Incentive spirometry for preventing pulmonary complications after coronary artery bypass graft

Freitas ERFS, Soares B, Cardoso JRosa, Atallah ÁN

Published Online:

January 21, 2009

Breathing complications after coronary artery bypass graft (CABG) surgery increase hospital stay and associated healthcare costs. CABG interferes with the lungs, causing sections of it to collapse which may lead to pneumonia. Re-inflating areas of collapsed lung may be done by a device - an incentive spirometer - that reinforces a pattern of breathing which prevents and reverses the process. This device is used alone or in combination with other physiotherapy techniques. We found evidence from four small trials that incentive spirometry offers no advantage over standard postsurgical physical therapy, or preoperative education in preventing breathing complications and pneumonia, improving lung function, or shortening length of hospital stay in patients undergoing coronary artery bypass graft. Bigger and better designed trials are needed to determine if there is any role for incentive spirometry.

Abstract (click to read)

Background:

Following coronary artery bypass graft (CABG), the main causes of postoperative morbidity and mortality are postoperative pulmonary complications, respiratory dysfunction and arterial hypoxemia. Incentive spirometry is a treatment technique that uses a mechanical device (an incentive spirometer) to reduce such pulmonary complications during postoperative care.

Objectives:

To assess the effects of incentive spirometry for preventing postoperative pulmonary complications in adults undergoing CABG.

Search strategy:

We searched CENTRAL on The Cochrane Library (Issue 2, 2004), MEDLINE (1966 to December 2004), EMBASE (1980 to December 2004), LILACS (1982 to December 2004), the Physiotherapy Evidence Database (PEDro) (1980 to December 2004), Allied & Complementary Medicine (AMED) (1985 to December 2004), CINAHL (1982 to December 2004), and the Database of Abstracts of Reviews of Effects (DARE) (1994 to December 2004). References were checked and authors contacted. No language restrictions were applied.

Selection criteria:

Randomized controlled trials comparing incentive spirometry with any type of prophylactic physiotherapy for prevention of postoperative pulmonary complications in adults undergoing CABG.

Data collection and analysis:

Two reviewers independently evaluated the quality of trials using the guidelines of the Cochrane Reviewers' Handbook and extracted data from included trials.

Main results:

Four trials with 443 participants contributed to this review. There was no significant difference in pulmonary complications (atelectasis and pneumonia) between treatment with incentive spirometry and treatment with positive pressure breathing techniques (continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP) and intermittent positive pressure breathing (IPPB)) or preoperative patient education. Patients treated with incentive spirometry had worse pulmonary function and arterial oxygenation compared with positive pressure breathing (CPAP, BiPAP, IPPB).

Authors' conclusions:

Individual small trials suggest that there is no evidence of benefit from incentive spirometry in reducing pulmonary complications and in decreasing the negative effects on pulmonary function in patients undergoing CABG. In view of the modest number of patients studied, methodological shortcomings and poor reporting of the included trials, these results should be interpreted cautiously. An appropriately powered trial of high methodological rigour is needed to determine those patients who may derive benefit from incentive spirometry following CABG.

This record should be cited as:

Freitas ERFS, Soares B, Cardoso JRosa, Atallah ÁN. Incentive spirometry for preventing pulmonary complications after coronary artery bypass graft. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD004466. DOI: 10.1002/14651858.CD004466.pub2

Assessed as up to date:

April 4, 2007

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Primary Review Group:

Heart Group

Health topics:

Heart & circulation > Heart surgery > Heart disease: myocardial ischemia/coronary disease

Heart & circulation > Myocardial ischemia/coronary disease > Surgery

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Incentive spirometry for preventing pulmonary complications after coronary artery bypass graft

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