Why hospitals continue use incentive spirometry

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I was recently reading that new studies shows that incentive spirometry have not shown to decrease pulmonary complications after cardiac or abdominal surgeries.The studies also revealed that deep breathing and coughing is just as effective as is incentive spirometry.

well I have read this in one of the nursing books.

I have a nursing book that endorses a paste of betadine & sugar as treatment for decubitis ulcers.

Here is a somewhat ugly to read html version of of a power point comparison between the use of IS and T/C/DB (if you have powerpoint installed there is a link at the top for it) from the Univ of OK school of nursing. To summarize, based on a review of multiple studies they couldn't recommend on method over the other. http://webcache.googleusercontent.com/search?q=cache:TZcD4Ixde18J:nursing.ouhsc.edu/Research/documents/ebp_2010/OUTeamTCDBLawes2010.pptx+incentive+spirometry+versus+deep+breathing+post+op&cd=16&hl=en&ct=clnk&gl=us

Here is something from 1990 with a pretty narrow area of application.

http://www.ncbi.nlm.nih.gov/pubmed/2134642

And another meta analysis from 1994

http://www.ncbi.nlm.nih.gov/pubmed/8265725

From my 15 minutes of googling it appears the outcome is the same whichever method is used.

My *personal* observation is that people given an IS and taught to do it are more inclined to work on their pulmonary toilet independently. As a surgical patient I can tell you that IS is a LOT less painful than C&DB even with good splinting and pain control.

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Specializes in Peds/outpatient FP,derm,allergy/private duty.

Along the same lines, when my daughter got a small peak-flow meter for home use and some graph paper, she was more compliant with her med regimen.

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Specializes in Med/Surg, Home Health.

Most patients (and even some nurses) dont know the CORRECT way to use the Incentive Spirometer. Yes, you suck in and pull up the "meter" but you also have to hold DOWN the other ball. There is a BIG difference when you do it the correct way. Ive had to show patients over and over how to do it the right way. While you hold down the other ball, it makes you take deeper breaths and hold it in differently and longer.

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I actually did my research paper last semester on whether or not IS is effective in preventing atelectasis. In the end we concluded that IS isn't as effective as people say/think it is, but further reasearch is needed (isn't it always?) regarding pt compliance, difference between IS machines, etc.

Here's a link to our paper - w/ sources at the end. Make of it what you will.

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Specializes in Med/Surg, Ortho, ASC.

Still waiting for OP to post citations...

"a nursing book I read" is not enough for me to overturn years of practical experience /results.

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Specializes in Tele, ICU, ED, Nurse Instructor,.
Most patients (and even some nurses) dont know the CORRECT way to use the Incentive Spirometer. Yes, you suck in and pull up the "meter" but you also have to hold DOWN the other ball. There is a BIG difference when you do it the correct way. Ive had to show patients over and over how to do it the right way. While you hold down the other ball, it makes you take deeper breaths and hold it in differently and longer.

Where I work, usually the RT teach them.

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Personally, I prefer pinwheels and blowing bubbles. But then again, I do peds. I've got to think though, I bet a little bottle of bubbles is cheaper than an incentive spirometer. :)

yeah, but your hands don't get sticky from a spirometer:jester:

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From my experience IS works wonders. Sometimes when I check my post-op's Q4 hour vs their sats have dropped a bit, but a few times on the incentive and they come right back up and stay up with continued use. Even if coughing and deep breathing are just as effective, I think the INCENTIVE part has a lot to do with it, it's all about feedback. We all love positive feedback!!

Or maybe we still use it because because everyone thinks its funny to listen to us yell "Suck in on it, don't blow!" to a 80 y/o HOH hip replacement :).

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Specializes in Post Anesthesia.

We use IS on every post op patient in CVSICU. From my non-scientific observation- 90% of the patients have no idea how to use an IS and have such poor memory retention post anesthesia- teaching a activity like IS is a waste of time. C/DB- splinting, pain management- will give you 100% better results than IS alone. But IS does no harm- so why not try?

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Yep that is what.

What are you getting at? Out with it already. I cannot find one single piece of literature that states "I.S. doesn't work", and about 500 that says it is effective. This one inparticular: The AARC clinical guidelines for SMI (Do you even know what that means?) http://www.rcjournal.com/cpgs/ispircpg.html] outlines it the best.Me thinks the OP is full of it and has a hidden agenda.

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At my facility, there is a new push to use BiPAP as a lung expansion therapy, which I absolutely cannot stand. The patients hate going on it for a few hours, it's more invasive, there is a big piece of equipment to deal with, and to this day, I don't think anyone has studied this (any one else out there knows, or is seeing this?) These docs seem to be doing their own experiment, I think, and I do NOT think that this in particular works better than IS and generally promoting pulmonary hygeine. But again, not studied (that I am aware of), so who knows.

>>Cripes, why don't they just order IPPB? NIPPV is a VENTILATOR, for Pt's with acute respiratory failure.

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At my facility, there is a new push to use BiPAP as a lung expansion therapy, which I absolutely cannot stand. The patients hate going on it for a few hours, it's more invasive, there is a big piece of equipment to deal with, and to this day, I don't think anyone has studied this (any one else out there knows, or is seeing this?) These docs seem to be doing their own experiment, I think, and I do NOT think that this in particular works better than IS and generally promoting pulmonary hygeine. But again, not studied (that I am aware of), so who knows.

Actually, there have been studies comparing IS to other more "invasive" therapies such as IPPB, CPAP, and BiPAP. Specific to your question, Matte, et al. compared the effects of IS, BiPAP, and CPAP in CABG pts. They found that the BiPAP and CPAP groups began to see improvement in forced expiratory volume, PaO2, and vital capacity before the IS group. Granted this study only followed pts two days post op, so that doesn't mean there was a significant difference in overall outcome or hospitalization time.

(Matte, P., Jacquet, L., Van Dyck, M., & Goene, M. (2002) Effects of conventional physiotherapy, continuous positive airway pressure and non-invasive ventilatory support wtih bilevel positive airway pressure after coronary artery bypass grafting. Acta Anaesthesiol Scand, 44(1), 75-81.) ]

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