Respiratory Care related topic and the role of AARC
Postoperative pulmonary complications
Postoperative pulmonary complications such as pneumonia, atelectasis, and respiratory failure are among the commonly encountered problems in the respiratory care. Upper-abdominal surgical procedures are found to have an association with increased level of complications, followed by thoracic surgery and lower-abdominal surgery. Usually, preoperative and postoperative respiratory therapies are used to prevent or treat the problem of atelectasis – which is the collapse of an expanded lung, and failure of pulmonary alveoli to expand at birth – and to improve the airway clearance. The chances of complications as well as its severity can be decreased by using therapeutic procedures that can increase the lung volume. In this case, Incentive spirometry is commonly used as a part of perioperative respiratory therapeutic strategy to stop and/or treat complications (Restrepo 1600).
Incentive Spirometry
Incentive spirometry, also referred to as sustained maximal inspiration uses a device known as incentive spirometer. Sometimes, after pulmonary surgeries, it becomes difficult and/or painful to take deep long breaths. The patient may also feel too weak to take deep breaths after such surgeries, and inability of sufficient breathing in a deep and slow manner can result in lung illnesses (NLM, nlm.nih.gov). Therefore, incentive spirometry is designed to copy natural sighing process or natural yawning as it encourages the patient to take long, deep, and slow breaths, and then holding the breath for some seconds. This helps in decreasing the pleural pressure, thereby increasing lung expansion and enabling better exchange of gases. An indicator attached to the incentive spirometer helps in determining the functioning of the lung or lungs as it indicates sustained inhalation vacuum. Repetition of the procedure can help in preventing or reversing atelectasis (Restrepo 1600).
Expiratory procedures as, for example, positive expiratory pressure (PEP) as well as vibratory PEP are unable to mimic the sigh. On the other hand, incentive spirometry is most commonly used clinically as well as in routine prophylactic and therapeutic regimen in perioperative respiratory therapy (Restrepo 1600). Incentive spirometer is also used for patients, who are recovering from rib damage or pneumonia to help them in reducing the chances of building up of fluid in the lungs.
Use of Incentive Spirometer
Incentive spirometer is designed in such a way that the patient can use it easily. The patient has to sit and take the device in his hand. Then, he has to place the mouthpiece in the mouth and make a good seal with the lips, so that there would be no openings while placing the mouthpiece. After placing it in the mouth, patient has to breathe out normally, while breathe in slowly. Breathing in of air (inhaling the air) causes a rise in a piece of device attached with the instrument. It is important for the patient to rise that piece as much as possible. Usually, healthcare experts place a marker on the piece to help the patient to know, how much he has to breathe. There is another smaller piece, which looks like a disc/plate (volume-oriented) or ball (flow-oriented), in the device. It is important for the patient to make sure that the ball has to stay in the middle of the chamber while breathing. Too fast breathing can result in increasing the level of ball and causing it to reach at the top, while too slow breathing can result in decreasing the level of ball and causing it to stay at the bottom. The patient is usually trained to hold the breath for 3 to 5 seconds, and then exhale slowly. Usually, it is recommended for patients to take 10 to 15 breaths with the spirometer after every 1 to 2 hours (NLM, nlm.nih.gov).
During the use of incentive spirometer, a patient can hold a pillow close to the belly while inhaling the air, if he or she has an incision in the abdomen or chest. This could help in decreasing the discomfort caused by the surgery. Moreover, patients have to know that whenever they start feeling light-headed or dizziness, while using incentive spirometry, they have to remove the mouthpiece from the mouth and take some normal breaths. After that, they can continue using the procedure. Furthermore, it is important for patients to know that improvement in breathing comes with practice as well as healing of the body (NLM, nlm.nih.gov).
Role of the American Association for Respiratory Care (AARC)
AARC is a professional organization that is working for Respiratory Care in the U.S. It is encouraging and promoting professional excellence in respiratory care and advancing the science as well as practice of respiratory care. In 2011, AARC released the guidelines for the procedure of Incentive Spirometry. Those guidelines were updates to the previous version that was released by the organization in 1991 (AHRQ, guideline.gov).
