I wish I still had the sense of wonder that my puppy has – instead as I grow older, many things just start feeling ‘sus’. When I first saw an Incentive Spirometer (IS) it sure looked like a scam to me ! Younger patients often say it looks like a bong 🤣 while elder ones feel it’s useless & gimmicky. Of course these days you see a lot more modern / sleeker designs including ones that come with phone apps.
Believe it or not, this device was made after postulating that post-op yawning confered some benefits to patients (we take in a deep breath during a yawn). The main stated benefit of Incentive Spirometry is prevention of post-op pneumonias, atelectasis, hypoxia, avoiding need for ventilation,reducing ICU stay, and improving overall mortality, etc. The myriad of studies done however were not structured well, lack standardization (use 10 times a day or 10 times an hour ?? 🤔 ; volume goal of 1500 cc or 2500 cc ? , etc. ) or confounded due to other things like activity with similar benefits. This wonderful summary paper published in 2018 did a mother of all reviews ! – a comprehensive review of reviews and found all the vast evidence was’t good enough. It concluded “Perhaps IS is not effective” but concedes that bad studies, lack of standards & poor patient compliance stand in the way to demonstrate utility. A study in 2019 showed less lung complications after rib fractures, An outpatient study showed 16% increase in lung inspiration volumes in patients underoing physical therapy, but did not have a control group to compare and since early ambulation , therapies can also make you breath deeper, so cannot say if IS use contributed.
That being said, as a hospitalist, it’s use makes logical sense, is cheap, it makes them cough & expectorate more, deep breathing reduces anxiety and gives patients something harmless to do, makes them sit up more to use it. I ask to aim for the 2500 cc mark (“if you aim for the stars, you can hope to reach the clouds”). Advise holding breath for 4 seconds before exhaling. I advise them to post-op & trauma patients, hypoxic patients , stroke & deconditioned patients.
A large barrier to my patients using it is that they simply forget to use it, their minds have ‘bigger fish to fry’. Indeed a study that used a reminder device or using bedside nurses to remind them found improved compliance and lower post-op complications after cardiac surgery. Maybe an app reminder on their phones or patient TVs might help ?I seek family help for reminders for example “hey Julie, your job today is to play boss & remind Greg to use this device couple times each times on every commericial break on TV !!”
âš p.s. : Note a small warning of using IS in patients with severe emphysema.
