Deep breathing exercises reduce atelectasis and improve pulmonary function after coronary artery bypass surgery. Incentive spirometry for preventing pulmonary complications after coronary artery bypass graft. The effects of intermittent positive pressure and incentive spirometry in the postoperative of myocardial revascularization. Arq Bras Cardiol ; 89 2 : 94 — Comparison between deep breathing exercises and incentive spirometry after CABG surgery.
Rev Bras Cir Cardiovasc ; 24 2 : — Preoperative use of incentive spirometry does not affect postoperative lung function in bariatric surgery. Transl Res ; 5 : — Effect of preoperative and postoperative incentive spirometry on lung functions after laparoscopic cholecystectomy.
Surg Laparosc Endosc Percutan Tech ; 20 3 : — Vats N. Effect of deep breathing exercises and incentive spirometry in the prevention of postoperative pulmonary complications in the patients of cancer esophagus undergoing esophagectomy. Ind J Physiother Occup Ther ; 3 3 : — Intrapulmonary percussive ventilation versus incentive spirometry for children with neuromuscular disease.
Arch Pediatr Adolesc Med ; 6 : — Kips JC. Preoperative pulmonary evaluation. Acta Clin Belg ; 52 5 : — The effect of abdominal binders on postoperative pulmonary function. Am Surg ; 75 2 : — Postoperative pulmonary complications after gynecologic surgery. Int J Gynaecol Obstet ; 93 1 : 74 — Incentive spirometry to prevent acute pulmonary complications in sickle cell disease.
NEJM ; 11 : — Weindler J , Kiefer RT. The efficacy of postoperative incentive spirometry is influenced by the device-specific imposed work of breathing. Chureemas G , Kovindha A. The use of sustained maximal inspiration SMI to improve respiratory function in spinal cord injury.
J Thai Rehabil ; 2 1 : 20 — Positive expiratory pressure device acceptance by hospitalized children with sickle cell disease is comparable to incentive spirometry. Respir Care ; 50 5 : — Respiratory physiotherapy and incidence of pulmonary complications in off-pump coronary artery bypass graft surgery: an observational follow-up study.
BMC Pulm Med ; 9 : Incentive spirometry with expiratory positive airway pressure reduces pulmonary complications, improves pulmonary function and 6-minute walk distance in patients undergoing coronary artery bypass graft surgery. Am Heart J ; 5 : Incentive spirometry with expiratory positive airway pressure brings benefits after myocardial revascularization. Arq Bras Cardiol ; 94 2 : — Asseessment of tidal volume and thoracoabdomilal motion using volume and flow-oriented incentive spirometer in healthy subjects.
Braz J Med Biology Res ; 38 7 : — Comparison of inspiratory work of breathing through six different spirometers. Respir Care ; 33 10 : — The effect of incentive spirometry on chest expansion and breathing work in patients with chronic obstructive air way disease: comparison of two methods. Chang Gung Med J ; 23 2 : 73 — Diaphragmatic mobility in healthy subjects during incentive spirometry with a flow-oriented device and with a volume-oriented device.
J Bras Pneumol ; 36 6 : — Flow-oriented incentive spirometer versus volume-oriented spirometer training on pulmonary ventilation after upper abdominal surgery. Egypt J Bronchoscopy ; 3 2 : — Respir Care ; 55 6 : — Previous Next. Back to top. They were also instructed to choose only one alternative for each question, except for one of the questions, in which they were informed that more than one answer would be accepted.
The researchers distributed and recollected the self-administered questionnaires from the participants using opaque and sealed envelopes to maintain the confidentiality of the responses and the anonymity of the participants. Descriptive statistics were presented as measure of central tendency mean , variability standard deviation , and frequencies.
The normality of data distribution was verified by the Shapiro-Wilk test. Comparisons between professionals from public versus private institutions were performed using the difference of two independent samples proportions test.
To evaluate bivariate associations between participant characteristics age, time of professional experience, workplace, higher professional degree, and use of scientific literature in English and the number of errors on the questionnaire, the Spearman correlation coefficient was used. The variables that presented correlation to the number of errors on the questionnaire and that were not highly correlated with each other were tested in the model.
The criteria for inclusion were based on p value 18 In the final model, only the variables that were statistically significant remained. The level of significance adopted was p 2 and by the statistical significance. The Statistical Package for the Social Sciences v Two hundred and forty-seven physical therapists were recruited and received a printed copy of the questionnaire.
The age of the participants ranged from 23 to 56 years with a mean of The duration of professional experience working with patients with respiratory dysfunctions ranged from 1 to 33 years, with a mean of 9.
Most of the physical therapists worked in hospitals Table 1 shows the absolute number and frequency of answers concerning IS concepts addressed by the questionnaire. Participants were also divided into two sub-groups according to the institution they work for public or private. Most professionals understand the aims of these devices and correctly instruct patients on their use for both types of IS, however, they do not seem to know the main indications and contraindications for IS.
Distribution of the responses regarding clinical practice concepts. Distribution of the responses regarding the instructions provided to patients for the use of the incentive spirometer. Most physical therapists are aware that the current scientific evidence indicates a superiority of volume-oriented IS compared to flow-oriented IS. A moderate percentage of professionals were aware of the different physiological effects described in the literature for both types of IS.
The majority of professionals access scientific databases only when necessary and always in English. Most physical therapists who did not use scientific literature in English worked in private institutions. Distribution of the responses regarding the evidence-based practice. Twenty-nine percent of the professionals reported the use of all these options and Figure 1 presents the aspects related to the choice of an IS type for the total group and for physical therapists from public and private institutions.
