Incentive Spirometry

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Incentive Spirometry
It is one of the ways to deliver lung expansion.
It helps to increase the trans-pulmonary pressure.
It mimics the natural sighing.
It is performed using devices that provides visual feedback.
The basic maneuverer of incentive spirometry is Sustained Maximal Inspiration (SMI.
SMI is a slow deep inspiration from Functional Residual Capacity (FRC) upto
Total Lung Capacity (TLC)followed by a 5-10 second breath hold.
So as the trans pulmonary pressure increases, lung expansion increases.

Indication

Presence of atelectasis
Presence of condition predisposing to atelectasis like upper abdominal surgeries, Thoracic surgeries etc..
In case of restrictive lung disease associated with quadriplegia, diaphragmatic dysfunction etc...
In post-operative period to monitor lung function.

Contraindication
Unconscious or uncooperative patient.
Patient unable to take deep breaths.

Complications
Acute respiratory alkalosis due to two rapid respiration
Signs of dizziness and numbness around the mouth
Pulmonary baro-trauma
Exacerbation of bronchospasm
Fatigue
Hyperventilation

Equipments used
They are simple, portable, and inexpensive.
they are categorized into 2.

Flow oriented
  It measures and visually indicates the inspiratory flow.  The vloume can be indirectly measured as
Volume = Flow X Time


Volume oriented
Measures and visually indicates the volume achieved. It uses bellows that rises according to inspired volume.

Administering the Incentive Spirometry
The application involves 3 phases

Planning
Implementation
Follow up

Planning:
It involves the assessment therapeutic outcomes selected at this phase.

Implementation:
The patient teaching has to be effective. the patient is positioned in a comfortable manner.  The patient is instructed to inspire slowly and deeply.  Initially the good set should be moderate.
The shoulders and upper chest should be relaxed and diaphragmatic breathing should be encouraged.
At the end of maximal inspiration, ask the patient to sustain it for 5-10 seconds.
A normal exhalation follows.
Give rest as long as needed.
Repetition 5-10 SMI/hour

Follow Up:
It includes re-assessment
Supervised till the patient masters the correct technique
Establish new and increasing inspiration volume each day.

Outcomes of Incentive Spirometry:
Absence or improvement of signs of atelectasis
Decrease in Respiratory rate (if it is increased)
normal pulse rate
Resolution of abnormal breath sounds
Improved chest radiography
Increased PaO2 and decrease PaCO2.
Increase SpO2
increased vital capacity and PEFR (Peak Expiratory flow rate)
Improved cough
Increased FVC