Objective: To systematically review the evidence
examining the use of incentive spirometry (IS) for the prevention of
postoperative pulmonary complications (PPCs).
We searched MEDLINE, CINAHL, HealthSTAR, and Current Contents databases
from their inception until June 2000. Key terms included “incentive
spirometry,” “breathing exercises,” “chest physical therapy,”
and “pulmonary complications.” Articles were limited to human
studies in English. A secondary search of the reference lists of all
identified articles also was conducted. A critical appraisal form was
developed to extract and assess information. Each study was reviewed
independently by one of three pairs of group members. The pair then met
to reach consensus before presenting the report to the entire review
group for final agreement.
Results: The search yielded
85 articles. Studies dealing with the use of IS for preventing PPCs
(n = 46) were accepted for systematic review. In 35 of these studies,
we were unable to accept the stated conclusions due to flaws in
methodology. Critical appraisal of the 11 remaining studies indicated
10 studies in which there was no positive short-term effect or
treatment effect of IS following cardiac or abdominal surgery.
The only supportive study reported that IS, deep breathing, and
intermittent positive-pressure breathing were equally more effective
than no treatment in preventing PPCs following abdominal surgery.
Conclusions: Presently, the evidence does not support the
use of IS for decreasing the incidence of PPCs following cardiac or
upper abdominal surgery.