The Incentive Spirometer

Uses of the Incentive Spirometer (IS)

It is thought that the IS is used to reduce the risk of post-operative pulmonary complications (PPCs) by increasing total lung inflation, tidal volume, and vital capacity.

What Does the Evidence Say?:

• The most current evidence DOES NOT support the use of incentive spirometry for any patient as a first line intervention to prevent or decrease risk of PPCs or improve pulmonary function.
• Other devices such as Threshold®IMT and PEP (Acapella) have shown greater effect in reducing PPCs, hospital LOS, and pulmonary function.
• Early mobilization, Diaphragmatic breathing exercises, and active cycle of breathing have also been shown to decrease risk of PPCs better than IS with no benefit of addition of IS to these interventions.
• Post-CABG and post-abdominal surgeries of all kinds were the primary populations studied with highest level evidence. Moderate level evidence in the same persuasion was given for post-trauma and cancer patients. Current evidence also reports poor compliance with IS performance.
• The IS has not been shown to be effective for patients being treated for COVID-19 (WCPT, 2020 – see resources page)

Is there anyone who can benefit from IS?

• Patients with recent rib fracture(s) until they can tolerate increased intensity of training. – Low Level Evidence
• Pre-operative training for very deconditioned patients until more intense training is tolerated. – Moderate Level Evidence

So what the heck do I do with it?

• Assessment of improvement of vital capacity when used before and after an intervention (i.e. PEP, IMT, diaphragmatic breathing) – Moderate Level
• May help regulate the normal cough mechanism – Low Level Evidence

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Does your hospital issue an IS or an IMT to every patient after an operation? Let me know in the comments!

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References:

• Eltoria, A.E., Szabo, A.L., Antoci, V., Vantetuolo, C.E., Elias, J.A., Daniels, A.H., Hess, D.R. (2017). Clinical Effectiveness of Incentive Spirometry for the Prevention of Pulmonary Complications. Respiratory Care. 65(4). Retrieved from http://rc.rcjournal.com/content/early/2017/12/26/respcare.05679

• Tyson, A.F., Kendig, C.E., Madebi, C. (2015). The Effect of Incentive Spirometry on Postoperative Pulmonary Function Following Laparotomy: A Randomized Clinical Trial. Jama Surgery. 150(3):229-236. doi:10.1001/jamasurg.2014.1846
• Katsura, M., Kuriyama, A., Takeshima, T., Fukuhara, S., Furukawa, T. (2015) Preoperative inspiratory muscle training for postoperative pulmonary complications in adults undergoing cardiac and major abdominal surgery. Cochrane Database of Systematic Reviews. http://doi.org//10/1002/14651858.CD010356.pub2

• de Alvarenga, G. M., Remigio Gamba, H., Elisa Hellman, L., Ganzert Ferrari, V., & Michel de Macedo, R. (2016). Physiotherapy Intervention During Level I of Pulmonary Rehabilitation on Chronic Obstructive Pulmonary Disease: A Systematic Review. The open respiratory medicine journal, 10, 12–19. https://doi.org/10.2174/1874306401610010012
• The WCPT Acute Care COVID-19 Treatment Guidelines. https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-hospitalized-patients.html