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Postoperatively, pulmonary complications require extraordinary attention from the medical community, as they are a direct cause of morbidity and mortality. The incentive spirometer can be easily used in pulmonary rehabilitation as a tool in inspiratory muscle training to reduce or prevent postoperative pulmonary complications and exercise the lungs. This activity reviews the use of the incentive spirometer in inspiratory muscle training and highlights the role of the interprofessional team in evaluating, treating, and managing the care of patients who meet the criteria to receive pulmonary rehabilitation. Objectives: Describe the proper use of an incentive spirometer. Identify indications for incentive spirometry and inspiratory muscle training. Review anatomy and physiology of lungs and diaphragm during inspiration. Outline the clinical significance inspiratory muscle training has on pulmonary complication prevention by an interprofessional team. Access free multiple choice questions on this topic.

An incentive spirometer is a device that measures the volume of the air inhaled into the lungs during inspiration. When breathing in through an incentive spirometer, a piston rises inside the device and measures the volume of the inspired air. The incentive spirometry device is widely used in physical, speech, and respiratory therapy as it encourages the patient to perform a slow and deep inspiration through visual feedback.[1] Breathing in slowly is important with spirometer use as it allows the lungs to stretch and opens the airways, which is intended to imitate the deep breathing seen in yawning or sighing.[2] The incentive spirometer uses visual feedback to assess a patient's inspiratory effort by measuring the inhalation volume. The incentive spirometer can be used in rehabilitation as a favorable tool, as it is inexpensive and easy to manage with no known side effects. It is simple to train and does not require assistance once a patient has learned how to use it properly. Furthermore, the visual feedback encourages patient compliance.[1] The use of the incentive spirometer in inspiratory muscle training has been shown to maintain or increase inhaled lung volume, prevent lung infection after surgery, and improve sputum expectoration. Although research on the effectiveness of incentive spirometry for chronic conditions is mixed, inspiratory muscle training is a vital factor in reducing or preventing postoperative pulmonary complications. Using an incentive spirometer following surgery can help preserve the lungs' integrity and keep the lungs clear. Deep breathing supports the movement of secretions and assists in opening lung spaces that may have become collapsed. Inspiratory muscle training stretches and exercises the lungs, keeping them engaged, especially while recovering from surgery.[2]

Inspiratory muscle training exercises have few complications.  Exercises can be modified through duration and intensity depending on the frailty of the patient. The focus should be on the quality of the slow deep breath with the goal of achieving at least 500 ccs of inspiratory volume for each breath. The patient should be educated on the after-effects that can be caused by deep breathing, such as coughing.[2]

Postoperative pulmonary complications require extraordinary attention from the entire medical community, as they are a direct cause of morbidity and mortality. The incentive spirometer can be easily used in pulmonary rehabilitation as a tool in inspiratory muscle training to reduce or prevent postoperative pulmonary complications and exercise the lungs. The role of the interprofessional team is critical in evaluating, treating, and managing the care of patients who are indicated to receive pulmonary rehabilitation. Any medical professional providing bedside care to a patient at risk for pulmonary complications should be educated in inspiratory muscle training and verify that the patient is proficient in using an incentive spirometer. To derive good outcomes, the goals and objective of using the incentive spirometer must be defined for the patient's compliance to be at the optimal level. An incentive spirometer regimen should include ten workouts per day, used correctly (i.e., inspire up to 500 ml ten times per workout). Other postoperative interventions to prevent lung complications include but are not limited to oral care, elevating the head of the bed at least 30 degrees, dangling legs the day of surgery if indicated, transferring multiple times per day when cleared by the surgeon, ambulation, and sitting up for meals.[6] Because incentive spirometry does not require special training, it is every medical professional's responsibility to address this with the patient. To improve outcomes in the postoperative setting, the role of the nurse and therapist is critical. The nurses will assist the team by monitoring the patient to ensure pain is adequately controlled and communicate with the clinician as needed if any common postoperative complications such as atelectasis are suspected. The therapist can assist by preventing prolonged immobilization and encouraging transfers and mobility training when indicated.[8] Further emphasizing the need for an interprofessional approach to the prevention of pulmonary complications includes the need for meticulous planning and discussion with other professionals involved in managing the patient. Quick and efficient patient training on an incentive spirometer may prevent morbidity, prevent future hospitalizations, and improve outcomes.[6] [Level 1]