Incentive Spirometry in Postoperative Care

Patient Selection and Protocol

High-risk patients, including those undergoing abdominal, thoracic, head, or neck operations, with chronic obstructive pulmonary disease, musculoskeletal abnormalities of the chest, abnormal pulmonary function tests, or age >60-75 years, benefit most from incentive spirometry 1, 2, 3
The American College of Surgeons and other guideline societies recommend incentive spirometry as part of a multimodal respiratory care program for high-risk patients, with 10 maximal inspiratory maneuvers hourly while awake for at least 2-4 weeks postoperatively 4

Patients should sit upright when using the incentive spirometer for optimal lung expansion, taking a slow, deep breath through the mouthpiece, holding for 3-5 seconds, then exhaling 4
The American Thoracic Society recommends performing 10 maximal inspiratory maneuvers every hour while awake, continuing for at least 2-4 weeks postoperatively to prevent respiratory complications 4

Incentive spirometry should be part of, not in addition to, comprehensive pulmonary care, including early mobilization, deep breathing exercises, supported coughing, and adequate pain control 5, 6, 4
The World Health Organization recommends early mobilization, with patients out of bed on the day of surgery, and deep breathing exercises 10 times every hour while awake 1, 3, 4

If patients are unable to perform incentive spirometry or deep breathing exercises effectively, CPAP or NIPPV at 8-10 cm H₂O for at least 8-12 hours following extubation is superior to standard oxygen therapy for hypoxemic patients 5, 3

Incentive spirometry should not be used as the sole intervention, but rather as part of multimodal care, and should not be applied to low-risk patients 5, 6, 4
Adequate pain control is essential to prevent ineffective incentive spirometry use, and early mobilization should not be delayed 1, 3, 4

The American Society of Anesthesiologists recommends that incentive spirometry (IS) should not be used as a standalone intervention, but rather as part of multimodal postoperative respiratory care in high-risk surgical patients, as adding IS to comprehensive physiotherapy does not improve outcomes compared to multimodal care alone 7
In patients undergoing thoracic surgery, the European Society of Anaesthesiology suggests that adding IS to standard care, including thoracic expansion exercises, supported coughing, and early mobilization, shows no difference in complication rates or hospital length of stay, with a strength of evidence rated as moderate 7
The European Respiratory Society recommends that in COPD patients undergoing surgery, IS may help reduce postoperative complications when combined with other interventions, such as smoking cessation, early mobilization, deep breathing exercises, and effective analgesia, with a strength of evidence rated as low 8, 9

The American College of Chest Physicians suggests that smoking cessation 4-8 weeks preoperatively, early mobilization, deep breathing exercises, and effective analgesia are essential components of perioperative care for COPD patients, with IS potentially playing a role as part of multimodal care, with a strength of evidence rated as moderate 8, 9