Atelectasis, which is a partial or total collapse of the lung, is one of the many post-operative complications of various types of surgery. Operations requiring anesthesia, orthopedic surgery performed in high-altitude locations and surgery that requires post operative bed rest with no change of position may cause this condition. Treatments may include diaphragmatic breathing exercise or use of a device called an incentive spirometer.
History
The incentive spirometer was the brainchild of Robert H. Bartlett, M.D., Alan B. Gazzaniga, M.D. and Tamar R. Geraghty, R.N. It was developed in the 1970s at the Department of Surgery, University of California, Irvine, at Orange County Medical Center. An article in the May, 14 1973 edition of the "Journal of the American Medical Association" titled "Respiratory Maneuvers to Prevent Postoperative Pulmonary Complications" explains that the device was developed as a means of encouraging deep breathing after abdominal or thoracic surgery
Identification
An incentive spirometer is a plastic device that is used to measure air flow and air volume. The patient sits at the edge of the bed and holds the device in an upright position. A mouthpiece is placed in the patient's mouth. As the patient breathes in, a yellow piston will rise inside the spirometer. Getting the piston to the top of the column is the goal of the exercise.
Diaphragmatic breathing is performed without any devices. The patient is advised to breathe in and expand the belly, while keeping the chest and shoulders relaxed.
Features
Diaphragmatic breathing and incentive spirometry have the same effects on the patient. The spirometer, however, provides the patient with both visual and auditory feedback.
Benefits
Both diaphragmatic breathing exercise and incentive spirometry facilitate coughing, which enables the patient to remove mucus from the lungs. If mucus stays trapped, the patient can develop pneumonia. When surgery is performed at high altitude, such as knee surgery performed near ski areas, the patient may experience post-operative low oxygen levels. If oxygen levels do not return to normal, the patient will be required to use an oxygen tank. Diaphragmatic breathing and incentive spirometry can help the patient return to normal oxygen levels.
Expert Insight
A study titled "Prevention of respiratory complications after abdominal surgery: a randomized clinical trial," was published on January 20th, 1996 in the British Medical Journal. The research was performed by J. C. Hall, R. A. Tarala, J. Tapper, and J. L. Hall at the University Department of Surgery at the Royal Perth Hospital in Australia. The research team compared the use of incentive spirometry and diaphragmatic breathing exercises in low-risk and high risk patients. Low-risk was defined as patients under age 60, and high-risk was defined as patients over age 60. The researchers found that diaphragmatic breathing exercises worked best for low-risk patients, whereas incentive spirometry was more efficient for high-risk patients.
References
- Journal of the American Medical Association:Respiratory Maneuvers to Prevent Postoperative Pulmonary Complications: May 14, 1973
- BMJ: Prevention of respiratory complications after abdominal surgery: a randomised clinical trial.
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