Incentive spirometry does not enhance recovery after thoracic surgery Absence of benefit of incentive spirometry in low-risk patients undergoing elective cholecystectomy. A controlled randomized study. Incentive spirometry for tracheostomy and laryngectomy patients. Incentive spirometry versus routine chest physiotherapy for prevention of pulmonary complications after abdominal surgery Influence of incentive spirometry on pulmonary volumes after laparotomy. [Ineffectiveness of incentive spirometry as coadjuvant of conventional physiotherapy for the prevention of postoperative respiratory complications after thoracic and esophageal surgery]. Incentive spirometry to prevent acute pulmonary complications in sickle cell diseases. The Effect of Abdominal Binders on Postoperative Pulmonary Function Comparison of continuous positive airway pressure, incentive spirometry, and conservative therapy after cardiac operations The efficacy of postoperative incentive spirometry is influenced by the device-specific imposed work of breathing. Incentive spirometry decreases respiratory complications following major abdominal surgery. A controlled trial of intermittent positive pressure breathing, incentive spirometry, and deep breathing exercises in preventing pulmonary complications after abdominal surgery. Oesophageal Doppler guided goal-directed haemodynamic therapy in thoracic surgery - a single centre randomized parallel-arm trial A comparative study of IPPB, the incentive spirometer, and blow bottles: the prevention of atelectasis following cardiac surgery. Are maximal inspiratory breathing exercises or incentive spirometry better than early mobilization after cardiopulmonary bypass? Incidence and hospital stay for cardiac and pulmonary complications after abdominal surgery 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. Prevention of respiratory complications after abdominal surgery: a randomised clinical trial Three physiotherapy protocols: effects on pulmonary volumes after cardiac surgery. Short-Term Respiratory Physical Therapy Treatment in the PACU and Influence on Postoperative Lung Function in Obese Adults Mininvasive abdominal aortic surgery. Early recovery and reduced hospitalization after multidisciplinary approach. The effectiveness of incentive spirometry with physical therapy for high-risk patients after coronary artery bypass surgery. Pre-operative inspiratory muscle training preserves postoperative inspiratory muscle strength following major abdominal surgery - a randomised pilot study. Pulmonary function and physical performance outcomes with preoperative physical therapy in upper abdominal surgery: a randomized controlled trial The effect of early mobilization protocols on postoperative outcomes following abdominal and thoracic surgery: A systematic review. Liberal or restrictive fluid administration in fast-track colonic surgery: a randomized, double-blind study. Short-term transcutaneous electrical nerve stimulation after cardiac surgery: effect on pain, pulmonary function and electrical muscle activity.
Objective : To investigate the additional effect of incentive spirometry to chest physiotherapy to prevent postoperative pulmonary complications after thoracic surgery for lung and esophageal resections . Design : R and omized controlled trial . Setting : University hospital , intensive care unit , and surgical department . Patients : Sixty‐seven patients ( age , 59 ± 13 yrs ; forced expiratory volume in 1 sec , 93 % ± 22 % predicted ) undergoing elective thoracic surgery for lung ( n = 40 ) or esophagus ( n = 27 ) resection . Interventions : Physiotherapy ( breathing exercises , huffing , and coughing ) ( PT ) plus incentive spirometry ( IS ) was compared with PT alone . Measurements and Main Results : Lung function , body temperature , chest radiograph , white blood cell count , and number of hospital and intensive care unit days were all measured . Pulmonary function was significantly reduced after surgery ( 55 % of the initial value ) and improved significantly in the postoperative period in both groups . However , no differences were observed in the recovery of pulmonary function between the groups . The overall score of the chest radiograph , based on the presence of atelectasis , was similar in both treatment groups . Eight patients ( 12 % ) ( three patients with lobectomy and five with esophagus resection ) developed a pulmonary complication ( abnormal chest radiograph , elevated body temperature and white blood cell count ) , four in each treatment group . Adding IS to regular PT did not reduce hospital or intensive care unit stay . Conclusions : Pulmonary complications after lung and esophagus surgery were relatively low . The addition of IS to PT did not further reduce pulmonary complications or hospital stay . Although we can not rule out beneficial effects in a subgroup of high‐risk patients , routine use of IS after thoracic surgery seems to be ineffective To determine the potential benefit of incentive spirometry , which has been advocated to prevent pulmonary complications after upper-abdominal surgery , we compared a group of patients receiving incentive spirometry  to another group receiving no specialized postoperative respiratory care . Forty patients in the American Society of Anesthesiologists ' class 1 and 2 who were undergoing cholecystectomy ( through right subcostal incision ) were included in the study and were r and omly allocated to one of the two groups . Patients receiving incentive spirometry were encouraged by a specialized respiratory physiotherapist to breathe deeply for five minutes hourly , 12 