Incentive Spirometry

[eshakalra]

We use incentive spirometer for sustained maximum inhalation. There is a general trend to use the device held upside down for expiration too. Can anyone help out by posting the link to any research realting to that or just discuss the logic behind its usage in such away.

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[alophysio]

Hi,

Just a disclaimer - i am a neuromusculoskeletal physio, not a cardioresp physio...

But i think the theory behind the upside down usage is that to blow and hold one or two balls up (triflo incentive spirometer), then you will need to have taken a deep breath to begin with.

Some people find the inhalation difficult and so can't do even one ball up. To encourage the patients by giving them an achievment, again * i think *, you turn the spirometer upside down.

THerefore, upside down is a level lower than one ball up during inhalation.

Obviosuly, the ideal is for nice, equal, lateral basal expansion but i guess anything deeper than what they are doing is better than nothing.

I hope that helps. I haven't looked for any research to back up my claims i am afraid...just personal experience.

[eshakalra]

thanx..ya dat has helped a bit to alleviate my query..

[Bala jeya perumal]

its helps me also

[katana]

the use of the spirometery upside down to do expiratory breathing exercise,
which is mainly used in COPD, it will give the patient some feed back about their force of blowing
i hope that helps

[psychophysio]

I never knew you could turn them upside down and blow into them! I will try and find one at work tomorrow and give it a go....

[mitmat75]

Using the spirometer for expiration is not a good idea come whatever the indication or condition
Expiratory flows of higher speeds will only promote airway collapse and do not help at all in complete alveolar emptying.

[chiku]

Am totally agreed with mitmat75, high flow expiration can lead to alveolar collapse especially for asmatic pt.

[alophysio]

Hi,

I agree that it can cause the issues you raise.

However, when would you give an asthmatic person incentive spirometry anyway?

For an acute, post abdominal surgery, with decreased basal exapnsion and LOTS of pain, anything that increases their inspiration is going to help.

To give the patient some sort of incentive to inspire more, you get them to exhale more completely. Then they will automatically breathe in a little more than before.

It is not rocket science - try it yourself - breathe out slowly (not forcefully) - it makes you want to take in a bigger breath than your normal tidal volume right?

We are all physios - i trust that we all can use our common sense and not give this to people in whom it is inappropriate.

In any case, just get the patient to get up for a walk and even do some stairs - that will get the resp rate increasing!

[sdkashif]

The process of increasing the strength and endurance of the muscles of breathing is called ventilatory muscle training. This technique usually focuses on the muscles of inspiration. VTM has been used in the treatment of patients with a variety of acute and chronic pulmonary disorders associated with weakness, atrophy, or insufficiency of the muscles of inspiration, specifically diaphragm and external intercostals. It has been suggested that principles of overload and specificity of training apply to skeletal muscles throughout the body, including the muscles of ventilation.

Three forms of ventilatory muscle training involve following:

Weight training to strengthen the diaphragm
Inspiratory resistance training
Incentive respiratory spirometry


Incentive spirometry is a form of low level resistance training that emphasizes sustained maximal inspiration. A synonymous term is sustained maximal inspiratory maneuver, which is performed with or without a spirometre. The patient inhales through the a spirometre that provided visual or auditory feedback as the patient breathes in as deeply as possible.Incentive spirometry increases the volume of air inspired and has been used to prevent alveolar collapse in postoperative conditions and to strengthen weak inspiratory muscles in patients with neuromuscular disorders.

Procedure for Incentive respiratory spirometry:

Place the patient in a comfortable position (Supine or semiupright).
Have the patient take three to four slow easy breaths.
Have the patient maximally exhale with the fourth breath.
Then have the patient place the spirometre in the mouth and maximally inhale through the spirometre and hold the inspiration for several seconds.
This sequence is repeated 5 to 10 times several times per day.

Precaution:

Avoid prolonged periods of any form of resistance training for inspiratory muscles. Unlike muscles of extremity, the diaphragn cannot totally rest to recover from a session of resistance exercises. Use of accessory muscles of inspiration (neck muscles) is a sign that the daiphragm is beginning to fatigue.

[alophysio]

Hi sdkashif,

Surely the initial question was about post-op use of the incentive spirometer, not about training the muscles of inspiration...

But interesting - i had forgotten about the training part! hahaha

[sdkashif]

Surely my motive was to provide the information about the incentive spirometry but I have provided the detail in the intial beginning to give a background information about the incentive spirometry as there was a lot of chaos that was created by some contributors to raise the objections about its use in the pulmonary conditions. That idea was just to provide them correct information and the right use of incentive spirometry.

[alophysio]

correct you are my friend! I have the feeling that people often don't read all the threads and may have been put off using the I.Spiro upside-down when it is appropriate...

I guess my post was to ensure context remained clear rather than objection to your useful information!

Thanks

[sdkashif]

Let me share further information on Incentive Spirometry and its use. Have a look over the links below that illustrate diagramatically the use of Incentive Spirometry and some detail about that.

Incentive Spirometry- University of Pittsburgh Medical Centre

Incentive Spirometry- Critical Care Medical centre