Incentive spirometry prescription and inspiratory capacity recovery guideline for the early period after open heart surgery

Abstract

Incentive spirometry (IS) is often used as lung expansion therapy for increasing postoperative IS inspiratory capacity (ISIC) in open heart surgery (OHS) patients. However, currently there is a lack of guidelines and prescription on how this therapy should be administered for these patients. Although there is some information on several patient- and surgery- related factors associated with ISIC volumes after OHS, the role of IS performance variables such as IS inspiration volumes (ISv) and IS inspiration frequency (ISf) has not been investigated. In order to formulate evidence-based IS therapy guidelines and prescription, this study investigated factors, which included ISv and ISf, to identify predictors of ISIC recovery in a cohort of OHS patients in Hospital Sultanah Aminah, Johor Bahru (HSAJB). This study involved collection of objective and precise IS performance data of 95 OHS patients using a newly developed and validated multisensor data collection device (ISDCD) for five consecutive postoperative days (POD). Data analysis identified ISv as the sole predictor of ISIC recovery which explaines 23%, 24%, 17% and 25% of variances for ISIC recovery on POD2, POD3, POD4 and POD5 respectively. Three pathways for postoperative ISIC recovery were also identified, namely for patients following the fastest pathway having the highest ISIC recovery rate of 19% for each POD, followed by 16% for the middle pathway and 12% for slowest. The findings facilitated the formulation of evidence-based IS therapy prescription and ISIC recovery guidelines from POD1 to POD4. However, these findings need to be verified further through research involving comprehensive and objective evaluation of IS performance using appropriate technology devices.