Incentive Spirometry and Deep Breathing Exercise for Improving Respiratory Volume in Preoperative Spine Surgery Patients
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Abstract
Objective: To investigate the effects of incentive spirometry and deep breathing exercises on forced vital capacity (FVC) and chest expansion in preoperative spine surgery patients.
Material & Methods: Fifty-eight patients who were scheduled for spine surgery were recruited from December 2016 to January 2019. Twenty-eight and 30 patients were scheduled for cervical and thoracic/lumbar spine surgery, respectively. All patients were informed of the study protocol, evaluated by a physical therapist, and provided with respiratory training via incentive spirometry and deep breathing exercises. FVC and chest expansion were measured and recorded prior to training, as well as two weeks and four weeks after respiratory training.
Results: In preoperative spine patients, FVC and chest expansion were significantly increased (p<0.05) after respiratory training with incentive spirometry and deep breathing exercises. The FVC in a seated position prior to respiratory training, after 2 weeks of training, and after 4 weeks of training is 2,277.9±599, 2,446.6±614.2, and 2,546.5±591.7 milliliters, respectively. The FVC in the supine position prior to respiratory training, after 2 weeks of training, and after 4 weeks of training is 2,080.2±589, 2,268.3±604.3, and 2,365.9±596.1 milliliters, respectively. Chest expansion in a seated position before respiratory training, after 2-week training, and after 4-week training is 4.2±1.3, 4.6±1.2 and 4.7±1.3 centimeters. Chest expansion in supine position before respiratory training, after 2-week training, and after 4-week training is 3.9±1.2, 4.5±1.3 and 4.5±1.2 centimeters respectively.
Conclusion: Preoperative respiratory training for 2 weeks and 4 weeks using incentive spirometry and conventional deep breathing exercises significantly increased both FVC and chest expansion in patients undergoing spine surgery.
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References
Nielsen PR, Jorgensen LD, Dahl B, Pedersen T, Tonnesen H. Prehabilitation and early rehabilitation after spinal surgery: randomized clinical trial. Clin Rehabil 2010;24:137-48.
Raw DA, Beattie JK, Hunter JM. Anaesthesia for spinal surgery in adults. Br J Anaesth 2003;91:886-904.
Ferguson MK. Preoperative assessment of pulmonary risk. Chest 1999; 115 (5 suppl):58s-63s.
Lee MJ, Konodi MA, Cizik AM, Bransford RJ, Bellabarba C, Chapman JR. Risk factors for medical complication after spine surgery: a multivariate analysis of 1,591 patients. Spine J 2012;12: 197-206.
Mills GH. Respiratory complications of anaesthesia. Anaesthesia 2018; 73 (Suppl1):25-33.
Degani-Costa LH, Faresin SM, Reis Falcão LF. Preoperative evaluation of the patient with pulmonary disease. Braz J Anesthesiol 2014;64:22-34.
Overend TJ, Anderson CM, Lucy SD, Bhatia C, Jonsson BI, Timmermans C. The effect of Incentive Spirometry on postoperative pulmonary complications: a systematic review. Chest 2001;120:971-8.
Lee MJ, Konodi MA, Cizik AM, Weinreich MA, Bransford RJ, Bellabarba C, Chapman J. Risk factors for medical complication after cervical spine surgery: a multivariate analysis of 582 patients. Spine (Phila Pa 1976) 2013;38:223-8.
Zucherman JF, Hsu KY, Hartjen CA, Mehalic TF, Implicito DA, Martin MJ et al. A multicenter, prospective, randomized trial evaluating the X STOP interspinous process decompression system for the treatment of neurogenic intermittent claudication: two-year follow-up results. Spine (Phila Pa 1976) 2005;30:1351-8.
Bernstein DN, Thirukumaran C, Saleh A, Molinari RW, Mesfin A. Complications and readmission after cervical spine surgery in elderly patients: an analysis of 1786 patients. World Neurosurg 2017;103:859-68.
Klein JD, Hey LA, Yu CS, Klein FJ, Coufal FJ, Young EP, et al. Perioperative nutrition and postoperative complications in patient undergoing spinal surgery. Spine (Phila Pa 1976) 1996;21:2676-82.
Roberts SB, Tsirikos AI. Perioperative management of major spinal surgery. Orthop Trauma 2013;27:220-8.
Smetana GW. Preoperative pulmonary evaluation. N Engl J Med 1999; 340:937-44.
Reis RC, Fernandes de Oliveira M, Rotta JM, Botelho RV. Risk of complications in spine surgery: a prospective study. Open Orthop J 2015;9:20-5.
Hartley M, Neubrander J, Repede E. Evidence-based spine preoperative education. Int J Orthop Trauma Nursing 2012;16:65-75.
Kulkarni SR, Fletcher E, McConnell AK, Poskitt KR, Whyman MR. Pre-operative inspiratory muscle training preserves postoperative inspiratory muscle strength following major abdominal surgery – a randomised pilot study. Ann R Coll Surg Engl 2010;92:700-7.
Celli BR, Rodriguez KS, Snider GL. A controlled trial of intermittent positive pressure breathing, Incentive Spirometry, and deep breathing exercises in preventing pulmonary complications after abdominal surgery. Am Rev Respir Dis 1984;130:12-5.