times daily , for three postoperative days . No statistically significant difference between the two groups was found in the radiologic evidence of postoperative pulmonary complications , arterial oxygen pressure , spirometric measurement , and clinical evaluation at the second or fourth postoperative day ( or both ) . In particular , deterioration on the chest x-ray film at the fourth postoperative day was observed in eight of 20 patients in the group receiving incentive spirometry and in six of 20 in the control group . Our study confirms the postoperative deterioration of respiratory function after upper-abdominal surgery and demonstrates the lack of therapeutic values of  incentive spirometry  in these patients at low risk for pulmonary complications Sustained maximal inspiration ( incentive spirometry ) is used for the prevention and management of atelectasis in major abdominal and thoracic surgery . Patients with head and neck surgery are predisposed to postoperative disturbances in lung function after extensive surgical resection , immobilization , or significant chest wall deformity from various reconstructive procedures . The patient often requires tracheostomy or permanent laryngeal stoma . A prospect i ve clinical study on patients with major head and neck surgery was conducted to evaluate the use of incentive spirometry to improve postoperative lung function . An adaptor was first design ed to allow patients with tracheostomy tubes to use the spirometers . Parameters studied include vital signs , arterial blood gases ( A-a gradient ) , and pulmonary function test . Significant improvement of lung function and lack of complication warrant the use of incentive spirometry in postoperative head and neck surgery patients We entered 876 patients into a clinical trial aim ed at preventing pulmonary complications after abdominal surgery . Patients either received conventional chest physiotherapy or were encouraged to perform maximal inspiratory manoeuvres for 5 min during each hour while awake , using an incentive spirometer . The incidence of pulmonary complications did not differ significantly between the groups : incentive spirometry 68 of 431 ( 15.8 % , 95 % CI 14.0 - 17.6 % ) , and chest physiotherapy 68 of 445 ( 15.3 % , CI 13.6 - 17.0 % ) . Nor was there a difference between the groups in the incidence of positive clinical signs , pyrexia , abnormal chest radiographs , pathogens in sputum , respiratory failure ( PO2 less than 60 mm Hg ) , or length of stay in hospital . We conclude that prophylactic incentive spirometry and chest physiotherapy are of equivalent clinical efficacy in the general management of patients undergoing abdominal surgery Twenty patients undergoing an upper abdominal procedure were r and omly assigned in two groups . One group was treated with both chest physical therapy and incentive spirometry and the other was treated with chest physical therapy alone .  Spirometric values , respiratory rate , tidal volume and vital capacity were determined during the postoperative course . We observed that patients treated with incentive spirometry bad a faster return to preoperative pulmonary volumes . This observation confirms the prophylactic role of incentive spirometry in the prevention of pulmonary complications after laparotomy We have studied the efficacy of routine use of incentive spirometry ( IS ) in two groups of patients : group 1 ( n = 18 ) with IS , and group 2 ( n = 19 ) , no IS . All patients suffered from lung or esophagus neoplasm and received respiratory physiotherapy before and after the operation . They underwent high chest and abdomen surgery .  The incidence of alterations of pulmonary auscultation , roentgenologic abnormalities and alterations of the alveolar-arterial difference of oxygen ( D[A-a]O2 ) as well as postoperative complications were similar in both groups . Patients undergoing digestive surgery  presented a higher frequency of pleural effusion ( p less than 0.05 ) and of them , the subgroup with IS stayed at the hospital for a longer time ( 47.2 + /- 32 days ) than the subgroup undergoing digestive surgery not su bmi tted to IS ( p less than 0.01 ) probably because of the higher incidence of neoplasms of the mean third of the esophagus in such group . In our study and in the context of the type of surgery studied , the routine use of IS does not decrease the frequency of clinical and roentgenologic alterations neither improves the efficacy of postoperative gas interchange BACKGROUND This study was design ed to determine the incidence of thoracic bone infa rct ion in patients with sickle cell diseases who were hospitalized with acute chest or back pain above the diaphragm and to test the hypothesis that incentive spirometry can decrease the incidence of atelectasis and pulmonary infiltrates . METHODS We conducted a prospect i ve , r and omized trial in 29 patients between 8 and 21 years of age with sickle cell diseases who had 38 episodes of acute chest or back pain above the diaphragm and were hospitalized . Each episode of pain was considered to be an independent event . At each hospitalization , patients with normal or unchanged chest radiographs on admission were r and omly assigned to treatment with spirometry or to a control nonspirometry group . Each patient in the spirometry group took 10 maximal inspirations using an incentive spirometer every two hours between 8 a.m. and 10 p.m. and while awake during the night until the chest pain subsided . A second radiograph was obtained three or more days after admission , or sooner if clinical ly necessary , to determine the incidence of