Study of effectiveness of incentive spirometry adjuvant to diaphragmatic breathing in post abdominal surgery patients

Dr Sucheta Meshram Bhowate

Volume : VIII, Issue : IX, September - 2019

Study of effectiveness of incentive spirometry adjuvant to diaphragmatic breathing in post abdominal surgery patients

Dr Sucheta Meshram Bhowate

Abstract :

Abdominal surgeries are performed routinely for the treatment and diagnosis of many diseases [1]. Postoperative pulmonary complications (PPCs) following abdominal surgery are frequent and are responsible for increased morbidity and mortality as well as length of hospital stay and health-related cost of care [2,3]. Common postoperative pulmonary complications include atelectasis, hypoxaemia, pneumonia, respiratory dysfunction and pleural effusion [4,5]. A basic postoperative complication is a lack of lung inflation which results from a change in eathing to a shallow, monotonous pattern without periodic sighs and temporary diaphragmatic dysfunction, caused by prolonged recumbent position, and impaired mucociliary clearance, along with the decreased cough effectiveness secondary to pain which increases the risks associated with retained pulmonary secretions[ 6]. Incentive spirometry is an inhalation-based prophylactic technique that encourages patients to mimic a natural deep sigh to periodically increase lung volume. As this technique is the prophylactic method of choice for many hospitals, several studies have tested its efficacy.. No single prophylactic technique clearly outperforms all others in preventing pulmonary complications.Hence incentive spirometry along with diaphragmatic exercise is studied to improve the respiratory mechanics in postoperativeperiod in patients who have undergone abdominal surgery. Incentive Spirometer (IS) which has been introduced into clinical practice by RH Bartlett [7]It is a lung expansion technique designed to induce sighing or yawning by making the patient take long, slow deep eaths. It prevents and treats atelectasis in alert patients who have a predisposition for shallow eathing. It is simple and relatively safe method for doing so Spirometry works by encouraging the patient to achieve a pre-set volume or flow. The volume is determined from predicted values or baseline measurements. [8].Many studies proved it to be an effective device to optimize respiratory functions postoperatively .Fewer studies failed to demonstrate incentive spirometry as an single method to improve respiratory indices and prevent pulmonary complications. Why Have the Studies Been Negative? Poor Methodology is important to point out that poor study methodology complicates the ability to interpret studies of IS efficacy[9] A retrospective analysis is done on the patients who have coperated for incentive spirometry and diaphragmatic exercise against those who denied the IS manoevre .25 patients in each group were studied.Group D comprising of patients who performed only diaphragmatic eathing exercise .Group SD comprising of patients performing incentive spirometry as well as diaphragmatic exercise as per designed protocol. . Results & statistical analysis were performed by using SPSS 10 software. The significance level is set at p ≤0.05.The test of paired sample t-test was used to analyze the data. Baseline demographic characteristics of the participant�s age, gender, height, weight, duration of surgery and anaesthesia and co-morbidities are presented in table 1.Demographic data was found statistically insignificant. Based on our study results, the pulmonary function { PEFR} after 6 hrs postoperatively although decreased but the difference in both the group is statistically insignificant.On 1st postoperative day patients showed a significant decrease in respiratory indices of both the groups. This is possibly owing to the fact that in the postoperative period there is shallow, monotonous eathing without periodic sighs and prolonged restraint in bed due to postoperative pain, incision site, analgesics, duration of anaesthesia and surgery, all of which decrease the ventilation to dependent lung regions [10].From second day onwards there was significant difference in PEFR values of D and SDgroup.SD group showed improvement in respiratory functions . Although respiratory function improved in both the groups but the magnitude of improvement is more pronounced in SD group.The possible reason for the improvement in pulmonary function in abdominal surgeries could be the use of incentive spirometry, which is a mechanical device used to encourage patients to take long, slow, sustained deep inspirations which leads to achieving maximal inflating pressure in the alveoli and maximal inhaled volume, and also helps to maintain the patency of the smaller airways. Postoperative hypoxaemia is reduced by using incentive spirometry which provides low-level resistance training to the diaphragm and minimizes fatigue thereby improving inspiratory muscle strength and enhancing lung inflation.Early mobilization reduce the incidence of postoperative pulmonary complications hence early mobilization is promoted in both the groups[20] Conclusion & Recommendations On the basis of the results Of the Study ,We Strongly Recommend The Following:Both Diaphragmatic Breathing Exercise And Incentive Spirometry Together Can Be Recommended Over Diaphragmatic Breathing Exercise Alone As An Intervention For The Improvement Of Pulmonary Function And Prevention Of Complications In The Patients With Abdominal Surgery