Start Date

18-6-2019 9:00 AM

End Date

18-6-2019 10:30 AM

Description

The Efficacy of Incentive Spirometry in Postoperative Pulmonary Complication Prevention:

An Integrative Review

Ziyad Thalji

Background: Both the postoperative pulmonary complications (PPC) of atelectasis and pneumonia increase risk of fatality among postoperative patients. Pulmonary stasis, as the result of surgery, promotes along with the inability to expel secretions and ventilate the parenchyma the potential for multi-drug resistant pathogens for compromised host entry. Post-operative atelectasis risk occurs when there is reduced respiratory muscle activity and strength for inspiration and expiration. The resultant pooling of secretions can promote the growth of pathogens to a common form known as pneumonia. The incentive spirometer (IS) is proposed to increase ventilation of lung parenchymal tissue and promote expelling pooled secretion by building respiratory muscle strength.

Objectives: To conduct an integrative review of the literature (IRL) consisting of the compilation and synthesis of research published studies on the efficacy of PPC prevention of atelectasis and pneumonia by the modality of IS use.

Method: Rates of PPC development among postoperative patients using IS were identified by means of an IRL (Liberati et al., 2009). For the scope of this paper, rates of atelectasis and pneumonia were used to determine PPC rates. The IRL allowed for the identification of the relevant data concerning the research question and recognize a gap in knowledge regarding the efficacy of IS in preventing PPC’s. Data was synthesized, arranged, and evaluated in the following categories: literature search, data evaluation, and data synthesis analysis.

Results: Among the eight selected research articles, common themes were defining PPC development through incidences of atelectasis or pneumonia and using IS as a variable in comparing rates of PPC’s or pulmonary function between control and intervention groups (postoperatively); however, the eight articles were organized by a third theme that fulfilled the research question. This theme being whether IS use was found to reduce rates of PPC’s among the samples. Six studies noted that IS was not effective in preventing PPC development, while two studies observed that IS did prevent PPC development. Chest-physiotherapy (CPT) was found to be cost effective with less PPC and length of stays (p<0.001) when IS was the control group.

Conclusions: Overall, IS use was found in majority of studies (6/8) to be ineffective in the prevention of PPC. One study found that CPT was more effective regarding PPC, hospital costs, and reduced length of stay than IS use. Return to the literature found that research supported IS implementation produces higher costs to health care, with greater than $1 billion in the US annually. The major limitations were found in the examination of the state of the literature that included methodological quality (economic constraints, poor documentation, small sample size, nonrandom trials, IS varied indication as control or intervention, variations in length of time to observe PPC development in patients between studies) and theoretical rigor concerning absence of conceptual frameworks. P-values of 0.05 were used to determine significance with both significant and nonsignificant findings among the eight articles. Future research recommendations: 1) quality studies that address the found limitations of this IRL, 2) intervention studies on intensive CPT as a possible evidence-based practice in comparison with IS with measurement of PPC outcomes in conjunction with cost analysis 3) perceptions of IS among healthcare professionals and 4) other variables such as length of surgeries, co-morbidities, and elevated American Society of Anesthesiologists scores that may be more significant determinants/risk factors of developing a PPC than IS prophylaxis.

Key Words: incentive spirometry, postoperative pulmonary complications, evidence-based practice, prevention, atelectasis, pneumonia

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Jun 18th, 9:00 AM Jun 18th, 10:30 AM

The Efficacy of Incentive Spirometry in Postoperative Pulmonary Complication Prevention: An Integrative Review

The Efficacy of Incentive Spirometry in Postoperative Pulmonary Complication Prevention:

An Integrative Review

Ziyad Thalji

Background: Both the postoperative pulmonary complications (PPC) of atelectasis and pneumonia increase risk of fatality among postoperative patients. Pulmonary stasis, as the result of surgery, promotes along with the inability to expel secretions and ventilate the parenchyma the potential for multi-drug resistant pathogens for compromised host entry. Post-operative atelectasis risk occurs when there is reduced respiratory muscle activity and strength for inspiration and expiration. The resultant pooling of secretions can promote the growth of pathogens to a common form known as pneumonia. The incentive spirometer (IS) is proposed to increase ventilation of lung parenchymal tissue and promote expelling pooled secretion by building respiratory muscle strength.

Objectives: To conduct an integrative review of the literature (IRL) consisting of the compilation and synthesis of research published studies on the efficacy of PPC prevention of atelectasis and pneumonia by the modality of IS use.

Method: Rates of PPC development among postoperative patients using IS were identified by means of an IRL (Liberati et al., 2009). For the scope of this paper, rates of atelectasis and pneumonia were used to determine PPC rates. The IRL allowed for the identification of the relevant data concerning the research question and recognize a gap in knowledge regarding the efficacy of IS in preventing PPC’s. Data was synthesized, arranged, and evaluated in the following categories: literature search, data evaluation, and data synthesis analysis.

Results: Among the eight selected research articles, common themes were defining PPC development through incidences of atelectasis or pneumonia and using IS as a variable in comparing rates of PPC’s or pulmonary function between control and intervention groups (postoperatively); however, the eight articles were organized by a third theme that fulfilled the research question. This theme being whether IS use was found to reduce rates of PPC’s among the samples. Six studies noted that IS was not effective in preventing PPC development, while two studies observed that IS did prevent PPC development. Chest-physiotherapy (CPT) was found to be cost effective with less PPC and length of stays (p<0.001) when IS was the control group.

Conclusions: Overall, IS use was found in majority of studies (6/8) to be ineffective in the prevention of PPC. One study found that CPT was more effective regarding PPC, hospital costs, and reduced length of stay than IS use. Return to the literature found that research supported IS implementation produces higher costs to health care, with greater than $1 billion in the US annually. The major limitations were found in the examination of the state of the literature that included methodological quality (economic constraints, poor documentation, small sample size, nonrandom trials, IS varied indication as control or intervention, variations in length of time to observe PPC development in patients between studies) and theoretical rigor concerning absence of conceptual frameworks. P-values of 0.05 were used to determine significance with both significant and nonsignificant findings among the eight articles. Future research recommendations: 1) quality studies that address the found limitations of this IRL, 2) intervention studies on intensive CPT as a possible evidence-based practice in comparison with IS with measurement of PPC outcomes in conjunction with cost analysis 3) perceptions of IS among healthcare professionals and 4) other variables such as length of surgeries, co-morbidities, and elevated American Society of Anesthesiologists scores that may be more significant determinants/risk factors of developing a PPC than IS prophylaxis.

Key Words: incentive spirometry, postoperative pulmonary complications, evidence-based practice, prevention, atelectasis, pneumonia