pulmonary complications . Bone scanning was performed no sooner than two days after hospital admission to determine the incidence of thoracic bone infa rct ion . RESULTS The incidence of thoracic bone infa rct ion was 39.5 percent ( 15 of 38 hospitalizations ) . Pulmonary complications ( atelectasis or infiltrates ) developed during only 1 of 19 hospitalizations of patients assigned to the spirometry group , as compared with 8 of 19 hospitalizations of patients in the nonspirometry group ( P = 0.019 ) . Among patients with thoracic bone infa rct ion , no pulmonary complications developed in those assigned to the spirometry group during a total of seven hospitalizations , whereas they developed during five of eight hospitalizations in the nonspirometry group ( P = 0.025 ) . CONCLUSIONS Thoracic bone infa rct ion is common in patients with sickle cell diseases who are hospitalized with acute chest pain .  Incentive spirometry can prevent the pulmonary complications ( atelectasis and infiltrates ) associated with the acute chest syndrome in patients with sickle cell diseases who are hospitalized with chest or back pain above the diaphragm Abdominal binders are ordered by some surgeons postoperatively for patient comfort and to prevent wound complications . There has been some question as to the compressive effect that an abdominal binder has on pulmonary function . We prospect ively r and omized 54 patients undergoing a midline laparotomy incision to two groups : a “ binder ” group and a “ no binder ” group .  Preoperative pulmonary function tests ( vital capacity and incentive spirometry ) were measured . Postoperatively , pulmonary function tests , pulse oximetry , oxygen requirement , pulmonary and wound complications , pain control , time to ambulation , and hospital length of stay were examined . Vital capacity as a per cent of preoperative values on postoperative Day 1 for the binder and nonbinder groups were 64.7 and 54.6 per cent , respectively , but this was not statistically significant . Average level of pain using the visual analog pain scale on postoperative Days 1 through 3 in the binder versus nonbinder groups was 4 versus 8 , 3 vs 6 , and 3 versus 7 , respectively . Time to ambulation was 18.6 hours in the binder group and 16.7 hours in the nonbinder group . Hospital length of stay in the binder and nonbinder groups was 3.9 days and 3.7 days , respectively . We conclude that abdominal binders in our patients with midline abdominal incisions had no significant effect on postoperative pulmonary function , but seemed to help with pain control Of 38 patients undergoing median sternotomy for cardiac operations all developed profound restrictive defects in pulmonary function during the first 72 h after tracheal extubation . Although decreased lung volumes were refractory to correction by vigorous , aggressive pulmonary therapy during this period , frequent and supervised treatment may prevent further deterioration in pulmonary function . The overall incidence of pneumonia was only 3 % ( 1/38 ) . Continuous positive airway pressure delivered by mask proved to be a nearly effortless form of postoperative respiratory therapy that was less painful than incentive spirometry or coughing and deep breathing , and therefore may be preferable STUDY OBJECTIVES The study evaluated the impact of the additional imposed work of breathing ( WBimp ) generated by two different spirometers on postoperative incentive spirometry performance in patients at high risk and moderate risk for postoperative pulmonary complications ( PPCs ) . Additionally , we investigated whether maximal inspiratory pressure ( PImax ) is an easy estimate of the WBimp imposed by incentive spirometers . DESIGN Prospect i ve , r and omized , single-blind clinical trial . SETTING ICU of a university hospital . INTERVENTIONS AND MEASUREMENTS Thirty male patients were assigned to a group at high risk for PPCs ( group A ; inspiratory capacity [ IC ] , < 1.6 L ) or to a group at moderate risk for PPCs ( group B ; IC , 1.6 to 2.5 L ) after upper-abdominal , thoracic , or two-cavity surgery . On the first or second postoperative day WBimp , IC , and PImax were recorded without spirometers ( baseline ) and during incentive spirometry with the Mediflo spirometer ( Medimex ; Hamburg , Germany ) ( high WBimp ) and the Coach spirometer ( Kendall ; Neustadt , Germany ) ( low WBimp ) using a pneumotachograph . In group A , the baseline and the ICs for both spirometers only differed slightly . In group B , the IC was significantly reduced for the Mediflo ( p < 0.05 ) , which imposed a WBimp twice as high as the Coach ( p < 0.01 ) . PImax was significantly increased for both the Mediflo and the Coach ( p < 0.01 ) . PImax was positively correlated with WBimp ( r = 0.8 ) . CONCLUSIONS Incentive spirometers differ considerably in their additional Wbimp with a potential impact on the efficacy of postoperative incentive spirometry performance . PImax might be an easy clinical estimate for the WBimp during incentive spirometry . Incentive spirometers with low WBimp permit increased maximal sustained inspiration and , thus , enhanced incentive spirometry performance , and , therefore , it might be more suitable for use in postoperative respiratory care Pulmonary complications are the leading cause of morbidity and mortality following major abdominal surgery . Chest physiotherapy aims to decrease the likelihood of these complications and hasten recovery . Exercises aim ed at maximising inspiratory effort are the most beneficial for the patients . The incentive spirometer is a h and held device that patients