Previous studies have suggested that between 17% and 88% of people having surgery on the upper abdomen will suffer complications that affect their lungs after the operation (postoperative pulmonary complications). The lung volume tends to fall after such surgeries. These complications can be made less likely and less severe with the careful use of treatments designed to encourage breathing in (inspiration) and thus increasing the volume of the lungs, as these volumes tend to fall after such surgeries. Incentive spirometers are mechanical devices developed to help people take long, deep, and slow breaths to increase lung inflation.
We reviewed the evidence about the effect of incentive spirometry (IS), compared to no intervention or other therapy, to prevent postoperative pulmonary complications (for example, pneumonia, fever, death) in people following upper abdominal surgery.
We included adults (aged 18 years and above) admitted for any type of upper abdominal surgery. The evidence is current to August 2013. We found 12 studies with a total of 1834 participants. The maximum period of time that a patient was followed by the doctor was seven days postoperatively. The quality of the included studies was uncertain because of poor reporting in the published articles.
The following results were examined in this review: clinical complications, respiratory failure (that is, inadequate gas exchange by the respiratory system), and pulmonary complications. The results from participants receiving IS were the same as for those receiving either no treatment, deep breathing exercises (DBE) or physiotherapy in the meta-analyses for clinical complications, respiratory failure, and pulmonary complications.
Quality of evidence
Because of poorly conducted studies (results not similar across studies; some issues with study design and; not enough data collected and organized) we ranked the overall quality of the evidence reported in this review as low.
Conclusion and future research
There is low quality evidence showing a lack of effectiveness of incentive spirometry for prevention of postoperative pulmonary complications in patients after upper abdominal surgery. This review underlines the urgent need to conduct well-designed trials in this field.