HOSPITAL-ACQUIRED PNEUMONIA (HAP), is a well-documented hospital complication that’s diagnosed when patients demonstrate signs and symptoms of pneumonia 48 or more hours after hospital admission. Consequences of HAP include prolonged lengths of stay in the hospital, expensive medical treatments, and discharge to a long-term care facility. Avoiding these consequences depends on nursing therapeutic respireatory interventions including, encouraging deep breathing, and instructing patients in the use of incentive spirometry.
Deep breathing and incentive spirometry have long been essential components in preventing HAP in postoperative patients. However, today nurses and respiratory therapist have no way to ensure paitent compliance.
An incentive spirometer is a handheld medical device that measures the volume of your breath. It helps your lungs recover after surgery or lung illness, keeping them active and free of fluid. A piston rises inside the device to measure your breath volume when you breathe from an incentive spirometer. A healthcare professional can set a target breath volume for you to hit. Spirometers are commonly used at hospitals after surgeries or prolonged illnesses that lead to extended bed rest. Your doctor or surgeon may also give you a take-home spirometer after surgery. In this article, we’re going to look at who might benefit from using an incentive spirometer, break down how spirometers work, and explain how to interpret the results.
Breathing slowly with a spirometer allows your lungs to inflate fully. These breaths help break up fluid in the lungs that can lead to pneumonia if it’s not cleared. An incentive spirometer is often given to people who’ve recently had surgery, people with lung disease, or people with conditions that fill their lungs with fluid. Here’s more information:
1. After surgery. An incentive spirometer can keep the lungs active during bed rest. Keeping the lungs active with a spirometer is thought to lower the risk of developing complications like atelectasis, pneumonia, bronchospasms, and respiratory failure. Pneumonia. Incentive spirometry is commonly used to break up mucus buildup that builds up in the lungs in people with pneumonia.
2. Respiratory conditions like Chronic obstuctive pulmonary disease (COPD). Cystic fibrosis, or COVID-19.
Your doctor, surgeon, or nurse will likely give you specific instructions on using your incentive spirometer. The following is the general protocol: Sit up on the edge of your bed or chair. Hold the incentive spirometer in an upright position. Breathe out normally. Place the spirometer mouthpiece in your mouth and close your lips tightly around it. Breathe in through your mouth as slowly and deeply as you can, causing the piston or ball to rise toward the top of the chamber. Hold your breath for 3–5 seconds or as long as possible. If the spirometer has a goal indicator, use this to guide your breathing. If the indicator goes above the marked areas, slow your breathing down. Remove the mouthpiece from your mouth. Breathe out normally. The piston or ball will return to the bottom of the chamber. Rest for a few seconds, then repeat the steps 10 or more times. Go slowly. Take some normal breaths between deep breaths to prevent light-headedness. Do this every 1–2 hours when you’re awake. After each set of 10 deep breaths, cough a few timesto clear your lungs. After each set of 10 breaths, it’s a good idea to cough to cleanse your lungs of any mucus buildup. You can also clear your lungs throughout the day with relaxed breathing exercises like the below: Relax your face, shoulders, and neck, and put one hand on your stomach. Exhale as slowly as possible through your mouth. Breathe in slowly and deeply while keeping your shoulders relaxed. Repeat four or five times per day.
Setting incentive spirometer goals Next to the central chamber of your spirometer is a slider. This slider can be used to set a target breath volume. Your doctor will help you set an appropriate goal based on your age, health, and condition. You can write down your score each time you use your spirometer. This can help you track your progress over time and also help your doctor understand your progress.
The main column of your incentive spirometer has a grid with numbers. These numbers are usually expressed in millimeters and measure the total volume of your breath. The piston in the main chamber of the spirometer rises upward along the grid as you breathe in. The deeper your breath, the higher the piston rises. Next to the main chamber is an indicator that your doctor can set as a target. There’s a smaller chamber on your spirometer that measures the speed of your breath. This chamber contains a ball or piston that bobs up and down as the speed of your breath changes. The ball will go to the top of the chamber if you’re breathing in too quickly and will go to the bottom if you’re breathing too slowly. Many spirometers have a line on this chamber to indicate the optimal speed.
ResearchTrusted Source has found conflicting results on the effectiveness of using an incentive spirometer compared with other lung strengthening techniques. Many of the studies looking at potential benefits were poorly designed and not well organized. But there’s at least some evidence it may help with: improving lung function reducing mucus buildup strengthening lungs during extended rest lowering the chance of developing lung infections But a randomized controlled trial from 2019Trusted Source showed that incentive spirometers could be used to prevent pulmonary complications in rib fracture patients.
In June of 2021, the U.S. Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for emergency use of the InSee incentive spirometer accessory for quantitatively tracking patient usage of Vyaire Medical’s AirLife incentive spirometer, as an aid in treatment of respiratory conditions by patients with Coronavirus Disease 2019 (COVID-19) in hospital settings.
In reaching their decision, FDA said there were no approved or cleared devices for quantitatively tracking patient usage of spirometers as an aid in treatment of respiratory conditions by patients with COVID-19 in hospital settings.
Use of InSee in conjunction with an incentive spirometer may assist in treating respiratory conditions and improve clinical outcomes by monitoring and encouraging more frequent and consistent usage of the spirometer, without reliance on the presence of the healthcare provider or reliance on the patient’s memory and reporting for use of the spirometer.
The FDA’s EUA letter further affirms the following about the InSee:
The InSee is a patented incentive spirometer smart accessory that quantitatively tracks patient usage of Vyaire Medical’s AirLife incentive spirometer.
Quantification of patient usage includes spirometer attempts, successes, and volumetric goals when a patient uses the incentive spirometer.
The InSee uses an infrared sensor, which monitors the movement of the spirometer’s internal cylinder. The cylinder contains a piston whose movement measures the volume of air that is inhaled. Using time-of-flight calculations, cylinder movement is converted to tidal volume, which is the volume of air moved with each breath and is a key marker of respiratory function. The data the InSee device collects is stored and is displayed on the bottom of the InSee.
A healthcare practitioner sets a target tidal volume for the patient before use. While sitting upright, the patient puts the mouthpiece of the incentive spirometer in their mouth and closes their lips tightly around it. The patient then slowly exhales and inhales as deeply as possible. The patient must breathe through their mouth or else the spirometer and InSee device will not function. As the patient uses the spirometer, the InSee measures the tidal volume and determines how many times a patient failed to reach the target tidal volume that was programmed in the InSee. It also determines the maximum tidal volume the patient was able to reach, with an alarm indicating success.
In addition, there is a set timer internal to the InSee that reminds the patient to use the spirometer and InSee via a blinking red LED and alarm that activates every 10 minutes (which can be adjusted by the healthcare provider). This alarm stops once the patient uses the spirometer and InSee. Lastly, there is an option that can be set where a blinking green LED and a success alarm activate when a “goal” is met. This alarm of success is different than the alarm of inactivity.
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