use to achieve effective inspiration . In a nonr and omised pilot study of 263 patients we have found that the addition of the incentive spirometer , as part of an intensive post-operative physiotherapy programme , decreased the occurrence of pulmonary complications ( 6 vs 17 % , p = 0.01 ) and length of stay on the surgical high dependency unit ( 3.1 vs 4 days p = 0.03 ) . The two groups were comparable when age , sex , smoking history , the need for emergency surgery and post-operative analgesia were compared Controversy exists regarding the routine use of aids to lung expansion in the prevention of pulmonary complications after abdominal surgery . We prospect ively r and omized 172 patients into 1 of 4 groups : the  control group ( 44 patients ) received no respiratory treatment  , the IPPB  group ( 45 patients ) received intermittent positive pressure breathing therapy for 15 min 4 times daily , the IS group ( 42 patients ) was treated with incentive spirometry 4 times daily , and the DBE group ( 41 patients ) carried out deep breathing exercises under supervision for 15 min 4 times daily . Roentgenographic changes , observed 24 h after surgery , were comparable in the 4 groups ( 20.5 to 36.6 % ) . Pulmonary complications were defined as the development of 3 or more of 6 new findings : cough , phlegm , dyspnea , chest pain , temperature greater than 38 degrees C , pulse rate more than 100 beats/min . The frequency of development of pulmonary complications was 48 % in the control group , 22 % in the IPPB group ( p less than 0.05 ) , 21 % in the IS group ( p less than 0.05 ) , and 22 % in the DBE group ( p less than 0.05 ) . Side effects of respiratory treatment were observed only in the IPPB group ( 18 % ; p less than 0.05 ) . Hospital stay in patients undergoing upper abdominal surgery was significantly shorter in the IS group ( mean + /- SD , 8.6 + /- 3 days ) than in the control group ( 13 + /- 5 days ) . This difference was not observed for the other 2 treatment groups . ( ABSTRACT TRUNCATED AT 250 WORDS Background Postoperative pulmonary and renal complications are frequent in patients undergoing lung surgery . Hyper- and hypovolaemia may contribute to these complications . We hypothesized that goal -directed haemodynamic management based on oesophageal Doppler monitoring would reduce postoperative pulmonary complications in a r and omized clinical parallel-arm trial . Methods One hundred patients scheduled for thoracic surgery were r and omly assigned to either  st and ard haemodynamic management ( control group ) or goal -directed therapy ( GDT group ) guided by an oesophageal Doppler monitoring-based algorithm . The primary endpoint was postoperative pulmonary complications , including spirometry . Secondary endpoints included haemodynamic variables , renal , cardiac , and neurological complications , and length of hospital stay . The investigator assessing outcomes was blinded to group assignment . Results Forty-eight subjects of each group were analysed . Compared to the control group , fewer subjects in the GDT group developed postoperative pulmonary complications ( 6 vs. 15 patients ; P = 0.047 ) , while spirometry did not differ between groups . Compared to the control group , patients of the GDT group showed higher cardiac index ( 2.9 vs. 2.1 [ l min - 1 m - 2 ] ; P < 0.001 ) and stroke volume index ( 43 vs. 34 [ ml m 2 ] ; P < 0.001 ) during surgery . Renal , cardiac and neurological complications did not differ between groups . Length of hospital stay was shorter in the GDT compared to the control group ( 9 vs. 11 days ; P = 0.005 ) . Conclusions Compared to st and ard haemodynamic management , oesophageal Doppler monitor-guided GDT was associated with fewer postoperative pulmonary complications and a shorter hospital stay . Clinical trial registration . The study was registered in the German Clinical Trials Register ( DRKS 00006961 ) . Following cardiac operations , 145 patients were treated with either intermittent positive-pressure breathing ( IPPB ) , blod bottles , or an incentive spirometer in an attempt to alter the incidence of atelectasis . Pulmonary complications occurred in 30 % of the patients receiving IPPB , 15 % of those using an incentive spirometer , and 8 % of those using blow bottles .  Gastrointestinal side-effects occurred in 20 % of the IPPB group and were rare in other groups . The cost of IPPB is also considerably greater than either incentive spirometry or blow bottles . IPPB is not essential to prevention of atelectasis in postoperative cardiac surgical patients and may be inferior to other methods Forty-nine adults who had undergone cardiopulmonary bypass surgery were r and omly assigned to one of three exercise programs to determine if either maximal inspiratory breathing exercises or incentive spirometry offered a therapeutic advantage over early mobilization alone . After extubation , the patients started their assigned exercise programs . A physical examination and pulmonary function tests were performed preoperatively , at the start of the exercise program , and 24 and 48 hours after the start of the program . The results showed a significant decrease ( approximately 50 % ) in lung volumes but no airflow obstruction in patients who had coronary artery bypass graft . In those patients who had valve replacement , lung volumes fell , and in addition , mild airflow obstruction occurred . A majority of patients had postoperative pulmonary complications . There were no significant differences among the exercise programs in improving lung volumes and airflow or in preventing postoperative complications . We conclude that maximal inspiratory breathing exercises or incentive spirometry , when used in addition to early mobilization , offers no therapeutic advantage over early mobilization alone after cardiopulmonary bypass surgery OBJECTIVE : Internists frequently evaluate preoperative cardiopulmonary risk and comanage cardiac and pulmonary complications , but the comparative incidence and clinical importance of these complications are not clearly delineated . This study evaluated incidence and length of stay for both cardiac and pulmonary complications after  elective laparotomy .  