Why do hospitals continue use the incentive spirometer?

RainMom · Aug 6, 2015

This made me laugh...and it made me sad. Teaching how to use it and encouraging (i.e. nagging...I'm good at that with the IS) at each round is important. :)

Me too! I cringe when I find it on the window shelf or in the closet. Our total joint replacement pts have the option to attend a class prior to surgery for education & Q/A time. They receive their IS at the class & learn how to use it then. However, while most of them bring it when they come in for surgery, it ends up forgotten in the suitcase. RT typically doesn't review with the pt (since they already received education) & unless the nurse is on top of things, it gets overlooked....until someone like me comes along, lol.

dudette10, MSN, RN · Aug 6, 2015

Me too! I cringe when I find it on the window shelf or in the closet. Our total joint replacement pts have the option to attend a class prior to surgery for education & Q/A time. They receive their IS at the class & learn how to use it then. However, while most of them bring it when they come in for surgery, it ends up forgotten in the suitcase. RT typically doesn't review with the pt (since they already received education) & unless the nurse is on top of things, it gets overlooked....until someone like me comes along, lol.

You are my nursing soul sister. I love the patient teaching aspect of our job, and I jokingly refer to myself as "Nurse Nag" with patients re: deep breathing/IS, ambulation/mobility (when medically appropriate), and self-advocacy.

mmc51264, BSN, MSN, RN · Aug 6, 2015

Ortho nurse here and we strongly encourage the use of them. I have seen them help with a fever on many occasions. You won't find many rooms on my unit where there isn't one and close-by and encouraged. I don't know about other types of sx, but joints, we use them.

Oceanpacific · Aug 6, 2015

I could believe that many people don't use the IS and therefore it may SEEM like IS is not effective. However I think a study of people who actually use the IS and can demonstrate their compliance would likely show great benefit when compared to a group of non-users. I agree that the study is of poor quality.

Which reminds me....once I read a study that said that obese women actively under report their weight. As proof of this they compared the weight noted on a woman's driver's license with her actual weight. The actual weight was often much higher than the weight on the license. I wanted to scream. In my state, a drivers license is good for over 10 years and the renewal, good for another 10 years comes with the weight already filled in. So, it frustrates me when people read a study and don't think about the kinds of bias and confounding factors that make some studies worthless.

Karou · Aug 6, 2015

I have seen patients improve by using their incentive spirometers appropriately. The key in that is correct technique and frequency.

Many nurses don't take the time to thoroughly educate patients in its importance or watch for a good return demonstration by the patient. Then the patient ends up with a plastic decoration at their bedside table. I had a precious patient last night call me into the room at shift change, very confused expression on his face, blowing into his IS. He said it was broke, the meter wasn't rising. I gave him credit for trying at least

Patients need to be encouraged and nagged to use it. It's vital they know how to do it correctly- good effort, positioning, frequency, repetition, coughing... I have truly seen improvement in oxygen saturation, lung expansion, and basilar crackles with correct and persistent use.

I am sorry, but one study won't change my opinion of its effectiveness when I have seen it working on my patients. Now, if many studies start debunking it and there is enough evidence to support that claim, then I am willing to listen.

Ruby Vee, BSN · Aug 6, 2015

If we didn't use I/S, how could we have those charming interactions with older folks who may be somewhat hard of hearing. You know, the ones that go "SUCK, Mrs. Jones. SUCK! Don't blow, SUCK!"

MunoRN, RN · Aug 6, 2015

It's not just a single study, Cochrane Collaboration looked at 12 different studies involving more than 1800 patients and found no apparent benefit, although they deemed the overall power of the studies to be "low". So to answer the question as to why we use them in the hospital, there isn't sufficient evidence to definitively say they provide no benefit so we still use them, but just as with every intervention we provide we should have a good understanding of what actual benefit they provide, which may not be much in the case of IS. And while I get that it "seems like" they do a lot, the whole purpose of obtaining reliable evidence is that what "seems like" it works often does nothing in reality.

Farawyn · Aug 7, 2015

It's not just a single study, Cochrane Collaboration looked at 12 different studies involving more than 1800 patients and found no apparent benefit, although they deemed the overall power of the studies to be "low". So to answer the question as to why we use them in the hospital, there isn't sufficient evidence to definitively say they provide no benefit so we still use them, but just as with every intervention we provide we should have a good understanding of what actual benefit they provide, which may not be much in the case of IS. And while I get that it "seems like" they do a lot, the whole purpose of obtaining reliable evidence is that what "seems like" it works often does nothing in reality.

Meh. I've seen it help turn the corner for post op cardio patients, if done correctly.

Then again, I believe in the power of the Q word, so what do I know?

BuckyBadgerRN, ASN, RN · Aug 7, 2015

Another new account making an outlandish, unsupported claim and then disappearing. What is the appeal of this?

In 2001 a group of researchers collected the entire database of studies regarding the incentive spirometer, and they concluded that "the evidence does not support the use of incentive spirometry for decreasing the incidence of postoperative pulmonary complications following cardiac or upper abdominal surgery." In other words, it's not effective as people think it is. Why do hospitals continue use incentive spirometry?

OCNRN63, RN · Aug 7, 2015

Meh. I've seen it help turn the corner for post op cardio patients, if done correctly.
Then again, I believe in the power of the Q word, so what do I know?

Are you kidding? I don't even use any word that need that letter!

Dogen · Aug 7, 2015

It's not just a single study, Cochrane Collaboration looked at 12 different studies involving more than 1800 patients and found no apparent benefit, although they deemed the overall power of the studies to be "low". So to answer the question as to why we use them in the hospital, there isn't sufficient evidence to definitively say they provide no benefit so we still use them, but just as with every intervention we provide we should have a good understanding of what actual benefit they provide, which may not be much in the case of IS. And while I get that it "seems like" they do a lot, the whole purpose of obtaining reliable evidence is that what "seems like" it works often does nothing in reality.

You made me curious, so I searched the Cochrane database for incentive spirometry and found two relevant meta-analyses, one for upper abdominal surgery (which seems like the one you found) and another for pulmonary complications after CABG. The CABG article analyzed seven RCTs and 592 patients, and the authors report, "Due to the lack of sufficient quality evidence, we still cannot make definitive statements about the effectiveness of IS for the prevention of pulmonary complications after CABG. Most studies were small and did not detect significant differences between groups."

Small n strikes again.

Farawyn · Aug 7, 2015

Are you kidding? I don't even use any word that need that letter!

Me neither!