Chest
Volume 89, Issue 5, May 1986, Pages 652-656
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Clinical Investigations
Absence of Benefit of Incentive Spirometry in Low-Risk Patients Undergoing Elective Cholecystectomy: A Controlled Randomized Study

https://doi.org/10.1378/chest.89.5.652Get rights and content

To determine the potential benefit of incentive spirometry, which has been advocated to prevent pulmonary complications after upper-abdominal surgery, we compared a group of patients receiving incentive spirometry to another group receiving no specialized postoperative respiratory care. Forty patients in the American Society of Anesthesiologists’ class 1 and 2 who were undergoing cholecystectomy (through right subcostal incision) were included in the study and were randomly allocated to one of the two groups. Patients receiving incentive spirometry were encouraged by a specialized respiratory physiotherapist to breathe deeply for five minutes hourly, 12 times daily, for three postoperative days. No statistically significant difference between the two groups was found in the radiologic evidence of postoperative pulmonary complications, arterial oxygen pressure, spirometric measurement, and clinical evaluation at the second or fourth postoperative day (or both). In particular, deterioration on the chest x-ray film at the fourth postoperative day was observed in eight of 20 patients in the group receiving incentive spirometry and in six of 20 in the control group. Our study confirms the postoperative deterioration of respiratory function after upper-abdominal surgery and demonstrates the lack of therapeutic values of incentive spirometry in these patients at low risk for pulmonary complications.

Section snippets

Materials and Methods

Forty patients in the American Society of Anesthesiologists’ class 1 and 2 who were undergoing elective cholecystectomy through right subcostal incision agreed after informed consent to participate in the study, which was approved by the committee of ethics of our institution. Patients with a ratio of weight to height greater than 0.45 were excluded from the study, as were patients over 65 years of age and those with an acute infection.

The patients were randomly assigned to one of the following

Results

The physical and clinical characteristics of the patients in the two groups were similar, as indicated in Table 1. The majority of the patients in both groups were middle-aged women. Anesthesia lasted less than three hours in the majority of patients in both groups (18 of 20 in either group). All patients received a similar dose of minor analgesics, and the number of patients, (nine in the control group and ten in the group receiving incentive spirometry) requiring meperidine and the average

Discussion

Our study confirms the high incidence of postoperative pulmonary complications after upper-abdominal surgery, which in the literature was found to be in the range of 30 to 70 percent.7, 14, 15, 16 Our study also confirms the important decrease in PaO2 after upper-abdominal surgery associated with the greatest measured depression in FVC which occurred on the second postoperative day, as noted in other studies.6, 8, 17

Nevertheless, comparison between the two groups revealed no significant

ACKNOWLEDGMENTS

We thank the staff of physiotherapists, Mrs. E. Agrebi for her secretarial work, and Mr. D. Robertson for his excellent technical assistance.

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    Manuscript received July 24, revision accepted November 4.

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