DESIGN : Nested case-control . SETTING : University-affiliated Department of Veterans Affairs Hospital . PATIENTS : Computerized registry of all 2,291 patients undergoing elective abdominal operations from 1982 to 1991.MEASUREMENT AND MAIN RESULTS : Strategy for ascertainment and verification of complications was systematic and explicit . The charts of all 116 patients identified by the registry as having complications and 412 ( 19 % ) r and omly selected from 2,175 remaining patients were review ed to verify presence or absence of cardiac or pulmonary complications , using explicit criteria and independent abstract ion of pre- and postoperative components of charts . From these 528 vali date d cases and controls ( 23 % of the cohort ) , 96 cases and 96 controls were matched by operation type and age within ten years . Hospital and intensive care unit stays were significantly longer ( p<0.0001 ) for the cases than for the controls ( 24.1 vs 10.3 and 5.8 vs 1.5 days , respectively ) . All 19 deaths occurred among the cases . Among the cases , pulmonary complications occurred significantly more often than cardiac complications ( p<0.00001 ) and were associated with significantly longer hospital stays ( 22.7 vs 10.4 days , p=0.001 ) . Combined cardiopulmonary complications occurred among 26 % of the cases . Misclassification-corrected incidence rates for the entire cohort were 9.6 % ( 95 % CI 7.2–12.0 ) for pulmonary and 5.7 % ( 95 % CI 3.8–7.7 ) for cardiac complications . CONCLUSIONS : For noncardiac surgery , previous research has focused on cardiac risk . In this study , pulmonary complications were more frequent , were associated with longer hospital stay , and occurred in combination with cardiac complications in a substantial proportion of cases . These results suggest that further research is needed to fully characterize the clinical epidemiology of postoperative cardiac and pulmonary complications and better guide preoperative risk assessment BACKGROUND The use of the incentive spirometry ( IS ) with expiratory positive airway pressure ( EPAP ) to prevent postoperative pulmonary complications ( PPC ) after coronary artery bypass graft ( CABG ) is not well established . This study sought to determine the effects of IS+EPAP after CABG . METHODS Thirty-four patients undergoing CABG were r and omly assigned to a control group or IS+EPAP group . Maximal respiratory pressures , pulmonary function test , 6-minute walk test and chest x-ray were performed at baseline as well as 1 week and 1 month after CABG . RESULTS Maximal inspiratory pressure was significantly higher in the IS+EPAP group compared to controls at both 1 week and 1 month ( P<.001 ) . Maximal expiratory pressure was significantly higher at 1 month compared to 1 week in IS+EPAP group ( P<.01 ) . At 1 month , forced vital capacity and forced expiratory volume in 1 second was significantly higher in IS+EPAP compared to controls ( P<.05 ) . Inspiratory capacity was higher at 1 month in IS+EPAP group compared to controls ( P<.05 ) . The distance walked in 6-minute walk test was higher at 1 month in IS+EPAP group ( P<.001 ) compared to controls . Lastly , radiological injury score at 1 week was lower in IS+EPAP compared to controls ( P<.004 ) . CONCLUSIONS In patients undergoing CABG , IS+EPAP results in improved pulmonary function and 6-minute walk distance as well as a reduction in PPC Abstract Objective : To evaluate the prevention of respiratory complications after abdominal surgery by a comparison of a global policy of incentive spirometry with a regimen consisting of deep breathing exercises for low risk patients and incentive spirometry plus physiotherapy  for high risk patients . Design : Stratified r and omised trial . Setting : General surgical service of an urban teaching hospital . Patients : 456 patients undergoing abdominal surgery . Patients less than 60 years of age with an American Society of Anesthesia classification of 1 were considered to be at low risk . Outcome measures : Respiratory complications were defined as clinical features consistent with collapse or consolidation , a temperature above 38 ° C , plus either confirmatory chest radiology or positive results on sputum microbiology . We also recorded the time that staff devoted to prophylactic respiratory therapy . Results : There was good baseline equivalence between the groups . The incidence of respiratory complications was 15 % ( 35/231 ) for patients in the incentive spirometry group and 12 % ( 28/225 ) for patients in the mixed therapy group ( P=0.40 ; 95 % confidence interval -3.6 % to 9.0 % ) . It required similar amounts of staff time to provide incentive spirometry and deep breathing exercises for low risk patients . The inclusion of physiotherapy for high risk patients , however , result ed in the utilisation of an extra 30 minutes of staff time per patient . Conclusions : When the use of re sources is taken into account , the most efficient regimen of prophylaxis against respiratory complications after abdominal surgery