated an incidence rate of 7.7 to 11.1% of pneumonia even in patients who underwent thoracoscopic surgery, which is considered as a minimally invasive procedure[26,27]. "
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    ABSTRACT: Aim: This study aimed to investigate the possible prevention of postoperative pulmonary complications (PPCs) by introduction of multidisciplinary team (MDT) approach in esophageal cancer patients who underwent esophagectomy. Methods: The retrospective cohort study of 132 esophageal cancer patients in a 900-bed university academic hospital between April 2008 and May 2011. The subjects included 120 patients who underwent esophagectomy. They were divided into two groups: 46 patients in the MDT approach group (MDT group) and 74 patients in the non-MDT approach group (NMDT group). Results: The results demonstrated that the rates of PPCs were 4.3% and 16.2% in the MDT group and NMDT group, respectively. After the logistic regression analysis and multivariate analysis for correction of all considerable confounding factors, the MDT group demonstrated a significantly lesser incidence rate of PPCs than the NMDT group (OR: 0.16, 95% confidential interval: 0.02-0.75). Conclusion: This study revealed that the MDT approach reduced the occurrence of PPCs in esophageal cancer patients who underwent esophagectomy. The adequate perioperative management and considerable early rehabilitation and mobilization with risk management should be provided to prevent PPCs.
    Preview · Article · Jan 2014 · Journal of Gastroenterology and Hepatology Research
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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.
    Full-text · Article · Feb 2012 · BMC Medical Informatics and Decision Making
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