title: Effectiveness of incentive spirometry in patients following thoracotomy and lung resection including those at high risk for developing pulmonary complications.
abstract: BACKGROUND
  Following thoracotomy, patients frequently receive routine respiratory physiotherapy which may include incentive spirometry, a breathing technique characterised by deep breathing performed through a device offering visual feedback. This type of physiotherapy is recommended and considered important in the care of thoracic surgery patients, but high quality evidence for specific interventions such as incentive spirometry remains lacking.
  
  
  METHODS
  180 patients undergoing thoracotomy and lung resection participated in a prospective single-blind randomised controlled trial. All patients received postoperative breathing exercises, airway clearance and early mobilisation; the control group performed thoracic expansion exercises and the intervention group performed incentive spirometry.
  
  
  RESULTS
  No difference was observed between the intervention and control groups in the mean drop in forced expiratory volume in 1 s on postoperative day 4 (40% vs 41%, 95% CI -5.3% to 4.2%, p=0.817), the frequency of postoperative pulmonary complications (PPC) (12.5% vs 15%, 95% CI -7.9% to 12.9%, p=0.803) or in any other secondary outcome measure. A high-risk subgroup (defined by ≥2 independent risk factors; age ≥75 years, American Society of Anaesthesiologists score ≥3, chronic obstructive pulmonary disease (COPD), smoking status, body mass index ≥30) also demonstrated no difference in outcomes, although a larger difference in the frequency of PPC was observed (14% vs 23%) with 95% CIs indicating possible benefit of intervention (-7.4% to 2.6%).
  
  
  CONCLUSIONS
  Incentive spirometry did not improve overall recovery of lung function, frequency of PPC or length of stay. For patients at higher risk for the development of PPC, in particular those with COPD or current/recent ex-smokers, there were larger observed actual differences in the frequency of PPC in favour of the intervention, indicating that investigations regarding the physiotherapy management of these patients need to be developed further.
authors: Department of Physiotherapy, Heartlands Hospital, Birmingham, UK. paula.agostini@heartofengland.nhs.uk
authors: Paula
authors: P
authors: Agostini
authors: Babu
authors: B
authors: Naidu
authors: Hayley
authors: H
authors: Cieslik
authors: Richard
authors: R
authors: Steyn
authors: Pala Babu
authors: PB
authors: Rajesh
authors: Ehab
authors: E
authors: Bishay
authors: Maninder Singh
authors: MS
authors: Kalkat
authors: Sally
authors: S
authors: Singh
mesh_terms: D000368:Aged; D001945:Breathing Exercises; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006801:Humans; D008175:Lung Neoplasms / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D008297:Male; D011013:Pneumonectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D011446:Prospective Studies; D001261:Pulmonary Atelectasis / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D016037:Single-Blind Method; D013147:Spirometry / Q000379:methods*; D013908:Thoracotomy / Q000009:adverse effects*; D006113:United Kingdom / Q000453:epidemiology
keywords: Equipment Evaluations; Lung Cancer; Respiratory Infection; Thoracic Surgery