1.Incentive spirometry inspiratory capacity changes and predictors after open heart surgery: a 5-day prospective study
Leela T. Narayanan ; Syed Rasul G. Syed Hamid
The Medical Journal of Malaysia 2020;75(3):226-234
Introduction: Incentive spirometry (IS) is commonly used for
increasing postoperative IS inspiratory capacity (ISIC) after
open heart surgery (OHS). However, little is known about the
serial changes in ISIC and their predictive factors.
Objective: The aim of this study is to identify the
postoperative ISIC changes relative to preoperative ISIC
after OHS, and determine their predictors, including patient
characteristics factors and IS performance parameters such
as inspiration volumes (ISv) and frequencies (ISf).
Methods: This is a prospective study with blinding
procedures involving 95 OHS patients, aged 52.8±11.5 years,
whose ISIC was measured preoperatively (PreopISIC) until
fifth postoperative day (POD), while ISv and ISf monitored
with an electronic device from POD1-POD4. Regression
models were used to identify predictors of POD1 ISIC, POD2-
POD5 ISIC increments, and the odds of attaining PreopISIC
by POD5.
Results: The ISIC reduced to 41% on POD1, increasing
thereafter to 57%, 75%, 91%, and 106% from POD2-POD5
respectively. Higher PreopISIC (B=-0.01) significantly
predicted lower POD1 ISIC, and, together with
hyperlipedemia (B=11.52), which significantly predicted
higher POD1 ISIC, explained 13% of variance. ISv at relative
percentages of PreopISIC from POD1-POD4 (BPOD1=0.60,
BPOD2=0.56, BPOD3=0.49, BPOD4=0.50) significantly predicted
ISIC of subsequent PODs with variances at 23%, 24%, 17%
and 25% respectively, but no association was elicited for ISf.
IS performance findings facilitated proposal of a
postoperative IS therapy target guideline. Higher ISv
(B=0.05) also increased odds of patients recovering to
preoperative ISIC on POD5 while higher PreopISIC (B=-
0.002), pain (B=-0.72) and being of Indian race (B=-1.73)
decreased its odds.
Conclusion: ISv appears integral to IS therapy efficacy after
OHS and the proposed therapy targets need further
verification through randomized controlled trials.