Reduction in lung volumes after AS promotes PPCs (atelectasis and pneumonia). We studied the effect of incentive spirometry (IS) vs. deep breathing exercises (DBE) on reducing the decline in VC in patients (Pts) undergoing elective lower AS (LAS) for N-MGD.
Pts 18 yrs. and older were randomized to IS or DBE. Slow VC was recorded (Ohmeda 5410, Englewood CO) and Pts were taught IS (Coach 2, DHD Healthcare, Wampsville, NY) or DBE in the preop holding area. Postoperatively, Pts were asked to perform IS or DBE 10 times hourly while awake. VC, occurrence of PPCs, and pain scores were recorded daily by an investigator blind to IS/DBE assignment. Data were analyzed by a repeated measures multivariate analysis of variance model, and correlation analysis. P<.05 was the level of significance for all analyses.
PPCs occurred in 4/119 Pts (3.4%), 2/62 (3.2%) in IS, 2/57 (3.5%) in DBE. Mean VC fell 28% by postop day #1 (POD-1) in IS (n=42), and 22% in DBE (n=38). VC increased 16% and 4% in IS and DBE respectively from POD-1 to POD-2 (p=.02 for IS vs DBE). Changes in VC did not correlate with pain scores in either group.CONCLUSIONS: VC fell significantly in Pts undergoing LAS for N-MGD, but PPCs were infrequent. Decline in VC did not correlate with pain score and is likely due to reflex inhibition of diaphragmatic function. IS may be more effective than DBE in restoring VC to preop levels.
The effect of LAS on lung volumes is considerable but the clinical impact (PPCs) is modest. IS may be more effective than DBE for performing sustained maximal inspiratory maneuvers postoperatively.
S. Shah, None.