The Use of Incentive Spirometry in Cardiopulmonary Physiotherapy

An incentive spirometer is a medical device used to help patients improve the functioning of their lungs. It is beneficial when lung capacity and function are impaired, such as after surgery or during prolonged bed rest. The device consists of a breathing tube, an air chamber, and sometimes a visual indicator to provide feedback and encouragement to the user.

Incentive spirometry is often recommended for patients who have recently undergone surgeries, especially abdominal or chest surgeries, to prevent postoperative pulmonary complications. It is also beneficial for patients with lung diseases like chronic obstructive pulmonary disease (COPD), pneumonia, or asthma, as it helps keep the lungs active and free from fluid accumulation.

Indications

• Any general surgery requiring hospital admission beyond one day

• Prolonged bed rest

• Patients with neuromuscular disease or spinal cord injury

• Children with cerebral palsy

• Rib fractures

• Chronic obstructive pulmonary disease (COPD)

• Video-assisted thoracoscopic surgery (VATS) for lung cancer

• Sickle cell disease

• Ankylosing spondylitis

• Parkinson’s disease

• Mild to moderate asthma

• Cystic fibrosis

• COVID-19

• Idiopathic pulmonary fibrosis

• Interstitial lung disease

• Multiple sclerosis

Contraindications

• Hemoptysis of unknown origin

• Pneumothorax

• Uncontrolled hypertension

• Aneurysm

• Nausea

• Vomiting or pain

• Confusion or dementia

How Does It Work?

The device operates on a simple principle: it encourages the patient to take slow, deep breaths. By inhaling through the device, the patient lifts a piston or ball inside the chamber. This action helps the user gauge their inhalation efforts and encourages them to inhale deeply and slowly, thereby expanding the lungs and improving respiratory muscles.

Does It Help Keep Your Lungs Healthy?

Yes, regular use of an incentive spirometer can have several benefits for lung health. It aids in clearing any accumulation of secretions in the lungs, improves pulmonary function, reduces the risk of atelectasis (collapse of part or all of the lung), and enhances oxygenation. For postoperative patients, it is a vital tool in preventing lung infections like pneumonia.

Are There Any Cons to Using an Incentive Spirometer?

Generally, incentive spirometry is considered safe. However, incorrect use can lead to problems such as hyperventilation, dizziness, or shortness of breath. It is crucial that the device is used as directed by a physiotherapist. Patients with certain conditions like pneumothorax (collapsed lung) should not use the device unless advised by a physiotherapist.

Proper Way to Use an Incentive Spirometer

• Sit or Stand Upright: Proper posture is crucial for effective lung expansion.

• Breathe Out Normally: Before using the device, exhale normally.

• Seal Your Lips Around the Mouthpiece: Ensure a tight seal to prevent air leakage.

• Inhale Slowly and Deeply: Inhale through the mouthpiece, raising the piston or ball in the chamber.

• Hold Your Breath: After a deep inhalation, hold your breath for about 5 seconds, or as instructed, to allow the lungs to fully expand.

• Exhale Slowly: Remove the mouthpiece and exhale normally.

• Repeat: Perform the exercises as prescribed. Incentive spirometry, while seemingly straightforward, plays a significant role in respiratory care, especially in recovery and rehabilitation settings. It empowers patients to actively participate in their healing and lung health maintenance.

Enhancing Healthcare Team Outcomes in Cardiopulmonary Physiotherapy

Postoperative pulmonary complications require extraordinary attention from the entire medical community, as they are a direct cause of morbidity and mortality. The incentive spirometer can be easily used in pulmonary rehabilitation as a tool for inspiratory muscle training to reduce or prevent postoperative pulmonary complications and exercise the lungs. The role of the interprofessional team is critical in evaluating, treating, and managing the care of patients who are indicated to receive pulmonary rehabilitation.

Any medical professional providing bedside care to a patient at risk for pulmonary complications should be educated in inspiratory muscle training and verify that the patient is proficient in using an incentive spirometer. To achieve good outcomes, the goals and objectives of using the incentive spirometer must be defined for optimal patient compliance. An incentive spirometer regimen should include ten workouts per day, used correctly (i.e., inspire up to 500 ml ten times per workout).

Other postoperative interventions to prevent lung complications include oral care, elevating the head of the bed at least 30 degrees, dangling legs on the day of surgery if indicated, transferring multiple times per day when cleared by the surgeon, ambulation, and sitting up for meals. Because incentive spirometry does not require special training, it is every medical professional’s responsibility to address this with the patient.

To improve outcomes in the postoperative setting, the role of nurses and therapists is critical. Nurses will assist the team by monitoring the patient to ensure pain is adequately controlled and communicate with the clinician as needed if any common postoperative complications, such as atelectasis, are suspected. The therapist can assist by preventing prolonged immobilization and encouraging transfers and mobility training when indicated.

Further emphasizing the need for an interprofessional approach to the prevention of pulmonary complications includes meticulous planning and discussion with other professionals involved in managing the patient. Quick and efficient patient training on an incentive spirometer may prevent morbidity, reduce future hospitalizations, and improve outcomes.