Indications of Incentive Spirometry. The procedure is helpful in the preoperative screening of patients, who can develop postoperative complications to get baseline flow or volume. It can also be used in respiratory therapy including daily use of the procedure along with deep breathing exercises, early ambulation, directed coughing, and optimal use of analgesia that can help in lowering the chances of postoperative pulmonary complications. Incentive spirometry can also help the patients, who are going through the process of coronary artery bypass graft. Positive airway pressure therapy along with incentive spirometry can help in pulmonary function and 6-minute walk distance, and decrease the chances of postoperative complications (Restrepo 1601).
Incentive spirometry can stop atelectasis that is related to the acute chest syndrome in patients of sickle cell disease. Moreover, the process is used for pulmonary atelectasis or the conditions that can lead to pulmonary atelectasis. Therefore, it can be used with upper-abdominal or thoracic surgery, lower-abdominal surgery, surgery in patients with chronic obstructive pulmonary disease (COPD), prolonged bed rest, presence of abdominal or thoracic binders, and restrictive lung defect related to a dysfunctional diaphragm or the respiratory musculature (Restrepo 1601).
Monitoring and resources. There are two kinds of incentive spirometers. One is Volume-oriented spirometer and the other is Flow-oriented spirometer. Volume-oriented incentive spirometer is commonly related to the larger inspiratory volume as compared to flow-oriented incentive spirometer. It is better to use incentive spirometers having a low additional imposed work of breathing (Restrepo 1602).
In case of personnel, it is important for them to have better ability to implement universal or standard precautions. They must have expertise in proper operation as well as clinical application of the device, which is also helpful in instructing the patients about the use of the device. The personnel must also show full ability to deal with adverse affects arising due to the use of the device (Restrepo 1602).
When the personnel fully train the patients to use the device, it is not necessary to directly supervise the patients. However, constant reassessment is important for optimal performance and better outcomes. Observation or assessment of the patient’s use of the device may include the frequency of sessions, effort or motivation, number of breaths and/or sessions, and inspiratory volume and flow (Restrepo 1602).
Limitations and Contraindications of Incentive Spirometry. Incentive spirometry is found to be of greater help for many patients, but it is important to consider that the efficiency and efficacy of the procedure depends on careful instruction, patient selection, and proper supervision in respiratory training. Postoperative complications cannot be resolved because of improper training and inadequate self-administration. Moreover, incentive spirometry alone is not helpful in completely eliminating postoperative complications. On a further note, in some conditions, patients would not get full benefits of the process as, for example, patients of neuromuscular disease may not find incentive spirometry as effective as intrapulmonary percussion ventilation in inhibiting atelectasis (AHRQ, guideline.gov).
Incentive spirometry is contraindicated in patients, who cannot be properly instructed or supervised to use the device. It is also contraindicated in patients, who may show absence of cooperation as, for example, very young patients or patients having developmental delays, patients having high level of sedation, and patients showing inability to breathe deeply due to pain or opiate analgesia (AHRQ, guideline.gov).
Recommendations. Incentive spirometry has to be used with other pulmonary therapeutic procedures to prevent postoperative pulmonary complications. It is important to use incentive spirometry with early mobilization, directed coughing, and deep breathing techniques. In order to prevent atelectasis after coronary artery bypass graft surgery, routine use of incentive spirometry is not recommended. Moreover, it is better to use volume-oriented device for patients (Restrepo 1603).
Works Cited
AHRQ. “Guideline Summary”. Agency for Healthcare Research and Quality. 2011. Web. 27 Mar. 2016 <https://www.guideline.gov/content.aspx?id=34793>.
NLM. “Using an incentive spirometer”. U.S. National Library of Medicine. U.S. Department of Health and Human Services. National Institutes of Health, 02 Mar. 2016. Web. 27 Mar. 2016 < https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000451.htm>.
Restrepo, Ruben D, et al. "Incentive Spirometry: 2011." Respiratory care 56.10 (2011): 1600-04. Print.
