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Incentive spirometers are mechanical devices introduced in an attempt to reduce postoperative pulmonary complications. The patient takes a slow deep breath in, with his lips sealed around the mouthpiece (See Fig. below) and is motivated by visual feedback, for example a ball rising to a pre-set marker. The patient aims to generate a predetermined flow or to achieve a pre-set volume and he is encouraged to hold his breath for 2-3 seconds at full inspiration.
A short sharp inspiration can activate the flow-generated incentive spirometer devices with little increase in tidal volume, but with a volume-dependent device an increase in tidal volume must be achieved before the pre-set level can be reached. The pattern of breathing while using an incentive spirometer is important. Expansion of the lower chest should be emphasized rather than the use of the accessory muscles of respiration which would encourage expansion of the upper chest.
After surgery, it may be too painful to take deep breaths. You may also feel too weak to take deep breaths. When you do not breathe deeply enough, this can lead to lung illness.
By using the incentive spirometer every 1 to 2 hours, or as instructed by your nurse or doctor, you can take an active role in your recovery and keep your lungs healthy. [Medline Plus]
Diaphragmatic movement is thought to be an important factor in the prevention of postoperative pulmonary complications. Incentive spirometer has been shown to increase abdominal movement in normal subjects, but not in subjects following abdominal surgery. Postoperatively, an increase in diaphragmatic movement has been observed by encouraging an increase in lung volume while using the pattern of breathing control without the resistive loading of an incentive spirometer. This may help to reduce postoperative pulmonary complications by increasing ventilation to the dependent parts of the lungs.
Incentive spirometer has been compared with intermittent positive pressure breathing (Oikkonen et al 1991), continuous positive airway pressure (Stock et al 1985) and chest physiotherapy (Hall et al 1991, Gosselink et al 1997) in patients following surgery. Few differences between the regimens have been reported. There may be a place for the use of incentive spirometers in children and in some adolescents to provide motivation to increase lung volume following surgery, but the use of breathing control and thoracic expansion exercises with an inspiratory hold should be encouraged, and combined with ambulation may be more effective in the prevention of postoperative pulmonary complications.
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