is deep breathing exercises for low risk patients and incentive spirometry for high risk patients . Key messages Key messages Most postoperative respiratory complications were due to atelectasis : less than 1 % of the patients developed pneumonia An American Society of Anesthesia classification > 1 and an age > /=60 years is a simple way of defining patients at high risk of respiratory complications and other adverse events after abdominal surgery A regimen consisting of deep breathing exercises ( low risk patients ) and incentive spirometry ( high risk patients ) is an efficient way of providing prophylaxis against respiratory complications after abdominal OBJECTIVE To evaluate inspiratory volume in patients undergoing cardiac surgery and to determine the effects that incentive spirometry ( IS ) and the breath stacking ( BS ) technique have on the recovery of FVC in such patients . METHODS A prospect i ve , controlled , r and omized clinical trial involving 35 patients undergoing cardiac surgery at the Hospital de Força Aérea do Galeão ( HFAG , Galeão Air Force Hospital ) , in the city of Rio de Janeiro , Brazil . The patients , all of whom performed mobilization and cough procedures , were r and omly divided into three groups : exercise control ( EC ) , performing only the abovementioned procedures ; IS , performing the abovementioned procedures and instructed to take long breaths using an incentive spirometer ; and BS , performing the abovementioned procedures , together with successive inspiratory efforts using a facial mask coupled to a unidirectional valve . Forced spirometry was carried out in the preoperative period and on postoperative days 1 to 5 . During the maneuvers , inspiratory volume was measured in the IS and BS groups . RESULTS On postoperative day 1 , FVC significantly decreased in all groups ( EC : 87.1 vs. 32.0 % ; IS : 75.3 vs. 29.5 % ; and BS : 81.9 vs. 33.2 % ; p < 0.001 for all ) , as did inspiratory volume in the IS and BS groups ( 2.29 vs. 0.82 L ; and 2.56 vs. 1.34 L , respectively ; p < 0.001 for both ) . Between postoperative days 1 and 5 , FVC partially normalized in all groups ( EC : 32.0 vs. 51.3 % ; IS : 29.5 vs. 46.7 % ; and BS : 33.3 vs. 54.3 % ; p < 0.001 for all ) . During the postoperative period , inspiratory volume was significantly higher in the BS group than in the IS group . CONCLUSIONS The three protocol s were equivalent concerning the recovery of FVC on the first five postoperative days . When compared with IS , the BS technique promoted higher inspiratory volumes in this sample of postoperative cardiac patients Background Even several days after surgery , obese patients exhibit a measureable amount of atelectasis and thus are predisposed to postoperative pulmonary complications . Particularly in ambulatory surgery , rapid recovery of pulmonary function is desired to ensure early discharge of the obese patient . In this study , we wanted to evaluate intensive short-term respiratory physical therapy treatment ( incentive spirometry ) in the postanesthesia care unit ( PACU ) and its impact on pulmonary function in the obese . Methods After ethics committee approval and informed consent , we prospect ively studied 60 obese patients ( BMI 30–40 ) undergoing minor peripheral surgery  , half of which were r and omly assigned to receive  respiratory physiotherapy  during their PACU stay , while the others received routine treatment . Premedication , general anesthesia , and respiratory setting s were st and ardized . We measured arterial oxygen saturation by pulse oximetry on air breathing . Inspiratory and expiratory lung functions were measured preoperatively ( baseline ) and at 10 min , 1 , 2 , 6 , and 24 h after extubation , with the patient supine , in a 30 ° head-up position . The two groups were compared using repeated-measure analysis of variance and t test analysis . Statistical significance was considered to be P < 0.05 . Results There were no differences at the first assessment , but , during the PACU stay , pulmonary function in the physiotherapy group was significantly better than the controls ’ ( p < 0.0001 ) , an effect which persisted for at least 24 h after surgery ( p < 0.009 ) . ConclusionS hort-term respiratory physiotherapy during the PACU stay promotes more rapid recovery of postoperative lung function in the obese during the first 24 AIM Clinical experience in gastrointestinal surgery demonstrated that a multimodal approach can improve the outcome and reduce the length of hospital stay . In this paper we investigate the impact of a multimodal clinical program , based on mininvasive surgery , epidural anesthesia and early feeding and mobilization , on postoperative morbidity and hospitalization after abdominal aortic surgery . METHODS A 2-armed study was design ed . All patients undergoing abdominal aortic surgery between May 2000 and April 2001 were enrolled in a multidisciplinary clinical program including thoracic epidural anesthesia and analgesia , left sub-costal minilaparotomy without evisceration , encouragement to feed and mobilize soon after surgery ( Multidisciplinary group : n=82 ) . For comparison purpose s , a retrospective analysis was conducted using the data of all patients operated on between January and December 1997 , receiving st and ard anesthesia care and a st and ard surgical and nursing program ( St and ard group : n=64 ) . RESULTS In the Multidisciplinary group we observed significantly better pain relief ( p<0.01 ) , earlier restoration of ambulation ( p<0.01 ) , earlier feeding ( p<0.01 ) and passage of stools ( p<0.01 ) . The incidence of complications was