Toor Harjyot, Kashyap Samir, Yau Anson, Simoni Mishel, Farr Saman, Savla Paras, Kounang Robert, Miulli Dan E
Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA.
Pain Management, Arrowhead Regional Medical Center, Colton, USA.
Cureus. 2021 Oct 4;13(10):e18483. doi: 10.7759/cureus.18483. eCollection 2021 Oct.
Background Incentive spirometry (IS) is the mainstay of care in postoperative patients that has been heavily studied in the inpatient setting. Studies have shown that the utilization of IS improves lung volumes and reduces the rate of pneumonia in post-surgical patients. However, the literature is ambiguous on its benefit as many studies also demonstrate no significant benefit, especially in comparison to early ambulation. Our study sought to determine whether a consistent IS regimen can improve lung function in an outpatient setting. Methods This prospective cohort study included patients in a physical medicine and rehabilitation clinic setting during the COVID pandemic. Patients with severe respiratory disease, baseline cough, those unable to perform deep breathing, fever greater than 100.4 F due to non-pulmonary on initial evaluation, or inability to fill out the forms and complete the study were excluded. Each participant was given the IS along with hands-on instruction on how to use the device and accurately record measurements. Patients were asked to lie down and inhale and exhale through the tube ten times. They were asked to mark the highest volume during their 10 breaths. Patients were instructed to complete this exercise three times a day for 30 days. Patients were also asked to perform light exercises or walking for 20 minutes per day three times a week and postural drainage. Patients were instructed to call their primary care physician if a 20% or more decrease from their baseline was noted or if they experienced any new coughs, fever, or shortness of breath during the 30 days of exercise. Results A total of 48 patients enrolled in the study with a (median) age of 58.0 years (SD 10.2 years), 21 females and 27 males. Baseline maximal inspiration for study participants was 1885.4 mL prior to exercise, with a subsequent increase in lung capacity observed for all participants enrolled in the study. At the end of the study period, week four, the average maximal inspiratory volume was 2235.4 mL. Paired t-test showed a significant difference between baseline (1885.4) and maximum (2235.4) volumes (t=-4.59, p<0.0001). Analysis of variance (ANOVA) showed no significant difference among Week 1-4 averages (F=1.08, p=0.36). None of the participants reported any symptoms (fever, coughing, shortness of breath) or COVID-19 infection during the 30-days period. None of the participants reported contacting primary care physicians. Conclusion When prescribed daily breathing exercises with an incentive spirometer, study participants experienced a 16% increase in maximal inspiratory volume over a span of 30 days and did not need to contact their primary care physician during the study period.
背景 激励性肺量计（IS）是术后患者护理的主要手段，在住院环境中已得到大量研究。研究表明，使用IS可改善肺容量并降低手术患者的肺炎发生率。然而，文献对于其益处并不明确，因为许多研究也表明没有显著益处，尤其是与早期活动相比。我们的研究旨在确定在门诊环境中持续的IS方案是否能改善肺功能。方法 这项前瞻性队列研究纳入了新冠疫情期间在物理医学与康复诊所就诊的患者。排除患有严重呼吸系统疾病、基线咳嗽、无法进行深呼吸、初次评估时因非肺部原因发热超过100.4华氏度、或无法填写表格及完成研究的患者。每位参与者都被给予了IS，并接受了关于如何使用该设备及准确记录测量值的实际操作指导。患者被要求躺下，通过管子吸气和呼气十次。他们被要求标记出10次呼吸中的最高容量。患者被指示每天完成这个练习三次，持续30天。患者还被要求每周进行三次，每次20分钟的轻度运动或散步以及体位引流。患者被指示如果发现与基线相比下降20%或更多，或者在30天的运动期间出现任何新的咳嗽、发热或呼吸急促，要联系他们的初级保健医生。结果 共有48名患者参与了该研究，（中位）年龄为58.0岁（标准差10.2岁），21名女性和27名男性。研究参与者运动前的基线最大吸气量为1885.4毫升，参与研究的所有参与者随后的肺容量均有所增加。在研究期结束时，即第四周，平均最大吸气量为2235.4毫升。配对t检验显示基线（1885.4）和最大值（2235.4）之间存在显著差异（t=-4.59，p<0.0001）。方差分析（ANOVA）显示第1 - 4周的平均值之间无显著差异（F=1.08，p=0.36）。在30天期间，没有参与者报告任何症状（发热、咳嗽、呼吸急促）或新冠病毒感染。没有参与者报告联系过初级保健医生。结论 当规定使用激励性肺量计进行每日呼吸练习时，研究参与者在30天内最大吸气量增加了16%，并且在研究期间无需联系他们的初级保健医生。
