Incentive Spirometry

The purpose of incentive spirometry is to facilitate a sustained slow deep breath. The device gives the individual visual feedback regarding flow and volume. The device can prevent and reverse atelectasis when used appropriately and regularly.

Guideline on appropriate use

1. Therapist demonstrates using a separate device and provides information sheet regarding technique, prescription of use and cleaning advice based on manufacturers instructions.
2. Patient should be in a relaxed position suitable for deep breathing (e.g. sitting upright in a chair or side lying if extra volume is required in one lung due to ventilation perfusion matching).
3. Patient creates a tight seal around the mouthpiece and inhales deeply and slowly. The patient watches the flow meter for visual feedback. If possible the patient sustains the inhalation to create an end-inspiratory hold. Ideally the inhalation is sustained for 4-5 seconds.
4. Patient relaxes seal around mouthpiece and exhales; normal breathing is resumed with relaxed shoulder girdle.

-Advise patient to take approximately ten incentive spirometry breaths per waking hour (use clinical reasoning to prescribe using Frequency, Intensity, Time and Type principles).
-Patients with an oxygen requirement can use device with a nasal cannulae or a device, which entrains oxygen.
-Deep breathing offers a similar effect. However, using an incentive device as feedback may create greater inhaled volumes, greater control of flow and more motivation to participate in therapy.
-The device can be used with paediatrics and individuals with learning difficulties.

-The device is not suitable for people with severe dyspnoea.

Indications

- Pre-operative screening of patients at risk of post-operative complications to obtain a baseline of their inspiratory flow and volume
- Presence of pulmonary atelectasis or conditions predisposing to atelectasis
o Abdominal or thoracic surgery
o Prolonged bed rest
o Surgery in patients with COPD
o Lack of pain control
o Restrictive lung disease associated with a dysfunctional diaphragm or involving respiratory musculature
o Patients with inspiratory capacity less than 2.5 litres
o Patients with neuromuscular disease or spinal cord injury

Contraindications or Precautions

- Patients who cannot use the device appropriately or require supervision at all times
- Patients who are non-compliant or do not understand or demonstrate proper use of the device
- Very young patients or paediatrics with developmental delay
- Hyperventilation
- Hypoxaemia secondary to interruption of oxygen therapy
- Fatigue
- Pain