significantly lower in the Multidisciplinary group : pulmonary ( 0 % vs 14.1 % ) , cardiac ( 2.4 % vs 9.4 % ) and gastrointestinal ( 0 % vs 10.9 % ) . None of the patients in the Multidisciplinary group required admission to Intensive Care . Median postoperative hospitalization was 3 days in the Multidisciplinary group compared to 9 days in the St and ard group ( p<0.01 ) . CONCLUSION These results suggest that a multidisciplinary intervention with review of the traditional surgical care program would enhance recovery , decrease morbidity and hospitalization after abdominal aortic surgery BACKGROUND AND PURPOSE The purpose of this study was to determine whether the addition of incentive spirometry ( IS ) to postoperative pulmonary physical therapy is more effective than physical therapy alone in reducing postoperative pulmonary complications in high-risk patients after coronary artery bypass grafting ( CABG ) . Patients were given the spirometer and instructed in its use , as often occurs in clinical setting s. SUBJECTS Patients with chronic airflow limitation following CABG ( N = 185 ) participated . METHODS Subjects were r and omly assigned to receive either postoperative pulmonary physical therapy ( breathing exercises , secretion removal , mobility ) or physical therapy combined with IS . RESULTS No difference was found between the two groups in atelectasis , spirometry , oxygen saturation , pulmonary infection , or hospital stay . CONCLUSION AND DISCUSSION Incentive spirometry combined with physical therapy is no more effective than postoperative physical therapy alone in reducing atelectasis for this population . Use of the spirometer , however , was not monitored , and although the study mimicked practice as it often occurs , the effectiveness of the spirometer can not be fully evaluated INTRODUCTION The aim of this pilot study was to assess the effect of pre-operative inspiratory muscle training ( IMT ) on respiratory variables in patients undergoing major abdominal surgery . PATIENTS AND METHODS Respiratory muscle strength ( maximum inspiratory [ MIP ] and expiratory [ MEP ] mouth pressure ) and pulmonary functions were measured at least 2 weeks before surgery in 80 patients awaiting major abdominal surgery . Patients were then allocated r and omly to one of four groups ( Group A , control ; Group B , deep breathing exercises ; Group C , incentive spirometry ; Group D , specific IMT ) . Patients in groups B , C and D were asked to train twice daily , each session lasting 15 min , for at least 2 weeks up to the day before surgery . Outcome measurements were made immediately pre-operatively and postoperatively . RESULTS In groups A , B and C , MIP did not increase from baseline to pre-operative assessment s. In group D , MIP increased from 51.5 cmH(2)O ( median ) pre-training to 68.5 cmH(2)O ( median ) post-training pre-operatively ( P < 0.01 ) . Postoperatively , groups A , B and C showed a fall in MIP from baseline ( P < 0.01 , P < 0.01 ) and P = 0.06 , respectively ) . No such significant reduction in postoperative MIP was seen in group D ( P = 0.36 ) . CONCLUSIONS Pre-operative specific IMT improves MIP pre-operatively and preserves it postoperatively . Further studies are required to establish if this is associated with reduced pulmonary complications Objective : Investigation of the effects of preoperative physical therapy on pulmonary function and physical performance before and after upper abdominal surgery . Design : Non-blind r and omized controlled trial . Setting : Tertiary public hospital and private university , São Paulo state , Brazil . Subjects : Thirty-two patients undergoing abdominal surgery . Interventions : Patients were r and omly assigned to receive physical therapy , with respiratory and global exercises , 2–3 weeks before surgery ( treatment group ; n = 16 ) or await operation without engaging in practicing ( control group ; n = 16 ) . After surgery , a physical therapy protocol was administered to all subjects until the seventh postoperative day . Main measures : Pulmonary function outcome variables were inspiratory and expiratory strength , respiratory muscle endurance and spirometry , and physical performance outcome variables were the functional independence measure and 6-minute walk test distance . Any postoperative pulmonary complications were recorded . Results : There were no between-group differences at r and omization . In the preoperative period , patients in the intervention group had higher inspiratory strength and respiratory muscle endurance than controls ( 88 cmH2O versus 64 cmH2O and 28 cmH2O versus 23 cmH2O , respectively ; P < 0 0.05 ) . On the seventh postoperative day , in addition to inspiratory force and respiratory muscle endurance , the intervention group showed better results than controls in the functional independence measure score ( 118 versus 95 ) and 6-minute walk test distance ( 368.5 m versus 223 m ) , all P < 0 0.05 . Postoperative pulmonary complications occurred in 11 patients in the control group and five in the intervention group ( P = 0.03 ) . Conclusion : Preoperative physical therapy improved pulmonary function and physical performance in the pre- and postoperative periods among patients undergoing upper abdominal surgery BACKGROUND Early mobilization is considered an important element of postoperative care ; however , how best to implement this intervention in clinical practice is unknown . This systematic review summarizes the evidence regarding the impact of specific early mobilization protocol s on postoperative outcomes after abdominal and thoracic surgery . METHOD The review was performed according to PRISMA guidelines . We search ed 8 electronic data bases to identify studies comparing patients receiving a specific protocol of early mobilization to a control group .  