Incentive spirometry for prevention of postoperative pulmonary complications in upper abdominal surgery.
BACKGROUND
Upper abdominal surgical procedures are associated with a high risk of postoperative pulmonary complications. The risk and severity of postoperative pulmonary complications can be reduced by the judicious use of therapeutic manoeuvres that increase lung volume. Our objective was to assess the effect of incentive spirometry (IS) compared to no therapy, or physiotherapy including coughing and deep breathing, on all-cause postoperative pulmonary complications and mortality in adult patients admitted for upper abdominal surgery.


OBJECTIVE
To assess the effects of incentive spirometry compared to no such therapy (or other therapy) on all-cause postoperative pulmonary complications (atelectasis, acute respiratory inadequacy) and mortality in adult patients admitted for upper abdominal surgery.


METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2006, Issue 3), MEDLINE, EMBASE, and LILACS (from inception to July 2006). There were no language restrictions.


METHODS
We included randomized controlled trials of incentive spirometry in adult patients admitted for any type of upper abdominal surgery, including patients undergoing laparoscopic procedures.


METHODS
Two authors independently assessed trial quality and extracted data.


RESULTS
We included 11 studies with a total of 1754 participants. Many trials were of only moderate methodological quality and did not report on compliance with the prescribed therapy. Data from only 1160 patients could be included in the meta-analysis. Three trials (120 patients) compared the effects of incentive spirometry with no respiratory treatment. Two trials (194 patients) compared incentive spirometry with deep breathing exercises. Two trials (946 patients) compared incentive spirometry with other chest physiotherapy. All showed no evidence of a statistically significant effect of incentive spirometry. There was no evidence that incentive spirometry is effective in the prevention of pulmonary complications.


CONCLUSIONS
We found no evidence regarding the effectiveness of the use of incentive spirometry for prevention of postoperative pulmonary complications in upper abdominal surgery. This review underlines the urgent need to conduct well-designed trials in this field. There is a case for large randomized trials of high methodological rigour in order to define any benefit from the use of incentive spirometry regarding mortality.
Guimarães
Michele Mf
MM
Department of Aesthetics and Cosmetology, Center of Maringa Higher Education (CESUMAR), Guedner Avenue 1610, Maringá, Paraná, Brazil.
El Dib
Regina
R
Smith
Andrew F
AF
Matos
Delcio
D
D000005:Abdomen / Q000601:surgery*; D000328:Adult; D001982:Bronchial Diseases / Q000517:prevention & control; D006801:Humans; D008171:Lung Diseases / Q000517:prevention & control*; D011014:Pneumonia / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control*; D001261:Pulmonary Atelectasis / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D012131:Respiratory Insufficiency / Q000517:prevention & control; D012138:Respiratory Therapy / Q000379:methods; D013147:Spirometry / Q000379:methods*; D014133:Tracheal Diseases / Q000517:prevention & control