Incentive Spirometry

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Incentive Spirometry
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I. S. Introduction

• Also called SMI (sustained maximal inspiration)
• Involves the use of a device that encourages a
  patient to make larger-than-normal inspiratory
  effort and establish a breathing incentive
• Involves pt. mentally and physically and is less
  expensive and usually as effective as IPPB

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Introduction (contd)

• I. S. devices let the patient see their own
  progress
• Results in the generation of increased negative
  transpulmonary pressures increased Vt for the
  primary purpose of opening and stabilizing
  atelectatic areas of the lung against recurrent
  atelectasis

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Indications for I. S.

• Prevention of postoperative complications
• - primary purpose is to help open closed
  alveoli, facilitate the cough reflex, help
  mobilize secretions, and prevent
  hyperventilation.
• Preoperative cleanup, which strengthens
  pulmonary muscles, increases voluntary
  ventilation, improves bronchial toilet
• Psychological support

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Contraindications for I. S.

• Uncooperative or physically disabled pt.
• Patient with mental or CNS disorders
• Patients that are physically unable to generate
  large enough Vt (10-15 ml/kg)

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Hazards and Complications of I.S.

• Hyperventilation may occur if SMI is performed
  too rapidly, without rest periods between deep
  breaths, which may lead to dizziness,
  light-headedness, a tingling sensation in the
  extremities, and possible muscle tremors
• Barotrauma in pt. with emphysematous blebs
• Pulmonary embolism from decrease Ppl

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Procedure for I. S.

• Determine baseline volume expectations
• - use IC to determine max. volume
  predicted IC(M) 0.11(H) - 0.015(A) -
  4.006 IC(F) 0.082(H) - 0.008(A) - 2.637
• If post-op, set realistic, achievable goals
  initially and increase level by 200 ml until pt.
  reaches desired Vt
• Make sure pt. understands proper use of device

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Procedure (contd)

• Stress importance of achieving goals and coughing
  to clear secretions
• Splint surgical incisions
• Noseclips can be used to better facilitate a deep
  breath
• Asses pt., incl. V.S. and chest auscultation
• Explain and demonstrate

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Procedure (contd)

• Proper technique includes having pt. inspire
  slowly and deeply from FRC
• At the end of max. inspir. have pt. do breath
  hold for 5 sec.
• Repeat 6 - 10 times or as prescribed
• Instruct proper cough
• Reassess pt.