Method ologic quality was assessed using the Downs and Black tool . RESULTS Four studies in abdominal surgery ( 3 r and omized controlled trials [ RCTs ] and 1 observational prospect i ve study ) and 4 studies in thoracic surgery ( 3 RCTs and 1 observational retrospective study ) were identified . None of the 5 studies evaluating postoperative complications reported differences between groups . One of 4 studies evaluating duration of stay reported a significant decrease in the intervention group . One of 3 studies evaluating gastrointestinal function reported differences in favor of the intervention group . One of 4 studies evaluating performance-based outcomes reported differences in favor of the intervention group . One of 5 studies evaluating patient-reported outcomes reported differences in favor of the intervention group . Overall method ologic quality was poor . CONCLUSION Few comparative studies have evaluated the impact of early mobilization protocol s on outcomes after abdominal and thoracic surgery . The quality of these studies was poor and results were conflicting . Although bed rest is harmful , there is little available evidence to guide clinicians in effective early mobilization protocol s that increase mobilization and improve outcomes BACKGROUND Evidence -based guidelines on optimal perioperative fluid management have not been established , and recent r and omized trials in major abdominal surgery suggest that large amounts of fluid may increase morbidity and hospital stay . However , no information is available on detailed functional outcomes or with fast-track surgery . Therefore , we investigated the effects of two regimens of intraoperative fluids with physiological recovery as the primary outcome measure after fast-track colonic surgery . METHODS In a double-blind study , 32 ASA I-III patients undergoing elective colonic surgery were r and omized to ' restrictive ' ( Group 1 ) or ' liberal ' ( Group 2 ) perioperative fluid administration .  Fluid algorithms were based on fixed rates of crystalloid infusions and a st and ardized volume of colloid .  Pulmonary function ( spirometry ) was the primary outcome measure , with secondary outcomes of exercise capacity ( submaximal exercise test ) , orthostatic tolerance , cardiovascular hormonal responses , postoperative ileus ( transit of radio-opaque markers ) , postoperative nocturnal hypoxaemia , and overall recovery within a well-defined multimodal , fast-track recovery programme . Hospital stay and complications were also noted . RESULTS ' Restrictive ' ( median 1640 ml , range 935 - 2250 ml ) compared with ' liberal ' fluid administration ( median 5050 ml , range 3563 - 8050 ml ) led to significant improvement in pulmonary function and postoperative hypoxaemia . In contrast , we found significantly reduced concentrations of cardiovascularly active hormones ( renin , aldosterone , and angiotensin II ) in Group 2 . The number of patients with complications was not significantly different between the groups [ 1 ( ' liberal ' group ) [ corrected ] vs 6 ( ' restrictive ' group ) [ corrected ] patients , P = 0.08 ] . CONCLUSIONS A ' restrictive ' [ corrected ] fluid regimen led to a transient improvement in pulmonary function and postoperative hypoxaemia but no other differences in all-over physiological recovery compared with a ' liberal ' [ corrected ] fluid regimen after fast-track colonic surgery . Since morbidity tended to be increased with the ' restrictive ' fluid regimen , future studies should focus on the effect of individualized ' goal -directed ' fluid administration strategies rather than fixed fluid amounts on postoperative outcome This study aim ed to evaluate the effectiveness of transcutaneous electrical nerve stimulation ( TENS ) for treatment of  postoperative pain in patients who underwent cardiac surgery . In addition , we sought to determine whether TENS would be related to improved pulmonary function and muscle electrical activity in this patient population . Forty-five patients , 32 males and 13 females , aged 41 - 74 years were r and omly allocated to receive TENS ( n=23 ) or sham treatment ( n=22 ) during 4 h on the third postoperative day . A 0 - 10 visual analogic scale was used to assess pain ; lung function was evaluated by spirometry and surface electromyography ( n=10 in each group ) was used to quantify electrically-induced muscle activity ( trapezius and pectoralis major ) . TENS was associated with significant reductions on spontaneous and cough-induced postoperative pain as compared to sham ( P<0.05 ) . There was also improvement in chest wall-pulmonary mechanics after TENS with proportional increases in tidal volume and vital capacity ( P<0.05 ) . In addition , electrical activity of both muscle groups was enhanced after TENS , but not post sham ( P<0.05 ) . TENS is a valuable strategy to alleviate postoperative pain following cardiac surgery with positive effects on pulmonary ventilatory function and electrical activity of thoracic and girdle muscles
CONCLUSION There was no evidence to support the use of incentive spirometry in the management of surgical patients .
OBJECTIVE To conduct a systematic review to evaluate the evidence of the use of incentive spirometry ( IS ) for the prevention of postoperative pulmonary complications and for the recovery of pulmonary function in patients undergoing abdominal , cardiac and thoracic surgeries .