Urell C, Emtner M, Hedenstrom H, Tenling A, Breidenskog M, Westerdahl E. Deep breathing exercises with positive expiratory pressure at a higher rate improve oxygenation in the early period after cardiac surgery - a randomised controlled trial. Eur J of Cardiothorac Surg 2011;40:162-7.
Genc A, Ikiz AO, Guneri EA, Gunerli A. Effect of deep breathing exercises on oxygenation after major head and neck surgery. Otolaryngol Head Neck Surg 2008;139:281-5.
Katz S, Arish N, Rokach A, Zaltzman Y, Marcus EL. The effect of body position on pulmonary function: a systematic review. BMC Pulm Med 2018;18:159.
Alaparthi GK, Augustine AJ, Anand R, Mahale A. Comparison of diaphragmatic breathing exercise, volume and flow Incentive Spirometry, on diaphragm excursion and pulmonary function in patients undergoing laparoscopic surgery: a randomized controlled trial. Minim Invasive Surg 2016; 1967532.
Mehrparvar AH, Sakhvidi MJZ, Mostaghaci M, Davari MH, Hashemi SH, Zare Z. Spirometry values for detecting a restrictive pattern in occupational health settings. Tanaffos 2014;13:27-34.
Johari J, Sharifudin MA, Rahman AA, Omar AS, Abdullah AT, Nor S, et al. Relationship between pulmonary function and degree of spinal deformity, location of apical vertebrae and age among adolescent idiopathic scoliosis patients. Singapore Med J 2016;57:33-8.
Jardins TD and Burton GG. Clinical manifestations and assessment of respiratory disease. 8th ed. Missouri: Elsevier 2020, pp.12-32.
Hawes MC, Brooks WJ. Improved chest expansion in idiopathic scoliosis after intensive, multiple-modality, nonsurgical treatment in an adult. Chest 2001;120:672-4.
Nygren-Bonnier M, Wahman K, Lindholm P, Markstrom A, Westgren N, Klefbeck B. Glossopharyngeal pistoning for lung insufflation in patients with cervical spinal cord injury. Spinal Cord 2009;47:418-22.
Sharma G, Goodwin J. Effect of aging on respiratory system physiology and immunology. Clin Interv Aging 2006;1:253-60
Tomich GM, Franca DC, Diorio ACM, Britto RR, Sampaio RF, Parreira VF. Breathing pattern, thoracoabdominal motion and muscular activity during three breathing exercises. Braz J Med Biol Res 2007;40:1409-17.
Paisani DM, Lunardi AC, Marques da Silva CCB, Porras DC, Tanaka C, Carvalho CRF. Volume rather than flow Incentive Spirometry is effective in improving chest wall expansion and abdominal displacement using optoelectronic plethysmography. Respir Care 2013;58:1360-6.
Blaney F, Sawyer T. Sonographic measurement of diaphragmatic motion after upper abdominal surgery: a comparison of three breathing manoeuvres. Physiother Theory Pract 1997;13:207-15.
Bhat S, Katoch A, Kalsotra L, Chrungoo RK. A prospective comparative trial of post-operative pulmonary function: laparascopic versus open cholecystectomy. JK Science 2007;9:83-86.
Pietak S, Weenig CS, Hickey R, Fairley HB. Anesthetic effects on ventilation in patients with chronic obstructive pulmonary disease. Anesthesiology 1975;42:160-6.
อารินทร์ ผามั่น, ธนศิริ เทพประสิทธิ์, อรอุมา โภคา, ปรีดา นันทากุล. ศึกษาเปรียบเทียบผลของการฝึกหายใจลึกระหว่างการฝึกหายใจโดยใช้กล้ามเนื้อกะบังลมและIncentive Spirometer (TRIFLO II) ต่อสมรรถภาพปอดในพระภิกษุสงฆ์สูงอายุ. ใน: ดร.อัครเดช ศิริพร. โครงการประชุมวิชาการทางกายภาพบำบัดระหว่างสถาบัน ครั้งที่ 4; 3 มิถุนายน 2558; ห้อง 222, 232, 234 อาคารจุฬาพัฒน์ 2 และห้อง 422 อาคารจุฬาพัฒน์ 4 จุฬาลงกรณ์มหาวิทยาลัย; 2558. หน้า 22.
Rehder K. Postural changes in respiratory function. Acta Anaesthesiol Scand 1998;42:13-6.
Katz S, Arish N, Rokach A, Zaltzman Y, Marcus EL. The effect of body position on pulmonary function: a systematic review. BMC Pulm Med 2018;18:159.
Baumgarten MC, Garcia GK, Frantzeski MH, Giacomazzi CM, Lagni VB, Dias AS, Monteiro MB. Pain and pulmonary function in patients submitted to heart surgery via sternotomy. Braz J Cardiovasc Surg 2009;24:497-505.
Renault JA, Costa-Val R, Rosseti MB, Houri NM. Comparison between deep breathing exercises and incentive spirometer after CABG surgery. Rev Bras Cir Cardiovasc 2009;24:165–72.
Restrepo RD. Wettstein R. Wittnebel L. Tracy M. AARC CLINICAL PRACTICE GUIDELINE: INCENTIVE SPIROMETRY: 2011. Respir Care 2011;56:1600-4.