Both IS types are usually found in private hospital and non-hospital institutions, while in a public setting, either for hospital and non-hospital institutions, flow-oriented IS was the most available spirometer. Aspects that influence the selection of an incentive spirometer type. Data were presented in absolute numbers and percentages. Model obtained by regression analysis for the influence of variables on the number of errors on the questionnaire. CI, confidence intervals for coefficients; R 2 , coefficient of determination.
The main results of this study were: 1 Gaps concerning the knowledge of the ISs indications and contraindications were identified for most of the physical therapists who work with patients with respiratory dysfunctions; 2 Volume-oriented IS was preferred by most of the professionals, however, only half of the sample has a scientific background to justify the choice of an IS type over the other; 3 Flow-oriented IS was the most available type in public institutions.
The ISs are therapeutic devices indicated for the improvement of alveolar ventilation and functional residual capacity in conditions of reduced lung compliance. The majority of the physical therapists considered the IS contraindicated for patients with tracheostomy, which is not true and completely possible if an adapter is used. Most of the participants were aware of the superiority of the volume-oriented IS compared to flow-oriented IS, however, only half of the sample knew the differences between the physiological effects of both types of IS reported by the literature.
Previous studies indicate that volume-oriented IS promotes a greater increase of the inspiratory time and a greater decrease of the respiratory rate compared to flow-oriented IS.
Recently, Eltorai et al. The authors highlighted that schools or clinical training at workplaces might be an opportunity to integrate evidence-based care into future practice. Different instructions for the target volume in volume-oriented IS are found in the literature, such as maximal inspirations; 8 , 9 , 22 slow deep inspirations; 24 deep inspirations sustained for 5 to 10 seconds; 14 , 25 slow deep inspirations sustained for 3 seconds; 6 , 26 or for 5 seconds.
The preference for this prescription is probably associated with the recommendation for protective ventilation of mechanically ventilated patients. Different instructions were also found in the literature for the use of the flow-oriented IS: slow deep inspirations; 24 slow deep inspirations sustained for 3 seconds 6 , 26 and for 5 seconds; 11 , 12 , 14 , 27 inspiration with elevation of the three spheres for as long as possible 23 and inspiration with elevation of two spheres. A recent update on why, how, and when to use the IS considers a slow and maximum inspiration followed by an inspiratory pause of 3 to 5 seconds as a mandatory instruction before the use of both types of IS.
This study did not aim to address the effectiveness of the IS through the questionnaire. We have used the questionnaire as a tool to get a picture of the knowledge of physical therapists working with patients with lung dysfunctions regarding topics already well established in the scientific literature, such as the aims, indications, contraindications, and known physiological effects of the IS and the main differences between volume and flow-oriented devices.
Our findings showed that most professionals do not fully understand the correct indications and contraindications of the IS. Therefore, improving professional's awareness about the current scientific evidences and the rationale behind ISs use is a necessary step to lead up to the development of new studies elucidating the role of this resource in clinical practice. Our results have shown that the length of professional experience and the lack of use of scientific literature in English were the main aspects related to errors in the questionnaire.
Therefore, professionals should find strategies to improve reading skills in English to keep up-to-date with the best scientific evidence. There was an increase in the difference between private and public healthcare settings in the s after the implementation of the Brazilian Unified Health System. The lower availability of volume-oriented IS in public institutions is probably due to its four times higher price when compared to the flow-oriented IS.
This study sent questionnaires only to physical therapists working in the city of Belo Horizonte. Thus, the results may not be representative of the entire population of physical therapists if we consider a national spectrum. Further investigation in other regions of the country would provide a broader national portrait, contributing to the external validity of the data. Most of the physical therapists from Minas Gerais who work with patients with respiratory dysfunctions do not fully understand the correct indications and contraindications of ISs.
Physical therapists stated their preference for volume-oriented IS, however, this choice is not necessarily based on the current scientific evidence, because many professionals were not aware of the physiological effects that justify the superiority of the volume-oriented IS compared to flow-oriented IS.
The development of strategies to bring the physical therapists closer to evidence-based practice is a necessary action to guarantee the best care for patients with respiratory dysfunctions.
We are grateful to all the physical therapists who have participated in this study. The funding sources had no role in the design, conduct, or reporting of this study.. Brazilian Journal of Physical Therapy. ISSN: See more Follow us:. Previous article Next article. Issue 5. Pages 01 September More article options. Incentive spirometer: Aspects of the clinical practice of physical therapists from Minas Gerais working with patients with respiratory dysfunction.
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I Accept Show Purposes. Table of Contents View All. Table of Contents. Uses and Benefits. Risks and Complications. Before You Get Started. How to Use. Cleaning Tips. What to Expect From a Spirometry Test. Frequently Asked Questions What is an incentive spirometer?
Learn More: Types of Pulmonary Diseases. Who needs an incentive spirometer? This includes people: Recovering from severe pneumonia With cystic fibrosis or children with cerebral palsy With pulmonary atelectasis collapsed lung With restrictive lung disease With neuromuscular disease or a spinal cord injury that affects lung function Who have undergone lung cancer surgery With COPD who have undergone abdominal or thoracic surgery.
What are the parts of an incentive spirometer? How do you use an incentive spirometer? To use an incentive spirometer: Sit upright. Exhale fully. Put the mouthpiece in your mouth, creating a tight seal with your lips. Inhale slowly so that the flow indicator remains in the middle of the smaller chamber and the piston rises to the level preset by your healthcare provider in the main chamber.
When you have inhaled to your full capacity, remove the mouthpiece. Hold your breath for three to five seconds. Exhale normally. Was this page helpful? Thanks for your feedback! Sign Up. What are your concerns? Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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