After any general anesthetic (specifically those provided for surgeries in the thoracic or upper abdominal compartments), physical activity and nutrition are crucial to promote recovery. In the ICU in particular, many patients receive incentive spirometers (IS) to facilitate “pulmonary hygiene” – a series of interventions to exercise the lungs, decrease atelectasis, mobilize secretions, and improve gas exchange. It’s used in combination with early ambulation, oral hygiene, elevating the head of the bed, etc. to reduce postoperative pulmonary complications although the benefit versus deep breathing exercises remains equivocal.
I like IS because it empowers patients to independently perform a goal-directed task with visual feedback (goal marker) showing day-to-day progress and motivation to “beat their record.” Families/caretakers at the bedside also help spur patients along to meet preset goals.
To properly use IS, one should sit up straight and hold the device upright. Keeping the flow indicator in the “better” or “best” position, inhale slowly and deeply followed by exhalation allowing the piston to return to 0. I usually have my patients repeat this ten times per hour but have them slow down if they feel light-headed.
As a side point, it’s important to provide appropriate analgesia before aggressive pulmonary recruitment. Pain can result in splinting which detracts from the benefits of deep breathing (ie, why would a patient use IS if it hurts?) Control pain and remove triggers (ie, chest tubes) whenever feasible!
Drop me a comment with your thoughts on IS!